Preventable, controllable and curable! Everything you need to know about osteoporosis

If you pay attention to the cases around you, you will find that more and more people are suffering from osteoporosis in recent years. If it is not handled properly, it will have many impacts on the patient's life. Osteoporosis is a preventable, controllable and curable disease. Let's learn about osteoporosis together.

I. Overview

Osteoporosis (OP) is a systemic, metabolic bone disease characterized by a progressive decrease in bone mass, skeletal brittleness, and susceptibility to fractures. It is one of the basic diseases that has long plagued patients in modern society. Clinically, it is mainly manifested by bone loss and degeneration of bone tissue microstructure. Clinically, there are two common types of OP according to the cause: primary OP and secondary OP. Primary OP is further divided into idiopathic OP, type I (postmenopausal OP) and type II (senile OP). Secondary OP refers to any OP that affects bone metabolism due to disease or drugs and other OP with clear causes.

The three main risk factors for OP are: long-term lack of exercise, decreased hormone levels with age, and an unreasonable diet. Exercise and proper physical activity help prevent and treat bone loss and osteoporosis. It is not only convenient, safe and economical, but also has other health effects, such as improving balance, increasing muscle strength and endurance, preventing falls, and reducing the incidence of fractures caused by osteoporosis.

my country's current average life expectancy is increasing, and the aging trend is becoming increasingly serious, making osteoporosis an important issue affecting human health. Due to the complex etiology of osteoporosis, such as aging and decreased sex hormone secretion, there is no direct method to measure and evaluate bone strength in clinical practice, while bone density is a common indicator for clinical diagnosis of osteoporosis. Osteoporosis increases the disability and mortality rate, seriously endangers the family happiness of patients, and also brings a heavy burden to society. Therefore, early prevention, early diagnosis, and early treatment are very necessary.

2. Causes

Unreasonable eating habits and age are the main reasons for the high incidence of osteoporosis. The results of a large-scale epidemiological survey in China show that the prevalence of osteoporosis in China is about 6.6%-19.3%, with women being higher than men. In addition, due to the nature of their work, public officials have high work intensity, high mental stress, and serious lack of sleep, exercise and sun exposure, which causes their osteoporosis incidence to be higher than that of the general population. Osteoporosis is manifested as a continuous decrease in bone mass, degeneration of bone tissue microstructure, decreased bone strength, and secondary increase in bone brittleness, causing symptoms such as pain and hunchback, and can easily lead to pathological fractures, which seriously affect physical health and quality of life.

3. Treatment of osteoporosis

Improve your lifestyle and eat a balanced diet

Try to take a balanced diet that is low in sodium, rich in calcium, and has an appropriate amount of protein (0.8-1.0g/kg). It is recommended to consume 300ml of milk, yogurt or equivalent dairy products every day. Exercises aimed at improving muscle strength and balance should also be performed, including resistance exercises and weight-bearing exercises. It is recommended that the daily exercise time be more than 30 minutes, and special attention should be paid to warming up before exercise and relaxing after exercise. Elderly men should pay special attention to quitting smoking and limiting alcohol, avoiding excessive coffee and carbonated drinks, and avoiding the use of drugs that affect bone metabolism. Take all possible measures to prevent falls.

Calcium and vitamin D supplements

It is recommended that elderly men take 1000-1200 mg of calcium per day. The daily dietary calcium intake can be roughly estimated. The average level in my country is about 400 mg of elemental calcium, so an additional 500-600 mg is needed, and food supplementation is preferred. Calcium carbonate is recommended for those who must use medications. 24-hour urine calcium should be checked before taking it, because the incidence of hypercalciuria in elderly men is high. Calcium citrate is recommended for those with renal and ureteral stones. The recommended intake of vitamin D is 800-1200 U/d, which needs to be titrated according to the serum 25-hydroxyvitamin D level, and the ideal value is 30-50 ng/ml. Vitamin D deficiency is common in elderly men. Supplementing different doses of vitamin D (5000 U/week, 10000 U/week and 15000 U/week) according to the degree of vitamin D deficiency can achieve better results. For elderly male osteoporosis patients whose liver and kidney diseases cause vitamin D hydroxylation to be blocked, active vitamin D should be added on the basis of ordinary vitamin D supplementation, and urine calcium and blood calcium levels should be monitored. Adequate calcium and vitamin D combined with anti-osteoporosis drug treatment can reduce the risk of fractures.

Use of anti-osteoporosis drugs

Drugs approved by the State Food and Drug Administration for the treatment of osteoporosis in men include alendronate sodium and zoledronic acid. Patients with new fractures and pain may consider short-term use of calcitonin. Active vitamin D, vitamin K and traditional Chinese medicine may also be used as appropriate. Drugs approved by European and American countries for the treatment of osteoporosis in men also include denosumab and parathyroid hormone analogs (teriparatide). Male osteoporosis patients who really need to use them can use them on the premise of obtaining informed consent.

4. Prevention of osteoporosis

The comprehensive prevention and treatment of osteoporosis should be carried out throughout the life cycle, including: improving bone growth and development, promoting the ideal peak bone mass in adulthood; maintaining bone mass and quality, preventing age-related bone loss; avoiding falls and fractures, and reducing disability rates. By establishing a three-level prevention and control system for osteoporosis, the allocation efficiency of medical resources can be improved and the prognosis of patients can be improved.

Primary prevention is suitable for people with low and medium risk of fractures. The goal of prevention is to reduce or delay bone loss in the elderly with aging through early intervention, thereby reducing the risk of osteoporosis. Intervention methods: osteoporosis knowledge education and improvement of self-management awareness and ability are low-cost.

Secondary prevention is suitable for people at high risk of fractures. The goal is to effectively treat, slow the progression of osteoporosis, and prevent fractures. Intervention methods: On the basis of primary prevention intervention measures, strengthen anti-fall knowledge education, regularly use anti-osteoporosis drugs such as active vitamin D, vitamin K2, alendronate, zoledronic acid, denosumab, teriparatide, etc., and carry out rehabilitation and psychological treatment if conditions permit. Anti-osteoporosis drugs and rehabilitation treatment can increase bone density, improve bone quality, and reduce the risk of fractures.

Level 3 prevention is applicable to people at extremely high risk of fractures. The goal is to reduce the occurrence of fractures and re-fractures, and to reduce disability and death caused by fractures. ① Those who have not had a fracture or have a history of brittle fractures: For people at extremely high risk of fractures, regardless of whether they have had a brittle fracture in the past, detailed communication should be conducted with the patient, and the risk factors for osteoporotic fractures should be carefully sorted out and analyzed to remove or reduce factors that are unfavorable to bone metabolism as much as possible. ② Those with new brittle fractures: A multidisciplinary joint management model for rapid assessment, treatment and rehabilitation of patients with new brittle fractures, especially hip or vertebral fractures, can significantly improve patient prognosis.

I hope everyone will pay attention to osteoporosis and prevent it.