With the aging of the population and changes in lifestyle, the number of people suffering from osteoporosis is increasing. Although people are familiar with the term “osteoporosis”, their understanding of it is often “half-understood” and “mixed”, and many osteoporosis patients have taken many detours in prevention and treatment due to misconceptions. Many patients with osteoporosis have taken many detours in prevention and treatment due to misconceptions and misguidance. The following is a review of some of the most common clinical misconceptions about osteoporosis, in the hope that they will be helpful to patients.
Myth 1: “osteoporosis” and “osteopenia” are the same thing?
Wrong. Although “osteoporosis” and “osteopenia” are only one word different, but the meaning is not the same. According to the definition of the World Health Organization (WHO), osteoporosis is a metabolic bone disease in which the bone density must be reduced by 2.5 standard deviations (SD) compared to the maximum bone mass of a normal adult to be called “osteoporosis”; a reduction of more than one standard deviation (SD) but not 2.5 SD is called “osteoporosis”. When the standard deviation (SD) is reduced by more than one standard deviation (SD) but not 2.5 standard deviations (SD), it can only be called “bone loss”. Many elderly people do have osteoporosis, but strictly speaking, they are in the category of “bone loss” and cannot be diagnosed as “osteoporosis” yet. Therefore, there is nothing wrong to pay attention to “osteoporosis”, but it is not necessary to see “osteoporosis”, but need formal bone density examination to finally confirm the diagnosis.
Myth 2: Judgment of osteoporosis based on conscious symptoms or blood calcium level
Wrong. Many elderly people think that as long as they do not have back and leg pain and their blood calcium is not low, they will not suffer from osteoporosis. First, in the early stage of osteoporosis, patients can have no symptoms or mild symptoms, so it is difficult to detect, and once they feel their back pain or fracture and then go to the clinic is often too late; second, low blood calcium and osteoporosis can not be equated, in fact, the majority of osteoporosis patients do not have low blood calcium, this is because when the loss of urinary calcium leads to a decline in blood calcium, it will stimulate parathyroid hormone (PTH ) secretion to mobilize bone calcium into the blood to maintain normal blood calcium. Therefore, the diagnosis of osteoporosis should not be based on the presence or absence of conscious symptoms and the decrease of blood calcium. For people at risk, regardless of the presence or absence of symptoms, they should go to the hospital regularly for bone density examination to make a clear diagnosis, instead of waiting until they find out they have back pain or fractures.
Myth 3: Osteoporosis is caused by calcium deficiency and can be cured by calcium supplementation alone
Wrong. Calcium is the main component of bones, but osteoporosis is not simply due to calcium deficiency, but mostly due to an imbalance of calcium-regulating hormones (such as a decrease in estrogen secretion, vitamin D synthesis and activation, etc.), and osteoclast activity exceeds osteoblast activity, resulting in the rate of bone loss exceeding the rate of bone formation. Therefore, it is not enough to rely on calcium supplementation alone to treat osteoporosis, but also to correct the imbalance of bone metabolism (i.e., to promote bone production on the one hand, and to stop bone loss on the other), in other words, calcium supplementation must be combined with anti-osteoporosis drugs (including drugs that inhibit bone resorption and promote bone formation) to effectively treat osteoporosis. To use an analogy, calcium supplementation is like providing cement for wall repair, but providing cement is not the same as repairing a wall, but also the operation of a plasterer, and anti-osteoporosis drugs play the role of a plasterer, which can regulate the “work” of the two aforementioned cells and finally “build” calcium into the wall. The “plasterer” can regulate the “work” of both of these cells to eventually “build” calcium into the walls. Large-scale clinical studies abroad have shown that even if calcium and vitamin D are taken regularly, they are still ineffective in preventing fractures if they are not regulated to inhibit osteolysis or promote osteogenesis.
Myth #4: As long as calcium intake is adequate, the body will not be deficient in calcium
Wrong. This is because calcium in food must be absorbed by the intestine with the help of vitamin D. After absorption, calcium needs to be deposited in the bones under the regulation of sex hormones, calcitonin and parathyroid hormone (PTH), etc. Any problem with one of the above links will lead to calcium deficiency.
Myth 5: Because osteoporosis is prone to fractures, it is better for patients to stay still than to move
Wrong. Some elderly patients with osteoporosis are afraid to go outdoors for exercise because they are worried that they may fracture accidentally. We say that maintaining normal bone density and bone strength requires constant exercise stimulation, lack of exercise will cause bone loss, physical exercise has a positive effect on the prevention of osteoporosis, especially in outdoor sunlight activities, can also increase the synthesis and absorption of vitamin D, and help the absorption and utilization of calcium in the body. If the elderly do not pay attention to exercise because they are worried about falling and causing fractures, muscle strength will be reduced, coordination will be reduced, and osteoporosis will only become more serious, but more likely to fall and cause fractures. The American College of Sports Medicine recommends that people with osteoporosis get proper exercise (such as weight training, fitness running, walking, etc.), which should be done twice a week for one hour each time. This increases muscle strength through exercise to protect bone health, thereby reducing the chance of fracture. Even patients with fractures who have been bedridden should often ask their family members to push themselves outdoors to get some sunlight so that the limbs can be moved and exercised passively.
Myth 6: Osteoporosis is a disease of the elderly and has nothing to do with young people
Wrong. Many young people regard osteoporosis as a disease of the elderly and seem to have nothing to do with them. However, the latest research found that women in their twenties and thirties (especially those with a thin body type) may also suffer from this disease, which is closely related to the poor lifestyle habits of young people.
