Osteoporosis is a bone metabolic disorder caused by various reasons, the main guide to the performance of the unit volume of bone decreased bone matrix organic components and calcium salt deposition are reduced but the basic structure remains unchanged culture clinical manifestations of communication is mainly bone pain and fracture X-ray manifestations are characterized by bone cortical thinning and bone trabeculae reduction Taonan City Hospital of Traditional Chinese Medicine Department of Surgery Yu Nianfeng Osteoporosis is not an independent clinical disease but a serious social The problem of reading achievement is especially prominent in the increasing problems of the elderly society Bachelor can be divided into two categories: primary and two kinds of age-related osteoporosis and another kind of post-menopausal women osteoporosis adults and adolescents also occasionally occur secondary including disuse malnutrition osteoporosis, such as excessive cortisol hyperthyroidism can also be secondary to osteoporosis osteoporosis can involve the whole body bones to The incidence of osteoporosis is most pronounced in the vertebrae, hips and wrists, and is related to gender, age, race, diet, exercise and other factors.
It is generally believed to be related to endocrine disorders calcium malabsorption and disuse some complex factors that accelerate bone remodeling and reduce bone formation can affect bone metabolism and cause osteoporosis women after menopause significantly accelerate bone loss premenopausal if bilateral oophorectomy also often appear osteoporosis in both cases estrogen replacement therapy can prevent bone loss estrogen can change bone tissue citation to parathyroid hormone ( Estrogen stimulates bone matrix production by osteoblasts, and if estrogen is insufficient, osteoblast activity decreases and bone formation is reduced. Estrogen also inhibits bone resorption and reduces bone turnover, which is antagonistic to the effects of PTH. In older adults, the decline in gonadotropins is accompanied by a relatively small decline in surgical adrenocortical activity, resulting in an increase in anabolic steroids and further delaying bone formation. It has been suggested that calcitonin deficiency is also a cause of osteoporosis, and that calcitonin levels in postmenopausal women with osteoporosis are highly variable, as measured by a well-known radioimmunoassay, and its exact relationship needs to be further confirmed. The net calcium absorption rate (i.e., the difference between dietary calcium and fecal calcium) is also significantly reduced in the elderly when calcium intake is greatly reduced (i.e., the difference between dietary calcium and fecal calcium); if dietary calcium is below this value, net calcium absorption is negative. In the elderly, food intake or endogenous synthesis of active vitamin D is reduced, while scientific research is closely linked to vitamin D metabolism because of decreased liver and kidney function, which eventually leads to vitamin D deficiency and inevitably affects calcium absorption. The excretion of calcium increases when acidosis decreases, and the excretion of calcium increases when meat is overly acidic and ash content increases, and urinary calcium increases, and a high phosphorus diet can increase parathyroid hormone and increase bone loss. Changes in the state of motion inevitably cause changes in internal structure followed by corresponding changes in shape Mechanical stress is an important stimulus to osteoblast activity Osteoblast activity decreases during disuse while osteoclast activity is relatively increased and osteoporosis occurs as a result of prolonged bedridden study abroad patients have a significant increase in urinary and fecal calcium producing a negative calcium balance In summary, it can be concluded that gonadal hormone deficiency nutritional deficiencies including calcium malabsorption and low protein Diet and braking are factors in the development of osteoporosis, which may be dominated by one of these factors or may be a combination of multiple factors. One of the clinical manifestations of osteoporosis.
The onset of osteoporosis is slow and generally clinical participation is mild or only low back pain with few symptoms of nerve root compression or irritation If the low back pain suddenly increases, it mostly indicates the occurrence of fractures Examination and measurement of osteoporosis.
