Overview: Chronic Degenerative Bone Disease
Chronic degenerative bone disease that occurs in the elderly, characterized by decreased bone mass, most of which are asymptomatic, but may be manifested by bone pain, fatigue, and fracture. The cause of the disease is unclear, and it may be related to aging of the skeleton and a variety of factors. Early diagnosis and treatment can effectively slow down the progression of the disease.
Definition
Osteoporosis in the elderly is generally defined as osteoporosis that occurs over the age of 70.
Osteoporosis is a systemic bone disease characterized by decreased bone mass and damage to the microstructure of bone tissue, leading to increased bone fragility and susceptibility to fracture.
Osteoporosis is divided into two categories: primary osteoporosis and secondary osteoporosis. Senile osteoporosis belongs to type II of primary osteoporosis.
The pathology of senile osteoporosis is characterized by a decrease in bone mineral content and destruction of bone microstructure, which is manifested by thinning of trabeculae, decrease in the number of trabeculae, and widening of trabecular gaps.
Morbidity
The prevalence of osteoporosis is associated with increasing age, according to 2018 data from the Health Commission.The prevalence of osteoporosis in women over 50 years of age is 32.1%, compared with 6% in men, while the prevalence of osteoporosis in women over 65 years of age is as high as 51.6%, compared with 10.7% in men.The prevalence of osteoporosis in women over 65 years of age is as high as 51.6%, compared with 10.7% in men.
Etiology
The etiology of senile osteoporosis is not known. It is generally believed to be related to the aging of bones and a variety of factors.
Causes
Age-related osteoporosis occurs mainly due to increased bone resorption and decreased bone formation caused by aging and various internal and external factors, and bone resorption is greater than bone formation, resulting in bone loss. Bone microstructural damage, which in turn increases bone fragility, leads to the development of osteoporosis.
Sex hormone deficiency
Estrogen deficiency is the main cause of postmenopausal osteoporosis in women and may be one of the causative factors of osteoporosis in men. Androgen deficiency also accelerates bone loss.
Active vitamin D deficiency and increased parathyroid hormone (PTH)
Decreased production of active vitamin D and compensatory increase in PTH secretion due to advanced age and renal hypoplasia lead to accelerated bone turnover and bone loss.
Decreased bone formation
Inadequate dietary calcium intake or deficiency of endogenous vitamins (especially vitamin D) can lead to osteoporosis.
Muscle Weakness
Muscle atrophy and reduced activity reduces stimulation of bone and is not conducive to the regulation of bone metabolism.
Risk Factors
People with any of the following risk factors are at high risk for osteoporosis in the elderly:
Uncontrollable factors
Advanced age, menopausal women, maternal family history.
Controllable factors
Calcium or vitamin D deficiency (low light exposure or low intake).
Nutritional imbalance in diet, inadequate or excessive protein intake, high sodium diet, low body weight (body mass index <18.5).
Smoking, excessive alcohol consumption, excessive coffee consumption.
Lack of physical activity, braking (prolonged bed rest, etc.).
Diseases that affect bone metabolism (e.g. hyperthyroidism, kidney disease, connective tissue disease, etc.).
Taking medications that affect bone metabolism (e.g. glucocorticoids, methotrexate, cyclosporine, etc.).
Symptoms
Major Symptoms
Mild osteoporosis has no obvious clinical symptoms. With the increase of bone loss and the destruction of bone microstructure, some patients may gradually develop clinical manifestations such as chronic bone pain, loss of muscle strength and fracture.
Bone pain
Often manifested as low back pain, fatigue or generalized bone pain. It is aggravated by weight-bearing or activity limitation, and in severe cases, bone pain is intolerable when turning over, sitting up or walking.
Bone pain is usually diffuse, with no fixed location, and no pressure points can be found on examination.
Muscle weakness
Muscle weakness is often aggravated by exertion or activity, and the ability to bear weight decreases or cannot bear weight.
Fracture
Fractures often occur after minor activity, trauma, bending, weight bearing, crushing or falling. Also known as fragility fractures. The most common parts of the spine are the thoracic and lumbar vertebrae, the hip, the radius of the forearm, the distal end of the ulna and the proximal end of the humerus, and other parts of the spine, such as the ribs, the pelvis, the humerus, and so on.
After one fragility fracture, the risk of another fracture increases significantly.
