As a “silent” disease, osteoporosis is silently eating away at people’s health. According to the White Paper on Osteoporosis Prevention and Control in China released by the International Osteoporosis Foundation, as of 2009, nearly 70 million people in China suffer from osteoporosis, and another 210 million people have bone mass below normalized standards, and there is a clear trend of “youthfulness” in the incidence of the disease.
Every 30 seconds, one person has an osteoporotic fracture
Osteoporosis is a systemic bone metabolic disease characterized by a decrease in bone mass and changes in bone quality (including macroscopic and microscopic structural changes and changes in bone properties), resulting in increased bone fragility and easy fracture.
According to research studies, osteoporotic fractures occur in 1 person every 30 seconds and 1 person every 22 seconds, and 1 out of 3 women over 50 years old will suffer from osteoporotic fractures; 1 out of 5 men over 50 years old will suffer from osteoporotic fractures. Therefore, it is urgent to pay attention to osteoporosis, especially for women.
Who is prone to osteoporosis?
Many people think that a lack of calcium makes them prone to osteoporosis and that osteoporosis is a lack of calcium, but it is not that simple; the risk factors for osteoporosis are mainly –
1. Inherent factors.
Ethnicity (Caucasians are more susceptible than yellow and black people), old age, menopause, maternal family history.
2. Non-inherent factors
Low body weight, medications (application of corticosteroids, etc.), related diseases (affecting bone metabolism), smoking, excessive alcohol consumption, coffee, etc., lack of physical activity, lack of calcium in the diet, vitamin D deficiency.
How is osteoporosis diagnosed?
The first step is to be able to determine the clinical manifestations of osteoporosis.
(1) Pain (low back and back pain is common).
(2) deformation of the spine and/or shortening of height.
(3) Fractures (fragility fractures).
The diagnosis of osteoporosis is based on the following 3 points.
1, the presence of fragility fractures: fractures occur with non-violent, minor external forces.
2. Bone mineral density (BMD) measurement.
(1) Dual-energy X-ray bone densitometry (DXA): It is currently recognized as the gold standard for the diagnosis of osteoporosis.
Due to the different absolute values of different BMD detectors, the T-value is usually used to determine whether the BMD is normal or not when the BMD value is used clinically (T-value indicates the ratio of the patient’s BMD to the peak BMD of the reference group). According to the WHO’s recommended standard, T ≥ -1 is normal bone mass, -1.0 < T < -2.5 is reduced bone mass, and T ≤ -2.5 is osteoporosis.
(2) Other measurement methods: such as X-ray, ultrasound, quantitative CT (QCT), peripheral DXA, etc., can be used for screening and differential diagnosis of osteoporosis.
(3) Differential diagnosis: other bone metabolic diseases, secondary osteoporosis, etc. need to be excluded.
How should osteoporosis be prevented and treated?
Once a fracture occurs in osteoporosis, it will lead to increased mortality on the one hand, and make treatment difficult on the other. Therefore, the prevention and treatment of osteoporosis is very important, and its strategies are mainly the following 4 points.
1. Healthy lifestyle.
Supplementation, persistent exercise, and sun exposure.
2.Bone health basic supplements (calcium, vitamin D).
Recommended dose of vitamin D: (1) vitamin D3: 400-800IU (10-20μg)/day; (2) alfacalcidol: 0.5-0.8μg/day; (3) osteopontin: 0.25-0.5μg/day.
3. Fall prevention.
Older people are prone to falls due to decreased neuromuscular function of the lower limbs and reduced responsiveness and balance. Older women who have fallen are prone to hip fracture, which is the most serious kind of fracture in osteoporosis and directly threatens life and quality of life.
4. Drug treatment.
It is generally accepted that treatment needs to be started when.
(1) When a fragility fracture occurs, regardless of bone density.
(2) Patients with osteoporosis (BMD: T ≤ -2.5), regardless of whether there has been a fracture.
(3) Patients with low bone mass (BMD: -2.5 < T < -1.0) and the presence of more than one osteoporosis risk factor.
The main therapeutic drugs are.
(1) drugs that inhibit bone resorption: mainly bisphosphonates, calcitonin, estrogens and selective estrogen receptor modulators (SERMs), etc. Bisphosphonates are the most widely used anti-bone resorption agents, among which zoledronic acid has the effect of strongly inhibiting osteoclast activity and reducing bone resorption, which can significantly reduce the risk of fracture; zoledronic acid is used for the treatment of osteoporosis in postmenopausal women, and the recommended dose is 5 mg by intravenous drip once a year.
(2) Drugs that promote bone formation: the main ones are parathyroid hormone, which is used for the treatment of severe osteoporosis and can improve bone density and reduce the risk of vertebral and non-vertebral fractures. Blood calcium levels should be monitored during treatment to prevent hypercalcemia, and the duration of treatment should not exceed 2 years.
(3) Drugs with multiple mechanisms of action: including strontium salts, active vitamin D and its analogues, and vitamin K2. osteotriol (active vitamin D), for example, can promote bone formation and mineralization and inhibit bone resorption, which is beneficial for increasing bone density, increasing muscle strength and balance in the elderly, reducing the risk of falls, and thus reducing the risk of fracture; long-term use should be monitored for blood and urine calcium levels.
Osteoporosis is a chronic systemic disease that should be prevented and treated with a combination of prevention and treatment. Patients should go to regular hospitals for regular bone density measurements to screen for osteoporosis and achieve early diagnosis, early prevention and early treatment. In addition, once fracture occurs in osteoporosis, it will bring more harm to patients, and it is important to avoid repeated fractures so as not to affect the quality of life of patients.