Osteoporosis was introduced by Pornmer in 1885, but people’s understanding of osteoporosis has gradually deepened with the development of history and technological advances. In the early years, it was generally considered that a decrease in bone mass throughout the body was osteoporosis, while in the United States, fractures in the elderly were considered osteoporosis. It was not until the 3rd International Symposium on Osteoporosis held in Denmark in 1990 and the 4th International Symposium on Osteoporosis held in Hong Kong in 1993 that osteoporosis was given a clear definition and recognized worldwide: primary osteoporosis is a systemic bone disease characterized by a decrease in bone mass and degeneration of bone microstructure, resulting in an increase in bone fragility and susceptibility to fracture. International Osteoporosis Day is celebrated every year on October 20.
Understanding and awareness of the definition of osteoporosis.
① Decrease in bone mass: it should include a decrease in the proportion of bone mineral and its matrix.
② Degeneration of bone microstructure: due to imbalance in bone tissue resorption and formation, etc., as evidenced by destruction, thinning and fracture of bone trabecular structures.
③Bone brittleness increases, bone mechanical strength decreases, fracture risk increases, and microfracture or complete fracture easily occurs due to reduced load bearing capacity. Compression fractures of the lumbar spine may occur quietly, or fractures of the distal end of the flexor, proximal femur, and upper end of the limb bone may occur with little external force.
Clinical manifestations of osteoporosis
(1) Pain. The most common symptom of primary osteoporosis is low back pain, which accounts for 70%-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, is light during the day, increases at night and when waking up in the morning, and increases when bending, muscle movement, coughing, and bowel movement. Bone pain generally occurs when 12% or more of bone mass is lost. In old age osteoporosis, the vertebral trabeculae atrophy and decrease in number, the vertebral body compresses and deforms, the spine flexes forward, the lumbar rash muscle doubles its contraction in order to correct the forward flexion of the spine, the muscle fatigue or even spasm, producing pain. A recent compression fracture of the thoracolumbar spine can also produce acute pain, with strong pressure pain and percussion pain in the spinal spinous process at the corresponding site, which can generally be gradually reduced after 2-3 weeks, and some patients can present with chronic low back pain. If the corresponding spinal nerve is compressed, radiating pain in the extremities, sensory-motor disorders in both lower extremities, intercostal neuralgia, retrosternal pain similar to angina pectoris, or epigastric pain similar to acute abdomen may occur. If compression of the spinal cord, cauda equina also affects the bladder and rectal function.
(2) Shortening of body length and hunchback. Mostly appear after the pain. The front part of the vertebrae of the spine is almost mostly composed of cancellous bones, and this part is the pillar of the body with a large weight, especially the 11th and 12th thoracic vertebrae and the 3rd lumbar vertebrae, which have a greater load and are easily compressed and deformed, causing the spine to tilt forward and the back curve to increase, resulting in hunchback, and as we grow older, osteoporosis increases and the curvature of the hunchback increases, resulting in significant knee contracture. Each person has 24 vertebrae, the height of each vertebra is about 2cm in normal people, when the elderly osteoporosis vertebral compression, each vertebrae shortened by about 2mm, the average length of the body shortened by 3-6cm.
(3) Fracture. This is the most common and serious complication of degenerative osteoporosis, which not only increases the patient’s pain and aggravates the economic responsibility, but also severely limits the patient’s activities and even shortens the life span. According to our statistics, the incidence of fractures in the elderly is 6.3%-24.4, especially in elderly women of advanced age (80 years or older). Fractures caused by osteoporosis are more common in the early stages of old age with distal radius fractures (Colles fractures) and later in old age with fractures of the lumbar spine and upper femur. Fractures generally occur when 20% or more of bone mass is lost, and for every 1.0 DS decrease in BMD, the incidence of vertebral fractures increases 1.5-2 times. About 20%-50% of patients with vertebral compression fractures have no obvious symptoms.
