Osteoporosis
Osteoporosis is a group of bone diseases caused by multiple causes, in which there is normal calcification of bone tissue, with a normal ratio of calcium salts to matrix, and a metabolic bone lesion characterized by a decrease in the amount of bone tissue per unit volume. In most osteoporosis, the decrease in bone tissue is mainly due to increased bone resorption. It is characterized by skeletal pain and ease of fracture. Osteoporosis and fractures are very dangerous, especially for postmenopausal women!
Clinical manifestations of osteoporosis
1. Pain
The most common symptom of primary osteoporosis is low back pain, which accounts for 70% to 80% of the patients with pain. Pain spreads along the spine to both sides, decreases when supine or sitting, increases when posterior extension or prolonged standing or sitting, and increases when bending, coughing, and bowel movements. Bone pain generally occurs when 12% or more of bone mass is lost. In old age osteoporosis, the vertebrae are compressed and deformed, the spine is flexed forward, and the muscles are fatigued or even spasmed, producing pain. A recent compression fracture of the thoracolumbar spine can also produce acute pain, with strong pressure and percussion pain in the spinal spinous process at the corresponding site. If the corresponding spinal nerve is compressed, radiating pain in the extremities, sensory-motor disorders in both lower extremities, intercostal neuralgia, and retrosternal pain similar to angina pectoris can be produced. If the spinal cord and cauda equina nerve are compressed, the function of bladder and rectum will be affected.
2. Shortening of body length and hunchback
Most of them appear after the pain. The anterior vertebrae of the spine are heavily loaded, especially the 11th and 12th thoracic vertebrae and the 3rd lumbar vertebrae, which are heavily loaded and easily compressed and deformed, causing the spine to tilt forward and forming a hunchback, and with age, osteoporosis increases and the curvature of the hunchback increases.
3.Fracture
It is the most common and serious complication of degenerative osteoporosis.
4.Decreased respiratory function
Compression fractures of thoracic and lumbar vertebrae, backward curvature of the spine and thoracic deformity can significantly reduce lung capacity and maximum air exchange, and patients can often suffer from chest tightness, shortness of breath and dyspnea.
Spinal fractures
The spine is the most common site of osteoporotic fractures. Spinal compression fractures are one of the most common complications of osteoporosis and are the leading cause of disability and death in the elderly, and patients with osteoporotic vertebral compression fractures (VBCFs) have a higher mortality rate than the general population. Medical therapy with calcium, VitD, bisphosphonates, raloxifene, estrogen replacement therapy, and parathyroid hormone can be very effective in reducing fracture risk. However, pain persists in more than 1/3 of patients. Despite medication, 15% of patients continue to suffer fractures. There is also a significant number of medically ineffective and non-compliant patients.
Stress fractures
Stress fractures, also known as fatigue fractures or cumulative strain injuries, are a type of skeletal injury caused by overuse when muscles become fatigued from overuse and fail to absorb the shock from repeated collisions in time to transmit stress to the bones so that long-term, repeated, minor direct or indirect injuries can cause small bone fractures or fractures in specific areas. Stress fractures mostly occur in weight-bearing parts of the body, such as the tibia and fibula of the lower leg and the foot (heel bone, navicular bone, metatarsal bone). The susceptible group is athletes with heavy weight-bearing feet, such as basketball, soccer and tennis players, as well as track and field athletes, gymnasts and ballerinas.
Hip fracture
Hip fractures are a common complication of osteoporosis, usually caused by falls, mainly intertrochanteric fractures and fractures of the femoral neck, and their incidence increases with age. Hip fractures have the following characteristics.
1. High mortality rate: Since they are elderly patients, they are often accompanied by a variety of geriatric diseases and are prone to complications such as pneumonia, urinary tract infection, decubitus ulcers and venous thrombosis of the lower extremities when bedridden after injury, and thus have a high mortality rate.
2. High rate of osteonecrosis and non-union: due to the anatomical reasons, the intracapsular fracture of the femoral neck is subjected to high torsional and shear stresses, which affects the stability of fracture repositioning; and due to the special characteristics of the blood supply to the femoral head, the fracture non-union rate is high.
3. High rate of deformity and disability: inter-rotor fractures of the hip often leave deformities such as hip inversion, external rotation and shortening of the lower limb, thus affecting the function of the lower limb, with an incidence of up to 50%.
4. Slow rehabilitation: Elderly patients have high requirements for rehabilitation and care due to poor physical recovery.
In the past, conservative treatment was adopted for hip fractures, but the long course of treatment and long bed rest caused higher complications, disability rate and death rate; at present, surgery is advocated for patients who can tolerate surgery to shorten fracture healing and bed rest time, reduce complications and improve the quality of life of patients.
Decrease in bone density
Calcium absorption rate decreases with age, with an average decrease of 5-10% for each additional 10 years of age. As the ability of calcium absorption decreases in the elderly, it is manifested as lower blood calcium. In order to maintain the constant blood calcium, the secretion of parathyroid hormone increases, which makes osteoclasts active and the calcium in bones free into the blood, which decalcifies the bones and aggravates osteoporosis.
Treatment and prevention
Effective measures for treatment are specifically the following.
1, exercise: many types of exercise help maintain bone mass.
2, nutrition: good nutrition is important for the prevention of osteoporosis, including adequate amounts of calcium, vitamin D, vitamin C and protein.
3. Fall prevention: The chance of falling should be minimized in patients with osteoporosis to reduce hip fractures and Colles fractures.
4. Drug therapy: Effective drug therapy can stop and treat osteoporosis, including estrogen replacement therapy, calcitonin, selective estrogen receptor modulators, and diphosphonates.
5.Surgical treatment: Surgical treatment is required only after a fracture occurs due to osteoporosis.
Osteoporosis brings great inconvenience and pain to patients’ lives, and the treatment is very slow, and once the fracture is life-threatening, therefore, special emphasis should be placed on the implementation of the three levels of prevention.
1. Primary prevention
We should start with children and adolescents, such as paying attention to reasonable dietary nutrition, consuming more foods with high calcium and phosphorus content, such as fish, shrimp, milk, dairy products, bone broth, eggs, beans, grains, green leafy vegetables, etc. Adhere to a scientific lifestyle, such as adhere to physical exercise, more sunbathing, do not smoke, do not drink alcohol, less coffee, strong tea and carbonated beverages, less sugar and salt, animal protein should not be too much, late marriage, less childbirth, breastfeeding period should not be too long, as much as possible to preserve calcium in the body, enrich the calcium pool, increase the peak bone to the maximum is the best measure to prevent osteoporosis later in life. For the high-risk group with genetic genes, focus on follow-up and early prevention.
2.Secondary prevention
Bone loss accelerates in middle age, especially in women after menopause. Bone density check should be conducted once a year during this period, and prevention and control measures should be taken early for people with rapid bone loss. In recent years, most scholars in Europe and the United States advocate starting long-term estrogen replacement therapy within 3 years after menopause, while insisting on long-term preventive calcium supplementation, in order to safely and effectively prevent osteoporosis.
3.Tertiary prevention
Patients with degenerative osteoporosis should be actively treated with drugs that inhibit bone resorption (estrogen, CT, Ca) and promote bone formation (active VitD), and measures to prevent falls and upsets should be strengthened. Patients with middle-aged and elderly fractures should be actively operated, strong internal fixation should be implemented, early activity should be provided, and comprehensive treatment such as physical therapy, physiotherapy psychology, nutrition, calcium supplementation, curbing bone loss, and improving immune function and overall quality should be given.