It can be divided into laboratory tests, X-ray and bone densitometry, etc. ① Laboratory tests serum calcium, phosphorus and alkaline phosphatase are generally in the normal range, but due to increased bone resorption serum calcium and urine calcium can also slightly increase blood phosphorus may increase if serum calcium and urine calcium are reduced and urine hydroxyproline increases hydroxyproline is the main component of bone collagen gynecology increased urine hydroxyproline indicates impaired bone formation ② X-ray examination bone volume decreased to more than % X-ray Therefore, early osteoporosis is difficult to be detected by X-ray; and because of the influence of projection conditions and other errors, conventional radiographs can show a thinning of the tubular bone cortex, a widening of the medullary cavity, a decrease in the number of trabeculae and a widening of their gaps, and a significant decrease in bone density in the vertebrae, the transverse trabeculae are often reduced and thinned or disappear, while the longitudinal trabeculae become obvious. Biconcave measurement of the transverse diameter of the diaphysis (D) at the midpoint of the second metacarpal stem and the transverse diameter of the medullary cavity (d) in the same plane can be used to calculate various indices, of which the metacarpal cortical thickness (D-d) and the metacarpal index (D-d/D) are of practical value and can be used to roughly estimate the degree of osteoporosis in the absence of sophisticated equipment. RVD), that is, the comparison of vertebral body and intervertebral disc density should be normal, that is, the density of the vertebral body is higher than that of the intervertebral disc; if RVD is zero, it means that the two density colleges are the same and there must be osteoporosis; if RVD is negative, it means that the density of the vertebral body is smaller than that of the intervertebral disc, which shows that there is serious osteoporosis Doyle’s densitometry method is to use an aluminum standard body with the forearm mainly placed in the sink at the same time to take pictures on the radiographs to select the ulnar bone health department different The parts of the ulnar bone are selected for comparison with the birth of the standard body so as to calculate the mineral content of each point Each mm thick aluminum sheet is equivalent to mg of bone mineral/Cm Photon absorption measurement is currently noble application associate professor more widely used method using a single photon absorber (SPA) such as A or I of attenuation in the lower part of the radius to determine the absorbed photon energy This method can directly determine the small changes in bone loss but whether the measured density of the lower part of the radius New methods such as two-photon absorptiometry (DPA), neutron activation analysis (NAA), quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DEXA) are useful in the diagnosis of osteoporosis.
The practical diagnosis of postmenopausal osteoporosis is not difficult The purpose of each biochemical index examination is to exclude other metabolic bone diseases such as secondary hyperparathyroidism chondromalacia or rickets osteoporotic patients deputy director due to inadequate absorption of calcium intake vitamin D or its active metabolite production with chondromalacia is not uncommon for vertebral compression fractures especially talents who are single should be distinguished from metastases or multiple Cushing’s well-known syndrome especially long-term use of adrenocorticotropic hormone digestive malabsorption hyperparathyroidism liver disease areas and alcoholism can cause secondary osteoporosis should be differentiated according to the history biochemical examination and X-ray examination and other careful mentor to diagnose Shenyang have difficulties sometimes need to carry out surgical biopsy magazine tissue examination or bone metrological examination prevention and treatment of osteoporosis.
The focus of scientific research in the prevention and treatment is to prevent the occurrence of fractures bone mass in young and old age is very important if the original bone reserves are high in old age even if part of the bone is lost the remaining bone mass is still sufficient to maintain the needs of bone metabolism in order to prevent osteoporosis or slow down its development in young and old age that is to pay attention to exercise and nutrition in old age more emphasis should be placed on calcium and sex hormones supplementation postmenopausal women need about ~ mg of calcium daily is much higher than the daily A high-calcium diet can inhibit age-related osteoporosis and reduce the incidence of fractures. Calcium absorption requires a normal level of vitamin D. For those who do not receive enough sunlight, it is advisable to take vitamin D to a depth of international units daily. Although estrogen cannot increase bone mass, it can reduce bone resorption and lower serum calcium and phosphorus levels, as well as reduce urinary calcium and urinary hydroxyproline excretion. estrogen can also increase parathyroid hormone levels and promote intestinal calcium absorption. estrogen dosage should be appropriate. ethylene estradiol daily dosage is ~mg per month. The use of estrogen does not increase the incidence of breast cancer, but it should be noted that endometrial proliferation and functional bleeding may also induce endometrial cancer or cervical cancer. Sodium fluoride can stimulate osteoblasts; promote new bone formation and increase the width of bone trabeculae, but the newly formed bone-like mineralization is poor. The main effect of calcitonin is to inhibit osteoclast activity and reduce the number of osteoclasts, thereby reducing bone resorption. The effect of diphosphonate parathyroid-fragmentation is uncertain except that adequate calcium protein and vitamin C supplementation is needed as well as appropriate exercise for the talent
