Osteoporosis is a common metabolic bone disease, mostly seen in menopausal women, the incidence of osteoporosis in men is only 1/6 of that in women. osteoporosis in postmenopausal women is related to endogenous estrogen, the decrease of estrogen, the inhibition of osteoclasts is weakened, the relative strengthening of osteoclasts, the imbalance between osteoclasts and osteogenesis is obvious, there is an increase in bone resorption and a decrease in bone formation, resulting in a gradual loss of bone mass.
I. Definition and classification of osteoporosis (OP) Definition.
It refers to a clinical syndrome in which the microstructure of bone tissue is damaged, characterized by a progressive decrease in bone mass (and bone quality) and leading to increased bone fragility and susceptibility to fracture. New: Osteoporosis is a metabolic bone disorder characterized by reduced bone strength increased bone fragility and susceptibility to fracture.
Second, epidemiological studies show that.
About 1/3 of the elderly aged 60-70 in China have osteoporosis, and half of those aged 80 or above suffer from osteoporosis, which is very harmful to the health and quality of life of the elderly, and 10%-20% of the patients die within 1 year after fracture. At present, 1/3 of hip fractures occur in Asia, and it is expected that by 2050, hip fractures in Asia will account for more than 50% of the world, and the population of China has reached 1.3 billion, of which more than 10% are over 60 years old, and China has entered an aging society, therefore, the problem of osteoporosis, which is a serious threat to the health of the elderly, cannot be ignored.
Third, the classification of osteoporosis.
Primary osteoporosis adolescent type, young adult type, these two categories are rare; Aging degenerative type includes: postmenopausal osteoporosis and senile osteoporosis. Secondary osteoporosis is due to a disease or drug triggered osteoporosis, such as endocrine osteoporosis, nutritional deficiency osteoporosis, drug osteoporosis, renal osteoporosis, etc.
Fourth, the typing primary.
It is also divided into postmenopausal osteoporosis – within 5-10 years after menopause and senile osteoporosis —– which occurs after the age of 70. Idiopathic osteoporosis – occurs mainly in adolescents and the etiology is not yet clear. Secondary osteoporosis refers to osteoporosis caused by diseases or drugs, etc.
V. Risk factors Uncontrollable factors.
Ethnicity, old age, female menopause, maternal family history. Controllable factors: low body weight, low sex hormones, smoking, excessive alcohol consumption, coffee and carbonated beverages, lack of physical activity, lack of calcium and vitamin D in the diet (low light exposure or low intake), diseases affecting bone metabolism and application of drugs affecting bone metabolism.
VI. Clinical manifestations.
Pain, shortening of stature, spinal deformation and fracture are common signs and symptoms of osteoporosis. Fracture: the most common site: hip, including femoral neck, intertrochanteric fracture, spinal compression fracture and distal radius: (colles, shims, Barton).
VII. Diagnosis WHO recommended diagnostic criteria.
1, Bone mineral density lower than 1 standard deviation of peak bone in healthy adults of the same sex and race is considered normal.
2.Reduction of 1 to 2 standard deviations is considered as reduced bone mass.
3.Decrease equal to and greater than 2.5 standard deviations for osteoporosis.
T value ≥ -1.0 is normal, -2.5 value < -1.0 is bone loss, T value ≤ -2.5 is osteoporosis.
VIII. Preventive treatment
Treatment content.
Removal of secondary causes of bone mineral loss, prevention and treatment of additional bone mineral loss, correction of lost bone mass, prevention and treatment of falls, reduction of fracture occurrence, and rehabilitation of patients who have fractured or become disabled to improve their quality of life.
Bone health basic supplements.
1, calcium: China’s Nutrition Society formulated the recommended daily calcium intake of adults 800mg (elemental calcium content) is the appropriate dose to obtain the ideal peak bone and maintain bone health, the recommended daily dose of calcium for postmenopausal women and the elderly is 1000mg, the average daily calcium from the diet of the elderly in China is about 400mg, so the average daily amount of elemental calcium should be supplemented with 500-600mg, calcium should be used in combination with Calcium should be used in combination with other therapeutic drugs. There is no sufficient evidence that calcium supplementation alone can replace other anti-osteoporosis drug therapy, and the choice of calcium should consider safety and effectiveness.
2. Vitamin D.
It facilitates the absorption of calcium in the gastrointestinal tract. Vitamin D deficiency can lead to secondary hyperparathyroidism and increase bone resorption, thus causing and aggravating osteoporosis. 200u (5ug/)/day is the recommended dose for adults, while the elderly often have vitamin D deficiency due to lack of sunlight and impaired intake and absorption, so the recommended dose is 400-800u/day. Some studies have shown that vitamin D supplementation increases muscle strength and balance in the elderly, thus reducing the risk of falls and thus fractures. Treatment should be combined with other medications, individual differences and safety should be noted, and blood and urine calcium should be monitored regularly.
Pharmacological treatment is indicated for those with existing OP or fragility fractures or those with reduced bone mass with risk factors for OP. Anti-bone resorption drugs: bisphosphonates, calcitonins, estrogen receptor modulators, estrogens. Bone formation promoting drugs: parathyroid hormone, active vitamin D, herbal medicine, phytoestrogens.