【Doctor’s Notes】
Diagnosis and Treatment of Osteoporosis
Zhang Xiaomin
The results of the first epidemiological survey of osteoporosis in my country released by the National Health and Medical Commission in 2018 showed that the prevalence of osteoporosis in people over 50 years old was 19.2%, among which middle-aged and elderly women had osteoporosis. The disease problem is particularly serious, with a prevalence rate as high as 32.1%. However, the public’s awareness of osteoporosis is far from enough. Many people only know that they have osteoporosis when they go to the hospital because of a fracture. If it is serious, it will directly affect the quality of life and life expectancy.
What are the symptoms of osteoporosis
Unexplained chronic low back pain is the most common symptom of osteoporosis. Second, light activities such as bending over, weight bearing, easy fracture after crushing or falling, short stature, hunched back, and fatigue after activity or exertion are all signs of osteoporosis. However, not all low back pain is osteoporosis. Not all osteoporosis has symptoms, and some people can have no symptoms at all.
How to tell if you have osteoporosis
Fragility fractures occur without trauma or with minimal trauma, such as in older adults Wrist fractures occur when opening the door and turning the door lock, ankle fractures occur when you go downstairs, and lumbar fractures occur when you bend over to lift or lift heavy objects, or hip fractures occur after a fall.
Measurement of bone mineral density Dual-energy X-ray absorptiometry is currently recognized as the gold standard for the diagnosis of osteoporosis. The measurement sites are mainly the lumbar spine, femoral neck and distal radius. Osteoporosis can be diagnosed with a T value of ≤ -2.5.
Who needs a bone density test
Any one of the following conditions indicates the risk of osteoporosis, and a bone density test is recommended.
Women over 50 years old, men over 65 years old, with unexplained chronic low back pain;
After the age of 40, the height decreased by more than 3cm;
45 years old Women not taking estrogen/progestin supplements after previous menopause or bilateral oophorectomy;
adults with low sex hormone levels of any cause;
Parents with Osteoporosis or a history of fragility fractures;
Have a history of spontaneous or minor injury fractures;
Smoking, heavy alcohol consumption, no dairy, and no calcium supplementation;
Exercise less than 30 minutes per day, or spend less than 10 minutes in outdoor activities per day, and do not take vitamin D, or stay in bed for a long time;
Have the following diseases: hypogonadism, Acromegaly, hyperthyroidism, hyperparathyroidism, type 1 diabetes, gastrointestinal disease, blood disease, chronic kidney disease, cardiopulmonary disease, rheumatoid arthritis, etc.;
Long-term Taking the following medicines: glucocorticoids, magnesium valproate, aminolutamide, triptorelin, antivirals, rosiglitazone, pioglitazone, omeprazole, and thyroid hormones.
How to treat osteoporosis after diagnosis
Osteoporosis is not terrible. Through scientific treatment, it can delay the rate of bone loss and prevent the occurrence of fractures. The main treatment methods are as follows:
Calcium supplementation There are many calcium supplements available on the market, such as calcium carbonate, calcium lactate, calcium gluconate, calcium amino acid chelate, etc. Among them, calcium carbonate has high calcium content and good absorption effect, but patients with stomach bloating and constipation need to be used with caution. Calcium citrate has a lower calcium content, less gastrointestinal adverse reactions, and citric acid may reduce the occurrence of kidney stones, making it more suitable for patients with gastric acid deficiency and at risk of kidney stones. Calcium lactate and calcium gluconate are relatively low in calcium content. It should be reminded that excessive calcium supplementation may increase the risk of kidney stones and cardiovascular disease.
Vitamin D Supplementation Adequate vitamin D increases intestinal absorption of calcium, improving muscle strength and balance. When vitamin D is used for the prevention and treatment of osteoporosis, the dose can be 20-30ug/day.
Drug therapy Supplementation of calcium and vitamin D alone is not enough, and some anti-osteoporosis drugs are needed.
Scientifically and effectively prevent osteoporosis
Enhancing nutrition, a balanced diet is recommended to drink 300ml of milk or the same amount of dairy products every day, and other Foods rich in calcium, such as beans, nuts, green leafy vegetables, etc.
Adverse lifestyle changes Quit smoking, limit alcohol consumption, and avoid drinking too much coffee and carbonated beverages.
Regular exercise For adults, regular aerobic exercise or muscle strength exercises (such as running, various ball games, skipping rope, cycling, dumbbells, barbells, table tennis, dancing, etc.) are recommended for a week Do 5 workouts, 30-60 minutes each.
Sunshine frequently UV rays can promote the synthesis of vitamin D in the body, thereby promoting the absorption of calcium. It is recommended to be outdoors in the sun between 11:00am and 3:00pm. Avoid strong sunlight to avoid skin burns.
（Author’s Department of Geriatrics, Second Hospital of Lanzhou University）