At present, the thinning and thinning of bone trabeculae in osteoporosis can be improved, thickened and thickened, thus increasing the bone volume and enhancing the biomechanical strength against fracture, but it is not yet possible to reconnect the broken bone trabeculae, and once the bone trabeculae are obviously slender and broken, it is difficult to make them connect and recover. Therefore, the disease should be prevented early, and prevention is more important and practical than treatment.
The most important purpose of osteoporosis prevention and treatment is to prevent the occurrence of fracture, how to prevent the occurrence of fragility fracture, mainly grasp two links, one is to strive to obtain a satisfactory peak bone (human body around 30 years old bone formation and decomposition has basically reached a balance, bone volume reached the highest level in life, called peak bone), the second is to prevent and reduce the loss of bone. Peak bone mass is determined by genetic factors (70-80%) and environmental factors (20-30%), among which it has been proven that adequate calcium intake and regular weight-bearing exercise are conducive to the establishment of the ideal peak bone mass. Prevention of bone loss should focus on early identification and active management of risk factors for osteoporosis.
The prevention and treatment of osteoporosis should be based on a combination of general measures and anti-osteoporosis drugs.
General measures
(A) Nutrition
1, calcium: calcium is an important part of the bone, 99% of the body’s calcium exists in the bone and teeth. The amount of calcium in bone is about 25 grams at birth and about 1500-2000 grams in adulthood. Adult bone is composed of about 2/3 of calcium salts and 1/3 of bone matrix. peak bone mass is mostly reported in the age group of 20-40 years, of which 90-95% is formed before the age of 20, especially in the 12-14 years of age between the fastest growth rate of bone mass. Several studies have confirmed that adequate calcium intake from an early age results in satisfactory peak bone mass. Adequate calcium intake can maintain bone mass in adulthood, reduce bone loss in postmenopause and old age, and reduce the risk of fracture. The recommended amount of calcium is 800 mg per day, and more calcium-rich foods should be consumed, such as milk and dairy products, which contain more calcium and are easily absorbed. If the amount of calcium in food is still insufficient, calcium supplements can be added.
2.Protein
Protein and amino acids are important raw materials for the synthesis of bone organic matter, but a high protein diet reduces the rate of calcium reabsorption by the renal tubules and increases urinary calcium excretion. A doubling of protein intake can increase urinary calcium excretion by 50%. Excess protein intake will increase the negative calcium balance (when the body absorbs less calcium than it excretes, it is called a negative calcium balance. When people enter old age, due to the declining function of body tissues and organs and the acceleration of bone calcium loss, the absorbed calcium cannot compensate for the excreted calcium, and the body is easily in a negative calcium balance. At this time, to ensure normal physiological function, the body has to use calcium from the bone bank to maintain the calcium balance in the body. Although the daily use of bone calcium is insignificant, but the slow and continuous use of bone calcium will eventually make the bone calcium deficit, osteoporosis, fractures and other pathological changes.) The lack of long-term protein intake causes insufficient bone matrix synthesis, and the formation of new bone lags behind, making it easy for osteoporosis to occur. Therefore, you should enter the appropriate amount of protein diet.
3, the amount of sodium intake should be controlled
If there is more sodium chloride salt, more urinary sodium will be excreted, and since the excretion mechanism of urinary calcium and urinary sodium is the same, the excretion of urinary calcium will also increase; for every 100mmol (2.3g) of sodium excreted by the kidneys, there is also 24-60mg of calcium lost, so we advocate a light and low salt diet.
4.Vitamin D
Human blood vitamin D3 and D2 accounted for about 90% and 10%, respectively, the former is mainly synthesized by the skin, the latter obtained by diet. Vitamin D promotes the absorption of calcium in the small intestine and kidney tubules, and has a dual effect on bone, that is, it can promote bone formation and stimulate bone resorption. Postmenopausal women and the elderly have reduced intestinal calcium absorption, the latter skin production of vitamin D is also reduced, only 30% of young people, so there must be enough light, 20-30 minutes of sunshine every day to ensure that the body synthesizes vitamin D, promote intestinal calcium absorption, enhance muscle strength and prevent falls.
5.Vitamin C
It is one of the important substances involved in the metabolism of protein, collagen and amino polysaccharide in bone tissue, and has a catalytic effect on the enzyme system, which facilitates the absorption of calcium and its deposition into the bones. Lack of vitamin C will affect bone tissue, capillaries and other metabolism, bone matrix, collagen synthesis is reduced, affecting the normal development of bones, leading to osteoporosis, bone fragility, fractures. Eat more fresh vegetables, fruits (including edible wild vegetables, wild fruits), reasonable processing and cooking, can prevent and control the lack of vitamin C.
6.Vitamin K
Vitamin K is a coenzyme of glutamate γ carboxylase, which can participate in the γ-position carboxylation of glutamate in osteocalcin, thus promoting bone mineral salt deposition and bone formation.Feskanic et al. (1999) conducted a dietary questionnaire survey on 72,327 nurses (age 38-63 years) in the United States to analyze the relationship between dietary vitamin K intake and hip fracture, and the results showed that a total of 10 years of follow-up hip The results showed that 270 hip fractures occurred during 10 years of follow-up, and the relative risk of hip fracture decreased by 30% after age adjustment for nurses with vitamin K intake above 109 μg/d, which was significant. Recently, the American Medical Association has increased the reference value of dietary vitamin K intake by 50%, i.e., 90 μg/d for women and 120 μg/d for men after the age of 19.
