Medical experts talk about popular science | A silent epidemic - osteoporosis

| The left picture shows the state of osteoporosis

Osteoporosis is a systemic, metabolic bone disease characterized by low bone mass and damage to the microstructure of bone tissue, which leads to increased bone brittleness and susceptibility to fractures. Osteoporosis can occur at any age, but is more common in postmenopausal women and elderly men. It has no unique clinical manifestations and may not cause any discomfort in the early stages, so osteoporosis is also called a "silent disease."

At present, the number of osteoporosis patients aged ≥50 years in my country is close to 70 million, accounting for more than 20% of the population in the same age group. 50% of early osteoporosis patients have no obvious symptoms, and patients usually discover the existence of osteoporosis when a fracture occurs. In addition, 70-80% of middle-aged and elderly fracture patients in my country are often accompanied by osteoporosis. Once an osteoporotic brittle fracture occurs, it means a high mortality rate. Studies have shown that the number of deaths caused by osteoporotic fractures is greater than the total number of deaths caused by myocardial infarction, stroke, and breast cancer. The harm caused by an osteoporotic fracture is equivalent to the harm caused by a stroke or myocardial infarction. The mortality rate of patients in the first year after the fracture is 20%~25%. The direct economic burden of each patient with osteoporotic hip fracture is RMB 32,776 per year, and the direct economic burden of osteoporotic hip fracture patients in my country is as high as RMB 108 billion per year.

For China, where the aging process is accelerating, the situation of osteoporosis prevention and treatment is becoming more severe. The current status of osteoporosis prevention and treatment in China can be summarized as "three deficiencies": lack of correct understanding of the harmfulness of osteoporosis, lack of correct understanding of osteoporosis prevention and treatment methods, and lack of correct understanding of potential osteoporosis risk factors.

| Why does osteoporosis occur? ——The causes of osteoporosis

1. Genetic factors: Osteoporosis is more common in white people, especially Northern Europeans, followed by Asians, and less common in blacks. It also includes a family history of fragility fractures.

2. Age factors: Elderly people over 70 years old and women after menopause have lower estrogen levels, which in turn causes an imbalance in bone metabolism and increases the risk of osteoporosis.

3. Unhealthy lifestyle: Smoking, excessive drinking, unbalanced diet, calcium and/or vitamin D deficiency are all risk factors for osteoporosis.

4. Diseases that affect bone metabolism: hypogonadism and common rheumatic and immune diseases, etc.

5. Drugs that affect bone metabolism: Common drugs such as glucocorticoids, anti-epileptic drugs, aromatase inhibitors, gonadotropin-releasing hormone analogs, antiviral drugs, thiazolidinediones, proton pump inhibitors and excessive thyroid hormones can affect bone health, reduce bone formation and increase bone destruction.

| Risk factors for osteoporosis

In summary, the risk factors for osteoporosis include genetic factors and environmental factors. Fractures are a serious consequence of osteoporosis, and there are also many extra-skeletal risk factors associated with fractures. Therefore, everyone should have a full and correct understanding of the risk factors related to osteoporosis, and try to avoid these risk factors in life, so as to improve everyone's quality of life.

| Who should pay attention to osteoporosis? ——Symptoms of osteoporosis

Myth: Osteoporosis is only for the elderly. I am still young and don’t need to worry.

Osteoporosis can also occur in young and middle-aged people, and even idiopathic juvenile osteoporosis can occur. In fact, it is never too early to start preventing and treating osteoporosis. Young and middle-aged people should increase their peak bone mass, increase bone mass reserves, and improve their tolerance to bone loss, so as to prevent osteoporosis in middle-aged and elderly people.

| Populations prone to osteoporosis

| What are the symptoms when osteoporosis occurs?

1. Pain: Back pain or whole body bone pain may occur. The pain usually occurs when turning over, sitting up, or walking for a long time. The pain worsens at night or during weight-bearing activities, and may be accompanied by muscle spasms and even limited movement. Usually, when we experience pain, we should pay attention to our bone health and seek medical attention as soon as possible.

