Director Wang Liang: Osteoporosis should be screened and prevented early

Every 3 seconds, there is an osteoporotic fracture.

Osteoporosis is a systemic bone disease characterized by low bone mass and destruction of bone tissue microstructure, leading to increased bone fragility and susceptibility to fractures.

The biggest damage of osteoporosis is osteoporotic fractures, and the most common fracture sites include the spine, hip and forearm. In particular, hip fractures are called the last fracture in life. The mortality rate of hip fractures within one year is as high as 20%, and the disability rate is as high as 80%. The International Osteoporosis Foundation reported in 2013: Every 3 seconds, there is an osteoporotic fracture in the world.

Osteoporosis often has no obvious clinical manifestations in the early stages. Most people only discover the problem after experiencing pain, spinal deformity, or even fractures. As a result, most people miss the best period for osteoporosis prevention and treatment. Director Wang Liang from the Department of Geriatrics at the Eighth Medical Center of the General Hospital of the Chinese People's Liberation Army shared with you content related to the prevention and treatment of osteoporosis.

01. What are the causes of osteoporosis?

It is very important to understand the risk factors of osteoporosis so that you can choose the right group for the right disease. The more risk factors you have, the greater the possibility of developing osteoporosis, so you need to be screened as early as possible.

The risk factors for osteoporosis are divided into uncontrollable factors and controllable factors.

Uncontrollable factors

Race (whites and Asians are at higher risk of osteoporosis than blacks), thin physique, elderly people, women who stop menstruating early (before 40 years old), and those with a family history of fragility fractures.

Controllable factors

Controllable factors include weight, bad living habits, related diseases, medications used, etc. Among them, the most common disease-related factors are endocrine system diseases, rheumatic immune system diseases, digestive system diseases, and neuromuscular system diseases.

Common diseases that cause osteoporosis

Endocrine diseases. Including: diabetes, hyperparathyroidism, hyperthyroidism, primary hyperparathyroidism, hypopituitarism, hypogonadism, Cushing's syndrome, anorexia nervosa, androgen resistance syndrome, hypercalciuria, etc.

Rheumatic and immune diseases. Including: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis.

Digestive system diseases. Including: inflammatory bowel disease, malabsorption, chronic liver disease, gastrointestinal bypass or other surgery, pancreatic disease, celiac disease, etc.

Neuromuscular diseases. Including: epilepsy, Alzheimer's disease, Parkinson's disease, multiple sclerosis, spinal cord injury, muscular atrophy, etc.

Blood system diseases. Including: multiple myeloma, lymphoma, leukemia, monoclonal immunoglobulin disease, hemophilia, sickle cell anemia, systemic mastocytosis, thalassemia, etc.

Other diseases. Including: moderate to severe chronic kidney disease, asthma, chronic metabolic acidosis, chronic obstructive pulmonary disease, organ transplantation, congestive heart failure, depression, acquired immunodeficiency syndrome, amyloidosis, etc. In addition, patients with a history of gynecological surgery, such as women with hysterectomy or oophorectomy, will have early menopause and should prevent the occurrence of osteoporosis.

Related drugs. Such as glucocorticoids, gonadotropin receptor agonists; proton pump inhibitors; barbiturates; antiviral drugs; long-term antidepressants; thyroid hormones; anticoagulants (heparin); anti-epileptic drugs; tumor chemotherapy drugs, etc., will increase the incidence of osteoporosis, especially glucocorticoids.

02. Classification of osteoporosis

Osteoporosis is divided into two categories: primary and secondary .

Primary osteoporosis includes postmenopausal osteoporosis (type I), senile osteoporosis (type II) and idiopathic osteoporosis (including juvenile type).

Secondary osteoporosis refers to osteoporosis caused by any disease and/or drug that affects bone metabolism and other clear causes.

03. Methods for assessing osteoporosis risk

The IOF osteoporosis risk one-minute test is based on the patient's brief medical history, from which questions related to osteoporosis are selected, and the patient is asked to judge whether they are correct or not, so as to preliminarily screen out patients who may be at risk of osteoporosis. This test is simple, fast and easy to operate, but it can only be used as a preliminary screening of disease risks and cannot be used for the diagnosis of osteoporosis. The specific test questions are as follows.

International Osteoporosis Foundation (IOF) Osteoporosis Risk One-Minute Quiz

Did any of your parents break their hips from a minor bump or fall?

