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The 48th article related to the prevention and treatment of osteoporosis published by Chief Physician Bian Pingda in “Life and Health”.
Recently, a 77-year-old Ms. Zhang came to the osteoporosis clinic. She was curled up in a wheelchair like a shrimp with her chin pressed to her abdomen. .
The family said that in recent years, her hunchback has gradually increased, she has eaten less and less, and often vomits, and she is getting thinner and thinner. In addition, after walking a few steps, she complained of low back pain and shortness of breath, so she could only lie in bed all day.
Three weeks ago, I had severe back pain without obvious incentives, which was unbearable. The local hospital suspected acute abdomen, and after the corresponding treatment was invalid, he came to our hospital for treatment.
MRI of the thoracic and lumbar spine showed that Ms. Zhang had fresh compression fractures of the lumbar 2 vertebrae, old compression fractures of the lumbar 1 and 5 vertebral bodies, thoracic 5, 6, 7, 8, 10, 11 vertebral body compression changes.
Patients like Ms. Zhang with severe thoracic deformity (including hunchback) caused by multiple thoracolumbar fractures can be said to be in the “late stage” of osteoporosis. The reason why Ms. Zhang has developed to this point is because she “mistakenly” missed two steps of rescue measures.
A mistake of not starting prevention after menopause
Ms. She did not start taking steps to prevent osteoporosis after menopause. The reason why women should take the initiative to prevent osteoporosis after menopause is because postmenopausal estrogen levels are low, and bone loss is significantly accelerated. The next 20 years is a critical period for women to prevent osteoporosis.
To prevent postmenopausal osteoporosis, first maintain a good lifestyle, such as a balanced diet, adequate sunshine, and regular exercise etc.; Secondly should take calcium and vitamin D. Generally speaking, postmenopausal women should supplement 1000-1200 mg of calcium and 600 international units of vitamin D every day; third, should Under the guidance of a physician, receive menopausal hormone therapy or take anti-bone resorption drugs such as bisphosphonates.
Double fault not actively treated after fracture
Patients with vertebral fractures often have osteoporosis, and after a vertebral fracture, the risk of another vertebral fracture is significantly increased. Ms. Zhang accidentally slipped while going downstairs 20 years ago and suffered a vertebral fracture, but it did not attract the attention of the patient and her family, and she did not receive anti-osteoporosis treatment in time, resulting in continuous bone loss and repeated vertebral fractures. Fractured, resulting in severe thoracic deformity.
Dual energy X-ray absorptiometry confirmed that Ms. Zhang had severe osteoporosis (diagnostic standard T value ≤-2.5), and her femoral neck BMD The T-score was -4.2, the T-score for the total hip was -4.4, and the T-score for the lumbar spine 3-4 was -5.2. If Ms. Zhang had started prophylaxis after menopause, or treated her fractures aggressively, her bone density would not have dropped so low and multiple vertebral fractures would not have occurred.
Integrated therapy
relieves pain and reduces fracture risk
We developed a comprehensive treatment plan for Ms. Zhang.
First, perform vertebroplasty. Because Ms. Zhang had obvious low back pain and the conservative treatment was not effective, she performed vertebroplasty (commonly known as bone cement) under local anesthesia to restore the compressed second lumbar vertebra and quickly achieve pain relief. Purpose.
Second, receive osteogenic treatment. Teriparatide is a representative drug for promoting bone formation. It can rebuild lost cancellous bone, stimulate the growth of cortical bone and trabecular bone, significantly increase bone mass, and reduce the risk of vertebral fractures. It is especially suitable for It is used by osteoporosis patients with vertebral fractures like Ms. Zhang.
Third, strengthen health education. Ms. Zhang should first pay attention to strengthening nutrition and eat more high-quality protein, such as milk, eggs and fish; secondly, she should adhere to appropriate activities, and she should be supported by someone or walk with a walker (to reduce the weight of the upper body). pressure on the lumbar spine), and pay attention to actively prevent falls.
However, the above measures can only relieve Ms. Zhang’s pain and reduce the risk of vertebral fracture, but cannot restore the compressed vertebral body to its original state. Therefore, osteoporosis is more expensive. Early prevention and early treatment.
(Bian Pingda, member of the Osteoporosis and Bone Mineral Disease Branch of Zhejiang Medical Association, Chief Physician of Zhejiang Provincial People’s Hospital)
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