Osteoporosis is a chronic disease closely related to human lifestyle and environment, and the occurrence and development of the disease are closely related to individual’s living habits, living environment and diet. Changing people’s life, diet and living environment through health education will certainly play a vital role in the prevention and treatment of osteoporosis, and Mr. Huang Jingheng highly valued health education as a low-input, high-output health care treatment measure, which is fundamental to the prevention strategy [1]. For health education, our hospital has adopted the following approaches to psychological interventions for patients with osteoporosis in recent years, which have achieved good auxiliary therapeutic effects.
I. Knowing the disease
Due to the interference of many external factors, people have many misconceptions about osteoporosis, and these misconceptions often mislead people about the direction of osteoporosis treatment, while delaying the treatment of osteoporosis. Resulting in many people with reduced bone mass leading to osteoporosis, while patients with osteoporosis become severely osteoporotic. And such misconceptions are often conjectured by people who know little about osteoporosis, or fabricated by people who want to achieve some special purpose. They are summarized in the following 8 points.
Myth #1: Calcium supplements alone can cure osteoporosis
This is one of the most widespread misconceptions, and even some doctors believe that calcium supplements can cure osteoporosis. In fact, calcium supplementation does play a rather important role in the prevention and treatment of osteoporosis, because osteoporosis is mainly caused by the disorder of calcium metabolism of bone, either because of some cause of excessive calcium metabolism, or because of some cause of slow calcium absorption, but in the final analysis it is all related to calcium. At the same time, from the dietary structure of our population, there is indeed a shortage of calcium intake. The general calcium intake of normal adults is not less than 1000mg per day, and pregnant women are calculated at 15mg/kg body weight, d. The daily calcium intake of postmenopausal women needs to reach 1500mg, while the average daily calcium intake of our people is only 400-500mg, which is far below the standard set by nutrition experts [2]. Therefore, it is a correct theory to make up for the deficiency of calcium intake. However, it is incorrect to treat osteoporosis by simply supplementing calcium for people who are already sick, the reason is that the real cause of calcium loss is not found, but only to blindly supplement raw materials, although it can play a certain therapeutic role, but with the aggravation of the primary cause, it is just like drinking hemlock to quench thirst, which eventually leads to insufficient intake and gradual aggravation of the disease. So in the treatment of osteoporosis to find the real cause of excessive calcium loss and slow absorption of calcium, from the root of the treatment in order to play a real prevention and treatment purposes.
Myth No. 2: “Calcium injection” for osteoporosis
“Calcium injection” is mainly used in the medical treatment of hypocalcemia, that is, when the blood calcium is so low that it needs to be supplemented by calcium injections, and generally not for too long. The reason for this is that calcium ions are involved in the contraction of the heart muscle, and too much calcium in the blood can be very toxic to the heart, even causing cardiac arrest. When the calcium ions in the blood are reduced for various reasons, the body will use bone calcium when the calcium intake from food is not enough to replenish it, and the conversion of bone calcium into ionized calcium to replenish the blood calcium is a slow process in which many metabolic activities are involved.
Or when bone calcium is metabolized too fast for some reason (e.g., postmenopausal estrogen secretion decreases), the calcium ion in the blood will increase transiently, and after a series of metabolic processes, the calcium ion content in the blood will be reduced to keep the calcium in the blood in equilibrium, but in this process, the calcium will not be completely reabsorbed back into the bone, but will be excreted out of the body, resulting in a gradual loss of bone calcium, resulting in osteoporosis, osteoporosis The onset of osteoporosis is a long-term process, in this process, short-term supplementation of blood calcium can not play any therapeutic role, long-term calcium supplementation is the fundamental treatment measures, “calcium injection” is a short-term calcium supplementation process, so it is not suitable for the treatment of osteoporosis.
