Among the risks of osteoporosis, this is the most easily overlooked! Some people consider thinness beautiful when they are young, but become "brittle bones" when they are old.

What is the relationship between osteoporosis and weight? How to supplement calcium after osteoporosis? Will calcium supplementation cause stones? Do you know little about osteoporosis or do you have "100,000 questions"?

October 20 is World Osteoporosis Day. It is estimated that there are about 90 million people suffering from osteoporosis in my country, of which about 70 million are women. However, even after a fragility fracture occurs, the treatment rate of osteoporosis is only 30%.

The prevalence rate is high, but the awareness rate, diagnosis rate and treatment rate are low. "One high and three lows" is the dilemma faced by the prevention and treatment of osteoporosis in my country.

Since the beginning of this year, the Zhejiang Big Health Famous Doctors Live Broadcast Room of Chao News has launched the "For Healthy Bones" series of live broadcasts, inviting experts in the fields of orthopedics and endocrinology in the province to enter the live broadcast room to continue popularizing health secrets for the prevention and treatment of osteoporosis and common misunderstandings. On the occasion of World Osteoporosis Day, we have sorted out these popular science keywords and presented everyone with a guide to the prevention and treatment of osteoporosis.

Being too fat or too thin can lead to osteoporosis

The theme of this year's World Osteoporosis Day is "Manage your weight, strengthen your bones." What is the relationship between osteoporosis and weight?

Dr. Zhongli Shi, an osteoporosis specialist at the Second Affiliated Hospital of Zhejiang University School of Medicine, said that in outpatient clinics, doctors will ask patients to fill out an osteoporosis self-test form, which contains 10 osteoporosis risk factors. "Weight is often the most easily overlooked factor."

"Being too thin or too fat can easily lead to osteoporosis." Shi Zhongli explained that, firstly, thin people have less fat, lower estrogen levels, increased osteoclast activity, and lower bone density than normal people; secondly, thin people are lighter, and their bones are weaker and more fragile. Thinner women also have lower muscle reserves. As they age, their muscle mass decreases rapidly, and bone mass is lost even faster after menopause. In addition, people with light weight will also have reduced muscle strength and coordination. If they lack exercise, muscle loss will accelerate as they age, and the probability of osteoporosis is also high.

Although obese people have abundant fat reserves, some people believe that this can promote bone formation, prevent osteoporosis, and reduce the risk of fractures. However, obesity can also lead to high expression of multiple pro-inflammatory factors, enhance osteoclast activity, increase bone resorption, reduce bone mass, and cause osteoporosis. Therefore, to prevent osteoporosis and maintain bone health, it is necessary to keep the body mass index within a normal range. Being too thin or too fat is not good.

If you suddenly become shorter or your teeth become loose, you should pay attention to it.

“Why did I break my bones?”

This is a question that Zhu Daan, chief physician, and Xie Jianxin, deputy chief physician, of the Department of Orthopedics at Shaoxing Central Hospital, are often asked by patients in the outpatient clinic. "By the time a fracture occurs, many people have actually suffered from osteoporosis for a long time, but it was not discovered in time."

Osteoporosis has precursors: for middle-aged and elderly people, especially women before and after menopause, they may suddenly experience back pain, a sharp decrease in height in a short period of time, their teeth may suddenly become loose, and they may be unable to chew food.

"Bones are like the load-bearing walls of the human body. When osteoporosis occurs, they cannot bear the body's weight. The weight will be dispersed outside the spine, especially the muscle tissue around the spine, causing pain in the waist and back," explained Zhu Da'an.

Zhu Da'an once treated an aunt in her 50s. She felt pain in her lower back and waist after a bumpy ride on a bus. Two days later, the pain was so severe that she couldn't get out of bed. She went to the hospital and was found to have a fracture.

"She had a mild compression fracture of the 12th thoracic vertebra. After the diagnosis, she still didn't believe it, saying: I didn't fall, how could I have a fracture?" Zhu Da'an explained that people in their 50s and 60s who suddenly have unexplained back pain, and who have no pain when lying down or getting up, but are particularly painful when getting up, are most likely to have osteoporosis fractures. "We performed a bone cement (percutaneous vertebroplasty) surgery on her, and she can move freely after the surgery, but we also reminded her that the root cause is osteoporosis, and intervention treatment is necessary, otherwise there will be a risk of fractures in the future."

Precisely because of this, Zhu Da'an suggested that middle-aged and elderly people should promptly self-check their bone mass and intervene early.

