What is Osteoporosis?

Osteoporosis (osteoporosis) is a systemic bone disease in which bone density and bone mass decrease, bone microstructure is damaged, and bone fragility is increased due to various reasons. Osteoporosis is divided into two categories: primary and secondary. Primary osteoporosis is divided into three types: postmenopausal osteoporosis (type ), senile osteoporosis (type ) and idiopathic osteoporosis (including adolescent type). Postmenopausal osteoporosis usually occurs within 5 to 10 years after menopause in women; senile osteoporosis generally refers to osteoporosis that occurs after the age of 70; and idiopathic osteoporosis mainly occurs in adolescents, and the cause is unknown. .

Basic Information

English name

osteoporosis

Visiting department

Orthopedics, Endocrinology

Multiple groups

Middle-aged and elderly

Common causes

Caused by endocrine disease, connective tissue disease, chronic kidney disease, gastrointestinal and nutritional diseases, hematological diseases, neuromuscular diseases

Common symptoms

Pain, shortened length, hump, fracture, decreased respiratory function

Causes of osteoporosis

In addition to primary osteoporosis mainly related to menopause and old age, osteoporosis may also be caused by a variety of diseases, called secondary osteoporosis. Common diseases that can cause osteoporosis are:

Endocrine disease

Diabetes (types 1 and 2), hyperparathyroidism, Cushing syndrome, hypogonadism, hyperthyroidism, pituitary prolactinoma, hypohypophysis, etc.

Connective tissue disease

Systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, dermatomyositis, mixed connective tissue disease, etc.

3. Chronic kidney disease

A variety of chronic kidney diseases cause renal osteodystrophy.

4. Gastrointestinal and nutritional diseases

Malabsorption syndrome, major gastrointestinal resection, chronic pancreatic disease, chronic liver disease, malnutrition, long-term intravenous nutritional support, etc.

5. Hematological diseases

Leukemia, lymphoma, multiple myeloma, Gaucher disease, and myelodysplastic syndrome.

6. Neuromuscular Diseases

Hemiplegia, paraplegia, motor dysfunction, muscular dystrophy, stiff-man syndrome and myotonic syndrome caused by various reasons.

7. Long-term braking

Such as long-term bed or space travel.

8. After organ transplant

9. Regular use of the following drugs

Glucocorticoids, immunosuppressants, heparin, anticonvulsants, anticancer drugs, aluminum-containing antacids, thyroid hormones, chronic fluorosis, gonadotropin-releasing hormone analogs (GnRHa), or dialysates for renal failure.

Clinical manifestations of osteoporosis

Disease symptoms

Osteoporosis itself includes three broad categories of symptoms

(1) Patients with pain may have back pain or sore body. Pain may increase or the movement may be restricted when the load increases. In severe cases, it may be difficult to roll over, sit up and walk.

(2) Severe spine deformity and osteoporosis may have shortened height and hump. Vertebral compression fractures can cause chest deformity, abdominal compression, and affect cardiopulmonary function.

(3) Fractures of non-trauma or minor trauma are fragile fractures. It is a low-energy or non-violent fracture, such as a fall from a standing height or less or a fracture due to other daily activities. Common locations for fragile fractures are the chest, lumbar spine, hip, radius, distal ulna, and proximal humerus.

2. The dangers of osteoporosis

Pain itself can reduce the quality of life of patients, spinal deformities and fractures can be disabling, restricting patients' activities, not being able to take care of themselves, and increasing the incidence of lung infections and bedsores. Society brings a heavy economic burden.

Osteoporosis test

The measurement of dual energy X-ray absorptiometry (DXA) is currently the world's recognized gold standard for the diagnosis of osteoporosis. Clinically recommended measurement sites are lumbar spine 1-4, total hip and femoral neck. T value = (measured value-peak bones of normal adults of the same sex and same race) / standard deviation of bone density of normal adults.

diagnosis	T value
normal	T value -1
Low bone mass	-2.5 <T value <-1
Osteoporosis	T value -2.5

Osteoporosis diagnosis

1. Osteoporosis (osteoprosis) is most common in postmenopausal women and the elderly. Primary osteoporosis secondary to other diseases is rare.

2. A common symptom is back pain, which is more common in the chest and lower back.

3. X-ray examination showed that the most obvious osteoporosis was the thoracic and lumbar spine. The collapse of the vertebral body can appear as a double-concave or wedge-shaped deformation of the fish tail, and the vertebral body is sometimes even completely flattened.

4. Bone metrology examination or quantitative histomorphology measurement. Abnormal changes in bone metabolism and bone mass can be observed.

Osteoporosis treatment

Basic measures

(1) Lifestyle adjustments A balanced diet rich in calcium, low salt, and the right amount of protein. Pay attention to proper outdoor activities, which will help physical exercise and rehabilitation for bone health. Avoid smoking, drinking and using drugs that affect bone metabolism with caution. Take various measures to prevent falls, such as paying attention to diseases and drugs that increase the risk of falling, and strengthen protection measures for yourself and the environment (including various joint protectors).

(2) Basic supplements for bone health 1) Calcium The Chinese Nutrition Society has established a recommended daily calcium intake of 800 mg (elemental calcium) for adults, and a recommended daily calcium intake of 1000 mg for postmenopausal women and the elderly. The average elderly in our country gets about 400mg of calcium from the diet every day, so the average amount of elemental calcium that should be added daily is 500mg ~ 600mg. 2) The recommended dose of vitamin D for adults is 200 units (5 g) / d, and the recommended dose for the elderly is 400 to 800 IU (10 to 20 g) / d. In the treatment of osteoporosis, the dosage can be 800 to 1200 IU (the content of vitamin D in calcium and vitamin D composite preparations currently sold in China is generally low). It is recommended that the serum 25OHD level of the elderly should be above 30ng / ml (75nmol / L) to reduce the risk of falls and fractures. Serum calcium and urine calcium should be monitored regularly and the dose adjusted as appropriate. However, if patients are accompanied by kidney stones and high urine calcium, calcium and vitamin D preparations should be used with caution.

