After a gust of wind, there are always trees that break or break their branches, while some are still standing tall. The reason for this difference is the different strength of the trunk supporting the tree, and thus the different ability to resist external forces, as well as the bones of the human body. Due to the different strength of the bones supporting the human body, some people suffer fractures under mild external forces, which is osteoporosis. Osteoporosis is a bone disease characterized by weakened bone strength and susceptibility to fracture, and its greatest danger is the complication of fracture.
Osteoporosis is actually very common and can cause serious consequences. Women over 50 years old have a 1/3 chance of having a vertebral fracture in their lifetime, causing problems such as height shortening, hunchback and chronic low back pain, which affects the quality of life. If the fracture occurs in the hip bone, it often leads to disability, and prolonged bed rest can easily lead to other complications such as pneumonia, blood clots, etc. Deaths from this are common, with up to 20% of hip fractures The elderly die from fracture complications within the first year, 40% of hip fracture patients are unable to walk within 1 year, 15-25% of survivors are disabled after the fracture and need dedicated care for life, and in addition 30% of osteoporotic fractures occur a second time within 1 year.
Bone loss is significantly accelerated in women after menopause, and the fastest bone loss occurs within 5 years after menopause, which is about 1/3 of the peak bone mass, and the fastest bone loss in men after age 70. However, although osteoporosis is common in the elderly, it is not an inevitable consequence of menopause and aging, and osteoporosis can be prevented and avoided.
The occurrence of osteoporosis is a gradual process, and the clinical manifestations caused by osteoporosis vary. Most patients do not have any symptoms, so osteoporosis is also called silent epidemic disease, and is only detected when a fracture occurs, and some patients have low back pain, and in severe cases, fractures occur.
The prevention and treatment of osteoporosis includes several levels: ideal calcium and vitamin D intake before peak bone mass is reached can increase peak bone mass and improve bone reserve; after peak bone mass is reached, the main goal is to slow down bone loss; for osteoporosis that has already occurred, effective treatment can achieve to slow down bone loss, increase bone density and bone strength, and prevent fractures from occurring.
The prevention and treatment of osteoporosis should start from the following five aspects:
First, increase peak bone mass during adolescence
Bone is a constantly changing living tissue, with old bone constantly being removed and replaced by newly formed bone, just like a bank account that can deposit and spend bone tissue. During childhood and adolescence, bones grow in size and strength because more bone tissue is deposited than expended. The amount of bone tissue in the skeleton (called bone mass) continues to increase until it peaks around age 25, with girls gaining 90% of their bone mass by age 18 and boys by age 20, and the best time to “invest” in bone health is during childhood and adolescence, creating a skeletal savings bank for children. The more you save at a young age, the longer you’ll have to grow up.
Achieving ideal peak bone mass at a young age and developing good bone health behaviors can prevent or reduce the risk of osteoporosis.
The two most important bone health habits are proper nutrition and adequate physical activity. Proper nutrition includes a diet with adequate calcium and vitamin D. Most children can get vitamin D through ultraviolet light from the sun, egg yolks and fortified milk, but many also fail to get adequate amounts of calcium in their diet.
Muscles get stronger the more you use them, and so do bones. Any sport is beneficial, but the best sports for bones are weight-bearing sports, such as walking, running, jumping, dancing, tennis, basketball, gymnastics and soccer, etc. More outdoor activities can increase vitamin D levels in the body.
Second, lifelong calcium supplementation
Calcium plays an important role in maintaining bone health, and the amount of calcium required varies at different stages of life.
The ideal daily calcium intake recommended by the NIH is shown in the table below. It should be noted that the Chinese diet is generally significantly deficient in calcium intake, according to statistics, the average daily calcium intake of adults in China is less than 400mg, which is still a long way from the ideal calcium intake level, so in daily life we should consciously increase calcium intake, such as developing the habit of drinking milk, eating more dairy products and drinking tofu and calcium fortified foods, generally speaking. Even so, still can not reach the ideal calcium intake level, some domestic statistics, the average calcium intake level of adults in Beijing is less than 400mg/day, so most people should supplement oral calcium preparations to achieve the ideal calcium intake level.
Age
Ideal daily calcium intake (mg/day)
Within 1 year of age
400-600
1-5 years old
800
6-10 years
800-1200
11-24 years old
1200-1500
25-50 years old women
1000
Pregnant and breastfeeding women
1200-1500
Postmenopausal women on estrogen replacement therapy
1000
Post-menopausal women without estrogen replacement
1500
Over 65 years of age, both men and women
1500
Third, reduce bone loss
After the human skeleton reaches its peak bone mass before the age of 30, bone resorption is greater than bone formation, so bone density gradually declines. Many factors promote bone loss, thus accelerating the decline in bone density, of which family history of osteoporosis, menopause and ageing are inevitable factors, in addition to these common risk factors prone to bone loss are: (1) coffee, strong tea and carbonated beverages; (2) taking glucocorticoids. (3) lean body mass BMI <20; (4) hypogonadism (estrogen or androgen deficiency); (5) a sedentary lifestyle and lack of weight-bearing exercise; (6) smoking (more than 20 cigarettes per day); (7) excessive alcohol consumption; (8) inadequate vitamin D intake; (9) long-term chronic diarrhea. Many of the above factors can be prevented and avoided.
Fourth, regular measurement of bone density after middle age
On the basis of preventive measures in place, women should have an initial bone density measurement in premenopause (around 45 years old) and men should have one in their 50s. Dual Energy X-Ray Bone Densitometry (DEXA) is the gold standard for bone densitometry, not only qualitative but also quantitative. Just as a sphygmomanometer can detect high blood pressure, DEXA can diagnose osteoporosis. Ordinary X-rays are not a sensitive indicator for the diagnosis of osteoporosis. Generally, the visible manifestation of X-rays can be found only when the bone loss exceeds 30%, so it is not meaningful for the early diagnosis of osteoporosis, and can only be helpful as a visual indication of the severity of osteoporosis and the presence of occult fractures in the later stages of osteoporosis.
V. Treatment of already detected osteoporosis
Treatment of already detected osteoporosis can reduce the symptoms of low back pain and prevent the occurrence of fractures, and for patients who have already had fractures, treatment can prevent the re-occurrence of fractures.
There are many drugs for osteoporosis treatment, including calcium, vitamin D preparations, bisphosphonates, calcitonin, selective estrogen receptor modulators (SERMS), parathyroid hormone preparations, etc. Among them, calcium and vitamin D are the basis of osteoporosis treatment, and clinical trials have confirmed that various bisphosphonates, calcitonin preparations, selective estrogen receptor modulators (SERMS), parathyroid hormone Clinical trials have confirmed the efficacy of various diphosphonates, calcitonin preparations, selective estrogen receptor modulators (SERMS) and parathyroid hormone preparations in increasing bone density and preventing fractures, providing a bright future for the treatment of osteoporosis, which can be treated and osteoporotic fractures can be completely prevented and avoided.