She almost became "brittle" because she easily "interrupted treatment"

Is calcium supplementation enough for osteoporosis? This is another question Xie Jianxin is often asked.

"Calcium supplementation is necessary, but it cannot be just calcium supplementation. Generally speaking, calcium and vitamin D should be supplemented together. For patients with moderate to severe osteoporosis, medication is also needed."

Xie Jianxin explained that after calcium supplementation, calcium ions will not actively move into the bones. To put it simply, drugs can help move calcium ions into the bones.

Shi Zhongli also often reminds patients that once they are diagnosed with osteoporosis and have suffered a fracture, they must receive standardized treatment and persist in treatment.

Recently, she just received an old patient, 71-year-old Aunt Fang. When she was young, Aunt Fang considered thinness as beauty. After retirement, she suffered from recurrent back and leg pain and was diagnosed with low bone density. Four years ago, Aunt Fang was diagnosed with osteoporotic fracture after an accidental fall.

After two years of anti-osteoporosis treatment, her bone density T value (less than -2.5 is osteoporosis) rose from -3.0 to -2.6, her waist pain was gone, and her bone density was close to normal. She thought she was well, so she stopped taking the medicine and did not go for follow-up examinations. A few months ago, she felt back pain again and came for another check-up.

Looking at the bone density of -3.5 on Aunt Fang's report, Shi Zhongli murmured to herself that, generally speaking, patients who adhere to standardized anti-osteoporosis treatment will not experience such a drastic drop in bone density.

Looking through Aunt Fang's previous medical records, we found out that she had "given up treatment". In the past two years, she only took calcium and vitamin D supplements on a daily basis, and did not keep up with sun exposure and outdoor exercise. Her blood calcium level was also low, her bones became more and more "brittle", and she became thinner and thinner, weighing only more than 80 kilograms. Due to the rapid loss of bone mass, she also had a serious hunchback. When she was young, she was more than 166 cm tall, but now she is only about 150 cm tall.

"If you continue like this, your bones will be so fragile that they won't even be able to support their own weight!" Shi Zhongli told Aunt Fang seriously that osteoporosis usually requires a course of treatment of up to 3 to 5 years, and after starting the treatment this time, she is not allowed to stop taking the medicine without permission.

She also reminded everyone that regardless of whether they have symptoms or not, once they are diagnosed with osteoporosis and have suffered a fracture, they must receive standardized treatment, persist in treatment, and undergo regular check-ups.

How to supplement calcium for osteoporosis? Will it cause stones?

Some patients also ask, will calcium supplementation cause stones in the body?

"As long as you take calcium supplements in a standardized and reasonable manner under the guidance of a doctor, this problem will not occur." Xie Jianxin explained that the more calcium you take, the better. If you take calcium supplements in excess, stones will indeed precipitate in the gallbladder, kidneys and other parts of the body. "If you take more calcium supplements, you can also do regular blood calcium and urine calcium tests."

Regarding how to supplement calcium, Song Baishan, a member of the Party Committee and vice president of Zhejiang Hospital, also wants to clarify a misunderstanding: many people do not pay attention to calcium intake after adulthood. "In fact, people in their thirties and forties are at their physiological peak. At this stage, more calcium should be stored in advance to cope with the loss later. Although a calcium tablet is large in size, only about 20% to 30% can be absorbed by the human body. Calcium absorption mainly depends on the participation of vitamin D3, so the two should be taken together."

Song Baishan also mentioned that the younger age of osteoporosis in recent years is mainly due to secondary factors, which are closely related to insufficient calcium intake and improper diet during lactation and pregnancy. Office workers stay up late and are used to drinking coffee, which can affect the absorption of calcium by the gastrointestinal tract. Some women do too much sun protection, and the body's inability to absorb ultraviolet rays can also affect the synthesis of vitamin D, leading to calcium deficiency.

How to prevent osteoporosis? Shi Zhongli suggested that in terms of diet, people should eat more seafood, soy products, and dairy products to supplement protein, calcium, and vitamin D. If the daily diet does not meet the standard, then you can supplement it with medication; in terms of exercise, you should insist on outdoor exercise, and recommend jogging, brisk walking, and more sun exposure. "Some osteoporosis patients are afraid to exercise, but this is not true. Exercise can promote the deposition of calcium in the bones, enhance muscle strength, improve balance, and prevent the recurrence of osteoporotic fractures."