'Silent Killer' - Osteoporosis

'Silent Killer' - Osteoporosis

Ji TuInstitute of Basic Medical Sciences, Chinese Academy of Medical [email protected]

What is osteoporosis?

Osteoporosis is a systemic disease and the most common bone disease in the elderly. The main characteristics of osteoporosis are low bone mineral content, bone structure destruction, reduced bone strength, and easy fractures. Pain, hunchback, height loss and fractures are characteristic manifestations of osteoporosis. However, many osteoporosis patients often have no obvious symptoms in the early stages of the disease. They are often found to have osteoporosis after a fracture occurs through imaging examinations such as X-rays or bone density tests. Therefore, osteoporosis is also called the silent killer.

Osteoporosis is the fourth most common chronic disease. Fractures are the direct consequence of osteoporosis. In mild cases, it affects the body's functions, and in severe cases, it causes disability or even death. Osteoporotic fractures are brittle fractures that usually occur after daily weight bearing, activities, bending over, and falling. Common fracture sites are the lower back, hips, and arms. The mortality rate due to various complications within the first year after hip fracture reaches 20-25%. More than 50% of the survivors will have varying degrees of disability. The direct economic burden of a patient with osteoporotic hip fracture is RMB 32,776 per year. The direct economic burden of osteoporotic hip fractures in China is RMB 108 billion per year.

In March 2021, Yuan Longping fell at the Sanya Hybrid Rice Research Base, resulting in a fracture of the left femoral trochanter, and then the old man's health deteriorated rapidly. Bed rest after the fracture became the fuse for aggravating cardiopulmonary disease, and gradually developed into multiple organ failure. Two months later, the respected Mr. Yuan unfortunately passed away.

Schematic diagram of greater trochanter fracture site

Influencing factors and high-risk groups of osteoporosis

Osteoporosis is affected by both congenital and acquired factors. Congenital factors refer to race, gender, age and family history; acquired factors include drugs, diseases, nutrition and lifestyle. Aging, menopause in women and sexual dysfunction in men are all causes of osteoporosis.

People with the following factors are at high risk of osteoporosis: old age; menopause in women; maternal family history (especially family history of hip fracture); low body weight; low sex hormones; smoking; excessive alcohol or coffee consumption; lack of physical activity; dietary calcium and/or vitamin D deficiency (low sunlight or intake); diseases that affect bone metabolism; and use of drugs that affect bone metabolism.

How to prevent and treat osteoporosis?

Osteoporosis is preventable and treatable. In recent years, the focus of prevention and treatment of osteoporosis has gradually shifted from treating the disease itself and its complications to early intervention and active management of osteoporosis risk factors. Early and correct diagnosis is very important for the effective treatment of osteoporosis and the prevention of osteoporotic fractures. People of all ages should pay attention to the prevention of osteoporosis. The lifestyle of infants, young children and young people is closely related to the occurrence of osteoporosis. The mineral content in human bones reaches its highest in the 30s, which is medically called peak bone mass. The higher the peak bone mass, the more reserves in the "bone mineral bank" in the human body, and the later the onset of osteoporosis in old age and the milder the degree. Actively improving diet and lifestyle in old age and insisting on calcium and vitamin D supplementation can prevent or reduce osteoporosis.

Dual-energy X-ray bone density test

The prevention and treatment of osteoporosis must be carried out under the guidance of a doctor, and its prevention and treatment strategies include basic measures and drug treatment.

Basic measures include lifestyle modifications and basic supplements for bone health.

(1) Adjust your lifestyle:

Increase the intake of calcium and appropriate amount of protein in the diet, and eat a low-salt diet. Calcium intake plays an irreplaceable role in preventing osteoporosis.

Pay attention to proper exercise. The human body's bone tissue is a living tissue. The activity of muscles during exercise will constantly stimulate the bone tissue and make the bones stronger. Exercise can also help enhance the body's responsiveness, improve balance function, and reduce the risk of falling.

Avoid smoking, drinking, etc. Smoking, drinking, excessive intake of caffeine and high-phosphorus beverages will increase the risk of osteoporosis.

Increase sunlight exposure. The vitamin D in Chinese people's diet is very limited. A large amount of vitamin D3 depends on the skin to be synthesized after being exposed to ultraviolet rays from the sun. Regular exposure to sunlight plays a very critical role in the production of vitamin D and calcium absorption. The average normal person gets at least 20 minutes of sunlight per day.

Be careful when using drugs that affect bone metabolism. Long-term use of hormone drugs, anti-epileptic drugs, antidepressants, etc., as well as thyroid disease, kidney disease and other diseases, will also increase the possibility of osteoporosis.

(2) Basic supplements for bone health:

Calcium and vitamin D. For people who don’t get enough calcium and vitamin D through their diet, calcium and vitamin D supplements may be considered.

Drug treatment includes anti-bone resorption drugs, bone formation promoting drugs and some multi-mechanism drugs, such as bisphosphonates and metformin (Teriparatide), etc. These drugs need to be used under the guidance of a doctor, and the specific treatment plan should be adjusted according to individual conditions.

Quantitative ultrasound calcaneal bone density test

High-risk groups should go to regular hospitals for osteoporosis testing as early as possible to achieve early diagnosis, early prevention, and early treatment. The key to preventing osteoporosis lies in a healthy lifestyle and eating habits. Regular physical examinations and timely intervention are also very important. If you are at high risk of osteoporosis, you should take preventive measures as soon as possible to avoid the occurrence and development of osteoporosis, which can minimize the risk of fractures, relieve symptoms such as bone pain, and improve the quality of life.

References:

[Clinical research progress | Union Hospital launches prospective treatment study for osteoporosis refracture] (https://ims.pumch.cn/detail/31250.html. )

[Involutional Osteoporosis]

(https://www.sciencedirect.com/topics/medicine-and-dentistry/involutional-osteoporosis.)

[Defeat osteoporosis, the National Health Commission teaches you how to prevent and control it] (http://health.people.com.cn/GB/n1/2018/1019/c14739-30352045.html)

[Things about osteoporosis] (http://www.nhc.gov.cn/interview/webcontroller.do?titleSeq=23761)