On the epidemiology of osteoporosis and fractures caused by osteoporosis
Key points.
1. the current status of the epidemiology of osteoporosis
2. Perioperative management of osteoporosis
Come to see detailed insights on.
About the current state of the epidemiology of osteoporosis?
Along with the aging of our society, orthopedic surgeons are meeting more and more patients with osteoporosis. According to our national statistics, there are now more than 200 million people over the age of 60, and especially in recent years, every orthopedic surgeon is able to meet more and more patients with osteoporosis in the clinic, especially fractures of the spine and hip, including fractures of the shoulder, elbow and wrist, a large number of which are low-energy injuries, causing such fractures, and often it is our orthopedic surgeons who attach great importance to surgery.
It is easy to neglect the perioperative management of osteoporosis because orthopedic surgeons tend to rely on internal medicine physicians to prevent and treat osteoporosis. So the theme of this year’s Osteoporosis Working Committee meeting is to give our young physicians, to keep focusing on osteoporosis in menopausal women. We used to think that this osteoporosis is the sole preserve of menopausal women, but this year it was also suggested that osteoporosis and men also have a very significant relationship. With the increase of age, the change of disease spectrum, a large number of clinical chronic obstructive pulmonary disease, asthma, including rheumatoid, a large number of hormone application caused by the secondary osteoporosis.
At the same time, some white-collar workers have irregular life, inactivity and sun exposure, and some young people also have osteoporosis. From epidemiological surveys, nearly 40 percent of people between the ages of 30 and 40 have low bone density and low bone mass. The epidemiological trend suggests that osteoporosis is becoming more and more prevalent with aging. If we do not pay attention to osteoporosis, perioperative prevention and prevention of osteoporosis in the elderly, then the quality of life of the elderly should be greatly affected, so we mainly propose this time, that is, let orthopedic surgeons pay attention to osteoporosis.
Because of its epidemiological trend, it has reached this time. Then we look at the world scope, from the 1930s to the 1980s, there was a very fast rising trend of osteoporotic fractures in Europe and America, and over the years, after the 21st century, the trend of osteoporotic fractures in Europe and America is a relatively stable trend. In Asia, especially in China, the amount of osteoporotic fractures has increased dramatically since the 1960s, especially after 2000, and some statistics were shown this morning, and after 2000, we have a very rapid increase in osteoporotic fractures.
There is an epidemiological statistic that from 2000 to 2006, hip fractures in women increased by 56% and hip fractures in men, that is, fractures caused by osteoporosis, increased by 49%, which is a very large and terrible figure. Therefore, we have been emphasizing that our orthopedic surgeons have not been aware of osteoporosis for some time and have not done enough to prevent osteoporosis. In addition, after the fracture of osteoporosis, how can we pay attention to and do a good job of internal fixation or joint replacement for patients with osteoporosis in terms of orthopedic technology and surgery? Therefore, our theme is to raise orthopedic surgeons’ awareness of osteoporosis and the importance of prevention and treatment of osteoporosis in the perioperative period.
What are the principles of perioperative management and internal fixation of fractures caused by osteoporosis?
The perioperative management of osteoporosis becomes more important for orthopedic surgeons. From the medical point of view, many specialties, such as endocrinology, geriatrics, rheumatology, obstetrics and gynecology, are in the prevention and treatment of osteoporosis, but once a patient has a fracture due to osteoporosis, especially in the perioperative period, only an orthopedic surgeon can do it, so at this time, it seems that orthopedic surgeons are more important in the prevention and treatment of osteoporosis.
Regarding the perioperative management of osteoporosis, we orthopedic surgeons should first recognize the importance of osteoporosis, and then the prevention and treatment of osteoporosis, especially the prevention of joint loosening after surgery, the loosening of internal fixation, including the delayed healing of fractures. So there should be a very standard primary prevention and secondary prevention of osteoporosis. The use of drugs is unfamiliar to orthopedic surgeons, because I am afraid that orthopedic surgeons focus on surgery, and surgeons or orthopedic surgeons are judged by how well they do surgery, but I do not think so, because osteoporosis involves various subspecialties of orthopedics. Each group has a relationship with osteoporosis, regardless of the joint, spine, trauma, including foot and ankle, in fact, their content and osteoporosis are related.