2. Spinal deformity: Severe osteoporosis patients may have spinal deformities such as shortened height or hunchback. Multiple thoracic vertebrae compression fractures can lead to chest deformity; severe lumbar vertebrae compression fractures may lead to abnormal abdominal organ function, causing constipation, abdominal pain, bloating, loss of appetite and other discomforts.

3. Fractures: Common sites are vertebrae (thoracic and lumbar), hips (proximal femur), distal forearms and proximal humeri. After an osteoporotic fracture occurs, the risk of re-fracture increases significantly.

In fact, osteoporosis usually has no obvious clinical manifestations in the early stages. However, as the disease progresses, bone mass continues to be lost, bone microstructure is destroyed, and patients will experience bone pain, spinal deformity, and even osteoporotic fractures. In addition, osteoporosis patients may experience multiple symptoms at the same time. Therefore, in addition to paying attention to the risk factors of osteoporosis in daily life, you should also pay attention to changes in your own health status in a timely manner, conduct regular bone examinations, and seek medical attention as soon as the above symptoms appear.

| Symptoms of osteoporosis

| How can I be sure if I have osteoporosis? —— Screening and testing for osteoporosis

It should be noted that osteoporosis can only be called osteoporosis when the medical history, risk factors, clinical manifestations, imaging examinations, bone density measurements, and laboratory tests are combined to indicate osteoporosis, and when there are clinical manifestations. Therefore, regular physical examinations and examinations of bone density (i.e. bone mineral density, BMD) by dual-energy X-ray absorptiometry (DXA) in hospitals with conditions are of great significance for a preliminary understanding of one's own bone condition and timely attention to one's own bone health status.

| Dual-energy X-ray examination of osteoporosis

| How can we effectively prevent and treat osteoporosis? ——Prevention and treatment of osteoporosis

Strong bones are the key to maintaining human health. The prevention and treatment of osteoporosis should be carried out throughout life. Osteoporotic fractures increase disability or mortality, so the prevention and treatment of osteoporosis are equally important. Regarding the prevention and treatment of osteoporosis, we may have the following misunderstandings:

Myth 1: To prevent and treat osteoporosis, I drink bone soup to supplement calcium.

In fact, only 20 mg of calcium is extracted from 1 catties of meat bones after 2 hours of steaming. The daily calcium requirement of our body is 800 mg, which means we need to stew 40 catties of bones every day and drink the stewed soup within 1 day. In addition, bone soup contains a lot of fat, and long-term excessive intake will increase the risk of cardiovascular and cerebrovascular diseases and diabetes.

Myth 2: I was diagnosed with osteoporosis, so I should start taking calcium tablets.

You can supplement some calcium and vitamin D by taking calcium tablets, but for patients with moderate to severe osteoporosis, calcium supplementation alone is not enough. We also need to carry out standardized treatment with targeted diet, exercise and anti-osteoporosis drugs.

Myth 3: Since osteoporosis is prone to fractures, I will just sit or lie down at home.

Everything has its limits. Excessive immobilization can lead to a decline in human body function. Long-term bed rest or inactivity can lead to muscle disuse atrophy and accelerated bone loss, further aggravating the symptoms of osteoporosis.

| Foods rich in calcium

| How should we prevent and treat osteoporosis effectively, systematically and in a standardized manner?

1. Strengthen nutrition and eat a balanced diet: It is recommended to consume a balanced diet rich in calcium, low in salt and appropriate amount of protein. The recommended daily protein intake is 0.8-1.0g/kg.

2. Sufficient sunlight: to promote the synthesis of vitamin D in the body. 11:00-15:00, 15-30 minutes each time, twice a week, avoid strong direct sunlight to prevent skin burns.

3. Regular exercise: Exercise suitable for osteoporosis patients includes weight-bearing exercise and resistance exercise. Regular weight-bearing and muscle strength training are recommended to reduce the risk of falls and fractures. Exercises such as walking, jogging, Tai Chi, yoga, dance and table tennis can enhance physical fitness.

4. Basic treatment: Add basic supplements for bone health, such as calcium and vitamin D. Supplementing calcium and vitamin D at the same time can reduce the risk of osteoporotic fractures.

