One in three women and one in eight men in the world today suffer from osteoporosis. Most patients quietly start at the age of 50 and when a fracture occurs the osteoporosis is already severe. The prevalence, severity, and difficulty in detecting this osteoporosis (potential) is due to the fact that its early symptoms are not noticed and it does not receive various nutritional supplements in time, which is probably the reason why “the child who does not cry has no milk to eat”.
Therefore, in order to improve the physical quality of the whole population, actively promote and popularize the knowledge of osteoporosis, and strive to prevent and treat osteoporosis is urgent.
(A) The concept of osteoporosis.
Osteoporosis is a systemic bone disease, characterized by low bone mass and microstructural damage to bone tissue, and ultimately leads to increased bone fragility and fracture-prone pathology, resulting in a clinical picture called osteoporosis. This disease is one of the common causes in the elderly, especially in postmenopausal women.
(B) Osteoporosis pathology.
Bone is composed of organic material (95% collagen fibers, bone cells, bone matrix) and inorganic salts (calcium ca., phosphorus p). It is the same as a building is composed of steel and cement. Calcium is the most abundant mineral in the body (around 30-40 years old) and subsequently bone metabolism is in negative balance, i.e. more absorption than regeneration. Especially after menopause in women, the rate of bone loss is 10 times greater, so the incidence of women is eight times higher than that of men.
(C) osteoporosis symptoms.
The early symptoms of osteoporosis are only back pain, but later may gradually appear as height shortening, hunchback (vertebral compression fracture), spine or joint deformation, generalized pain (multiple microfractures) and limited mobility.
(iv) Osteoporosis is highly susceptible to fracture.
It is true that, as an old saying goes, “When a wolf is hit by a sisal pole, both ends are afraid”. If you suffer from osteoporosis, you may fracture with a slight external force. For example, when coughing and sneezing, when bending over to hold a child, when bending over to pick up something, when turning around and turning back, or when falling down inadvertently.
(E) Prevention and treatment of osteoporosis.
(1) Food supplement is better than medicine: normal people need to supplement calcium 800~1000mg and sufficient amount of high quality protein daily, because low protein diet for the elderly is also one of the important causes of osteoporosis. And milk is one of the most abundant natural foods in calcium and protein.
500g(ml) of milk/24h per day = 600mg of calcium + 14g of high quality protein (i.e. 6/8 of the body’s calcium requirement).
Each 100mg of dried tofu contains 200mg of calcium.
Limit salt to 3-5g/24h. daily.
Abstain from sugar (because of its depletion of vitamin B and calcium).
(2) Eat well in the morning, full at noon and less in the evening…. Meat, poultry and fish contain high phosphorus should be supplemented. Avoid excessive alcohol consumption, smoking.
(3) Chinese medicine: “kidney main bone”, kidney herbs and yam, purple and car have good curative effect.
(4)Exercise: daily walking 8000 steps/24h, gymnastics, taijiquan, sunbathing,
(5) Prevention of falls, especially snow, rain, fog, icy roads and traffic congestion. To eliminate external force causing fracture, even if the external force is very slight.
(6) Osteoporosis drugs :
(1) calcium preparations: is one of the more certain drugs for the treatment of osteoporosis efficacy and safety, such as calcium carbonate, calcium gluconate, calcium amino acid sting. The third generation of ultra-micronized calcium carbonate preparations and amino acid calcium preparations, such as calcium nano, calcium L-aspartate, etc.. They are characterized by good solubility, good absorption (its absorption rate is generally 60% to 80%, but also up to 90% or more), high bioavailability, and low stimulation of the gastrointestinal tract, which is currently the more ideal calcium supplementation preparation.
(2) bone mineralizer: calcium and vitamin D supplementation is beneficial for people with insufficient calcium intake, and is a “basic measure” to prevent osteoporosis. Vitamin D is the only hormone that promotes intestinal calcium absorption, and the combination of vitamin D and calcium supplements and parathyroid hormone can have a complementary effect. For example, alfacalcidol.
(3) Bone resorption inhibitors: Calcitonin (mikacalcitonin and efacalcitonin) is preferred. Calcitonin lends itself to subcutaneous, intramuscular or nasal absorption (200-400u/24h for mikacalcitol nasal spray) and is effective for women with osteoporosis who have been menopausal for more than five years. Loss of appetite, flushing, rash, nausea and dizziness may all be reactions to the drug.