In summary, advocating a diet rich in calcium and vitamins, low in salt and moderate in protein can help prevent and treat osteoporosis.
(ii) Exercise
Moderate amount of regular exercise, especially weight-bearing exercise, can increase peak bone mass and reduce and delay bone loss. In 2002, Petit et al. reported the effect of jumping exercise (3 times a week for 10 minutes each time for 7 months) on bone structure of girls aged 9-12 years in school and found that the bone density between the femoral neck and greater trochanter increased significantly in the test group compared with the control group, and the cross-sectional modulus, cross-sectional area and cortical bone thickness in the femoral neck area increased. Bone thickness increased, indicating that exercise not only increases bone density but also improves bone structure and bone strength in girls in early adolescence. Exercise increases testosterone and estrogen levels, leading to increased calcium utilization and absorption, and also appropriately increases blood flow to the bone cortex. Muscle is a mechanical force on bone tissue, and well-developed muscles result in thick bones and high bone density. Exercise can make the muscle developed and enhance muscle strength.
The above nutrition and exercise should be throughout a person’s life, child – youth – adult – old age.
(C) to correct bad habits
1, addicted to smoking
Adolescent and adult smokers are often prone to low bone mass, women with smoking habits, menopausal bone mineral density (BMD) is 5-10% lower than that of nonsmokers, and the rate of hip fracture increases in old age. Women who smoke are thinner and more likely to experience early menopause. Smoking (at least 20 cigarettes a day) of men and women intestinal calcium absorption is often significantly reduced.
2, alcohol abuse
Excessive alcohol can damage the liver, reduce the production of 25 hydroxyvitamin D and 1,25 dihydroxyvitamin D, affecting the intestinal absorption of fat, vitamin D and calcium. Excess alcohol also acts directly on osteoblasts and inhibits bone formation. Reduced testosterone levels and excessive cortisol secretion have been reported in alcoholics. All of the above can lead to osteoporosis.
3, excessive caffeine
Coffee, tea, Coca-Cola contains caffeine, excessive caffeine intake increases urinary calcium excretion, but also can mildly reduce intestinal calcium absorption. If you drink coffee for a long time, more than 2 cups per day, you should pay attention to calcium supplements at the same time to ensure adequate calcium intake.
(iv) Avoid the application of osteoporosis-inducing drugs of the inhibitory effect of the proliferation of osteoblasts, the synthesis of collagen are reduced. Advocate the application of hormone 3 months should be checked bone density, monitor the occurrence of osteoporosis.
1, glucocorticoids: for the most likely to cause osteoporosis drugs, recent studies have concluded that not only the therapeutic amount will cause osteoporosis, prednisone daily 7.5mg physiological amount will also cause osteoporosis, the most bone loss within a year of using the drug, especially within 6 months, serious cases accompanied by fractures, mostly seen in cancellous bone rich vertebrae and ribs. Induced osteoporosis is mainly glucocorticoids have a direct inhibitory effect on osteoblasts, but also stimulate osteoclasts, so that bone resorption increases, but also to reduce intestinal calcium absorption, renal tubules to reduce calcium reabsorption and PTH (parathyroid hormone) increase, recent studies have confirmed that on prostaglandin E, insulin-like growth factor and transforming growth factor
2, anti-epileptic drugs: liver microsomal enzyme (cytochrome P450 enzyme) system mediates drug oxidation reactions and steroid hormone conversion in the liver, phenytoin sodium, phenobarbital and carbamazepine and other anti-epileptic drugs induce its activity, so that the inactivation and excretion of vitamin D and its active metabolites accelerated, 8-70% of people reported a decrease in blood 25 (OH) D3 levels, but also intestinal absorption of calcium to reduce . Long-term drug use can induce osteoporosis or osteochondrosis. Antiepileptic drugs should be used at the lowest possible dose and monitored for the possibility of osteoporosis.
3, long-term thyroxine replacement therapy: can promote bone resorption, increased bone loss and reduced bone density.
4, heparin: long-term and heavy use can induce osteoporosis. Those who receive heparin 15,000-30,000 units per day for more than 6 months have reported the occurrence of spontaneous vertebral or rib fractures, the mechanism of which has not been fully elucidated and is related to reduced bone formation and increased bone resorption. There are few cases of osteoporosis caused by low molecular heparin.
(E) Prevention of falls
Falling is often a direct cause of fracture. Elderly people have weak muscles, reduced reaction and balance, and are prone to falls. They should take precautions, such as wearing comfortable non-slip shoes, paying attention to ground obstacles when walking, avoiding going out on rainy and snowy days, avoiding walking at night in places with poor lighting conditions, leveling the floor at home, preventing uneven and curly carpets, keeping the passage from the bedroom to the bathroom clear, installing energy-saving lamps in the bathroom, and having lighting at night. Those who take drugs that may cause postural hypotension should move slowly when changing position; those who take sleeping pills should not overdose and walk when fully awake; those with visual impairment or Parkinson’s disease should be taken care of when moving.