I. Definition
Osteoporosis was introduced by Pornmer in 1885, but people’s understanding of osteoporosis has gradually deepened with the development of history and technological progress. In the early years, it was generally considered that a decrease in bone mass throughout the body was osteoporosis, and in the United States, fractures in the elderly were considered as 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.
①Decrease in bone mass: It should include the reduction of bone mineral and its matrix in equal proportion.
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. Lumbar compression fractures may occur quietly, or fractures of the distal end of the flexor, proximal femur and upper end of the limb bone may occur without significant external force.
Second, the 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. The pain spreads along the spine to both sides, decreases when lying down or sitting, increases when posterior extension or prolonged standing or sitting, is light during the day, increases at night and early morning when waking up, 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, cauda equina also affects the 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, and as we age, osteoporosis increases and the curvature of the hunchback increases, resulting in significant knee contracture. Each person has 24 vertebrae, the height of each vertebrae in normal people is about 2cm, when the elderly osteoporosis vertebrae 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, aggravates the economic responsibility, and severely restricts the patient’s activities, and even shortens the life span. According to our statistics, the incidence of fracture in elderly people is 6.3%-24.4, especially in elderly women (over 80 years old). 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 end of the femur. Fractures generally occur when 20% or more of bone mass is lost, and for every 1.0 DS reduction 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 in breathing.
Once the symptoms arise, the body shape changes, which is a blow to the beauty lovers, coupled with pain, mobility problems, medical payment for fracture surgery, etc., it 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 health care is very important, do not neglect the “bone care” work is not yet your turn, and do not think you are too old to take care of it, it is never too late to preserve the bone.
Third, osteoporosis can be divided into three categories
The first category is primary osteoporosis, which is a physiological degenerative lesion that inevitably occurs with age. This type is divided into two 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 occurring during pregnancy and lactation in women can also be included in idiopathic osteoporosis.
IV. Treatment
1.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 old suffer from osteoporosis of different severity; and the prevalence of osteoporosis in women over 75 years old is as high as over 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 together well, we can definitely relieve your worries and pain.
2.Medication treatment
1.Hormone supplementation therapy: Estrogen plus luteinizing hormone can prevent and treat osteoporosis. If there is no uterus, progesterone is not needed.
2.Alendronate: The trade name Fosamax inhibits the effect of osteoclasts and has the effect of preventing and treating osteoporosis at the same time.
3, Calcitonin: absorbed by subcutaneous, intramuscular or nasal injection, effective for women with osteoporosis who have stopped menstruating 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.