Myth No. 3: Osteoporosis is “long bone spurs”
The “long bone spur”, also known as osteophytes, is a normal physiological process, except that the growth and development of the body in the process of life experienced by different ways, resulting in different degrees of osteophytes. In addition to the involvement of endocrine factors, lifestyle and the nature of work play a big role in this process. People who exercise a lot and work mainly with physical labor are prone to such conditions, while people who are heavy will also suffer from such results because their limbs are in a long-term weight-bearing state. Osteosclerosis generally occurs in the bone tissue at the site of osteophytes. Osteoporosis is caused by a decrease in bone mass, so “bone spurs” are negatively associated with osteoporosis. Osteoporosis usually occurs in patients with low exercise and thin body size.
Myth No. 4: “Back pain” is osteoporosis
Patients with osteoporosis generally have varying degrees of low back pain, but low back pain is not always caused by osteoporosis. Generally speaking, low back pain can be caused by a variety of reasons, such as: organ involvement pain, for example, insufficient blood supply to the heart muscle will cause pain in the left back, nephritis will cause low back pain on the same side, etc. Soft tissue contusions caused by trauma can cause soreness in the corresponding area. Strain myofasciitis can also cause widespread low back pain. Gynecological pelvic inflammatory disease can cause low back pain, etc. All these diseases can cause low back pain, but what are the characteristics of osteoporotic low back pain? Generally speaking, osteoporotic low back pain is widespread in area, and the pain will be relieved after bed rest and aggravated by weight-bearing exercise, while the pain caused by strain myofasciitis will generally be relieved after exercise and aggravated after rest. Therefore, it is important to target the treatment of low back pain caused by osteoporosis with the participation of a professional physician.
Myth No. 5: Joint pain is caused by osteoporosis
Generally speaking, osteoporosis causes bone pain around the body, and the general identification measures in the diagnosis process of osteoporosis are carried out for cancellous bone. Therefore, it is wrong to think that at the ends of long bones (near the joints) are mostly composed of cancellous bone and that joint pain is caused by osteoporosis. In the degenerative aging process of the joints, it is the degeneration and damage of the articular cartilage that is the main cause of joint pain.
The degeneration of joints generally produces the following processes.
(1) Cartilage wear leads to the invasion of inflammatory mediators into the joint cavity. In this process, the body forms a large number of phagocytic cells, inflammatory mediators in the joint cavity in order to absorb the free cartilage debris produced by overwork, and these substances lead to initial reactions such as joint swelling, fluid accumulation, and pain in the joint cavity, and good results are achieved if the physician is involved in the treatment of chemotherapy during this process.
(2) Inflammatory mediators stimulate the synovial proliferation period, during which excessive and frequent overworking of the joint produces a large number of inflammatory mediators that stimulate lesions in the synovial membrane, resulting in synovial proliferation, while the inflammatory mediators also have a negative effect on the normal articular cartilage, resulting in the normal articular cartilage also being eaten away and absorbed.
(3) The period of periarticular bone sclerosis, the physiological function of articular cartilage in this period is not enough to compensate for the overuse of the joint, resulting in the hardening of the cancellous bone around the joint to compensate for the role of articular cartilage, with the hardening of the bone, further aggravating the wear and tear of articular cartilage, thus leading to a vicious cycle. It is the inflammatory mediator stimulation in this process that is the main cause of joint pain. Therefore, general joint pain is not caused by osteoporosis. A professional doctor can clearly identify this pathogenic process and apply the appropriate medication for each link to solve or alleviate the pathogenic process.
Myth No. 6: Osteoporosis is caused by “cramps”
It is generally believed that a transient decrease in blood calcium causes “cramps”, but in fact, the causes of “cramps” are very complex, and a simple “cold” may be the main cause. In fact, the causes of cramps are very complicated. In patients with osteoporosis, there is a compensatory replenishment of bone calcium in the process of calcium loss, so that the blood calcium is basically normal, so generally will not cause leg cramps due to calcium deficiency.
