Osteoporosis is a disorder of systemic bone metabolism characterized by damage to the microstructure of bone tissue, a constant decrease in bone mineral composition and bone matrix in equal proportions, thinning of bone mass, a decrease in the number of bone trabeculae, increased bone fragility and an increased risk of fracture. In medicine, osteoporosis was first proposed by Pornmer in 1885, but it was not until the International Symposium on Osteoporosis held in Denmark in 1990 that a clear definition of osteoporosis was given and recognized worldwide: primary osteoporosis is a systemic disease characterized by a decrease in bone mass and degeneration of bone microstructure, resulting in increased bone fragility and susceptibility to fracture. Bone disease. The main manifestations are: reduction of bone mass, osteocalcinolysis, compression fracture of the spine, resulting in the appearance of “turtle back” and some age-related diseases such as dyspnea, osteophytes, hypertension, dementia and diabetes; degeneration of bone microstructure, decrease of bone strength and increase of brittleness, making it difficult to carry the original load.
Dangers of osteoporosis Osteoporosis leads to uneven stress on bones, or bone fragility, the body produces a reparative response and the formation of bone spurs, the result of this abnormal distribution of bone components, can also cause disc protrusion, osteoporosis is often the intrinsic cause of fractures, osteonecrosis, fractures do not heal, rheumatoid and rheumatoid arthritis the greatest danger lies in the loss of function of subchondral bone tissue honeycomb-like changes, and the cause The cause is closely related to the influx of immune cells from the bone marrow into the joints. Osteoporosis can have consequences such as bone pain, hunchback, short stature, fractures and even disability. Common osteoporotic fractures include hip fractures and spinal fractures, and they often lead to secondary complications. On the eve of World Osteoporosis Day on October 20, Zhu Hanmin, director of the Osteoporosis Society of the Shanghai Medical Association and professor of East China Hospital, raised this warning: Osteoporosis can deform vertebral bones and cause gastrointestinal diseases due to abdominal pressure; osteoporosis can also make the spinal bones weak and bedridden and cause lung infections.
Classification of osteoporosis.
Osteoporosis (sometimes referred to as osteopenia) can be divided into the following categories.
(1) primary osteoporosis: such as senile osteoporosis, postmenopausal osteoporosis, etc.
(2) Secondary osteoporosis: such as hyperthyroidism osteoporosis, diabetic osteoporosis, etc.
(3) Idiopathic osteoporosis of unknown cause: such as hereditary osteoporosis, etc.
According to the scope of the occurrence of osteoporosis can be further divided into the following two categories.
(1) Systemic osteoporosis: such as senile osteoporosis, hyperthyroidism osteoporosis, etc.
(2) Limited osteoporosis: such as rheumatoid arthritis osteoporosis, local osteoporosis caused by the fixation of limb plaster, etc.
Etiology and pathology of osteoporosis.
The factors causing bone loss in middle-aged and elderly people are very complex, and recent studies have concluded that they are closely related to the following factors.
(1) The reduction of sex hormone secretion in middle and old people is one of the important causes of osteoporosis. It is a recognized fact that estrogen level decreases after menopause, resulting in increased bone resorption.
(2) With age, the secretion of calcium-regulating hormones is dysregulated, resulting in disorders of bone metabolism.
(3) The elderly have a lack of protein, calcium, phosphorus, vitamins and trace elements due to the loss of teeth and lower digestive function, poor bone nano, and less intake of goodness.
(4) With the growth of age, the reduction of outdoor exercise is also an important reason why the elderly are prone to osteoporosis.
(5) Recent studies in molecular biology have shown that osteoporosis is closely related to vitamin D receptor (VDR) gene variants.
Symptoms 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. The pain spreads along the spine to both sides, decreases when lying on the back 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 stooling. Bone pain generally occurs when 12% or more of bone mass is lost. In elderly osteoporosis, the vertebral trabeculae atrophy and decrease in number, the vertebral body compresses and deforms, the spine flexes forward, and the lumbar rash muscle doubles its contraction in order to correct the forward flexion of the spine, resulting in muscle fatigue and 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 and cauda equina also affects bladder and rectal function.
(2) Shortening of body length and hunchback. Most of them appear after the pain. The anterior part of the vertebrae of the spine is almost mostly composed of cancellous bone, 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 dorsal curvature to increase, resulting in a hunchback. Each person has 24 vertebrae, the height of each vertebra is about 2cm in normal people, the vertebrae compress when the elderly osteoporosis, each vertebrae shorten about 2mm, the average length of the body shortened 3-6cm.
(3) Fracture. This is the most common and serious complication of degenerative osteoporosis.
(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 air exchange, and patients can often experience chest tightness, shortness of breath, and dyspnea.
Diagnostic tests for osteoporosis.
The diagnosis of osteoporosis needs to rely on a comprehensive analysis of clinical manifestations, bone mass measurement, X-ray films and indicators of bone conversion biochemistry.
1.Biochemical examination: The measurement of blood and urine minerals and certain biochemical indicators can help determine the state of bone metabolism and the speed of bone renewal rate, which is important for the differential diagnosis of osteoporosis.
(1) Bone formation indicators.
(2) Bone resorption indicators: 1) urinary hydroxyproline. 2) urinary hydroxylysine glycoside. 3) plasma antitartrate phosphatase. 4) urinary collagen pyridine cross-linking (PYr) or type I collagen cross-linking N-terminal peptide (NTX).
(3) Blood and urine bone mineral composition detection: 1) serum total calcium. 2) serum inorganic phosphorus. 3) serum magnesium. 4) urine calcium, phosphorus and magnesium determination.
2.X-ray examination.
X-ray is still not lost as a more popular method to check osteoporosis.
3, bone mineral density measurement.
(1) single photon absorptiometry (SPA).
(2) Dual-energy X-ray absorptiometry (DEXA).
(3) Quantitative CT (QCT).
(4) Ultrasound (USA).