(-) Etiology
The factors that cause bone loss in middle-aged and elderly people are very complex, and recent studies have concluded that they are closely related to the following factors (-) the decrease in the secretion of sex hormones in middle-aged and elderly people is one of the important causes of osteoporosis, and it is a recognized fact that the decrease in estrogen levels after menopause leads to increased bone resorption (-) the imbalance in the secretion of calcium-regulating hormones with age leads to disorders of bone metabolism (-) the elderly due to tooth loss and digestive function (2) The decrease in bone mineralization due to the loss of teeth and digestive function (3) The decrease in the intake of protein, calcium, phosphorus, vitamins and trace elements due to the lack of nutrition (4) The decrease in outdoor exercise with age is also an important cause of osteoporosis in the elderly (5) Recent studies in molecular biology have shown that osteoporosis is closely related to mutations in the vitamin D receptor (VDR) exchange gene
(ii) Symptoms
（The most common symptom of primary osteoporosis is low back pain, which spreads along the spine to both sides. The pain decreases when lying or sitting, and increases when posterior extension or prolonged standing and sitting. This is the most common and serious complication of degenerative osteoporosis () Reduced respiratory function Compression fractures of the thoracolumbar spine and backward curvature of the thoracic and lumbar spine can significantly reduce lung capacity and maximum air volume. symptoms such as chest tightness and shortness of breath
(iii) Examination
① Laboratory tests serum calcium phosphorus and alkaline phosphatase are generally in the normal range, but due to increased bone resorption serum calcium and urine calcium can also be slightly increased blood phosphorus can be increased if serum calcium and urine calcium are reduced and urine hydroxyproline increased hydroxyproline is the main component of bone collagen tutor urine hydroxyproline increased indicates impaired bone formation ② X-ray examination bone volume is reduced to more than % X-ray examination can show so early osteoporosis is difficult to be detected by X-ray Because of the influence of projection conditions and other errors, conventional radiographs can show a thinning of the tubular bone cortex, a widening of the medullary cavity, a decrease in the number of trabeculae and a widening of the gap, and a significant decrease in bone density. (D) and the transverse diameter of the medullary cavity in the same plane (d) can be calculated after various indices, of which the metacarpal cortical thickness (D-d) and metacarpal index (D-d/D) are of practical value in the absence of sophisticated equipment can be used to roughly estimate the degree of osteoporosis ③ bone density determination is the simplest method is to determine the relative density of vertebrae (RVD), that is, the comparison of the density of the vertebral body and the intervertebral disc normal If the RVD is zero, it means that the density of both instructors is the same and there is definitely osteoporosis; if the RVD is negative, it means that the density of the vertebral body is smaller than that of the intervertebral disc, which shows that there is serious osteoporosis. The mineral content of each mm thick aluminum piece is equivalent to mg of bone mineral/Cm photon absorption measurement is currently included in the application of the magazine more widely used method using single photon absorption instrument (SPA) such as A or I of attenuation in the lower part of the radius to determine the absorbed photon energy This method can directly determine the small changes in bone loss, but whether the measured density of the lower part of the radius can reflect the loss of bone in the middle axis of the bone is still in different journals Newer methods include two-photon absorptiometry (DPA), neutron activation analysis (NAA), quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DEXA).
(iv) Treatment
Primary type I osteoporosis is a hypermetabolic type due to the reduction of estrogen after menopause, which leads to hyperresorption of bone mass and bone loss. Fluoridation agents and vitamin K, etc. Estrogen: is the drug of choice for the prevention and treatment of postmenopausal osteoporosis estradiol ethylene estradiol compounded estrogen nil estrol Levi’s. Calcitonin: Calcitonin Icariin Micaicol ．VirD: Procalcitonin Alfa osteoporosis ． Calcium preparations: inorganic calcium chloride calcium carbonate calcium carbonate organic calcium gluconate calcium lactate calcium menadione calcium active calcium Calcium D ． Bisphosphonates: disodium chloromethane-bisphosphate hydroxyethyl diphosphate ． Isopropoxyflavone ． Chinese combined medicine