Myth No. 7: Drinking “bone soup” can replenish bones
We often find in the clinic that many patients often believe in the proverb “eat what grows” and drink a big bowl of ribs soup or bone broth for three meals every day. In fact, the calcium content of bone soup is not high, some people experimented with 1kg of pork bones boiling soup 2h, the calcium content of the soup is only about 20mg. The recommended daily intake of calcium for adults is 800mg, and osteoporosis patients need more, so bone broth is far from enough to meet the needs of calcium. However, the fat content of bone broth is very high, so it is often not what you want, “bone marrow oil” often makes the patient’s body fat, but the bone quality is not changed, therefore, osteoporosis patients should be under the guidance of doctors to adjust the diet structure.
Myth No. 8: Calcium supplements are prone to kidney stones
This view may come from a recent study in the United States that excessive calcium and vitamin D supplementation may increase the risk of kidney stones, but the main problem in our population is the low intake of calcium. Calcium combines with oxalate in the gastrointestinal tract and is excreted through the stool, so that there is less oxalate in the urine and less chance of forming kidney stones. In other words, if there is a lack of calcium in the body, oxalate in the gastrointestinal tract cannot be excreted, and stones will be formed. The American conclusion is not suitable for Chinese people. This is because, compared to the average recommended calcium intake in China, the current average calcium intake of Chinese people is less than 400 mg, and calcium deficiency is still common. In contrast, the calcium intake for middle-aged and elderly people over 50 years of age in the United States is 1200 mg, and the study supplemented the experimenter with an additional 1000 mg of calcium, so that the daily calcium intake is as high as 2000 mg, which is almost the highest tolerable amount for our population. With an extra-large dose of calcium, after the calcium combines with oxalate inside the gastrointestinal tract, the excess calcium is excreted from the urine, increasing urinary calcium and thus the risk of kidney stones. So instead of developing kidney stones, proper calcium supplementation can reduce the incidence of kidney stones.
In conclusion, a true understanding of osteoporosis is the primary health education factor. After excluding the above-mentioned misconceptions, we define the specific symptoms of osteoporosis as follows.
1, short stature and stooping back, which is the main manifestation of osteoporosis, and generally if it appears, it proves that one must suffer from osteoporosis.
2, low back pain, activity aggravated, pain after rest to reduce the low back pain is caused by osteoporosis.
3, thin body type, poor nutritional status, anorexia and paranoia or gastrointestinal diseases caused by the poor nutritional status is also one of the causes of osteoporosis.
4, addicted to smoking and alcohol, age factor, generally addicted to smoking and alcohol should pay attention to the prevention of osteoporosis, age factor in the development of osteoporosis factors account for a large proportion, in women before and after menopause, that is, around 45 to 50 years old should be regular bone density test, and men generally between 63 to 77 years old when androgen secretion reduction caused by osteoporosis, so at this age should also Bone density test should be conducted.
5, long-term medication, other diseases, long-term application of glucocorticoids patients are prone to osteoporosis, while thyroid disease, diabetes, multiple endocrinopathies, primary hyperparathyroidism, secondary hyperparathyroidism, bronchial asthma, pulmonary heart disease, ankylosing spondylitis, bone destruction caused by bone tumors and many other diseases are prone to secondary osteoporosis.
In the self-identification of osteoporosis we use the one-minute self-test protocol recommended by the International Osteoporosis Foundation for patients to perform a self-test. The test protocol is as follows: Are you a potential osteoporotic patient? Please answer “yes” or “no”.
1. Have either of your parents ever had a hip fracture from a minor collision or fall?
2.Have you ever injured your bones from a minor collision or fall?
3.Do you often take hormonal drugs such as cortisone and prednisone for more than 3 months in a row?
4.Have you lost 3 cm of height? 5.Do you often drink too much alcohol (more than the safe limit)?
6.Do you smoke more than 20 cigarettes a day?
7, do you often suffer from dysentery and diarrhea (caused by celiac disease or enteritis)?
8.Answer: Did you go through menopause before the age of 45?