Complications
Deformity: Shortened height and hunchback may be present in severe cases of osteoporosis. Thoracic deformity due to vertebral compression fracture, chest tightness, shortness of breath, dyspnea and even cyanosis.
Cardiopulmonary compression: Patients with thoracic deformity have decreased lung capacity, maximum lung ventilation and cardiac output, which makes them susceptible to upper respiratory tract and lung infections.
Combination of other diseases
Hip fracture patients need to stay in bed for a long time, and may be complicated by deep vein thrombosis of the lower limbs or acute pulmonary embolism, which may result in swelling of the lower limbs, hemoptysis, chest pain, and respiratory difficulties.
And elderly patients can be combined with a variety of chronic diseases, often due to infection, cardiovascular disease or chronic failure and death.
Consultation
Department of Medicine
Orthopedics
If you have generalized pain, such as low back pain or limb pain, we suggest you to consult orthopedics in time.
Emergency Department
If the patient is unable to move after a fall, especially if there are emergencies such as respiratory distress, coma, hemorrhage, etc., it is recommended to call 120, and the ambulance will take the patient to the Emergency Department for further treatment.
Other Departments
Osteoporosis is a multidisciplinary disease. In some hospitals, other departments such as Geriatrics, Rheumatology, Endocrinology, Obstetrics and Gynecology, and Traditional Chinese Medicine are also concerned with the diagnosis and treatment of osteoporosis.
Preparation
Preparation for consultation: registration, preparation of documents, common problems
Tips
If you have a fracture, try to keep the fractured part of the body as immobile as possible. If necessary, use a stretcher or a flatbed truck, or call 120 immediately for prompt medical attention.
Do not take medication for pain or other discomforts, as this may cover up your condition.
List of medical preparation
Symptom list
In particular, you should pay attention to the time of symptom onset, special manifestations, etc.
Is there any bone or joint pain? How long did the pain start? How long did it last? Does it get worse or worse with activity? Which position hurts the most? Does the pain radiate to any other area?
Did you fall and break any bones? Is there any localized pain, swelling or dysfunction?
Any shortening of height, hunchback or spinal deformity? Approximately how long ago did it start? How many centimeters shorter than when you were young?
Any chest tightness, chest pain, dyspnea, hemoptysis, cough, sputum, etc.?
Is there any swelling with pain in the lower limbs?
List of medical history
Any rheumatoid arthritis?
Any diagnosed gastrointestinal disorders such as hyperthyroidism or hyperparathyroidism, type 1 diabetes, Crohn’s disease or celiac disease, or malnutrition?
Has a fracture occurred in adulthood as a result of a fall or mild traumatic injury?
Is there regular heavy alcohol consumption (more than 2 units of ethanol per day, equivalent to 1 pound of beer, 3 tael of wine, or 1 tael of hard liquor)?
Do you currently smoke, or have you ever smoked? How much do you smoke per day?
How much daily exercise? (including housework, walking, running, etc.)
Did the female have her ovaries removed before age 50 and is not taking estrogen/progesterone supplements?
Have men experienced impotence, loss of libido, or other symptoms associated with low androgens?
Has a parent ever been diagnosed with osteoporosis or ever broken a bone after a minor fall? Are any of the parents hunchbacked?
Checklist
Test results from the last 6 months, which can be brought to the doctor’s office
Laboratory tests: serum bone-derived alkaline phosphatase, blood osteocalcin, type I collagen carboxy prepeptide, blood PTH, blood calcium, blood phosphorus, blood 1,25-(OH)2D3, urine calcium/urine creatinine ratio, etc.
Imaging: dual-energy X-ray, localized X-ray, CT, magnetic resonance imaging, bone densitometry, etc.
Medication list
Medication used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office
Glucocorticoids: dexamethasone, prednisone tablets, methylprednisolone tablets, etc.
Pain medications: ibuprofen, diclofenac sodium, celecoxib, etc.
Others: e.g. methotrexate, cyclosporine, etc.
Diagnosis
Diagnosis is based on
Medical history
Middle aged, postmenopausal female, history of fragility fracture or family history of fragility fracture.
Presence of multiple risk factors for osteoporosis in the elderly: e.g. advanced age, calcium and vitamin D deficiency, braking, prolonged bed rest, low body weight, etc.
Clinical manifestations
Unexplained chronic low back pain.
Shortening of stature (>4 centimeters shorter than when young) or spinal deformity.
Susceptibility to fractures, impaired mobility of limbs, etc.
