With the development of society, the aging of population and the progress of people’s health concept, osteoporosis is becoming a popular topic day by day, and more and more patients come to the clinic for osteoporosis. One day, a grandmother came to the clinic with an x-ray of her joints and said upon entering, “Doctor, I have osteoporosis, prescribe some calcium tablets.” Although this grandmother was alerted to osteoporosis, she walked into a misunderstanding. On the one hand, the public does not understand the scientific concept of osteoporosis and the common sense of treatment; on the other hand, some health product advertisements are bombarded with high-density broadcasting, instilling some biased and even incorrect views into the audience. Unknowingly, many elderly people have walked into the misunderstanding. This grandmother’s words are so typical that one sentence contains two common misconceptions. Misconception 1: Is “osteoporosis” the same as “osteopenia”? The difference between “osteoporosis” and “osteopenia” is a word, but the concepts are completely different. As we age, we lose bone mass and our bones become thinner and looser, which is a normal physiological aging process. This process can be seen on X-rays, and radiologists will often write “bone thinning” or “osteoporosis” on the report; many elderly people will come to the clinic with such a report, but is this osteoporosis? Although the bone quality of the elderly is definitely more lax than that of the young, but to use an advertising slogan, “not all osteoporosis is called osteopenia”. According to the definition of the World Health Organization, osteoporosis is a metabolic bone disease with a numerical standard of bone density: compared with the highest bone mass achieved in youth, a reduction of 2.5 normal fluctuations (standard deviation) is called osteoporosis; below the normal value of more than one standard deviation but has not reached 2.5 standard deviation, can only be considered a reduction in bone mass. To make a simplistic analogy, for example, if an exam is passed with a score of 60-100, the average score is 80, and the fluctuation range is 20 points up and down, then a score of 30-60 is considered to be a reduction in bone mass, and a score of 30 or less can be diagnosed as osteoporosis. In other words, from the bone density values, the first is the lower of the normal value, then the bone loss, and finally must reach a considerable degree to be considered osteoporosis. Many elderly people do have osteoporosis, but it is strictly within the range of bone loss, and if no osteoporotic fracture has occurred, then osteoporosis cannot yet be directly diagnosed. Therefore, it is right to raise awareness of osteoporosis, which is also the goal of the popularization of science; however, it is not necessary to see “osteoporosis” on the grass, which requires a formal bone density test to determine. However, is it okay if you haven’t reached osteoporosis? No, it is not. If there is already a reduction in bone mass, a reduction in height of more than 3 cm, a history of fractures, premature menopause, or a history of osteoporotic fractures in the mother’s side of the family, etc., you have risk factors and need to start standardized treatment for osteoporosis. These risk factors can be easily determined using the International Osteoporosis Foundation’s (IOF) one-minute self-assessment chart (see attached), or by seeking help from a doctor to determine them. Myth #2: Is treating osteoporosis all about taking calcium pills? You can often see commercials on TV, as if taking certain calcium tablets will completely cure osteoporosis and you can rest easy. Is the treatment of osteoporosis really that simple? Osteoporosis is a systemic metabolic bone disease characterized by reduced bone strength and a sparser and more fragile bone microarchitecture, the immediate consequence of which is a greatly increased risk of fracture. Bone tissue is composed of bone cells and matrix, in which calcium does play a very important role, but it does not mean that increasing calcium intake will improve bone strength, which is a completely different concept. Treatment of osteoporosis includes basic therapeutic measures such as a calcium-rich diet, more sun exposure, weight-bearing walking, and reducing the intake of alcohol, tobacco, and coffee; however, these measures are not enough for the treatment of the disease, and regular anti-osteoporosis medication must be administered. The first is calcium supplementation, because according to our Chinese diet, the calcium provided by the existing diet is not enough to treat osteoporosis, so 600-800mg of calcium is needed daily; this is the theoretical basis of “taking calcium tablets”. In addition to calcium supplements, the second type of medication is vitamin D, especially active vitamin D. Vitamin D is now recognized as an important regulator of calcium and phosphorus metabolism, and is so important for neuromuscular coordination in the elderly that some doctors have elevated its status to that of a human hormone. Both calcium and vitamin D are basic in the pharmacological treatment of osteoporosis and are generally indispensable. The third category of drugs is the regulation of the function of osteoblasts or osteoclasts of bone metabolism, specifically, drugs that inhibit osteolysis or promote osteogenesis. In clinical practice, the main drugs are bisphosphonates represented by alendronate and zoledronic acid, osteoclast-inhibiting drugs such as calcitonin and estrogen modulators, and osteogenic drugs such as parathyroid hormone fragments. These drugs play a major role in the treatment of osteoporosis and generally have to be used for a long time, requiring patients to strictly follow medical advice, take the drugs regularly and review them on a regular basis. Therefore, taking calcium tablets is only part of the standardized anti-osteoporosis treatment and its role is limited. Large-scale clinical studies abroad have shown that even if calcium and vitamin D are taken on a regular basis, they are ineffective in preventing fractures if anti-breaking or bone-enhancing drugs are not taken regularly. So, it is right to take calcium tablets, but it is not enough to rely on them to treat osteoporosis. Osteoporosis is a quiet beast that must be recognized and understood, along with sufficient weapons to tame it. It is urgent to get out of the misunderstanding and to diagnose and treat it scientifically.