Pay attention to bone health - a brief discussion on the prevention and treatment of osteoporosis

Editor's Note: October 20th of each year is World Osteoporosis Day. The Osteoporosis and Bone Mineral Disease Branch of the Chinese Medical Association and the Health Communication Branch of the Chinese Preventive Medicine Association jointly released the Chinese theme of World Osteoporosis Day in 2024: "Manage your weight, strengthen your bones". In order to popularize knowledge about osteoporosis and prevent and reduce the occurrence of osteoporotic fractures, this journal has launched a solicitation and commissioning activity on the occasion of World Osteoporosis Day, and selected excellent articles for readers.

Zhang Zhenlin Osteoporosis is a "silent killer" lurking in the vast majority of postmenopausal women and elderly men. Patients may not experience pain or any other symptoms before a fracture occurs. However, this systemic disease has already developed silently in the human body, causing the patient's bone mass to decrease, the microstructure of bone tissue to be destroyed, and the bones to become "brittle". It is not detected until fractures occur in the spine, hip, and wrist.

As the aging of the population in my country becomes increasingly serious, osteoporosis has become an important public health issue facing my country. The national epidemiological survey on osteoporosis shows that the prevalence of osteoporosis in people over 50 years old in my country is 19.2%, including 32.1% for women and 6.9% for men; the prevalence of osteoporosis in people over 60 years old is 32%, including 51.6% for women and 10.7% for men. However, the prevention and treatment of osteoporosis in my country is currently facing the severe challenge of "one high and three lows", with a high prevalence rate, but low awareness, diagnosis and treatment rates.

The onset of osteoporosis is mainly related to two factors: on the one hand, the peak bone mass between the ages of 20 and 40. The so-called peak bone mass is the peak bone density. Surveys and studies have shown that men generally reach the highest bone density between the ages of 25 and 30, and women generally reach the highest bone density between the ages of 30 and 35. That is to say, the bone mass is the highest during this period, the bone quality is the best, and the strength against fractures is the greatest. Therefore, if you want to maintain bone health and prevent osteoporosis, you should obtain higher bone mass during the peak period between the ages of 20 and 40, so as to maintain better bone quality. On the other hand, a series of risk factors such as the decline in estrogen levels in women after menopause, the decline in testosterone levels in elderly men, and insufficient calcium or vitamin D intake lead to rapid bone loss (the annual bone loss rate can be greater than 3%), which in turn causes osteoporosis and osteoporotic fractures, especially fractures of the hip or thoracolumbar spine, which are more harmful and are one of the main causes of disability and death in elderly patients. According to statistics, within one year of a hip fracture, about 20% of patients die from various complications and 50% of patients may become disabled.

As we all know, for all diseases, "prevention" is better than "treatment". In recent years, the country has vigorously advocated the shift from disease management to health management, and to achieve health management throughout the life cycle. From birth to infancy, adolescence, middle age, and finally to menopause or old age, bone health throughout the life cycle is very important. Only by taking some corresponding strengthening measures in each stage of life can we maintain healthier bones and better prevent the occurrence of osteoporosis.

First, in adolescence, in addition to strengthening exercise, ensuring adequate sunshine, and taking in adequate calcium, vitamin D, and high-quality protein, it is also necessary to give up some bad habits, including smoking, alcoholism, and some excessive weight loss measures, and avoid excessive drinking of coffee and carbonated drinks, so as to achieve higher bone mass between the ages of 20 and 40. Secondly, attention should be paid to high-risk groups such as the elderly with low body mass index, especially those with some chronic diseases (such as diabetes), and those who use certain drugs that affect bone metabolism (such as glucocorticoids, which only use 5 mg each time and can cause osteoporosis for more than 3 months).

Osteoporosis usually has no obvious clinical manifestations in the early stages and is often easily overlooked. Some physical signals may indicate the risk of osteoporosis, such as leg cramps, back pain, shortened height, hip or thoracolumbar fractures, muscle weakness, and decreased mobility. Both men and women are recommended to have a routine bone density test after the age of 40 to clarify their own bone density baseline. After the age of 50, a bone density test should be done once a year. Once a bone density test indicates bone loss or osteoporosis, clinical recommendations are to further improve related examinations and identify related diseases (such as hyperparathyroidism, blood system diseases, etc.); after confirming that it is primary osteoporosis, in addition to supplementing calcium and vitamin D, bone resorption inhibitors or bone formation-promoting drugs are used for treatment to increase bone density, improve bone quality, and reduce the occurrence of fractures.

(Author: Wei Zhezhang Zhenlin, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Bone Disease Clinical Research Center)