Have you ever injured your bones from a minor bump or fall?

Do you often take hormonal drugs such as cortisone and prednisone for more than 3 consecutive months?

Have you lost 3 cm in height?

Do you often drink excessively?

Do you smoke more than 20 cigarettes a day?

Do you suffer from dysentery and diarrhea frequently?

Women's answer: Did you go through menopause before the age of 45?

Have you ever had no menstrual periods for more than 12 consecutive months (except during pregnancy)?

Men Answer: Are you suffering from symptoms of erectile dysfunction or lack of sexual desire?

If the answer to any one of the above 10 questions is "yes", it is positive and you should go to the hospital in time to test the dual-energy X-ray bone density to confirm whether you have osteoporosis.

Osteoporosis Self-Screening Tool for Asians

OSTA is based on a study of postmenopausal women in eight Asian countries and regions. It collects multiple osteoporosis risk factors and conducts bone density measurement to obtain two simple screening indicators, namely age and weight. The calculation method is: (weight kg - age) × 0.2, and the results are evaluated as follows:

▶A result greater than -1 indicates a lower risk of osteoporosis

▶A result less than -4 indicates high risk and treatment should be started as soon as possible

▶The result is between -1 and -4, which indicates medium risk. It is recommended to consult a hospital and take precautions.

OSTA mainly screens the risk of osteoporosis based on age and weight, but it should be pointed out that OSTA uses too few indicators and its specificity is not high. It needs to be judged in combination with other risk factors and is only applicable to postmenopausal women.

04. Diagnosis of osteoporosis

Dual-energy X-ray absorptiometry (DXA) measurement is the current gold standard for diagnosing osteoporosis. In April 2022, ACOG released a new guideline for the treatment of postmenopausal osteoporosis, which mentioned that dual-energy X-ray absorptiometry (DXA) is the preferred test method for identifying bone loss and assessing fracture risk.

The diagnostic criteria for osteoporosis are based on the T-score results measured by DXA. The measurement sites are mainly the lumbar spine and proximal femur. If the measurement of the lumbar spine and proximal femur is limited, the distal 1/3 of the radius on the non-dominant side can be selected. The classification criteria for DXA bone density measurement published by WHO: T-score ≥ -1, normal bone mass; -2.5 < T-score < -1, bone loss; T ≤ -2.5, osteoporosis; T ≤ -2.5+, brittle fracture, severe osteoporosis.

Recommendation: Men over 50 years old and postmenopausal women should routinely undergo dual-energy X-ray absorptiometry or quantitative CT (QCT) testing at least once a year to diagnose osteoporosis.

The bone mass of the body increases with age from birth, reaching a peak at around 20 to 30 years old, and then gradually decreases. Exercise can promote the full absorption of elements such as vitamin D, reduce bone loss, and delay the occurrence and development of osteoporosis. It is recommended to increase weight-bearing exercise appropriately, that is, the bones must bear the body or other additional weight during exercise (such as brisk walking, jogging, and lifting dumbbells, barbells, etc.), to help improve muscle strength, enhance bone density, effectively prevent falls, and avoid fractures.

Expert Profile

Wang Liang

Chief Physician, The Eighth Medical Center, PLA General Hospital

Doctor of Medicine in Endocrinology and Metabolism, studied under Professor Pan Changyu,

Director of the Department of Geriatrics of the Eighth Medical Center of the General Hospital of the People's Liberation Army of China, chief physician, and enjoys the post allowance for outstanding professional and technical personnel in the entire army.

He is currently the chairman of the Osteoporosis Branch of the China Association for International Exchange and Promotion of Medical Health Care, vice chairman and secretary-general of the Osteoporosis Branch of the Chinese Society of Gerontology and Geriatrics, standing committee member and leader of the community group of the Osteoporosis and Bone Mineral Disease Branch of the Beijing Medical Association, deputy editor-in-chief of the "Chinese Osteoporosis Journal", editor-in-chief of the "Medical Reference News - Osteoporosis Special Issue", and editor-in-chief of the Youth Editorial Committee.

He has undertaken or participated in 13 national, military and provincial and ministerial projects, won one first prize and one second prize in China Medical Science and Technology, three third prizes in military medical achievements, the 2015 China Pharmaceutical Development Award Kangchen Outstanding Young Scholar Award in Osteoporosis Medical Research, edited or co-edited nine monographs, and published more than 130 papers and articles in domestic and foreign journals.