Mrs. Wang is 69 years old, and several of her children are coming together to celebrate her 70th birthday that day. Seeing that her beloved grandson was also coming, Mrs. Wang went to the supermarket in front of her house to buy some of her grandson’s favorite foods. Although there were not many things, she felt a sore back on the way home, getting heavier and heavier, and could not get up when she arrived home. When I got to the hospital, I took a picture and guess what? Compression fracture of the second and third lumbar vertebrae! The family members could not help but question: how did the old man, who was usually well, suddenly fracture? The doctor explained that the root cause of the fracture was that Mrs. Wang was suffering from osteoporosis. So what is osteoporosis?
I. Concept
Osteoporosis is a systemic bone disease in which the quality of bone is reduced and the bones become brittle, thus making them prone to fracture.
Causes: Just as rocks become loose when blown by wind and trees become brittle when old, human bones also become brittle. A healthy bone or iliac is like a steel bar, flexible and not easy to break; but once the bone is osteoporotic, it is like a matchstick, which will break when gently folded.
Osteoporosis can occur in any group of people and age, in general, thin people, long-term smoking, excessive alcohol consumption, like to drink coffee and carbonated beverages, etc., do not like physical activity, calcium and vitamin D deficiency in the diet of people prone to suffer from this disease. It is especially common in postmenopausal women and older men.
Symptoms
There are three main symptoms: bone and joint pain, spinal deformation and height shortening, and fracture.
The cause of bone pain: osteoclasts destroy bone. The pain usually occurs in the second half of the night or in the early morning hours. The worse the bone pain, the faster the osteoporosis progresses (like invisible bugs gnawing away at the bones). Many people often mistake this pain for arthritis or other ailments and ignore the diagnosis and treatment.
Fracture: It may occur after only mild trauma or daily activities (Mrs. Wang is a typical example). Once this fracture has occurred once, the risk of reoccurrence will increase significantly.
Third, the dangers of osteoporosis
Bone and joint pain: affects the patient’s quality of life, unable to walk normally and participate in social activities.
Once a fracture occurs, bedridden, prone to bedsores and pneumonia and other diseases, the patient suffers and it adds burden to the family and society.
IV. Diagnosis
Doctors usually make the diagnosis based on two aspects: clinical symptoms and bone density measurement.
Osteoporosis: BMD < peak bone -2.5 SD
Severe osteoporosis: BMD < peak bone mineral density -2.5 SD with one or more fractures.
V. Prevention and treatment
1.General prevention
It should be understood that prevention is more important than treatment. It is like “mending the fold before the sheep are lost”! Attention should be paid to do the following “two to two do not”.
(1) to choose a diet rich in calcium and protein. Milk, beans, lean meat, fish and shrimp, etc.
(2) Do not smoke, drink alcohol and drink coffee and carbonated beverages.
(3) Be active outdoors and get more sunlight. It is recommended to exercise for half an hour in the morning and walk for half an hour in the evening. It is better to participate in fitness dance for middle-aged and elderly people. We have found that many middle-aged and elderly people who participate in such fitness activities do not suffer from osteoporosis.
(4) Never fall: be especially careful when going up and down stairs, be sure to hold on to the railing, especially in buildings without lights; be doubly careful when walking in rain and snow and on slippery roads; stand firmly and hold on when going up and down buses; pay attention to the steps of the road when walking; install small night lights in bedrooms and toilets at night; choose suitable shoes, with soft-soled flat-heeled cloth shoes that fit your feet.
2.Medication
(1) Calcium: China’s Nutrition Society has set a recommended daily calcium intake of 800mg (elemental calcium amount) for adults, and 1000mg for postmenopausal women and the elderly, generally, the average daily calcium from the diet is about 400mg, so the average daily additional elemental calcium should be 500-600mg. We think that the calcium supplement is better than the Calcium D, Calcium Amino Acid Griddle Calcium and Amway’s Calcium Magnesium Tablets.
(2) Vitamin D: It is beneficial to the absorption of calcium in the gastrointestinal tract. The recommended dose is 200 units (5ug/d) for adults and 400-8001U (10-20ug)/d for the elderly due to the recommended dose. vitamin D increases muscle strength and balance in the elderly, therefore reducing the risk of falls.
(3) Active vitamin D: Rocaquel (osteotriol), Alpha D3. one tablet once daily. More suitable for middle-aged and elderly people.
3.Anti-bone resorption drugs and drugs to promote bone formation
Osteoblasts and osteoclasts in the human body, respectively, play a role in the generation and destruction of bone, just like the construction team and demolition team in the human body, depending on who plays the main role?
(1) Bisphosphonates: Alendronate (Fosamax) can significantly increase the bone density of the lumbar spine and hip, and significantly reduce the risk of fractures in the vertebrae and hip and other parts of the body. It’s like weakening the demolition team.
It is delivered with 200ml of water in the morning on an empty stomach, with no lying down or eating for 30 minutes after entering the medicine.
It is very convenient once a week.
(2) Calcitonin type: also weakens the demolition team force. The obvious feature is that it can relieve pain.
There are two types of calcitonin-like preparations currently used in clinical practice: salmon calcitonin and eel calcitonin analogs.
There are two dosage forms: intramuscular injection, and nasal inhalation.
Note: Sufficient cement and gravel are needed to build a house, and adequate amounts of calcium are needed to synthesize new bone, so further calcium supplementation is necessary after calcitonin use.
(3) Selective estrogen receptor modulators (SERMs) and estrogens effectively inhibit osteoclast activity and weaken demolition teams. Renoxifene is commonly used. However, it should be applied under the guidance of a specialist.
(4) Parathyroid hormone: It is like increasing the strength of the construction team. Studies have confirmed that small doses of rhPTH (1-34) have the effect of promoting bone formation, and is currently a promising drug for osteoporosis osteogenesis treatment. It should be applied under the guidance of a specialist.
4.Chinese herbal medicine and Chinese patent medicine for kidney and bone, and identify the evidence for treatment
Just now scattered to introduce you to some knowledge of osteoporosis, I do not know if you heard clearly? I think as long as the audience is active in prevention and treatment, it is possible to avoid the recurrence of the case of Mrs. Wang. Meanwhile, for the convenience of the audience, we have opened a combined Chinese and Western medicine specialist clinic on the fourth floor of the outpatient department of Yangpu Central Hospital every Friday morning, which will provide scientific diagnosis and treatment according to the standard and combined Chinese and Western medicine methods. Director Liang Xinglun of the Department of Geriatrics welcomes you to come for consultation and medical treatment.