Why do I feel so hunched and painful? It turns out I have osteoporosis!

Recently, a 71-year-old lady visited multiple departments of our hospital for back pain. Because she had hypertension and coronary heart disease, she was worried that she might have myocardial infarction, arterial dissection, or even biliary and pancreatic diseases. She went to multiple departments for examinations but the cause was not confirmed. She was recommended to our orthopedic clinic by doctors from other departments. After our detailed questioning and physical examination, we found that the old lady's back pain occurred after she folded the quilt, and she did not have obvious pain when lying flat on the bed. Once she turned over or got out of bed, the pain worsened. Her height has also shortened in recent years. When pressing and tapping the spine and the muscles next to the back pain, obvious pain occurred. Based on the above information, it is highly suspected that there is an osteoporotic fracture of the thoracolumbar spine. After magnetic resonance imaging, it was indeed found that the 11th thoracic vertebra was fractured. The "culprit" of the back pain has finally been found!

In fact, when elderly people experience more severe or prolonged back pain after minor trauma, it is likely that they have suffered a spinal fracture. In the public's impression, spinal fractures are very serious things, and they often occur only after serious trauma, such as car accidents, falls from heights, etc. The premise of this correct cognition is that people who suffer these serious traumas are often young people with good bone quality. Only severe violence will cause fractures, and these patients are often "seriously injured." However, when we enter old age, with the degeneration of bones and changes in bone metabolism, our bones gradually become "brittle" and even vulnerable. Minor injuries or activities in daily life will cause fractures, which we call osteoporotic fractures. The biggest difference between low back pain caused by fractures and pain caused by myocardial infarction, arterial dissection or biliary and pancreatic diseases is that there is a clear correlation between pain and low back activity. Low back activity will aggravate the pain, while the symptoms are milder when lying in bed. Of course, some elderly people have degraded pain perception or cannot describe their symptoms well. It is recommended to go to the hospital for evaluation as soon as possible, and don't let your imagination run wild or treat it indifferently because of trouble.

The incidence of osteoporosis may be higher than you think

The results of the first epidemiological survey on osteoporosis in my country in 2018 showed that the prevalence of osteoporosis in the population over 50 years old was 19.2%, including 6.0% for men and 32.1% for women; the prevalence of osteoporosis in the population over 65 years old reached 32.0%, including 10.7% for men and 51.6% for women. Studies have shown that the probability of men and women around 50 years old suffering from osteoporotic fractures in their lifetime is 13.1% and 39.7% respectively. According to the World Health Organization, the number of osteoporotic fractures in my country will reach 6 million by 2050. In view of such a high incidence rate, it is recommended that women over 50 years old and men over 65 years old should screen their bone density during routine physical examinations to understand their osteoporosis status. For those who have premature menopause, fractures, and height reduction, bone density should be checked earlier.

Common symptoms of osteoporosis: "hunchback, shortness, pain"

So how should we prevent osteoporosis in daily life? There are three common symptoms of osteoporosis patients, namely hunchback, shortness and pain. First of all, osteoporosis is "targeted", focusing on cancellous bone. The vertebral bodies in the spine are composed of cancellous bone, which is the main target of osteoporosis. The trabeculae in the vertebral body are reduced, the gaps are increased, and the vertebral body becomes "empty". It cannot bear the weight and will be flattened, resulting in compression fractures. From the appearance, it looks like a hunchback, the upper body cannot be straightened, and the height is shorter. You can measure your height regularly at home. If your height is 4 cm less than when you were young, you should be alert to osteoporosis. If you suffer from violence, or if you experience pain in the relevant parts after slight external force such as coughing, lifting heavy objects, falling, folding quilts and other housework, and it is obvious after activity, you should be alert to whether an osteoporotic fracture has occurred.

Online intelligent assessment of osteoporotic fracture risk

In the Internet age, everyone is using their mobile phones to browse their social media. Fortunately, you can assess your risk of osteoporotic fractures within 10 years online without having to go to the hospital. WHO Fracture Risk Assessment Tool, FRAX® is a system developed by the World Health Organization to assess the probability of fractures in individuals aged 40-90 years. Because it is developed based on real patient data and combines the probability of fractures with multiple clinical risk factors, this system has a good predictive effect on hip fractures and fractures of the spine, forearm, hip or shoulder caused by osteoporosis within 10 years. You may want to pick up your mobile phone or computer and search the FRAX website (https://www.sheffield.ac.uk/FRAX/tool.aspx?lang=chs) to quickly assess the risk of osteoporotic fractures in the next 10 years. The assessment can be performed regardless of whether there are bone density test results, but filling in the bone density results will make the assessment more accurate. For specific operation methods, you can also refer to the following article of our team (Amazing? Know the risk of fracture in the next 10 years in advance. Link address: https://mp.weixin.qq.com/s/9dwDifWHbIr6H__bzz-UzQ).

The key to preventing and treating osteoporosis: Eat carefully and get more sun exposure

Some people think that eating too much will make them fat, and believe that "it's more expensive to be thin in old age", so they try their best to avoid eating meat and eggs and dairy products. In fact, this is unnecessary. Calcium is the main component of bones. If the body lacks calcium, bone density will decrease, and then develop into osteoporosis. The daily calcium intake of Chinese people in their daily diet is generally insufficient. It is recommended that people aged 65 take 1000 mg of calcium every day. Today, you may wish to study the recipes when you go home. Foods rich in calcium include dried shrimp, milk, dried tofu, etc. Drink 250ml of milk for breakfast, eat more vegetables rich in calcium such as rapeseed and celery for lunch and dinner, and add appropriate amounts of dried shrimp or dried tofu, which can not only add deliciousness, but also get the calcium needed for the day. If you cannot eat meat due to religious reasons, you can drink soy milk instead or take calcium tablets. Supplementing with sufficient protein can reduce muscle loss in the elderly and prevent sarcopenia, which is also very important for maintaining bone density and reducing the risk of falls.

If you eat foods containing calcium but your body does not absorb it, it will be in vain. The human digestive tract needs the help of vitamin D to absorb calcium, and 80% of the vitamin D needed by the human body comes from the skin being exposed to sunlight, and the remaining 20% ​​comes from food. It is recommended to go outdoors in the early morning or before sunset to avoid the strong direct sunlight at noon, so that the skin can produce vitamin D, which will then act on the intestines after metabolism to promote calcium absorption. In addition, outdoor activities can also increase muscle strength, train the ability of limb balance and coordination, and reduce the risk of falling during activities, which is really killing two birds with one stone.

Author: Chen Weixin, Lin Hong, Li Juan

Instructor: Dong Jian

Unit: Department of Orthopedics, Zhongshan Hospital Affiliated to Fudan University

Institute of Medical Science Popularization, Fudan University

Department of Orthopedics, Shanghai Geriatric Center

This article was funded by the following project: Shanghai Science and Technology Commission Science Popularization Project

(No.: 20DZ2312000)

Shanghai Municipal Health Commission Outstanding Academic Leader Project

(No.: GWV-10.2-XD11)