Osteoporosis Treatment Guidelines, Osteoporosis Diagnosis Criteria, Osteoporosis Causes and Effects, Osteoporosis Symptoms, Osteoporosis Prevention,

Osteoporosis Treatment Guidelines, Diagnosis Criteria, cause

Osteoporosis

Osteoporosis Treatment Guidelines, Diagnosis Criteria, cause: Osteoporosis is a systemic bone disease in which bone mineral density and bone mass are degraded due to various reasons, bone microstructural damage, resulting in increased bone fragility, which is prone to fracture. Osteoporosis Treatment Guidelines, Diagnosis Criteria, cause.  Osteoporosis is divided into two major categories: primary and secondary. Primary osteoporosis is divided into postmenopausal osteoporosis (type I), senile osteoporosis (type II) and idiopathic osteoporosis (including juvenile type). Postmenopausal osteoporosis usually occurs in women 5 to 10 years after menopause; senile osteoporosis generally refers to osteoporosis after 70 years of age in the elderly, and idiopathic osteoporosis mainly occurs in adolescents, the cause is still unknown. Osteoporosis Treatment Guidelines, Diagnosis Criteria, cause.

You will Learn:

1: Basic Information:

2: Osteoporosis Causes and Effects:

3: Osteoporosis Symptoms:

4: Osteoporosis Check:

5: Osteoporosis Diagnosis Criteria:

6: Osteoporosis Treatment Guidelines:

7: Osteoporosis Prevention:

8: Osteoporosis prognosis:

1: Basic Information:

Name: Osteoporosis
Visiting department: Orthopedics, Endocrinology
Multiple groups: Middle and old aged
Common cause: Endocrine diseases, connective tissue diseases, chronic kidney diseases, gastrointestinal and nutritional diseases, blood system diseases, neuromuscular diseases.
Common symptoms: Pain, shortened length, hunchback, fracture, decreased respiratory function

2: Osteoporosis Causes and Effects:

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

1. Endocrine disease:
Diabetes (type 1 and type 2), hyperparathyroidism, Cushing syndrome, hypogonadism, hyperthyroidism, pituitary prolactinoma, and pituitary hypofunction.

2. 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 lead to renal osteodystrophy.

4. Gastrointestinal diseases and nutritional diseases:
Malabsorption syndrome, gastrointestinal resection, chronic pancreatic disease, chronic liver disease, malnutrition, long-term intravenous nutritional support treatment.

5. Blood system diseases:
Leukemia, lymphoma, multiple myeloma, high snow disease, and abnormal bone marrow proliferation syndrome.

6. Neuromuscular system diseases:
Hemiplegia, paraplegia, motor dysfunction, muscular dystrophy, stiff syndrome and myotonia syndrome caused by various reasons.

7. Long-term braking:
Such as long-term bed or space travel.

8. After organ transplantation:

9. Regular use of the following drugs:
Glucocorticoids, immunosuppressive agents, heparin, anticonvulsants, anticancer drugs, aluminum-containing antacids, thyroid hormones, chronic fluorosis, gonadotropin-releasing hormone analogs (GnRHa) or dialysate for renal failure.

3: Osteoporosis Symptoms:

1: High-risk group:
People with risk factors for osteoporosis are at risk for osteoporosis. Risk factors for osteoporosis include:

  1. Inherent factors of the human race (white and yellow people are more at risk of osteoporosis than black), old age, female menopause, and maternal family history.
  2. Non-inherent factors, low body weight, hypogonadism, smoking, excessive drinking, coffee and carbonated beverages, lack of physical activity, braking, nutritional imbalance in diet, excessive or insufficient protein intake, high sodium diet, calcium and (or) vitamin D deficiency (less light or low intake), diseases affecting bone metabolism or applications affecting bone metabolism drugs (glucocorticoids, immunosuppressive agents, heparin, anticonvulsants, anticancer drugs, aluminum-containing acid-resistant Agent, thyroid hormone, GnRH-a or dialysate, etc.).
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2. Disease symptoms:
Osteoporosis itself includes three major types of symptoms:

  1. Patients with pain may have back pain or soreness. When the load increases, the pain is aggravated or the activity is limited. In severe cases, it is difficult to turn over, sit up and walk.
  2.  Spinal deformity Osteoporosis can be shortened and hunched. Compressive fractures of the vertebral body can lead to thoracic deformity, abdominal compression, affecting cardiopulmonary function.
  3.  Fractures that are non-traumatic or minor trauma are fragility fractures. It is a low-energy or non-violent fracture, such as a fracture from a standing height or less than a standing height or due to other daily activities. Common sites for fragility fractures are the thoracic, lumbar, hip, ankle, distal ulna, and proximal humerus.

