Basic measures
(1) Lifestyle modification: Choose a balanced diet rich in calcium, low in salt and moderate in protein. Get more sunlight and do more outdoor exercises, at least 20-30 minutes of sunlight per day. Avoid smoking, alcohol abuse and drugs that affect bone metabolism (e.g. glucocorticoids). Take various measures to prevent falls: wear non-slip shoes, use walking sticks, etc.
(2) Basic supplements for bone health.
The recommended daily calcium intake for adults is 800 mg (elemental calcium), which is a suitable dose to obtain the ideal bone peak and maintain bone health. Calcium intake can slow down the loss of bone and improve bone mineralization. When used for the treatment of osteoporosis, it should be used in combination with other drugs. Calcium should be selected with regard to its safety and effectiveness. Principles of calcium selection.
① High calcium content.
②High solubility (water solubility);
③High intestinal absorption rate;
④Good bioavailability;
⑤ Low content of heavy metals. (See “calcium those things – do not know how to take care of health” chapter)
②Vitamin D: It facilitates the absorption of calcium in the gastrointestinal tract. Vitamin D deficiency can lead to secondary hyperparathyroidism, which increases bone resorption, thus causing or aggravating osteoporosis. The recommended dose for adults is 200 units (5ug)/d. Older adults often have vitamin D deficiency due to lack of sunlight and impaired intake and absorption, so the recommended dose is 400-800 IU (10-20ug)/d. Some studies have shown that vitamin D supplementation increases muscle strength and balance in older adults, thus reducing the risk of falls and thus the risk of fractures.
Special drug therapy.
Indications: Patients with osteoporosis (BMD T-value <-2.5), with or without previous fracture ;
People with low bone mass (-2.5
Principles of use
a first choice of an anti-bone resorption drug, bisphosphonates are preferred because they have the best effect in reducing vertebral fractures; b calcitonin may be preferred after surgery for fragility fractures or in patients with significant pain; c selective estrogen receptor modulators are available for postmenopausal women.
d After 2-3 years of treatment, assess the efficacy using bone mineral density, bone biochemical indexes or imaging. If the effect is positive but the risk of fracture is still high, continue the corresponding 1-2 courses of treatment and then assess again until the bone mineral density reaches the normal range; e If the treatment is not effective or is not tolerated by the patient, switch to another anti-bone resorption drug and add a bone synthesis promoter, such as PTH and strontium salt, for 2 – 3 years later to assess the efficacy.
(1) Anti-bone resorption drugs.
(1) Bisphosphonates: effectively inhibit osteoclast activity and reduce bone conversion. Clinical data show that alendronate (i.e., Fosamax or Gubernate) can significantly increase the bone density of the lumbar spine and hip, and significantly reduce the risk of fracture of the vertebrae and hip and other parts. The latter is more convenient to take, less irritating to the digestive tract, effective and safe, and thus has better compliance.
Calcitonin: It can inhibit the biological activity of osteoclasts and reduce the number of osteoclasts. It can prevent bone loss and increase bone mass. There are two types of calcitonin preparations currently used in clinical practice: salmon calcitonin and eel calcitonin analogs. 200 IU of synthetic salmon calcitonin nasal spray (MIGA) daily can reduce the incidence of vertebral fractures in patients with osteoporosis.
Another outstanding feature is its ability to significantly relieve bone pain, which is effective in chronic pain caused by osteoporotic fractures or skeletal deformities as well as bone pain caused by diseases such as bone tumors, thus making it more suitable for osteoporotic patients with painful symptoms. The specific dosage and usage will depend on individual conditions and the course of the disease.
(iii) Selective estrogen receptor modulators (SERMs): such as raloxifene, can effectively inhibit osteoclast activity and reduce bone turnover to premenopausal levels in women. It can stop bone loss, increase bone density, and significantly reduce the incidence of vertebral fractures, making it an effective drug for the prevention and treatment of postmenopausal osteoporosis.
The drug is only used for female patients and is characterized by selective action on the target organs of estrogen, with no adverse effects on the breast and endometrium. It reduces the incidence of estrogen receptor-positive invasive breast cancer and does not increase the risk of endometrial hyperplasia or endometrial cancer. It has a regulatory effect on blood lipids. However, it is temporarily contraindicated in perimenopausal women with severe hot flashes, and is contraindicated in those with a history of venous embolism and a tendency to thrombosis, such as during long-term bed rest and sedentary periods.
Estrogens: These drugs can only be used in female patients. Estrogenic drugs can inhibit bone turnover and prevent bone loss. Estrogen or estrogen-progestin supplementation therapy (ERT or HRT) can reduce the risk of osteoporotic fractures and is an effective measure to prevent and treat postmenopausal osteoporosis. Based on a comprehensive assessment of the pros and cons of hormone supplementation therapy, the following principles are recommended for hormone supplementation therapy: Indications: Women with menopausal symptoms (hot flashes, sweating, etc.) and/or osteoporosis and/or risk factors for osteoporosis, especially advocating greater benefit and less risk when started early in menopause.
The protocol, dose, preparation selection and treatment duration of hormone therapy should be individualized according to the patient’s condition and the lowest effective dose should be applied. Adhere to regular follow-up and safety monitoring (especially breast and uterus). Whether to continue the drug should be evaluated annually according to the characteristics of each woman for pros and cons.
(2) Drugs to promote bone formation.
(1) Parathyroid hormone (PTH): small doses of rhPTH (1-34) have a role in promoting bone formation and are effective in treating severe postmenopausal osteoporosis, increasing bone density and reducing the risk of vertebral and nonvertebral fractures, and are therefore indicated for patients with severe osteoporosis. It must be applied under the guidance of a medical professional. The duration of treatment should not exceed 2 years. The general dose is 20ug/d, injected intramuscularly. Blood calcium levels should be monitored during administration to prevent the occurrence of hypercalcemia.
②Strontium salt Promotes VD synthesis and bone mineralization, stimulates bone formation, and increases bone formation units and bone density.