Laboratory Tests
Routine Tests
Blood routine, liver and kidney function, serum alkaline phosphatase (ALP), etc.
Patients with primary osteoporosis usually have normal calcium, phosphorus and alkaline phosphatase values, but may have mildly elevated alkaline phosphatase levels when fractures occur.
Immunologic Tests
Blood parathyroid hormone (PTH), for example, may be increased or normalized in elderly patients with osteoporosis, and is higher in osteoporosis caused by primary hyperparathyroidism, renal bone disease, etc. It is mainly used in the differential diagnosis of osteoporosis.
Bone metabolism indicators
Such as type I collagen carboxy prepeptide, osteocalcin, 25-hydroxyvitamin D, etc.
Type I collagen carboxy prepeptide, alkaline phosphatase and osteocalcin are indicators of bone formation and are significantly elevated in osteoporosis patients. The above indicators are commonly used for monitoring the disease and evaluating the efficacy of treatment.
25-Hydroxyvitamin D is used to determine the need for active vitamin D supplementation.
Imaging
Quantitative ultrasound
Quantitative ultrasound can be used to determine the presence of osteoporosis or calcium deficiency.
It is primarily used to screen for osteoporosis.
Radiographic Absorption of Finger Bones
A quicker and easier way to measure bone density in the finger bones and is used for initial screening for osteoporosis.
Routine X-ray
Thoracic and lumbar spine X-ray can qualitatively assess the presence of osteoporosis.
More importantly, it can assess the presence of fractures and other pathologic bone changes.
Magnetic Resonance Imaging (MRI)
Magnetic resonance of the thoracolumbar spine is mainly used to assess the presence of disc herniation and deformation.
It can be used for the differential diagnosis of low back pain, and can also be used to clarify the need for further surgical treatment.
Note that MRI is not recommended for patients who have metal objects placed in their bodies.
Dual-energy X-ray absorptiometry (DXA)
This test is now recognized as the gold standard for osteoporosis bone mass screening.
DXA routinely examines the posterior-anterior position of the first to fourth lumbar vertebrae, the left proximal femur, including the femoral neck, greater trochanter, Ward’s triangle, and the total hip.
The T-value is generally used to determine the level of bone density, and the T-value is mainly used to determine the risk of osteoporosis.
It is used for the diagnosis of osteoporosis and the evaluation of its efficacy.
Quantitative CT (QCT)
Quantitative CT can measure the bulk density of cancellous bone and cortical bone, and can reflect the loss of cancellous bone at an early stage.
In addition to early screening for osteoporosis, QCT can also be used to observe the efficacy of osteoporosis medications.
Diagnostic criteria
The current diagnosis of osteoporosis is based on dual-energy X-ray absorptiometry (DXA) bone densitometry and/or fragility fracture.
For postmenopausal women and men aged 50 years and older, BMD levels are recommended to be judged using a T-value, with a T-value ≤ -2.5 as the diagnostic criterion for osteoporosis.
If T ≤ -2.5 < T < -1, the diagnosis is low bone mass; if T ≤ -2.5 or history of fragility fracture, the diagnosis is osteoporosis; if T ≤ -2.5 combined with one or more fractures, the diagnosis is severe osteoporosis.
Note that osteoporosis cannot be diagnosed if the T value of one of the lumbar vertebrae from 1 to 4 lumbar vertebrae is ≤-2.5, but the mean value is >-2.5.
Fractures occurring as a result of non-traumatic or minor trauma are a clear manifestation of decreased bone strength and are therefore the end result and comorbidity of osteoporosis. A fragility fracture is clinically diagnostic of senile osteoporosis.
Differential diagnosis
The main clinical manifestation of senile osteoporosis is bone pain, which needs to be differentiated from the following diseases.
Primary or metastatic bone tumor
Similarity: both may present with bone pain, pathologic fracture and other manifestations.
Differences: Bone tumors have osteolytic destruction on X-ray, and radio-concentrated areas can be seen on bone scan. And they are usually accompanied by tumor-related clinical manifestations, such as emaciation and cachexia. According to the tumor markers and imaging examination, it can be differentiated.
Ankylosing spondylitis
Similarity: Both may present with bone pain, deformity and other manifestations.
Differences: The low back pain caused by ankylosing spondylitis is mainly relieved after activities and aggravated after resting, and ankylosing spondylitis usually occurs in young people. Osteoporosis occurs in the elderly, and the pain worsens after activity. It can be differentiated on the basis of radiographs and serum HLA-B27 testing.