As I mentioned earlier, the prevention of osteoporosis is to prevent the vicious circle of osteoporosis from being interrupted, because a very important problem encountered by perioperative orthopaedic surgeons is that the patient brakes after a fracture, and once the braking is combined with the fracture, there is a rapid bone loss. The rapid bone loss at this time, often we start to do surgery, after the surgery, the patient’s internal fixation is prone to failure, and at the same time the rapid bone loss and our internal fixation, the patient still has to brake, so that the loss of bone volume, the patient’s pain, fracture non-union, failure of internal fixation, a series of comorbidities.
The vicious circle after osteoporotic fracture is very difficult, so one of the first tasks of perioperative management is to break this vicious circle. The basic medication is definitely vitamin D, ordinary vitamin D and active vitamin D plus calcium, which is the basic medication. Regarding the drugs that inhibit bone resorption and promote bone healing, there are bisphosphonates and parathyroid hormone PTH, so it is worthwhile for our orthopedic surgeons to pay attention to how to use this drug. There are a lot of experiments, including our clinical experience, to confirm that the use of bisphosphonates before, after and at any time after the fracture does not have a great impact on the healing of the fracture.
During the discussion at last year’s annual osteoporosis conference, because the basis of the action of bisphosphonates is the inhibition of osteoclasts, we all know that after the fracture to have osteoblasts, osteoclasts are very important when the plastic transformation. This year, according to foreign data and some of our domestic scholars, it is said that the early application of bisphosphonates after fracture does not affect the healing of the fracture and does not affect the biomechanical strength of the fracture. It is only the disappearance of the fracture line is a little late and the bone scab is larger when shaping. So this year there is a consensus that the most preferred bisphosphonates have no significant effect on fracture healing, just two points, and they do not affect the patient’s healing either.
As for osteoporotic fractures, from the orthopedic trauma, there are many new techniques and materials for internal fixation. In 2006 and 2007, the Osteoporosis Group of the Orthopedic Branch of the Chinese Medical Association formulated a guideline for the treatment of osteoporotic fractures. This guideline contains many principles for the treatment of osteoporotic fractures.
The first principle is to fixate so that the fracture ends are in close contact, including we have some sliding nails for sliding hip intertrochanteric fractures, including the current PFNA, which has static locking and dynamic locking, which are to make the fracture heal better and make better contact, this is the first principle; the second principle, in some places close to the joint, wide support fixation is advocated, including the distal radius, proximal humerus, we use The second principle is that in some places close to the joint, wide support fixation is advocated, including the distal radius, proximal humerus, the locking plate, and the wide support fixation that we use, and the other is to reduce the occlusion effect. Obstruction effect is also a very important cause of osteoporosis, and another is that when we do artificial joints, when we do some vertebral nailing, we also have to have some special techniques in terms of osteoporosis.
In particular, we do vertebral body forming PVPPKP, do a lot in the clinic, although there are so many problems have not been solved, such as leakage of bone cement, toxic reaction of bone cement, re-fracture of adjacent vertebrae, and the ability to play several vertebrae at a time, which are controversial. But after the emergence of some new surgical instruments, these controversies are gradually being solved, for example, a central expander from Israel, including some new products from Taiwan, and these new products play a very big role in the treatment of osteoporotic fractures.
Therefore, there are two very important perioperative treatment, one is the perioperative prevention and treatment of osteoporosis, prevention is to reduce the degree of osteoporosis, and then prevent the occurrence of re-fracture; the second is the improvement of internal fixation devices, including when we do internal fixation, we can do the reinforcement of internal fixation, using bone cement to do the reinforcement of internal fixation. Some new techniques are used, one is medicine and the other is new techniques. For the perioperative management, if each of our orthopedic surgeons has a good understanding of these two issues, they will be able to handle them better and reduce the failure rate, even in this medical environment nowadays, and reduce the occurrence of such medical disputes. Many of our orthopedic surgeons, after the osteoporotic fracture, do not pay attention to the prevention of drugs, do not pay attention to the technology of internal fixation, and finally the nail fell off, the plate fell off, the joint loosened, causing many medical disputes, so this thing is very important.
China has entered an aging society, orthopedic surgeons will encounter more and more patients with osteoporotic fractures, how to face it, which is inescapable, only to improve their own business level, the ability to understand the disease, including the ability to have effective measures. In this way, our patients can safely pass through the perioperative period and can be better managed.