5. Quit smoking, limit alcohol consumption, avoid excessive coffee and carbonated beverages, and try to avoid or use less drugs that affect bone metabolism.

6. Prevent falls: Especially the elderly with poor legs and feet should be extra careful not to fall.

7. Take anti-osteoporosis drugs regularly: For patients with moderate to severe osteoporosis, adjuvant treatment is required through drug intervention. After a clear diagnosis of osteoporosis, take anti-osteoporosis drugs regularly as prescribed by the doctor. Drugs with a broad anti-fracture spectrum (such as alendronate sodium) are usually preferred. For those with low and moderate fracture risk (such as young postmenopausal women with low bone density but no history of fracture), oral drug treatment is the first choice. For those who cannot tolerate oral medication, have contraindications, have poor compliance, and have a high risk of fracture, injectable preparations can be considered.

The above is about the prevention and treatment of osteoporosis. In view of the fact that osteoporosis is not obvious in the early stage, prevention and treatment are particularly important. In daily life, we should pay more attention to our living habits, maintain a good diet, exercise outdoors more often, control tobacco and alcohol, and go to the hospital for regular physical examinations. At the same time, the elderly and postmenopausal women should be more vigilant. Only by doing a good job of preventing osteoporosis can everyone be healthier and have a better quality of life.

Author | Qin Yanguo

Professor, chief physician, doctoral supervisor, dean of the Second Hospital of Jilin University and deputy director of the Orthopedic Medical Center. Won the title of "National Advanced Individual in Fighting the COVID-19 Epidemic", and the Young and Middle-aged Scientific and Technological Innovation Leader of the Ministry of Science and Technology. Director of the Jilin Provincial Key Laboratory of Orthopedic Precision Surgery, Director of the Jilin Provincial Advanced Materials Medical Translation Engineering Research Center, Deputy Director of the Jilin Provincial Bone and Joint Disease Clinical Medical Research Center, and Deputy Director of the Jilin Provincial 5G Medical Application Science and Technology Innovation Center. Member of the Joint Group and Youth Member of the Orthopedic Branch of the Chinese Medical Association, Vice Chairman of the Youth Committee of the Digital Medicine Branch of the Chinese Medical Association, Standing Member of the Scientific Research and Publishing Working Committee of the Chinese Medical Doctor Association, and Member of the Orthopedic Physician Branch of the Chinese Medical Doctor Association.

In recent years, the research has focused on the application of minimally invasive precision surgery of bones and joints and digital medical technology in the field of orthopedics. It mainly focuses on the application of metal 3D printing structure configuration and surface functionalization in bone tissue engineering; artificial intelligence-assisted diagnosis of bone and joint diseases; 5G and artificial intelligence and other advanced scientific and technological applications in the construction of public health systems, the construction of smart hospitals-medical alliances, and the application and clinical transformation of multidisciplinary remote joint diagnosis and treatment of complex diseases. He has won 2 first prizes in Jilin Province Science and Technology Progress, 2 Chinese Medical Science and Technology Awards, and 6 digital intelligent medicine-related invention patents authorized by the first inventor, including 1 international invention patent.

| Discipline Introduction

As the leading discipline in Northeast China, the Orthopedic Medical Center of the Second Hospital of Jilin University covers the Orthopedic Clinical Diagnosis and Treatment Center, the Orthopedic Teaching and Research Section, and the Orthopedic Research Institute, integrating medicine, teaching, and research. The Orthopedic Clinical Diagnosis and Treatment Center consists of multiple subspecialties such as joint surgery, spine surgery, trauma surgery, sports medicine, foot and ankle and repair and reconstruction surgery. The Orthopedic Research Institute has been approved as the Jilin Provincial Orthopedic Research Institute, the Jilin Provincial Clinical Medical Research Center for Bone and Joint Diseases, the Jilin Provincial Digital Medicine Clinical Translation Engineering Research Center, the Jilin Provincial Digital Medicine Science and Technology Innovation Center, the Jilin Provincial Digital Orthopedics International Joint Research Center, the Jilin Provincial Key Laboratory of Orthopedic Precision Surgery, and the Jilin Provincial Advanced Materials Medical Translation Engineering Research Center.