Multiple myeloma
Similarities: Both may present with bone pain, pathologic fractures, and hypercalcemia.
Differences: Multiple myeloma patients may also present with anemia, bleeding tendency, infection, proteinuria, hematuria and other renal function impairment. M-protein appears in serum and there is week proteinuria. It can be differentiated according to the results of bone marrow aspiration and serum M protein measurement.
Primary hyperparathyroidism
Similarities: Both may present with bone pain and deformities.
Differences: Primary hyperparathyroidism may also present with symptoms of hypercalcemia such as nausea, vomiting, and generalized weakness. In addition, the skeletal changes in hyperparathyroidism are fibrocystic osteitis. Blood PTH, blood calcium, blood phosphorus, bone X-ray and DXA should be used to differentiate.
Treatment of hyperparathyroidism
General treatment
Supplement adequate protein to improve nutritional status. Patients with renal failure should choose high-quality protein and appropriately limit its intake.
Correct bad life habits, quit smoking and avoid alcohol, strengthen exercise, engage in more outdoor exercise, and formulate appropriate exercise mode, exercise type and exercise amount according to one’s own condition, so as to prevent falls.
It can be appropriate to sunbathe outdoors, and do a good job of ultraviolet protection for the eyes and mouth and other parts of the body.
Medication
Osteoporosis medication is required for patients with fragility fractures, low bone mass, and those diagnosed with osteoporosis.
Bone resorption inhibitors
Bone resorption inhibitors include bisphosphonates, RANKL inhibitors, estrogen receptor modulators, estrogen, and calcitonin.
Bisphosphonates
Bisphosphonates can inhibit bone resorption, lower blood calcium, and can also effectively reduce the risk of osteoporotic fracture and improve bone density. They are the first choice of anti-osteoporosis drugs for elderly osteoporosis patients.
Commonly used drugs include alendronate, etidronate, ibandronate, risedronate, zoledronic acid, ibandronate, etidronate disodium and clodronate disodium. pamidronate, risedronate, tiludronate and zoledronic acid.
Precautions.
Oral bisphosphonates may cause upper gastrointestinal symptoms or gastrointestinal discomfort, such as abdominal pain, nausea, vomiting, diarrhea or constipation, and other adverse reactions. Be sure to take the drug strictly according to the instructions on the drug.
Take appropriate calcium and vitamin D supplements while taking the medication.
Monitor renal function, especially for intravenous use.
RANKL inhibitor
This is a monoclonal antibody that reduces the formation and survival of osteoclasts, thereby decreasing the rate of bone resorption, increasing bone mass, improving the strength of cortical or cancellous bone, and reducing the risk of fracture.
It is used clinically for the treatment of postmenopausal osteoporosis by subcutaneous injection every 6 months.
The drug should be applied with vigilance against the occurrence of hypocalcemia, and attention should be paid to calcium supplementation therapy and monitoring of blood calcium during the use of the drug.
Estrogen drugs
Estrogen can inhibit the activity of osteoclasts and effectively prevent bone loss, thus preventing and treating osteoporosis in postmenopausal women.
Commonly used estrogens include conjugated estrogen and estradiol. Progesterone is recommended to use natural or near-natural progesterone. Tibolone is a specific type of menopausal hormone therapy. It is indicated for women only.
Estrogen supplementation therapy (ERT) is used for women without a uterus and estrogen and progesterone supplementation therapy (HRT) regimen is used for women with a uterus. Long-term application maintains bone density and reduces fracture risk.
Selective estrogen receptor modulators
These drugs bind to estrogen receptors and exert estrogen-like effects, inhibiting bone resorption, increasing bone density, and reducing the risk of vertebral fractures. In the breast and uterus there is no estrogenic stimulatory effect.
Drugs used in osteoporosis treatment include raloxifene, rasoxifene, and bardoxifene.
Precautions.
This class of drugs is mainly used for the treatment of osteoporosis in elderly women and not in men.
Like estrogenic drugs, these drugs may mildly increase the risk of thromboembolic events, and are therefore contraindicated in individuals with a history of venous embolism and a predisposition to thrombosis.
Calcitonins
Calcitonin analogs inhibit osteoclast bioactivity and reduce the number of osteoclasts, and are effective in treating acute bone loss and pain after osteoporotic fractures.
Commonly used drugs mainly include salmon calcitonin, eel calcitonin and so on.