2. Drug intervention

Calcium supplementation alone is not enough for the treatment of osteoporosis, and drugs need to be added according to the situation of the patient.

(1) Indications for drug therapy: osteoporosis (T-2.5) or fragile fracture; or bone loss (-2.5 <T <-1.0) and more than one osteoporosis Risk factors. Bone mineral density is measured unconditionally, but medication is also needed if: a fragile fracture has occurred; the OSTA screening is a high risk; the FRAX tool calculates a hip fracture probability of 3% or any important osteoporosis The probability of fracture is 20%.

(2) Anti-bone resorption drugs 1) Bisphosphonates. Alendronate, sodium zoledronate, and risedronate are optional drugs. 2) Calcitonins are more suitable for patients with osteoporosis who have pain symptoms. Not suitable for long-term use. Salmon calcitonin, injected subcutaneously or intramuscularly, 2 to 5 times per week depending on the condition; salmon calcitonin nasal spray; eel calcitonin, intramuscularly. 3) Selective estrogen receptor modulators (SERMs) can reduce the incidence of estrogen receptor-positive invasive breast cancer in female patients without increasing the risk of endometrial hyperplasia and endometrial cancer. Raloxifene, has a history of venous embolism and is prone to thrombosis such as prolonged bed rest and sedentary use. 4) Estrogen can only be used in female patients. Pros and cons should be fully evaluated and the following principles should be followed: Indications: Women with menopausal symptoms (hot flashes, sweating, etc.) and / or osteoporosis and / or risk factors for osteoporosis, especially the early onset of menopause Use, the greater the benefit and the less the risk. Contraindications: Estrogen-dependent tumors (breast cancer, endometrial cancer), thrombotic diseases, vaginal bleeding of unknown origin, active liver disease, and connective tissue disease are absolute contraindications. Uterine fibroids, endometriosis, family history of breast cancer, gallbladder disease and pituitary prolactinoma should be used with caution. Those who have a uterus should use an appropriate dose of progestin to prevent estrogen from stimulating the endometrium. Women who have undergone hysterectomy should use only estrogen and no progestin. Hormone treatment plan, dosage, preparation choice and treatment duration should be individualized according to the patient's situation. Use the lowest effective dose. Follow up with regular follow-up and safety monitoring (especially breast and uterus).

(3) Parathyroid hormone (PTH), a drug that promotes bone formation , should not be treated for more than 2 years. Intramuscular injection, monitor blood calcium levels during medication to prevent the occurrence of hypercalcemia.

(4) Strontium salt strontium ranelate, taken before bedtime. Not recommended for CCr (creatinine clearance) <30ml / min.

(5) Other drugs 1) Active vitamin D is more suitable for the elderly, those with renal insufficiency, and those lacking 1 hydroxylase. Includes 1-hydroxyvitamin D (-calciferol) and 1,25 dihydroxyvitamin D (calciferol). Regularly monitor blood and urine calcium levels. Calcitriol and -calciferol can be used in combination with other anti-osteoporosis drugs in the treatment of osteoporosis. 2) Take vitamin K2 (tetramenaquinone) after meals. Prohibited in patients taking warfarin.

3. Surgical treatment

(1) Minimally invasive surgery (vertibroplasty) and kyphoplasty is one of the new developments in minimally invasive spine treatment. It is suitable for fresh vertebrae without severe spinal cord or nerve root symptoms and severe pain. Compression fractures have a good analgesic effect.

(2) Treatment of comminuted fractures The osteoporotic distal radius ulna fractures in the elderly are mostly comminuted fractures, involving the articular surface, and residual deformities are easy to heal after fracture healing, often causing wrist and finger dysfunction. The treatment method is usually manual reduction, which can be fixed with splint or plaster, or fixed with an external fixator. For a few unstable fractures, surgery can be considered.

(3) Treatment of hip fractures Hip fractures have the following characteristics: High mortality, prone to complications such as pneumonia, urinary system infections, bedsores, venous thrombosis of the lower extremities. Osteonecrosis rate and non-union rate are high. Teratogenicity and disability are high. Slow recovery. Surgical treatment includes internal fixation, artificial joint replacement and external fixation. Non-surgical treatment is also available.

Osteoporosis prevention

Strengthen exercise and ensure adequate calcium intake from adolescence, while preventing and actively treating various diseases, especially chronic wasting diseases and malnutrition, malabsorption, etc., to prevent various gonad dysfunction diseases and growth and development Disease; Avoid long-term use of drugs that affect bone metabolism, etc., you can obtain the ideal peak bone mass as much as possible, reducing the risk of osteoporosis in the future.

Calcium supplementation in adulthood is a basic measure to prevent osteoporosis. It cannot be used alone as an osteoporosis treatment drug, but only as a basic auxiliary drug. The prevention of adulthood mainly includes two aspects. The first is to delay the rate and extent of bone loss as much as possible. For postmenopausal women, the accepted measure is to supplement estrogen or estrogen and progesterone as soon as possible. The second is to prevent fractures in patients with osteoporosis. Avoiding risk factors for fractures can significantly reduce the incidence of fractures.

Osteoporosis prognosis

The decisive factors are: whether the primary disease leading to osteoporosis is cured or controlled; whether the risk factors of osteoporosis can be minimized;