From time to time, patients and friends come to the clinic to ask this question: why the bone density measurement says osteoporosis, but the radiographs say osteoporosis, which is not contradictory? What is the connection between the two? The following will give you a brief explanation. Osteomalacia: It is a disease in which the pathological proliferation of bone causes impaired movement of local joints, muscles and ligaments, accompanied by pain as the main symptom. The familiar “bone spurs” are actually a special type of osteophytes. Osteomalacia, including degenerative osteoarthritis (see osteoarthritis chapter), hypertrophic osteoarthropathy, and achondroplasia (see achondroplasia chapter). Tian Hongtao, Department of Orthopaedics, Wuhan Union Medical College Hospital Causes: the cause of osteoarthritis has not yet been clarified, it can be affirmed that with age, the bone and joint will gradually degenerate, when the bone and soft tissue contact due to long-term pressure, tension, injury, resulting in the gradual loss of water and elasticity of the cartilage between the joints, the bone and the bone wear and tear, the human body in order to reduce the pressure between the bone, the joints, the bone and joint edges of the natural will be Increase a part to reduce this pressure, especially the greater activity of the neck, waist, knee, heel and other parts of the foot. It is essentially a physiological compensatory function of the human body, a self-protective reaction produced by the body to adapt to changes in force. High-risk group: it occurs in middle-aged and old people over 40 years old and staff engaged in load-bearing, standing and sitting for a long time, and it is common to see lesions in joints and spine with a large range of activities. Pathogenesis: It involves joints and cartilage tissues throughout the body. When the disease is mild, there is no abnormality in appearance, and it only manifests as pain in the joints when they are just moving, and with the continuation of the activities, the pain can be gradually improved and disappeared. When the disease worsens, there will be redness, swelling, fluid accumulation and even deformation of the joints, with increasing pain and limited joint movement. The pain of osteoarthritis is closely related to weight-bearing movement of the joints and changes in climate and temperature. (See Osteoarthritis for more details.) Timing of treatment: not elimination of osteophytes Just as the skin grows wrinkles, osteophytes are a normal physiological phenomenon in the human body, and as long as they do not cause pathological changes, they can coexist peacefully with osteophytes. If it causes pain, numbness, or discomfort, it should be treated. Treatment principle: “Control the development of osteophytes, soften the calcified tissue being formed, eliminate inflammation, promote healing of damaged tissue, relieve pain, and achieve clinical cure.” Then adhere to the rehabilitation health care exercise to control the recurrence of the disease. Osteoporosis: a metabolic disease characterized by decreased bone mass and destruction of bone tissue structure, leading to increased bone fragility and easy fracture. It can be categorized into primary and secondary according to its causes. (See Osteoporosis for more details.) Etiology: Although the mechanism is unknown, it is related to estrogen, active vitamin D deficiency, genetic factors, nutritional status, and drug use (e.g., glucocorticoids). Risk groups: Postmenopausal women and the elderly. Although men are not at high risk for osteoporosis, it is a fact that about 25% of fractures in men over 50 years of age are related to osteoporosis. Osteoporosis is also more likely to occur in women who are physically inactive, thin, or have a combination of type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease, hyperparathyroidism, hypothyroidism, and endocrine disorders. Pathogenesis: Mostly in the spine, long bones of the limbs backbone. The pain does not necessarily appear in the early stage of the disease, and once the pain, usually occurs in the labor or at night. It is related to the time and degree of weight-bearing, and also related to climate and temperature changes. Patients with more severe osteoporosis may also have radiating pain in the anterior chest, two ribs, abdomen and soft tissues in the groin, which is due to vertebral fracture deformity of the spine. Osteoporosis usually has no redness or swelling of the joints, no effusion, and normal joint movement. Prevention and treatment: see Osteoporosis Osteomalacia and osteoporosis are twin bone diseases, and osteoporosis is not caused by calcium supplementation. Simple understanding: Osteomalacia and osteoporosis are caused by calcium deficiency. After middle age, the human body is in negative calcium balance (i.e., more loss than intake), whenever calcium intake is insufficient, the body’s blood calcium self-stabilizing system will increase the secretion of parathyroid hormone to dissolve bone calcium to replenish the blood calcium, so that the blood calcium will maintain the original level. A person with normal calcium metabolism, if in a few days or months of short-term calcium deficiency, and can not make the blood calcium affected and reduced. However, if the body is chronically deficient in calcium and it is not corrected, it can deviate the stabilization system of blood calcium. The parathyroid glands are stimulated by calcium deficiency for a long period of time and continue to secrete excessive amounts of thyroxine, causing the parathyroid glands to gradually enter a state of hyperactivity, which in turn results in the paradoxical phenomenon of a decrease in bone calcium and an increase in blood calcium and soft tissue calcium levels. High blood calcium stimulates increased secretion of calcitonin, which promotes osteogenesis, which is the hormonal basis for the coexistence of osteoporosis and osteomalacia. Osteomalacia is the body’s compensation for osteoporosis, the new bone formed by the body with this compensation is far from being able to make up for the large amount of lost old bone, the calcium that should enter the bone inside is deposited and repaired in some of the most stressed bone surfaces, such as cervical vertebrae, lumbar vertebrae, heel and other parts of the body, which is osteomalacia. Osteoporosis treatment: General treatment: including exercise and weight loss (see “Osteoarthritis” & “Osteoporosis” for details) Medication: There are many reasons for joint pain, but most of them are not inflammation, or only mild inflammation, and most of them can be treated with analgesics. In most cases, it can be treated with analgesics. If the response to analgesic treatment is not good, non-steroidal anti-inflammatory drugs can be used, especially when the joints have inflammation, such as prolonged stiffness, swelling, localized fever. You can also use some herbal patches, localized compresses and so on. Cartilage-protective drugs: There are two main types of drugs, namely chondroitin sulfate and glucosamine sulfate, which mainly improve the structure of the joints, thus improving the symptoms of patients with osteoarthropathy. Joint replacement: If the joint is deformed and the pain cannot be relieved by medication, it can be completely solved by knee replacement. For more details, reply to “Osteoarthritis” or “Osteoporosis” to get the related scientific articles. (Image from the Internet) Author: Wuhan Union Orthopaedic Hospital Tian Hongtao Title: Associate Professor, Associate Chief Physician Specialty: Artificial Joint Replacement Joint Diseases: Necrosis of the femoral head, osteoarthritis of the knee joint, rheumatoid arthritis, ankylosing spondylitis, joint infections, osteoarthritic deformities; Outpatient Time: All day every week on the first, third and sixth day of the week; Contact Information: Tel: 13908622515 Welcome to follow my public number Bone Outside Marshal Tian. Welcome to pay attention to my WeChat public number Bone outside the handsome Tian Dad or Sina microblogging @ Bone outside the handsome Tian Dad