(4) Decreased respiratory function. Compression fractures of the thoracic and lumbar spine, backward curvature of the spine, and thoracic deformity can significantly reduce lung capacity and maximum ventilation, and the incidence of lobar emphysema in the anterior region of the upper lobe of the lung can be as high as 40%. Most elderly people have no degree of emphysema, lung function decreases with age, and if combined with thoracic deformity due to osteoporosis, patients often have symptoms such as chest tightness, shortness of breath, and difficulty breathing. Once the symptoms arise, the body shape changes, which is a blow to the beauty lovers, plus the pain, mobility and medical payment for fracture surgery, which is a great burden to individuals, families and society. At present, there is no safe and effective method to help restore the original shape of osteoporotic bones, therefore, preventive care is very important.
Osteoporosis can be divided into three main categories.
The first type is primary osteoporosis, which is a physiological degenerative lesion that inevitably occurs with age. This type is divided into 2 types, type Ι for postmenopausal osteoporosis, seen in women shortly after menopause. type Π for senile osteoporosis, which occurs mostly after the age of 65.
The second type is secondary osteoporosis, which is triggered by some factors such as other diseases or drugs.
The third category is idiopathic osteoporosis, which is mostly seen in adolescents or adults aged 8 to 14 years old, mostly with a genetic family history, and more women than men. Osteoporosis that occurs during pregnancy and lactation in women can also be included in idiopathic osteoporosis.
Exercise prescription for osteoporosis
Osteoporosis is a common and frequent disease among the elderly. According to some statistics, nearly one third of women over 45 years of age suffer from osteoporosis of varying severity; and the prevalence of osteoporosis among women over 75 years of age is as high as 90%.
In addition to the symptoms of osteoporosis such as bone pain and cramps, there is another point to note. Osteoporosis leads to increased brittleness of the bone, which makes it prone to fracture. Therefore, osteoporosis should be actively diagnosed and treated, and should not be taken lightly and allowed to develop. If you experience any of the above discomforts, you should go to the hospital for treatment.
Discomfort all over the body, weakness in the back and legs, inexplicable bone pain. After detailed examination and diagnosis of osteoporosis, the doctor can take some painkillers and calcium supplements as appropriate. In addition, you need to make some cooperation, such as ensuring enough sleep, one hour of sunshine every day, and exercise for half an hour or more every day. The more meaningful exercise methods for osteoporosis are walking, playing tai chi, doing various exercise exercises, and swimming exercises if you have the conditions. Sunbathing and sports exercise first for a short period of time, and then slowly increase and extend the exercise time. Eating food should not be picky, should eat low salt, light meals, pay attention to nutrition to be rich. 1 bottle of milk should be guaranteed every day. If the bone pain and cramps are not relieved after 2 weeks of treatment according to the above method. You can go back to your doctor to prescribe some injection medicine to help regulate your body’s internal bone calcium level.
For people with osteoporosis, this disease really cannot be treated with just injections and medication. It is a chronic disease that occurs slowly as each of us gets older. The occurrence of this disease is very much related to our lack of exercise, and one should never underestimate the important role of exercise in the prevention and treatment of osteoporosis. Human bone tissue is a kind of living tissue, people will keep stimulating bone tissue during exercise, bone tissue will not easily lose calcium, bone trabecular structure in bone tissue will be arranged more reasonable, so that osteoporosis is less likely to occur.
Some studies have found that elderly people who regularly participate in sports have particularly good balance and higher bone density in their bodies than elderly people of the same age who do not like sports; and they are less likely to fall, which may effectively prevent fractures from occurring.
Osteoporosis is not terrible, as long as we doctors and patients work well together, we can definitely relieve you of your worries and pain.
There are five types of drugs currently available for the treatment of osteoporosis as follows.
1. Hormone supplementation therapy: Estrogen plus luteinizing hormone can prevent and treat osteoporosis. If there is no uterus, progesterone is not needed.
2, alendronate (alendronate): the trade name Fosamax inhibits the role of osteoclasts, while having the effect of prevention and treatment of osteoporosis.
3.Calcitonin: absorbed by subcutaneous, intramuscular injection or nostril, effective for women with osteoporosis who have stopped menstruation for more than five years. Side effects include loss of appetite, flushing, rash, nausea and dizziness. However, as soon as the medication is stopped, the rate of bone loss will begin to accelerate, so long-term treatment is necessary.
4.Calcium and vitamin D: the combination is more effective.
