What is osteoporosis?
Osteoporosis is a systemic disorder of bone metabolism, which is characterized by the damage of bone microstructure, the decrease of the ratio of bone mineral components to bone matrix, the thinning of bone, the decrease of bone trabecula, the increase of bone brittleness and the increase of fracture risk. Osteoporosis is generally divided into two categories, namely primary osteoporosis and secondary osteoporosis. Degenerative osteoporosis can be divided into postmenopausal osteoporosis and senile osteoporosis. The prevalence rate of the elderly is 60.72% for men and 90.47% for women.
What causes osteoporosis?
The factors leading to bone loss in middle-aged and elderly people are very complicated. In recent years, it is considered that it is closely related to the following factors.
(1) The decrease of sex hormone secretion in middle-aged and elderly people is one of the important causes of osteoporosis. It is recognized that the decrease of estrogen level after menopause leads to the increase of bone resorption.
(2) With the increase of age, the secretion of calcium regulatory hormone is out of balance, which leads to the disorder of bone metabolism.
(3) Due to tooth loss and decreased digestive function, the elderly have insufficient intake of protein, calcium, phosphorus, vitamins and trace elements, poor bone absorption, malnutrition and many nutritional deficiencies.
(4) With the increase of age, the decrease of outdoor exercise is also an important reason why the elderly are prone to osteoporosis.
(5) Recent molecular biology research shows that osteoporosis is closely related to the variation of vitamin D receptor (VDR) gene.
What are the symptoms of osteoporosis?
(1) pain. The most common symptom of primary osteoporosis is low back pain, and patients with pain account for 70%-80%. Pain spreads to both sides along the spine, which is relieved when lying on your back or sitting, aggravated when standing upright or standing for a long time, and aggravated when sitting for a long time. The pain is mild during the day, aggravated when you wake up at night and early in the morning, aggravated when you bend over, exercise your muscles, cough and defecate. Generally, bone pain can occur when bone mass is lost 12% or more. In senile osteoporosis, the trabecular bone of vertebral body shrinks, the number decreases, the vertebral body is compressed and deformed, the spine bends forward, the psoas muscles contract twice, muscle fatigue even spasms to correct spinal flexion, resulting in pain. The recent thoracolumbar compression fracture can also cause acute pain, and the corresponding spinous process of the spine can have intense tenderness and percussion pain, which can be gradually relieved after 2-3 weeks, and some patients can have chronic low back pain. If the corresponding spinal nerves are compressed, radiation pain of limbs, sensory dyskinesia of both lower limbs, intercostal neuralgia, retrosternal pain and epigastric pain similar to acute abdomen can be produced. If the spinal cord and cauda equina are compressed, the function of bladder and rectum will be affected.
(2) Shortened body length and hunchback. Most of them appear after pain. The front part of the vertebral body of the spine is almost composed of cancellous bone, which is the pillar of the body, with heavy negative weight, especially the 1 1, 12 thoracic vertebra and the third lumbar vertebra, which are subjected to large stress and are easy to be compressed and deformed, making the spine lean forward and the dorsiflexion aggravated, forming a hunchback. With the increase of age, osteoporosis is aggravated and the curvature of hunchback is increased, which leads to obvious contracture of knee joint. Everyone has 24 vertebral bodies, and the height of each vertebral body in normal people is about 2cm. When osteoporosis occurs in the elderly, the vertebral bodies are compressed, each vertebral body is shortened by about 2mm, and the average body length is shortened by 3-6cm.
(3) fracture. This is the most common and serious complication of degenerative osteoporosis.
(4) Decreased respiratory function. Thoracolumbar compression fracture, kyphosis and thoracic deformity can significantly reduce vital capacity and maximum ventilation, and patients often have symptoms such as chest tightness, shortness of breath and dyspnea.
What tests do osteoporosis need to do?
The diagnosis of degenerative osteoporosis depends on the comprehensive analysis and judgment of clinical manifestations, bone mass measurement, X-ray film and biochemical indexes of bone turnover.
1. biochemical examination: the determination of blood and urine minerals and some biochemical indexes is helpful to judge bone metabolism and bone renewal speed, which is of great significance for differential diagnosis of osteoporosis.
(1) Bone formation index.
(2) Bone resorption index: 1) urinary hydroxyproline. 2) Urinary hydroxylysine glycoside. 3) plasma tartrate-resistant hydrochloric acid phosphatase. 4) urine collagen pyridine crosslinking (PYr) or type I collagen crosslinking N- terminal peptide (NTX).
(3) Detection of bone mineral composition in blood and urine: 1) Serum total calcium. 2) Serum inorganic phosphorus. 3) Serum magnesium. 4) Determination of urinary calcium, phosphorus and magnesium.
2.X-ray examination: X-ray is still a popular method to examine osteoporosis.
3. Bone mineral density measurement:
(1) single photon absorption spectrometry (SPA).
(2) Dual-energy X-ray absorption method (DEXA).
(3) quantitative CT(QCT).
(4) Ultrasound (USA).