9. Answer: Have you ever had no menstruation for more than 12 consecutive months (except during pregnancy)? If some or all of your answers are “yes”, you may be at risk for osteoporosis, but this does not prove that you have osteoporosis. A bone density test by a medical professional is needed to determine if you have this condition. You can take your test results to your doctor for guidance and he will advise you if further testing is necessary. Therefore, to achieve a true diagnosis of osteoporosis, it is best to do so under the intervention of a doctor’s consultation.
Second, the way of prevention and treatment
After the patient has mastered the condition, health education intervention will be well carried out for the condition. In health education intervention we generally divide into two ways, the first is the general health education way, that is, the way used for most primary osteoporosis patients, and the second is the special health education way, for special cases, secondary osteoporosis patients for special psychological intervention. Firstly, we introduce the general health education approach.
1.Diet and lifestyle guidance
(1) Dietary guidance for osteoporosis patients: usually the diet of osteoporosis patients should be based on foods with high calcium content, generally speaking, small fish, shrimps and dried fruit foods are rich in calcium. The calcium content of dairy products and soy products is also relatively rich. The following is a table analysis of the calcium content of some foods that are frequently contacted in daily life.
(2) Lifestyle guidance for patients with osteoporosis.
①, the first thing to emphasize in the lifestyle guidance is the duration of sunlight. The reason is that the ultraviolet rays in sunlight are absorbed by human skin and can convert vitamin D into active vitamin D that people can use, i.e., osteotriol, so it is generally recommended that the time of sunlight should not be less than 30 minutes per day, and the sunlight way should be chosen for direct sunlight, not interval for example, glass and other objects that have a strong ability to reflect ultraviolet rays, otherwise it will be regarded as invalid, for the cold weather in this region in winter. Sunshine time is relatively small, generally do not advocate reluctant outdoor sunbathing, so to use the appropriate drugs under the guidance of doctors to make up for the lack of vitamin D intake caused by the lack of sunlight exposure.
②, secondly, to change bad habits, for example: brain workers in the process of work relatively less exercise, so the possibility of osteoporosis of the spine will increase, in our recent social survey of the prevalence of osteoporosis in the working population of Daqing area proved this, for such people, we will recommend more coordinated exercise. For patients who are addicted to smoking and alcohol, we recommend abstaining from smoking and alcohol. For anorexic patients, we will help them to change their diet to increase the nutritional balance of food, etc. The change of bad habits plays an important part in the prevention and treatment of osteoporosis.
2.Guidance on outdoor exercise and exercise forms
Outdoor exercise is the main form of exercise for osteoporosis patients. We advocate that osteoporosis patients should engage in continuous low-intensity exercise, such as tai chi, walking, ballroom dancing with a soothing rhythm, etc. The intensity of exercise should not be too high and the duration of exercise should not be too long, but the quality of exercise and the coordination of various muscles around the body should be emphasized.
3.Psychological intervention
Psychological intervention for patients with osteoporosis also plays a part in the recent treatment of patients with osteoporosis. Generally we take the following approach.
(1) Because the psychological burden of elderly patients are very heavy, so, first of all, it is stated that osteoporosis itself will not undergo more significant changes, and the progress is relatively slow, so the process of prevention and treatment will be relatively easy, except for severe osteoporosis medication will also be relatively smooth, and the choice of drugs will be as gentle as possible to produce less and no side effects.
(2) The patient should be relieved of the psychological burden and pay enough attention to the disease. Although the disease of osteoporosis itself will not change significantly, the complications of osteoporosis are all relatively serious. In particular, intertrochanteric fractures of the femur, compression fractures of the lumbar spine, and non-violent fractures of other parts of the body are caused by osteoporosis, so it is important to carry out prevention and treatment of osteoporosis for people with osteoporosis or susceptibility to osteoporosis.