3. The harm of osteoporosis:
Pain itself can reduce the quality of life of patients, spinal deformity, fractures can be disabled, patients’ activities are limited, life cannot take care of themselves, increase the incidence of lung infections, hemorrhoids, not only the increase in patient quality of life and mortality but also for individuals, families, and Society brings a heavy economic burden.

4: Osteoporosis Check:

The measured value of dual-energy X-ray absorptiometry (DXA) is currently recognized worldwide as the gold standard for the diagnosis of osteoporosis. The clinically recommended measurement sites are lumbar vertebrae 1 to 4, total hip and femoral neck. T value = (measured value – same sex with the same ethnic normal adult bone peak) / normal adult bone density standard deviation.

diagnosis: T value

normal: T value ≥ -1

Low bone mass: -2.5

Osteoporosis: T value ≤ -2.5

5: Osteoporosis Diagnosis Criteria:

1. Osteoporosis is most common in menopausal women and the elderly, and secondary osteoporosis secondary to other diseases is rare.

2. Common symptoms are back pain, more common in the chest and lower back.

3. X-ray examination shows that the most obvious osteoporosis sites are the thoracic vertebrae and lumbar vertebrae. The collapse of the vertebral body can be manifested as a fish-like double-concave or wedge-shaped deformation, and the vertebral body is sometimes even flattened.

4. Bone metrology or quantitative histomorphometric measurements. Abnormal changes in bone metabolism and bone mass can be observed. ‘Osteoporosis Treatment Guidelines, Diagnosis Criteria, cause’

6: Osteoporosis Treatment Guidelines:

1. Basic measures:

  1.  Adjusting lifestyle 1 A balanced diet rich in calcium, low salt, and moderate protein. 2 Pay attention to proper outdoor activities, which will help the physical exercise and rehabilitation of bone health. 3 Avoid smoking, alcohol, and caution with drugs that affect bone metabolism. 4 Take various measures to prevent falls, such as paying attention to whether there are diseases and drugs that increase the risk of falling, and strengthen their own and environmental protection measures (including various joint protectors).
  2. Basic supplements for bone health 1) Calcium The recommended nutrition for daily calcium intake in adults is 800 mg (elemental calcium). The recommended daily calcium intake for postmenopausal women and the elderly is 1000 mg. The average elderly in China receives about 400 mg of calcium per day from the diet, so the average daily amount of calcium to be supplemented is 500 mg to 600 mg. 2) There commended dose for vitamin D adults is 200 units (5 μg) / d, and the recommended dose for the elderly is 400 ~ 800 IU (10 ~ 20 μg) / d. The dosage of osteoporosis can be 800-1200 IU (the vitamin D content in the calcium and vitamin D complexes currently sold in China is generally less). It is recommended that serum 25OHD levels in older adults should be above 30 ng/ml (75 nmol/L) to reduce the risk of falls and fractures. Blood calcium and urinary calcium should be monitored regularly and doses adjusted as appropriate. However, if the patient is accompanied by kidney stones and high urinary calcium, calcium and vitamin D preparations should be used with caution.
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2. Drug intervention:

The addition of calcium alone is not enough for the treatment of osteoporosis, and it is necessary to add drugs according to the patient’s condition.

1: indications for drug treatment have osteoporosis (T ≤ -2.5) or have experienced brittle fractures; or have decreased bone mass (-2.5 < T < -1.0) and more than one osteoporosis Risk factors. Unconditional determination of bone density, but also in the following cases: drug treatment: 1 has occurred brittle fracture; 2OSTA screening is high risk; 3FRAX tool calculates the probability of hip fracture ≥ 3% or any important osteoporosis The probability of fracture occurrence is ≥20%.