Since calcitonin is not effective in reducing the risk of non-vertebral and hip fractures and may have a potential cancer risk, long-term use is not recommended. Currently, they are mainly used for the relief of bone pain and are usually used continuously for no more than 3 months.
Osteopoietic drugs
The only bone-building drugs currently available in China are parathyroid hormone analogs.
Parathyroid hormone analogs are representative of pro-bone formation drugs, which can stimulate osteoblast activity, promote bone formation, increase bone density, improve bone quality, and reduce the risk of vertebral and non-vertebral fractures.
The parathyroid hormone analog currently available in the country is teriparatide.
The drug should not currently be used for more than 2 years.
It is rarely used today because of the controversy regarding its effects on bone quality.
Calcium and active vitamin D
Adequate calcium intake is beneficial in increasing bone mass, slowing bone loss, improving bone mineralization and maintaining bone health. Examples include calcium carbonate, calcium acetate, and calcium gluconate.
Active vitamin D promotes intestinal calcium absorption, increases calcium reabsorption in renal tubules, inhibits PTH secretion, and reduces the risk of osteoporosis and fractures. Commonly used active vitamin preparations such as osteotriol or alfacalcitol.
Changes in blood calcium and blood phosphorus need to be monitored during administration to prevent hypercalcemia and hyperphosphatemia.
维生素K2
Tetraenylmenaquinone is an isoform of vitamin K2 that promotes bone formation and has some inhibitory effect on bone resorption. It can mildly increase bone mass in patients with osteoporosis and is indicated in patients with osteoporosis to improve bone mass.
Pain relief treatment
The disease causes mild to moderate pain throughout the body. Treatment can be supplemented with analgesics.
Such as NSAIDs, including celecoxib, etoricoxib, aspirin, ibuprofen, indomethacin, diclofenac and naproxen. They can relieve pain, reduce chronic inflammation of joints and muscles, and improve somatic function.
Long-term use of such drugs has gastrointestinal adverse effects such as stomach ulcers and bleeding.
Calcitonin can be used in the treatment of osteoporotic bone pain.
Surgical treatment
Indications: osteoporotic vertebral compression fracture, hip fracture, severe arthritis, severe deformity of bone, etc.
Minimally invasive vertebral body surgery
Indications: For spinal fractures, stable compression fractures with the posterior wall of the vertebral body intact and without neurological symptoms.
The main surgical procedures are percutaneous vertebroplasty (PVP) and percutaneous balloon dilatation kyphoplasty (PKP).
Open Vertebral Body Surgery
Indications: Vertebral body fracture patients with severe compression and nerve compression symptoms.
Main surgical procedures: posterior pedicle screw fixation and injured vertebra pinning.
Internal fixation surgery
Mostly intramedullary nail fixation.
Suitable for patients with closed osteoporotic fracture, internal fixation surgery is not recommended if the fracture is open.
It is the most common surgical procedure for osteoporotic fractures. However, due to the decrease in bone mass in osteoporotic patients, there may be cases of poor fixation of intramedullary nails and displacement.
Arthroplasty
Indications: It is mainly applicable to cases with serious bone damage of articular cartilage and subchondral bone, joint stiffness, dislocation, obvious deformity, and serious impact on limb function.
Hip arthroplasty is more often used for hip fractures caused by senile osteoporosis.
Significance: It can effectively relieve the pain of advanced joint lesions and improve joint function.
Post-operative rehabilitation
Physical therapy: Pulsed electromagnetic field, extracorporeal shock wave, whole-body vibration, ultraviolet light and other physical factor therapy can increase bone mass. Ultrashort wave, microwave, transcutaneous electrical nerve stimulation, intermediate frequency pulse and other treatments can reduce pain.
Exercise therapy
The main focus is on preventing falls and re-fractures through strength and balance training.
Three hours of balance and muscle strength training per week is recommended for at least 4 months. After that, 2 to 3 times a week of plyometric training is recommended. This includes progressive muscular strength training with emphasis on the back muscles to improve posture.
In addition, muscular endurance training needs to be enhanced by performing exercises such as Tai Chi and yoga.
In conclusion, in the treatment of senile osteoporotic fracture, anti-osteoporosis treatment must be taken into account, and comprehensive treatment measures must be adopted to minimize complications, improve bone quality, and prevent re-fracture.
Prognosis
Cure
There is no effective cure for this disease, but active treatment can effectively relieve symptoms, improve bone metabolic processes, avoid or reduce the risk of complications such as bone deformation and fractures, and improve quality of life.