How to treat
Drug therapy:
Primary type I osteoporosis belongs to hypermetabolic type, which is due to the decrease of estrogen after menopause and bone loss due to high absorption. Therefore, estrogen, calcitonin, calcium preparations and other bone resorption inhibitors should be selected. Primary type II osteoporosis is the imbalance of regulatory hormones caused by aging, which leads to low bone formation. Bone formation promoters such as active vitamin D, anabolic steroids, calcium preparation, fluorinating agent and vitamin K2 are used.
1. Estrogen is the first choice for the prevention and treatment of postmenopausal osteoporosis. (1) estradiol1-2 mg/d (2) diethylstilbestrol 0.25mg/ night. (3) compound estrogen 0.625 mg/d, (4) nilestriol 2mg/ half a month. (5) liviai。
2. Calcitonin: (1) calcitonin. (2) Yiganning. (3) dense calcium interest.
3. Vitin: (1) Luo calcium. (2) Alfacalcidol.
4. Calcium preparation: (1) inorganic calcium: 1) calcium chloride. 2) calcium carbonate. 3) calcium carbonate. (2) Organic calcium: 1) calcium gluconate. 2) calcium lactate. 3) Calcium aspartate. (3) active calcium. (4) calcium D.
5. Diphosphate: (1) disodium chloromethyl diphosphate. (2) Sodium hydroxyethyl diphosphate.
6. Isopropoxy flavone.
8. Chinese medicine.
/Cha/Shen Quan /7 18/
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How to treat osteoporosis?
The treatment of primary osteoporosis is still mainly drugs. There are two purposes of treatment: preventing pathological fractures and relieving low back pain. Because osteoporosis is due to the increase of bone absorption, and the related bone formation can not be fully carried out. Therefore, drugs that inhibit bone resorption should be widely used; Such as calcium, estrogen and calcitonin. The other is drugs that promote bone formation, such as fluoride, bisphosphonate and parathyroid hormone.
(1) When calcium is used to promote teenagers, the daily intake of calcium (elemental calcium) is 1000- 1200mg, 800- 1000mg for adults and1000-for postmenopausal women. Patients with kidney calculi's disease or high urinary calcium concentration at risk of kidney calculi should not consume too much calcium. All patients with osteoporosis should be properly supplemented with calcium. At present, although there is no clear evidence that calcium supplementation alone can reduce the occurrence of fractures, calcium supplementation should at least be used as an auxiliary treatment for osteoporosis. Mainly to improve the calcium content in the diet. If the food intake is not enough, calcium-containing preparations need to be supplemented. What needs to be explained here is that the amount of calcium tablets is not equal to its calcium content. When taking calcium tablets, you should calculate according to the actual situation. Calcium carbonate, calcium chloride, calcium lactate and calcium gluconate contain 40%, 27%, 13% and 9% of elemental calcium respectively. If calcium is supplemented after meals, it will be better to drink 200 ml of water while waiting. It is better to take it in batches than once. People with gastric acid deficiency should take calcium citrate.
(2) Estrogen is the first choice to prevent postmenopausal bone loss in women, mainly by inhibiting bone resorption and rebuilding bone metabolism balance. It is generally best to start using it after menopause. Estrogen alone may cause breast cancer and endometrial cancer, so the lowest effective dose should be used, supplemented by appropriate progesterone. At present, nilestriol, progesterone, livial and premarin tablets are commonly used. Women receiving estrogen therapy should have regular gynecological and breast examinations before and during medication.
(3) Calcitonin inhibits the activity of osteoclasts through rapid action and reduces the number of osteoclasts through slow action, which has the functions of relieving pain, increasing activity function and improving calcium balance. Salmon calcitonin famotidine, 50 units intramuscular injection, every other day or once a day; Spray 200-400 units on the nasal mucosa every day. Eel calcitonin Mingyining, every time 10 unit, twice a week or every time to increase the unit, every week 1 time, intramuscular injection. Adverse reactions include nausea, flushing on face and hands and fever. The disadvantage is that it is expensive and difficult to popularize.
(4) Vitamin D and its metabolites can promote calcium absorption and bone mineralization in small intestine, while active vitamin D can promote bone formation, increase osteocalcin production and alkaline phosphatase activity. Active vitamin D consists of calcium (0.25 μ g each time, 1-2 times a day) and α (alpha)-D3 (0.25- 1 μ g daily).
(5) Bisphosphonate is a new bone resorption inhibitor that has been used in clinic since 1980s. At present, there are many varieties such as hydroxyethyl phosphonate (also known as etidronate), chloromethyl phosphonate (also known as bone phosphonate), pamidronate, alendronate (also known as fosamax), tirudophosphonate and risedronate. On 1995, the US Food and Drug Administration approved alendronate sodium for postmenopausal women with osteoporosis. In order to facilitate drug absorption and reduce the irritation to esophagus, it should be taken on an empty stomach and drink 500- 1000 ml warm water half an hour before meals. You should avoid taking it with calcium.
(6) Fluoride directly acts on osteoblasts to stimulate bone formation. Monofluorophosphate is slowly released in the small intestine through the action of hydrolase, which can last for 12 hours. At present, Tylenol used in clinic is composed of glutamine monofluorophosphate, calcium gluconate and calcium citrate. Each tablet contains 5 mg of fluorine and element calcium 150 mg, three times a day, each time 1 tablet, and is taken with meals after chewing.
(7) A large number of animal experiments have proved that parathyroid hormone can promote osteogenesis. It is still under further study.