What is primary prevention of osteoporosis? Primary prevention of osteoporosis means that people who do not yet have osteoporosis but have risk factors for osteoporosis should be prevented or delayed from developing osteoporosis and avoiding the first fracture. Chen Dayong, Department of Orthopedics, Shanghai First People’s Hospital Branch What is secondary prevention of osteoporosis? Secondary prevention of osteoporosis refers to pre-existing osteoporosis with a T value ≤ -2.5 or a fragility fracture that has occurred, and the ultimate goal of its prevention and treatment is to avoid the occurrence of a fracture or another fracture. A complete prevention and treatment strategy for osteoporosis includes basic measures, pharmacological interventions and rehabilitation. What are the main elements of basic measures? ”Basic measures” are important and indispensable in the prevention and treatment of osteoporosis, but they are not “all” and “only”. They include lifestyle modification and the application of basic bone health supplements. How to adjust the lifestyle? Lifestyle modification includes the following: 1. A balanced diet rich in calcium, low in salt and moderate in protein. It is recommended to ensure one egg and one bottle of milk per day. Through a proper diet, improve calcium intake and maintain a balanced nutrition. 2.Appropriate outdoor activities and sunshine contribute to exercise and rehabilitation therapy for bone health. Exercise and rehabilitation therapy should be tailored to the individual. Develop exercise and rehabilitation programs according to each person’s different conditions. 3.Avoid smoking and alcohol abuse, and be careful with drugs that affect bone metabolism. Corticosteroid drugs, anti-tumor drugs, etc. can affect bone metabolism. 4.Take various measures to prevent falls, and pay attention to whether there are diseases and drugs that increase the risk of falls. 5.Strengthen protective measures for yourself and the environment (including various joint protectors), etc. What are the basic supplements for bone health? The basic supplements for bone health are mainly calcium and vitamin D. Our nutrition society has set the recommended daily calcium intake of 800mg (elemental calcium) for adults to obtain the ideal bone peak. Calcium intake can slow bone loss and improve bone mineralization. When used for the treatment of osteoporosis, it should be used in combination with other drugs. There is insufficient evidence to suggest that calcium supplementation alone can replace other anti-osteoporosis drug therapy. The safety and efficacy of calcium should be considered when choosing a calcium supplement. Vitamin D promotes calcium absorption and is beneficial for bone health, maintaining muscle strength, improving physical stability, and reducing the risk of fracture. The recommended dose for adults is 200 units (5 μg). Older adults often have vitamin D deficiency due to lack of sunlight and impaired intake and absorption, so the recommended dose is 400-800 units (10-20 μg). Hospitals that are able to do so should test patients’ serum 25OHD concentrations. The International Osteoporosis Foundation recommends serum 25OHD levels equal to or higher than 30ng/ml (75nmol/L) in the elderly to reduce the risk of good fractures from falls. When is pharmacological intervention necessary? Pharmacological intervention should be performed whenever one of the following conditions is present: 1. Patients with confirmed osteoporosis (BMD T-value ≤ -2.5), regardless of whether there has been a fracture; 2. Patients with low bone mass (BMD: -2.5 > T-value ≤ -1.0) and more than one risk factor for osteoporosis, regardless of whether there has been a fracture. 3. In the absence of bone densitometry, if the patient has had a fragility fracture, or if the OSTA index screening is “high risk”, or if the FRAX@ tool calculates the probability of hip fracture ≥ 3% and the probability of any significant osteoporotic fracture ≥ 20%. What are the anti-osteoporosis medications? There are several anti-osteoporosis drugs with different main mechanisms, ranging from predominantly inhibiting bone resorption, to predominantly promoting bone formation, to having multiple mechanisms. The most commonly used drugs in clinical practice are bisphosphonates, calcitonin, active vitamin D and similar drugs. There are also estrogens, parathyroid hormones, selective estrogen receptor modulators, strontium salts, vitamin K2, phytoestrogens, and herbal medicines.