Osteoporosis (OP) is a systemic bone disease characterized by low bone mass, damage to bone microarchitecture, and reduced bone strength, leading to increased bone fragility and susceptibility to fracture. Bone strength reflects two major aspects of the skeleton, namely bone mineral density and bone mass.
Osteoporosis can occur in different genders and ages, but is more common in postmenopausal women and older men. Osteoporosis is divided into two major categories: primary and secondary. Primary osteoporosis is divided into three categories: postmenopausal osteoporosis (type I), senile osteoporosis (type II), and idiopathic osteoporosis. Postmenopausal osteoporosis generally occurs within 5-10 years after menopause in women; osteoporosis in the elderly generally refers to osteoporosis that occurs after the age of 70; secondary osteoporosis refers to osteoporosis caused by any disease and/or medication that affects bone metabolism; and idiopathic osteoporosis occurs mainly in adolescents and has an unknown etiology.
Osteoporosis is a degenerative disease with an increased risk of developing it with age. With the increase of human life expectancy and the advent of an aging society, osteoporosis has become an important human health problem. In areas such as Beijing, the prevalence of vertebral fractures in women over 50 years of age is 15%. The hip fracture rate in Chinese is expected to increase significantly in the coming decades. The lifetime risk of osteoporotic fracture in women (40%) is higher than the combined risk of breast, endometrial and ovarian cancer, and the lifetime risk of osteoporotic fracture in men (13%) is higher than that of prostate cancer.
A serious consequence of osteoporosis is the occurrence of osteoporotic fractures (fragility fractures), commonly in the spine, hip, and distal forearm. The risk of osteoporotic fractures is high, leading to increased disability and mortality. If a hip fracture occurs within 1 year, 20% of people die from complications, and about 50% of those who survive are disabled and unable to care for themselves, resulting in a significant decrease in quality of life.
Osteoporotic fractures are preventable and treatable. Early prevention can prevent osteoporosis and its fractures. Even if a fracture has occurred, the risk of re-fracture can be effectively reduced with appropriate and reasonable treatment. It is therefore important to disseminate knowledge about osteoporosis, to achieve early diagnosis, to predict the risk of fracture in time and to use standardized prevention and treatment measures.
Pain, spinal deformation and fragility fractures are the most typical clinical manifestations of osteoporosis. However, many patients with osteoporosis may have no obvious symptoms of pain in the early stages, and osteoporosis is often detected only after a fracture has occurred, either by bone densitometry or by bone density.
Patients may also have low back pain or skeletal pain around the body, and the pain may worsen when the load increases or the activity is limited, and in severe cases, there are difficulties in turning, sitting and walking.
Severe osteoporosis may result in height shortening and hunchback, spinal deformity and limited extension.
A fragility fracture is a low-energy or non-violent fracture, such as a fall from a standing height or less than a standing height, or a fracture that occurs as a result of other daily activities.
After a fragility fracture has occurred, the risk of a second fracture is significantly increased.
Old age, female menopause, low body weight, hypogonadism, smoking, excessive alcohol consumption, excessive coffee consumption, lack of physical activity, braking, nutritional imbalance in the diet, excessive or inadequate protein intake, high sodium diet, calcium and/or vitamin D deficiency (low light exposure or low intake) are risk factors for osteoporosis.
Osteoporosis risk one-minute test questions.
(1) Have you ever injured your bones from a minor bump or fall?
(2) Have your parents ever had a hip fracture from a minor collision or fall?
(3) Do you regularly take hormonal drugs such as cortisone and prednisone for more than 3 months in a row?
(4) Have you lost height (more than 3 cm) since you were younger?
(5) Do you regularly drink a lot of alcohol?
(6) Do you smoke more than 20 cigarettes a day?
(7) Do you often suffer from diarrhea? (due to gastrointestinal diseases or enteritis)
(8) Answer for women: Did you become menopausal before the age of 45?
(9) For women: Have you ever been without menstruation for more than 12 months (except during pregnancy)?
(10) Men: Do you suffer from impotence or lack of sexual desire?
If one} of the responses is “yes”, then you are at risk for osteoporosis.
The common clinical indicators used to diagnose osteoporosis are the occurrence of fragility fractures and/or low bone density.
There is a lack of clinical means to directly measure bone strength; therefore, bone mineral density or bone mineral content measurement is an objective and quantitative indicator for the clinical diagnosis of osteoporosis and for assessing the extent of the disease.
Fragility fractures are a clear indication of decreased bone strength and are the end result and complication of osteoporosis. The clinical diagnosis of osteoporosis is made when a fragility fracture occurs.
Bone density reflects approximately 70% of bone strength.
The clinically used Dual Energy Absorptiometry (DXA) measurement is currently the internationally accepted standard for the diagnosis of osteoporosis.
BMD is usually expressed as a T-Score (T-value).
BMD values less than 1 standard deviation below the peak bone mass of a normal adult of the same sex and race are considered normal.
A decrease of between 1 and 2.5 standard deviations is considered low bone mass (decreased bone mass).
A reduction equal to and greater than 2.5 standard deviations is considered osteoporosis.
Severe osteoporosis is considered when there is also one or more fractures.
Prevention and treatment strategies for osteoporosis include basic measures, pharmacological interventions, and rehabilitation.
A balanced diet rich in calcium, low in salt and moderate in protein.
A balanced diet rich in calcium, low in salt and protein, with adequate outdoor activity and sun exposure, physical activity and rehabilitation for bone health.
Avoid smoking, alcohol and drugs that affect bone metabolism, etc.
Take various measures to prevent falls.
Basic bone health supplements :Calcium and vitamin D (including active vitamin D)
Pharmacological interventions: bisphosphonates, calcitonins, estrogens, parathyroid hormones (small doses of rhPTH 1-34 have a pro-bone formation effect), selective estrogen receptor modulators and strontium salts.