Osteoporosis is a skeletal disease characterized by weakened bone strength and easy fracture, and its greatest danger is the complication of fracture, which is one of the most important public health problems in economically developed countries and an increasingly prominent problem in developing countries. The incidence of osteoporotic fractures in the United States in 1995 exceeded the incidence of cardiovascular, stroke and breast cancer combined. In recent decades, rapid progress has been made in the field of osteoporosis. Early detection and diagnosis of osteoporosis can be achieved through bone densitometry, especially dual-energy X-ray bone densitometry (DEXA), and treatment of osteoporosis can increase bone density and improve bone quality, thus effectively avoiding the occurrence of fractures, and for patients who have already had fractures, current treatments can effectively avoid re-fractures. A survey abroad found that clinicians are generally not sufficiently aware of osteoporosis, and a large number of patients with osteoporosis have not been properly diagnosed and treated. The situation in China is also not optimistic. The authors once analyzed the inpatients of Peking Union Medical College Hospital in the past 10 years and also found that most patients were diagnosed only after fractures were noticed and osteoporosis visible on X-ray was found; the majority of postmenopausal patients with osteoporosis were not diagnosed; many patients with clearly diagnosed osteoporosis did not receive proper treatment; a large number of patients with asthma, renal disease, rheumatic immune disease and organ transplantation It is necessary to popularize the knowledge of osteoporosis among physicians in order to detect, diagnose and treat osteoporotic patients early. Osteoporosis is common and can have serious consequences. In the United States, 20% of Asian women over the age of 50 suffer from osteoporosis and 52% from bone loss, while 7% of men suffer from osteoporosis and 35% from bone loss. 1/3 of women over the age of 50 have a lifetime chance of vertebral fracture, which often leads to disability if the fracture occurs in the hip, and long-term bed rest is prone to other complications, such as pneumonia and blood clots, and death is common, with up to Up to 20% of elderly people with hip fractures die from fracture complications within the first year, 40% of hip fracture patients are unable to walk within one year, 15-25% of survivors are disabled after the fracture and require personal care, and 30% of osteoporotic fractures occur a second time within one year. Bone loss is significantly accelerated in women after menopause, and the fastest bone loss occurs within 5 years after menopause, which is about 1/3 of the peak bone mass, and the fastest bone loss in men after age 70. Bone loss is a process that occurs over decades, and bone loss is osteoporosis when it reaches a certain level. In addition to age and menopause, many factors accelerate bone loss, including physical and mechanical factors such as prolonged bed rest, endocrine diseases (e.g. hypogonadism, hyperthyroidism, hyperparathyroidism, pituitary lesions, adrenal cortical or gonadal diseases), kidney disease, tumors, rheumatoid and digestive diseases (malabsorption), and the use of drugs (glucocorticoids, heparin, immunosuppressants, etc.). (glucocorticoids, heparin and immunosuppressants, etc.). Osteoporosis is a gradual process, and the clinical manifestations of osteoporosis vary, most patients have no symptoms and are only detected when a fracture occurs. Before the fracture occurs, patients may be seen in various clinical departments for various combined risk factors, such as orthopedics or rheumatology for low back pain, gynecology for premature ovarian failure (amenorrhea before 45 years old), urology or gynecology for male hypogonadism, gastroenterology for long-term chronic diarrhea, or gastroenterology for bronchial asthma, nephrotic syndrome, systemic lupus erythematosus, rheumatoid arthritis, thrombocytopenic purpura, and other primary diseases. Therefore, it is necessary for doctors in related departments to have certain knowledge and understanding of osteoporosis. I. Recognize the risk factors and clinical features of osteoporosis Risk factors that predispose to osteoporotic fractures are: (1) female; (2) older than 65 years; (3) lean body mass BMI <20; (4) family history of osteoporosis; (5) hypogonadism (estrogen or androgen deficiency); (6) sedentary lifestyle; (7) smoking (more than 20 cigarettes per day); (8) excessive alcohol consumption (more than 20 cigarettes per day) (8) Excessive alcohol consumption (more than 2 drinks per day); (9) Inadequate intake of vitamin D. The clinical manifestations of osteoporosis mainly include 1) pain: the most common site is low back pain, other sites include joint pain in the limbs, heel pain and radiating pain, numbness and tingling sensation in some limbs, etc. 2) height shortening or hunchback: usually the more severe the degree of osteoporosis, the lower the position of the apex of the hunchback and the more severe the degree of hunchback. 