(3) Generally, elderly patients do not treat “seemingly non-disease” diseases as an important matter, but after a fracture occurs, the medical costs incurred are quite expensive, so it is important to convince the elderly to “treat the disease before it occurs”. Therefore, it is a very important part to convince the elderly to “cure the disease before it happens”, that is, it is cost-effective to spend a small amount of money each year to prevent the large amount of money spent on complications such as fractures, and also to avoid the pain caused by fractures and the loss of family members’ labor caused by nursing.
4.Preventing falls
Fall prevention is a popular international approach to the prevention and treatment of osteoporosis in recent years. Due to the varying degrees of bone pain and other causes of osteoporosis patients, resulting in muscle atrophy and weakness or poor coordination of muscles in the area, causing osteoporosis patients to fall more easily than healthy people in normal life. Therefore, increasing muscle strength and preventing falls become an important part of osteoporotic fracture prevention. Generally, in addition to appropriate sports to increase muscle coordination, physicians should be involved in health education, i.e., pharmacological intervention.
Physician intervention
What kind of situation requires physician intervention is a problem that osteoporosis patients have more doubts, and for this problem, our hospital has also made more specific explanations.
1, the choice of calcium agents applied to prevent osteoporosis, generally according to the individual’s physical condition and lifestyle habits, as well as personal dietary structure characteristics to make a judgment, and according to this judgment to make a specific treatment plan, in the process of follow-up to adjust the treatment plan, in order to finally get the best personal treatment.
2, the choice of anti-osteoporosis drugs, according to the severity of the disease and the individual differences of patients to make the initial treatment plan, generally after a period of bone metabolism cycle, depending on the changes in the disease to adjust the application of such drugs to pay attention to the inhibition of bone metabolism and the promotion of calcium absorption combined to achieve the best treatment results.
3, the choice of anti-fall drugs, generally according to the patient’s physical condition, the use or non-use of such drugs, the use of drugs that require the body to metabolize or do not need metabolism can be applied directly, etc.
4.Chinese medicine auxiliary treatment, in the choice of Chinese medicine, the treatment of kidney deficiency is the main focus, the kidney is the main bone, the liver and kidney to strengthen the tendons and bones of drugs for the prevention and treatment of osteoporosis also occupies a heavier weight.
5, the application of physical therapy or not, in the choice of treatment side effects are small, while the bone pain is more obvious patients for physical therapy should also master certain indications.
6.Comprehensive treatment and evaluation of treatment effect. In the process of treatment for a period of time, the doctor should evaluate the efficacy of each patient in order to find the most effective treatment plan for individual cases, and change the factors that affect the treatment effect in the process of treatment at any time.
III. Conclusion
In the same way that blood pressure is controlled in hypertensive patients to prevent cerebral hemorrhage and atherosclerosis, and blood glucose is controlled in diabetic patients to prevent plantar disease and foot necrosis due to peripheral vascular embolism, the development of osteoporosis is controlled to prevent and reduce the occurrence of fractures.
Both the serious complications arising from the first two and those arising from the latter cause great suffering and economic burden to patients, while the care of patients wastes a lot of social manpower. The prevention and treatment of osteoporosis has not received as much attention from all walks of life as the first two. From a large-scale social survey conducted in the United States in 1986, the number of simple femoral neck fractures caused by osteoporosis amounted to more than 240,000, 70,000 people at a cost of more than $7 billion, and wrist fractures amounted to more than 100,000 people. Each year more than 1.5 million people suffer from osteoporotic fractures, i.e. 4,110 cases per day occurring every 20 seconds, and 145 deaths per day due to fractures caused by osteoporosis, with a 12-20% first-year morbidity and mortality rate of femoral neck fractures [3, 4]. to a deformity rate of 65%. The prevention and treatment of osteoporosis is becoming more and more important because of the large number of people in our country and the growing number of aging population at the same time.
Health education for patients is an important therapeutic measure in the prevention and treatment of osteoporosis. Receiving proper and good health education will play a role in the prevention, diagnosis and treatment of the disease. Emphasis and publicity on health education will be a more powerful aid to the prevention and treatment of osteoporosis.