1. Surgical treatment of spinal fractures Osteoporotic spinal compression fractures (OVCF) are one of the most common and more serious complications of osteoporosis. However, in elderly patients, prolonged bed rest is not only likely to cause complications such as decubitus ulcers, pneumonia and urinary tract infections, but also further aggravates bone loss, leading to difficulty in healing of the vertebrae, formation or aggravation of humpback, and a significantly increased risk of secondary fracture. For patients in good health, surgery can be used to minimize these complications. (1) Percutaneous vertebroplasty (PVP) is one of the most commonly performed minimally invasive spine procedures, and can be performed from the cervical, upper thoracic, and total spine with a digital C-arm angiography unit or angiography flat panel C-arm X-ray and CT guidance. After reaching the anterior 1/3 of the vertebral body near the midline, the cement is injected under imaging surveillance, and the injection must be stopped immediately if intravenous, paravertebral, or intracanal leakage is detected. Intravenous antibiotics are administered several hours before surgery, intraoperative vital signs are closely monitored, and postoperative CT reconstruction is used to observe the repositioning of the vertebral body, cement filling and leakage. For pathological fractures of the vertebral body caused by malignant tumors of the vertebral body, in addition to selective bilateral puncture, unilateral puncture is also possible, and the effect is equivalent to bilateral puncture. (2) Percutaneous posterior kyphoplasty (PKP) is often performed in the prone position with general anesthesia because of the long operation time and the inability of elderly patients to tolerate prolonged prone position. The PKP procedure is more effective than the PVP procedure. Compared with PVP, PKP allows for less resistance to injection and less pressure on the cement in the vertebral body, allowing for filling with a more viscous cement and less pressure, reducing the risk of cement leakage and embolism formation. For severe vertebral fractures with large fracture masses entering the spinal canal and compressing the nerves, open surgery is required. (3) The surgical approach depends on the extent of the fracture, the displacement of the fracture fragment, and the patient’s general condition. For patients with minor fracture displacement, little loss of effective volume of the spinal canal, and no obvious symptoms of nerve compression, the fracture can be repositioned and fixed via the posterior pedicle system to restore the physiological curvature of the spine and the height of the fractured vertebral body; for the bone block entering the spinal canal, it can be repositioned by direct anterior compression, and if there is difficulty in repositioning, some of the bone block can be removed from the lateral front and repositioned by compression to enlarge the internal diameter of the spinal canal and rebuild The spinal stability can be reestablished. (4) If the fracture is severe and the vertebral body is compressed, the fractured vertebral body is likely to leave a cavity in the fractured vertebral body after repositioning, which may lead to fracture of the internal fixation or delayed kyphosis after removal of the internal fixation, and bone grafting in the injured vertebral space via the injured vertebral arch is recommended. In addition, if the internal fixation screw is easy to loosen and dislodge when the bone is heavily osteoporotic, a small amount of bone cement can be injected into the pedicle before the screw is placed. It should be emphasized that the anterior approach is mainly used for patients with more fracture blocks into the spinal canal, significantly reduced effective volume of the spinal canal, and more severe neurological symptoms, and the fracture blocks into the spinal canal should be surgically removed and internally fixed, or even the whole vertebral body should be resected and artificially replaced. 2. Surgical treatment of hip fracture 2.1. Intertrochanteric fracture The patient loses the ability to move immediately after the intertrochanteric fracture, and is prone to bed sores, pneumonia, urinary tract infection, pulmonary embolism and deep vein thrombosis of the lower extremity due to prolonged bed rest. Therefore, surgery should be performed as soon as the patient’s general condition permits in order to reduce the occurrence of complications. The main surgical methods are closed reduction internal fixation, incisional reduction internal fixation and artificial joint replacement. (1) Closed reduction internal fixation is suitable for fractures with no or mild displacement in the cis-rotor interval type and good reduction by traction, and is performed by percutaneous multiple hollow compression screws under C-arm X-ray. (2) The most representative nail plate system for incisional internal fixation is the power hip screw (DHS) system, and the intramedullary fixation devices include Gamma nail and proximal femoral intramedullary nail (PFN). (3) For elderly patients with significant osteoporosis, artificial hip replacement can be used for comminuted intertrochanteric fractures; for patients with basically intact acetabulum and little wear on the acetabular joint surface, artificial femoral head replacement is recommended. For patients with poor acetabular condition, total hip replacement is recommended. For patients with poor acetabular condition, total hip replacement is recommended. Most of the femoral prostheses are cemented prostheses; if the bone defect is severe or the ridge is severely crushed, the femur can be reconstructed with allogeneic bone plates and its own crushed fracture fragments, wire-bound and cemented, and then implanted into the femoral prosthesis; or tumor-based special femoral prostheses are used. The advantage of using a cemented prosthesis is that it can be used for weight-bearing after the surgical trauma disappears, which can significantly reduce the bed-rest complications and morbidity and mortality rate. 2.2. Femoral neck fractures are usually treated by surgery as early as possible. For Garden I and II fractures with less obvious displacement and a roughly intact femoral neck, percutaneous internal fixation with multiple hollow compression screws under C-arm X-ray fluoroscopy is often used; for Garden III and IV fractures with obvious displacement, the blood circulation of the femoral head and neck is damaged, and the fracture healing rate is low after resetting, treatment with total hip replacement (THR) is recommended. 