3) fracture: due to increased bone fragility, patients with osteoporosis can suffer from fracture due to slight external force. The common sites include the thoracolumbar spine, the distal radius and the proximal femur. In addition, many patients are asymptomatic and are only detected when a fracture occurs. Therefore, for postmenopausal women or older men, the possibility of osteoporosis should be thought of when low back pain or height shortening or fracture occurs, especially if one or more risk factors are present. Second, check bone density The diagnosis of osteoporosis depends on X-ray, single photon bone densitometer (SPA), dual photon bone densitometer (DPA), dual energy X-ray bone densitometer (DEXA), quantitative CT scan (QCT), ultrasound bone densitometer and other methods, of which radiography is not a sensitive indicator of osteoporosis examination, when there are visible changes in X-ray, bone density loss is already above 30% In contrast, dual-energy X-ray bone densitometry is considered a golden indicator for the diagnosis of osteoporosis. Like the measurement of blood pressure can detect hypertension, bone densitometry can detect and diagnose osteoporosis at an early stage and can be used as an indicator for the evaluation of treatment effects. Therefore, for people at risk of osteoporosis, early bone density screening is the key to early detection of osteoporosis. According to the American Academy of Clinical Endocrinologists (AACE), the following groups of people should undergo bone density screening: (1) those with amenorrhea before the age of 45; (2) postmenopausal women with a family history of osteoporosis; (3) those with frequent low back pain, hunchback or height shortening of more than 3 centimeters compared to the previous; (4) those with abnormal vertebrae or reduced bone mass found on X-ray, who need to exclude osteoporosis; (5) those with long-term (more than 3 months) application of glucocorticoids; (6) the presence of hyperparathyroidism, hyperthyroidism, diabetes mellitus and liver and kidney diseases that increase the risk of osteoporosis; (7) male hypogonadism; long-term alcohol consumption; (8) long-term calcium intake is insufficient; (9) long-term gastrointestinal diseases, such as malabsorption and major gastric resection for more than 10 years; (10) high urinary calcium, with or without kidney stones (11) those who are less active for a long time; (12) those who suffer from rheumatoid arthritis and ankylosing spondylitis; (13) those who take excessive thyroid hormone, methotrexate and antidepressant drugs for a long time. It is never too early to start osteoporosis prevention and treatment, and it is never too late to start, to increase peak bone mass during adolescence and to reduce bone loss in adulthood, to encourage patients to develop scientific habits of life and reasonable diet, and to encourage adequate calcium and vitamin D intake as the basis of osteoporosis treatment, and to encourage weight-bearing exercise for bone health. Adequate calcium and vitamin D intake is the foundation of osteoporosis treatment. Calcium is a major component of mineralized tissue and plays an important role in the development of bones and teeth. The ideal calcium intake is the amount necessary to achieve maximum peak bone mass for adult bone mass maintenance and minimum bone loss in old age. The NIH recommends 1,200 to 1,500 mg/day of elemental calcium for adolescents aged 11-24 years, 1,000 mg/day for women aged 25-50 years, 1,000 mg/day for men aged 25-65 years, 1,500 mg/day for postmenopausal women without estrogen replacement therapy, and 1,500 mg/day for all men and women aged 65 years or older, while the actual daily calcium intake of the Chinese population is not encouraging. The results of a survey conducted by the Chinese Academy of Preventive Medicine on 90,000 people 10 years ago showed that the average daily intake of calcium was only 405 mg, and the situation has not improved significantly in recent years. Treatment of established osteoporosis includes removing the causes and risk factors for continued bone loss, considering estrogen replacement therapy or selective estrogen receptor modulators (SERMs) in postmenopausal women, and androgen replacement therapy in men with hypogonadism, and for glucocorticoid osteoporosis, the American College of Rheumatology ACR and the British Glucocorticoid Osteoporosis Review Group have published a review of glucocorticoid osteoporosis. The ACR recommends that all patients taking prednisone (5 mg/d) for more than 3 months should receive a daily calcium supplement of 1500 mg, vitamin D3 800 IU, and a bisphosphonate (alendronate or risedronate) in order to prevent bone loss and fracture, and if a bisphosphonate is contraindicated or not tolerated, calcitriol should be considered. tolerated, calcitonin therapy should be considered. In summary, osteoporosis is common and can have serious clinical consequences. With an aging population, the number of patients will increase and physicians in all specialties should and can do something about it.