2: Anti-bone resorption drugs 1) bisphosphonates may be selected from the group consisting of alendronate (Alendronate), sodium zoledronate, and risedronate sodium. 2) Calcitonin is more suitable for patients with osteoporosis with pain symptoms. Not suitable for long-term use. Salmon calcitonin, subcutaneous or intramuscular injection, 2 to 5 times per week according to the condition; salmon calcitonin nasal spray; salmon calcitonin, intramuscular injection. 3) Selective estrogen receptor modulators (SERMs) are used in female patients to reduce the incidence of estrogen receptor-positive invasive breast cancer without increasing the risk of endometrial hyperplasia and endometrial cancer. Raloxifene has a history of venous thrombosis and is prone to thromboses, such as prolonged bed rest and sedentary periods. 4) Estrogens can only be used in female patients. The pros and cons should be fully evaluated and the following principles should be followed: 1 Indications: Women with menopausal symptoms (hot flashes, sweating, etc.) and/or osteoporosis and/or osteoporosis risk factors, especially early menopause Use, the risk is greater and the risk is smaller. 2 contraindications: estrogen-dependent tumors (breast cancer, endometrial cancer), thrombotic diseases, unexplained vaginal bleeding and active liver disease and connective tissue disease are absolute contraindications. Uterine fibroids, endometriosis, family history of breast cancer, gallbladder disease, and pituitary prolactinoma are used with caution. In patients with a uterus, estrogen should be combined with an appropriate dose of progesterone to counteract the stimulation of estrogen on the endometrium. Women who have undergone hysterectomy should use only estrogen and no progesterone. Hormone treatment regimens, dosages, formulation choices, and duration of treatment should be individualized based on the patient’s condition. Apply the lowest effective dose. Adhere to regular follow-up and safety monitoring (especially breast and uterus).

3: Promote the bone formation drug parathyroid hormone (PTH), the treatment time should not exceed 2 years. Intramuscular injection, blood calcium levels should be monitored during medication to prevent hypercalcemia.

4: salt strontium ranelate, taken before going to bed. It is not recommended to use CCr (creatinine clearance) <30ml/min.

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5: Other drugs 1) Active vitamin D is more suitable for the elderly, renal insufficiency, 1α hydroxylase deficiency. It includes 1α-hydroxyvitamin D (α-calciferol) and 1,25-dihydroxy vitamin D (calcitriol). Regular monitoring of blood calcium and urinary calcium levels. Calcitriol and α-calciferol can be combined with other anti-osteoporosis drugs in the treatment of osteoporosis. 2) Vitamin K2  is taken after a meal. Disabled for patients taking warfarin.

3. Surgical treatment:

1: Minimally invasive surgeryVeritabroplasty and kyphoplasty are one of the new developments in minimally invasive surgery for vertebrae. They are suitable for fresh vertebral bodies without spinal cord or nerve root symptoms and severe pain. Compressive fractures have a good analgesic effect.

2: Treatment of comminuted fracturesOsteoporotic ulnar fractures in the elderly are mostly comminuted fractures, involving the articular surface. The fractures tend to remain deformed after healing, often causing wrist and finger dysfunction. The treatment method is generally reset by hand, and can be fixed by splint or plaster, or fixed by an external fixator. Surgical treatment may be considered for a few unstable fractures.

3: Treatment of hip fractures Hip fractures have the following characteristics: 1 high mortality, prone to pneumonia, urinary tract infections, hemorrhoids, venous thrombosis of lower extremities and other complications. 2 bone necrosis rate and non-healing rate are high. 3 teratogenic, high disability rate. 4 recovery is slow. Surgical treatment includes internal fixation, artificial joint replacement and external fixators. Non-surgical treatment can also be used.

7: Osteoporosis Prevention:

Strengthen exercise from adolescence, ensure adequate calcium intake, and prevent and actively treat various diseases, especially chronic wasting diseases and malnutrition, malabsorption, etc., to prevent various gonadal dysfunction diseases and growth and development. Diseases; avoid long-term use of drugs that affect bone metabolism, and try to obtain the ideal peak bone mass and reduce the risk of osteoporosis in the future.
Adult calcium supplementation is a basic measure to prevent osteoporosis. It cannot be used alone as a therapeutic drug for osteoporosis but as a basic auxiliary drug. Prevention in adulthood mainly includes two aspects. First, try to delay the rate and extent of bone loss. For postmenopausal women, the accepted measure is to add estrogen or estrogen and progesterone mixture as soon as possible. Second, the prevention of fractures in patients with osteoporosis, and avoiding risk factors for fractures can significantly reduce the incidence of fractures.

8: Osteoporosis prognosis:

1: whether the primary disease-causing osteoporosis is cured or controlled.

2: whether the risk factors for osteoporosis can be minimized.

3: whether primary and recurrent fractures can be prevented.

Conclusion:

Postmenopausal osteoporosis usually occurs in women 5 to 10 years after menopause. “Osteoporosis Treatment Guidelines, Diagnosis Criteria, cause”  senile osteoporosis generally refers to osteoporosis after 70 years of age in the elderly, and idiopathic osteoporosis mainly occurs in adolescents, the cause is still unknown.

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