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The 52nd article related to the prevention and treatment of osteoporosis published by Chief Physician Bian Pingda in “Life and Health”.
Last week at the osteoporosis clinic, a 53-year-old emaciated woman (BMI 16.87) came to see Ms. Li, who was suffering from neck pain recently. See “Cervical Spondylosis”. Asked about the medical history, it was found that Ms. Li had the habit of sitting on the bed and watching TV, but there was no obvious discomfort such as dizziness, numbness of fingers, and fluttering when walking.
I said, since you only have neck pain, you might as well adjust your lifestyle first, such as not sitting in bed or on the sofa watching TV for a long time, participating in more outdoor activities, etc. , but you are so thin and prone to osteoporosis, it is best to check first. She took my advice.
Bone mineral density in a woman in her 70s
Dual energy X-ray absorptiometry in the outpatient clinic showed that Ms. Li’s lumbar spine 1-4 Bone mineral density T value was -3.1, and osteoporosis was diagnosed (diagnostic standard was T value ≤ -2.5).
The detection of serum bone metabolism markers indicated that the patient had rapid bone loss (the special sequence of type I collagen carboxy-terminal peptide beta was 526pg/ml); the blood biochemical examination showed white Low protein (38.2 g/L, reference range 40.0-55.0 g/L), hyperlipidemia (total cholesterol 7.41 mmol/L, reference range 3.11-5.96 mmol/L), but no abnormality in liver and kidney function.
Inquiry about the medical history, the patient has no history of diabetes, hypertension, malignant tumor and rheumatoid arthritis, and no history of thyroidectomy and bilateral oophorectomy, and denied the long-term use of glucocorticoids Hormone history. Five years ago, when he went up the mountain to dig bamboo shoots, he suffered a fracture of the seventh rib on the right side, but he denied any history of lumbar spine and hip fractures.
The patient is non-smoking and drinking, does not drink coffee, has two children, and is 43-year-old postmenopausal. Her mother died of lung disease in her 30s, her father was alive, and neither of her parents had a history of hip fractures.
Causes of premature menopause
It is well known that postmenopausal women, especially women who experience premature menopause, are prone to osteoporosis loose. This is because women after menopause have low estrogen levels in the body, enhanced osteoclast activity, accelerated bone loss, and thus prone to osteoporosis.
Those who are thin (BMI <19 kg/m2) are also prone to osteoporosis. This is because body weight is a mechanical load factor, and bone load can be converted into mechanical stress that helps promote bone formation, inhibit bone resorption, and increase bone density.
So, why did Ms. Lee go through premature menopause? Why so thin? Could there be genetic factors at play?
Ms. Li has a sister who is 51 years old this year. She is 154 cm tall and weighs 54 kg (BMI 22.77 kg/m2). She has not yet reached menopause, and her bone density test is normal. In this way, genetic factors are unlikely.
Continue to ask for medical history. Ms. Li said that she was also “chubby” and wanted to lose weight at the age of 40. She only ate an apple for breakfast every day for nearly half a year. She lost weight, but suffered severe hair loss and menopause. For this reason, I have been to many tertiary hospitals, and I do not know how much Chinese medicine I have taken, but the effect is very small…
It turned out to be caused by blind diet to lose weight and induced premature ovarian failure. !
Ms. Li’s current treatment strategies
First of all, Ms. Li should increase The intake of high-quality protein (such as milk, eggs, fish), reduce the intake of fatty meat, animal offal and other high-cholesterol foods, and insist on participating in outdoor activities, but must pay attention to avoid falling.
Secondly, choose zoledronic acid injection (5mg, intravenous infusion once a year) or RANKL inhibitor denosumab injection (60mg, every 6 months) 1 subcutaneous injection), and pay attention to calcium and vitamin D supplementation, and review bone mineral density and serum bone metabolism markers after 12 months. In addition, the patient has hyperlipidemia, so it is necessary to add statin lipid-lowering drugs.
After the above treatment, Ms. Li’s bone mineral density will definitely increase and the risk of fracture will decrease, but her bone density cannot be completely restored to normal.
If she doesn’t blindly diet to lose weight, she may not be menopausal now, and her bone density may still be normal. However, there is no if…
Female friends who are or are going on a diet, be sure to take precautions!
(The picture is from the Internet, please inform if there is any infringement)