If treatment is not timely, it may lead to complications, such as lumbar back fracture, hip fracture, respiratory system infection, chest tightness, dyspnea, etc., which seriously affects the quality of life and may even be life-threatening.
Prognostic factors
Effective and standardized treatment of senile osteoporosis can relieve low back pain symptoms, maintain a normal quality of life, and reduce the risk of fracture.
The following factors may affect the prognosis and lead to a poor prognosis:
Presence of common geriatric comorbidities such as cardiovascular and cerebrovascular diseases, metabolic diseases, and chronic kidney disease;
Comorbid osteoporotic fractures;
Lack of formal anti-osteoporotic treatment, failure to follow up in time, and lack of appropriate postoperative rehabilitation management.
Hazards
With the progression of the disease, thoracic deformity, osteoporotic fracture or muscle atrophy may occur, which seriously affects the quality of life of patients.
In some patients with severe fractures, prolonged bed rest, etc. may result in lower extremity venous thrombosis, pulmonary embolism and severe pneumonia, heart failure, etc., which may lead to death.
Daily
Daily Management
Dietary management
Foods rich in vitamin D: animal liver, egg yolk, marine fish, cod liver oil, mushrooms, etc.
Also pay attention to the rationality of meal preparation for scientific calcium supplementation. Eat less pickled food, such as salted vegetables and canned food.
Reduce the consumption of alcohol, strong coffee, tea and carbonated beverages, and quit smoking. The intake of fat and sugar should not be too high.
Life management
Elderly osteoporosis patients should establish a good living habit, ensure sufficient sleep every day, and maintain an optimistic and happy mood.
Sun exposure can promote the synthesis of vitamin D and calcium absorption, but attention should be paid to the sun protection of sensitive areas such as eyes.
Keep the indoor environment clean and tidy, and avoid excessive clutter on the floor to prevent tripping; the floor, bathroom and kitchen floor should be wet-proof, non-slip and fall-proof. The elderly should be protected from dizziness and falls when getting up or standing up.
Exercise management
Exercise can improve body agility, strength, posture and balance, etc. and reduce the risk of falling, thus reducing the occurrence of osteoporosis fracture and also increase bone density.
Osteoporosis patients should consult a medical professional for relevant assessment before starting new exercise training and choose the appropriate exercise.
Land-based exercises such as jogging and walking are preferred for the elderly population with better physical function, no high risk of osteoporotic fracture and no obvious activity limitation.
For patients with poor physical fundamentals, high risk of fracture and inability to tolerate higher-intensity exercise, lower-impact training, such as water exercise and tai chi, may be preferred.
Disease monitoring
If bone pain worsens with impaired mobility, it is recommended to go to the hospital for examination and treatment in a timely manner. In order to detect osteoporosis or osteoporotic fracture as early as possible.
Patients who have already developed osteoporotic fracture and are bedridden for a long period of time, pay close attention to the presence of coughing, coughing up sputum, chest tightness, dyspnea, swelling and pain in the lower limbs, chest pain, etc., and be alert to the possibility of lung infection, venous thrombosis in the lower limbs and pulmonary embolism, which require prompt medical attention.
Follow-up examination
Purpose of follow-up: During the treatment period, the efficacy of the treatment should be monitored, adverse drug reactions should be assessed, and adherence to the treatment should be evaluated in order to achieve the therapeutic goal and reduce the risk of fracture.
Follow-ups: Follow-ups usually occur at intervals of 1 month to 6 months or 6 months to 1 year, depending on the doctor’s orders. If there is a worsening of symptoms, timely consultation is required.
Items to be reviewed
Laboratory tests: blood calcium, 25(OH)D level, urine calcium, urine phosphorus, serum bone-derived alkaline phosphatase, blood osteocalcin, type I collagen carboxy prepeptide, etc.
Imaging examination: DXA bone density, spine imaging examination, etc.
Prevention
The elderly should be screened for bone density at an early stage for early detection and treatment.
Reasonable diet, adequate calcium and vitamin D supplementation.
Improve lifestyle by getting more sunshine and appropriate outdoor walking and activities.
For those who already have osteoporosis, they should prevent falls, avoid climbing high to get objects, prevent slippery floors, and avoid going out in rainy or snowy weather.
Take the initiative to learn about osteoporosis, strive for early diagnosis and timely prediction of fracture risk.