In addition, bisphosphonates have similar effects to estrogen, but the latter is used only in women, while bisphosphonates are available for both men and women. Alun phosphate sodium enteric tablets (Gupta 70mg 1 tablet/1 time/1 week) and Alun phosphate sodium tablets (Fosamax 70mg 1 tablet/1 time/week) are also good. They are the third generation of diphosphonates, which not only eliminate the inhibition of normal bone mineralization, but also enhance the anti-bone resorption efficacy.
(4) Bone formation promoter: small doses of parathyroid hormone. Recombinant parathyroid hormone (PTH1-34) is currently available.
(5) Hormonal supplementation therapy: estrogen plus luteinizing hormone for prevention and treatment of osteoporosis. If there is no uterus, progesterone is not needed.
(6) Bone peptide preparation, which is a new clinical drug emerging at present, is effective for osteoporosis. Once 2ml (1 stick) once a day, intramuscular injection, 20-30 days as a course of treatment.
(vii) Clinical selection of drugs.
(1) Postmenopausal osteoporosis: for those who develop osteoporosis with menopausal symptoms in early menopause, estrogen replacement therapy is very effective, but its contraindications should be strictly controlled; if the age is over 55 and there are no obvious menopausal symptoms, it is recommended to use estrogen receptor modulators (SERMs) or diphosphonates, and active vitamin D3 should be supplemented in autumn and winter.
(2) Age-related osteoporosis: active vitamin D3 metabolite deficiency and vitamin D resistance with increased compensatory PTH secretion are important causes of age-related osteoporosis, so active vitamin D3 supplementation is necessary for the treatment of age-related osteoporosis, but calcitonin and bisphosphonates are very effective for those elderly with significant bone loss and significant bone pain or osteoarthritis.
(3) Male osteoporosis: Studies have found that androgens are effective only for men with low testosterone levels, and clinical treatment of male osteoporosis with diphosphonates, active vitamin D3 and calcitriol.
(4) Secondary osteoporosis: treatment of the primary disease is a prerequisite, but the simultaneous application of active vitamin D3, diphosphonates or calcitonin is also important for the prevention and treatment of secondary osteoporosis.
(5) Osteoporosis with osteoarthritis: osteoporosis and osteoarthritis are the most common degenerative diseases of the skeletal system in the elderly, and concomitant clinical complications are very common. Calcitonin and active vitamin D3 can not only treat osteoporosis, but also have good promotion effect on cartilage damage repair, while diphosphonates can both treat osteoporosis and inhibit excessive osteophytes, so calcitonin, active vitamin D3 and diphosphonates are the choice of clinical treatment for osteoporosis with osteoarthritis.
(6) Osteoporosis treatment aimed at improving bone mass: PTH1~34 (parathyroid hormone) or diphosphonates can be used for severe osteoporosis requiring rapid improvement of bone mass, but diphosphonates should be used with caution in bedridden patients.
(7) Osteoporosis treatment for the purpose of relieving bone pain: calcitonin should be chosen, and diphosphonate treatment can be considered for allergic patients. However, whether calcitonin or bisphosphonates are not analgesics, the effect of pain relief should be produced gradually, so the combination of non-steroidal analgesic drugs can be applied purposefully for a short period of time in the early stage of treatment to ensure analgesic efficacy and improve patient compliance.
(8) Osteoporosis treatment aimed at improving muscle strength: Decreased muscle strength is another important clinical manifestation of osteoporosis, and is also the main cause of osteoporotic fractures. Enhancing muscle strength and improving neuromuscular coordination are the advantages and characteristics of active vitamin D3 treatment for osteoporosis, and HRT can also partially improve muscle strength.
(9) Prevention of osteoporotic fractures: the ultimate goal of osteoporosis prevention and treatment is to avoid fractures, and most clinical osteoporosis treatment drugs have certain efficacy in reducing osteoporotic spine fractures, but evidence-based medical research has shown that new bisphosphonates (alendronate, risedronate) have significant efficacy in reducing osteoporotic spine and hip fractures, while calcitonin and active vitamin D3 can improve bone The effect of calcitonin and active vitamin D3 on reducing the incidence of osteoporotic fractures is also evident, as they improve bone quality and biomechanical properties.
Patients with osteoporotic fractures that must be treated surgically should emphasize concomitant antiosteoporotic drug therapy.
In conclusion, the prevention and treatment of osteoporosis should begin with peak calcium levels in the 30s and 40s, so that they remain in a relatively dynamic balance. When osteoporosis has already developed, treatment can be effective even if it is not.