3. Surgical treatment of distal radius fracture For osteoporotic distal radius fracture that does not involve the articular surface of the distal radius or does not involve much, and has good stability after manual repositioning and external fixation, the main treatment is to give external fixation with a plaster or splint. However, most of these fractures have damage to the articular surface of the distal radius, and external fixation after manual reduction is prone to fracture re-displacement and unevenness of the articular surface, so surgery is mostly recommended for unstable fractures. The surgical methods include internal fixation with an incisional plate, internal fixation with a limited incisional reduction followed by percutaneous prying, and single-arm external fixation brace after closed reduction. If the articular surface of the distal radius is obviously collapsed, it can be fixed with an external fixation brace by manipulation, repositioned by percutaneous prying with a Kirschner needle, injected with bone formation inducer to fill the bone defect and induce bone formation, or implanted with autologous bone, lyophilized allograft bone and bone cement to support the articular surface to prevent articular surface collapse and the occurrence of traumatic arthritis. 4.Surgical treatment of proximal humerus fracture Proximal humerus fracture often involves the joint surface of shoulder joint, and due to the involvement of joint surface and pain, the movement of shoulder joint is reduced, resulting in shoulder muscle atrophy and shoulder joint adhesion, which affects the function of shoulder joint. Treatment should be decided according to the extent of the fracture and the displacement of the fracture. For simple fractures such as Neer I and II fractures, external fixation of the upper extremity in a draped cast without fixation of the shoulder joint is recommended, and the patient can move the shoulder joint appropriately under gravity traction early to prevent shoulder joint adhesions. For Neer III fractures, surgical treatment is generally preferred, but in order to preserve and restore the function of the shoulder joint, closed reduction should be performed if possible, and simple surgery should be performed if not. Simple surgery is either external fixation with a percutaneous kyphosis pin or limited internal fixation with a kyphosis pin. If there is difficulty in the reduction, then internal fixation with incision is performed. In Neer IV fractures, because of the severity of the fracture and the basic destruction of the articular surface, closed reduction and open reduction are more difficult, and the blood circulation of the humeral head is severely damaged. For complex proximal humeral fractures involving the shoulder joint, surgical treatment can enable early functional exercise of the shoulder joint, facilitating the recovery of joint function and reducing the occurrence of complications such as shoulder joint adhesions and stiffness. Prevention of osteoporotic fractures The prevention of osteoporotic fractures is also based on the prevention of osteoporosis. Because the formation of osteoporosis is a progressive and irreversible pathological process, it is impossible to completely restore the normal structure of bone once it is found, even after treatment, so the prevention of osteoporosis is more important than the treatment. Only by actively preventing the occurrence of osteoporosis can the incidence of osteoporotic fractures be effectively reduced. Reasonable intake of calcium and phosphorus to obtain a satisfactory peak bone mass and to prevent and reduce bone loss are the fundamentals of osteoporosis prevention. At present, China has adopted three levels of preventive measures: Ñ level for universal health education, including dietary prevention (appropriate protein intake, calcium-rich and low-salt diet, vitamin D) and exercise prevention; Ò level for comprehensive prevention and treatment of high-risk groups, mainly to strengthen community health management of high-risk groups, regular physical examination, early detection, early treatment; Ó level for The treatment of osteoporosis should be promptly treated to improve symptoms, prevent fractures and reduce the incidence of fractures. After the occurrence of osteoporosis, measures to prevent fracture include quitting smoking and limiting alcohol, moderate weight control, insisting on daily muscle strength exercise and whole body balance and coordination exercise, appropriate outdoor activities to increase sunlight, taking various measures to prevent falls and preventive and correct medication. In terms of anti-osteoporosis medication, experts suggest that firstly, in the early stage of osteoporotic fracture, due to enhanced bone resorption, bed rest and braking lead to further bone loss, so it is advisable to use drugs that inhibit bone resorption (calcitonin is the first choice of treatment); secondly, the rational use of calcium, as calcium absorption is mainly in the intestinal tract, so calcium supplements are mainly taken orally; thirdly, supplementation with active vitamin D3, not only can promote bone formation and bone mineralization, but also increase bone mineralization. Third, supplementation with active vitamin D3 not only promotes bone formation and mineralization, increases bone mass, and reduces the risk of re-fracture, but also helps to enhance muscle strength, improve neuromuscular coordination, and prevent falls; Fourth, supplementation with bisphosphonates can effectively increase bone density in the lumbar spine and hip, reducing the risk of fracture and post-fracture mortality, but some studies have shown that bisphosphonates affect the quality of bone scab reconstruction, so the early use of bisphosphonates in osteoporotic fractures is controversial. Fifth, the use of raloxifene, a selective estrogen receptor modulator, has been shown to be effective in increasing bone mineral density and reducing the incidence of osteoporotic fractures, but some studies have shown that this drug may increase the risk of venous thrombosis in the lower extremities of bedridden patients, so it should be used with caution in bedridden patients after fracture and is contraindicated in patients with a history of venous embolism and thrombotic tendency.