5.Bone peptide preparation, which is a new clinical drug used to treat rheumatoid rheumatism, is effective for osteoporosis. Postmenopausal osteoporosis is a high prevalence of postmenopausal women, foreign statistics show that the risk rate of occurrence in women over 60 years old is 58%. It is associated with reduced levels of hormones synthesized by the ovaries, resulting in bone pain and fractures, which seriously affects the quality of life of women and increases their disability and mortality rates. Since its pathogenesis has not been fully elucidated, the treatment of drugs has certain limitations, and the long-term use of Western medicine is likely to bring many side effects to patients.
A scientific study on health care acupuncture for middle-aged and elderly people found that moxibustion can increase serum estrogen levels in healthy elderly people. Inspired by this, the researchers, based on traditional Chinese medical theory and modern medical research on postmenopausal osteoporosis, concluded that the root cause of postmenopausal osteoporosis is “kidney deficiency”, coupled with acquired disorders and other causes of osteoporosis, and that the treatment is based on kidney tonification, combined with the method of strengthening the spleen. The clinical effect was observed by using dual-energy X-ray bone densitometry (DEXA) and related biochemical test indexes, and a drug control group was set up to compare the efficacy. After treatment, the patient’s bone pain and other symptoms were firstly relieved or disappeared, and the biochemical indexes were significantly improved. After 6 months, the bone density test had improved to different degrees, and the bone density of the 2nd to 4th lumbar vertebra and the upper end of the femur increased significantly
Prevention
Osteoporosis brings great inconvenience and pain to patients’ lives, and the treatment is slow and life-threatening in case of fracture, therefore, special emphasis should be placed on the implementation of three-level prevention.
Primary prevention: It should start with children and adolescents, such as paying attention to reasonable dietary nutrition and consuming more foods with high Ca and P content, such as fish, shrimp, shrimp skin, kelp, milk (250ml contains Ca300mg), dairy products, bone broth, eggs, beans, refined grains, sesame seeds, melon seeds, green leafy vegetables, etc. Try to get rid of “risk factors”, 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 childbearing, breastfeeding period should not be too long, as far as possible to preserve the calcium in the body, enrich the calcium pool, the bone The best measure to prevent osteoporosis in the later stages of life is to increase the peak value of calcium to the maximum. Strengthen the basic research of osteoporosis, and focus on the follow-up and early prevention for the high-risk groups with genetic predisposition.
Secondary prevention: bone loss accelerates in middle age, especially in women after menopause. Bone density examination should be conducted annually 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, and at the same time insisting on long-term preventive calcium supplementation or using bone peptide oral preparation bone peptide tablets for preventive treatment, in order to safely and effectively prevent osteoporosis. In Japan, it is mostly advocated to prevent osteoporosis with active Vit D (rocalciferol) and calcium, and to pay attention to the active treatment of diseases related to osteoporosis, such as diabetes, rheumatoid arthritis, steatorrhea, chronic nephritis, hyperparathyroidism/hyperthyroidism, bone metastatic cancer, chronic hepatitis, liver cirrhosis, etc.
Tertiary prevention: Patients with degenerative osteoporosis should be actively treated with medication to inhibit bone resorption (estrogen, CT, Ca), promote bone formation (active Vit D), oral preparation of bone peptide (bone peptide tablets), and should also strengthen measures to prevent falls, bumps, trips and upsets. For middle-aged and elderly fracture patients should actively operate, implement strong internal fixation, early activity, physical therapy, physiotherapy psychological, nutrition, calcium supplementation, pain relief, promote bone growth, curb bone loss, improve immune function and overall quality and other comprehensive treatment. , degenerative osteoporosis is the basic law of bone development, growth and aging, but subject to hormonal regulation (mainly PTH osteoclastic: estrogen, CT osteogenesis; Vit D3 two-way regulation), nutritional status, physical factors (sunlight, weight), immune status (systemic fitness, disease), genetic genes, lifestyle (smoking, alcohol, coffee, eating habits, exercise, mental and emotional), economic If we can strengthen the awareness of self-care, improve the level of self-care and actively intervene scientifically at an early stage, degenerative osteoporosis can be delayed and prevented, which will have important and realistic social and economic benefits to improve the physical and mental health and quality of life of hundreds of millions of middle-aged and elderly people in China.