Nowadays, many young people stay at home, go out to the car, lack of outdoor exercise, sunshine time is not enough; eat partial food, addicted to alcohol and tobacco, like to drink strong tea and coffee; some young fashionable women, in order to pursue a slim body and desperately dieting to lose weight. All the above-mentioned bad lifestyle, resulting in insufficient calcium intake, vitamin D synthesis is reduced, may suffer from osteoporosis at a young age.
Myth 7: Prevention of osteoporosis does not need to start at a young age
Wrong. Bone, like other tissues, is constantly undergoing metabolism, resulting in the destruction of old bone and the formation of new bone, or what is known medically as “bone resorption” and “bone formation”. From birth to youth, the formation of bone is greater than bone resorption, making the amount of bone in the body gradually increased, about 30 – 35 years of age, the human bone volume reaches its highest peak (i.e. peak bone), after a period of time, the formation of bone gradually less than bone resorption, that is, the amount of bone will slowly decrease, especially women in the postmenopausal 5 to 10 years The bone loss will be greatly increased due to hormonal changes. The higher the peak bone mass is, the more the “bone mineral bank” reserves in the human body, the more the time of osteoporosis will be delayed and the less it will occur in old age. Therefore, the prevention of osteoporosis must start from childhood. Calcium and exercise only after middle age, the preventive effect will often be greatly reduced.
Misconception seven, osteoporosis is a minor disease, no big deal
Wrong. Osteoporosis is not just a backache, it has the characteristics of “four highs and one low”, namely high morbidity, high disability, high mortality, high medical costs and low quality of life. Fracture is the most serious complication of osteoporosis, especially the fragility fracture of the hip in the elderly, resulting in long-term bed rest, a serious decline in quality of life, mortality is even higher than some cancers.
Myth 8: Bone fragility in old age is a natural law, there is no need to intervene
Wrong. Many people believe that osteoporosis is the inevitable result of aging, which can neither be avoided nor reversed, and therefore there is no need for treatment. Osteoporosis is caused by a decline in the level of hormones (mainly sex hormones) in the body after aging, which accelerates bone resorption and delays bone formation, resulting in continuous loss of bone mass. Proper treatment, including estrogen, active vitamin D supplementation and medication such as bisphosphonates, can delay bone loss and prevent fractures. It can be said that regular treatment can be effective whenever it is received, not only to improve the symptoms of back pain, but also to indirectly reduce the risk of fracture and maximize the quality of life. Of course, from the perspective of treatment, the earlier the treatment, the better the effect, and treatment is definitely better than no treatment.
Myth 9: Blood calcium is not low, which means there is no osteoporosis and therefore no need for calcium supplementation
Wrong. Calcium concentration in the blood is regulated by a variety of hormones (such as parathyroid hormone, calcitonin, active vitamin D, etc.) to maintain it within a narrow normal range. When calcium intake or loss is insufficient and blood calcium decreases, the body will increase osteoclast activity through hormonal regulation and mobilize calcium from the bones into the blood to maintain normal blood calcium; conversely, when dietary calcium intake is excessive, calcium-regulating hormones will stimulate osteoclast activity to deposit excess blood calcium in the bone. If this balance is disturbed, osteoporosis will occur.
It is clear that normal blood calcium does not mean that there is no calcium deficiency in the bones, and that blood calcium levels do not reflect the presence or absence and severity of osteoporosis. In fact, even if a serious fracture occurs in primary osteoporosis, the blood calcium level is still normal, so the need for calcium supplementation cannot be determined simply by the blood calcium level.
Myth 10: Calcium is a nutrient for the bones, so it is not harmful to take more supplements
Wrong. Calcium deficiency can lead to osteoporosis, but calcium supplementation is never good. Excessive calcium intake does not turn into bones, but also increases the burden on the digestive tract, stomach pain, constipation and other discomforts, and more seriously, can cause hypercalcemia, increasing the risk of kidney stones and cardiovascular disease. Therefore, before taking calcium supplements for prevention, you must go to the hospital for blood calcium, urine calcium and other related examinations, and take reasonable medication under the guidance of a physician, as well as increase outdoor exercise, avoid smoking and alcohol abuse, and use drugs that affect bone metabolism with caution.
According to the National Osteoporosis Foundation (NOF), the daily calcium requirement of human body is related to age and gender: men under 70 years old and women under 50 years old need to supplement 1000 mg of calcium per day, and men over 71 years old and women over 51 years old need to increase the daily calcium requirement to 1200 mg. The recommended daily calcium intake for adults set by the Chinese Nutrition Society is 800 mg, and the recommended daily calcium intake for postmenopausal women and the elderly is 1000 mg.
Myth 11: If you have osteophytes, you cannot take calcium supplements
Wrong. Many elderly patients with osteoporosis also have osteophytes (commonly known as bone spurs), and some elderly people worry that calcium supplements in this case will aggravate the osteophytes. We say that “calcium supplementation” and “bone spurs” are two completely different concepts. Calcium supplementation increases blood calcium, which is metabolically deposited into the bones, making them denser rather than overgrown. On the contrary, one of the causes of osteophytes is the ectopic deposition of calcium in the compensatory process of the body after osteoporosis (calcium is often deposited on the surface of the cervical vertebrae, lumbar vertebrae, and knee joints to form “bone spurs”), and calcium supplementation can precisely correct the calcium deficiency of the body, thus partially correcting this abnormal process and reducing the formation of “bone spurs”. “Therefore, for patients with osteophytes, calcium supplementation in appropriate amounts will not cause and aggravate osteophytes, but can also play a role in improving bone metabolism, treatment and prevention of osteophytes.