After the age of 40, "brittle bones" are very serious! This screening must be done! Especially for these 5 groups of people...

They live cautiously every day, dare not lift heavy objects, cannot exercise much, and even have to take their time to turn over in sleep, for fear of getting bumped... This is the normal life of patients with "brittle fractures". Due to severe osteoporosis, an unintentional sneeze, cough or even a fall may cause a fracture, and the fractures are repeated.

"Prevention of the first fracture is very important, especially for vertebral compression fractures. Even if nails are inserted or bone cement is used, more than 50% of people will fracture again within three years if they do not receive anti-osteoporosis treatment. " In the clinic of Zhang Zhenlin, director of the Department of Osteoporosis and Bone Diseases at the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, every time he sees a patient coming in a wheelchair or with crutches, he can't help but ask, "Why didn't you come earlier?"

“I didn’t know osteoporosis could lead to fractures, I thought it was caused by aging.”

“I don’t know how to prevent osteoporosis.”

“I didn’t know I would have multiple fractures.”

…

Many people’s answers indicate that there is a general lack of knowledge about osteoporosis, and it is even more difficult to talk about early prevention and intervention.

In fact, the awareness rate of osteoporosis among patients over 50 years old in China is only 7.0%; the osteoporosis diagnosis rate among patients who have suffered fragility fractures is only about 2/3, and less than 1/4 of them receive effective anti-osteoporosis drug treatment[1]. Middle-aged and elderly women, especially postmenopausal women, are an important group of people who must pay attention to their bone health and prevent, diagnose and treat osteoporosis early.

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01

Don't treat osteoporosis as a disease

Many people do not think that osteoporosis is a "disease". They believe that it is normal to have leg and foot pain or bone loss as people age. They do not know how to prevent and treat osteoporosis, which department of doctors to find for treatment, or they think that taking calcium tablets or basking in the sun can cure osteoporosis.

These erroneous or one-sided perceptions have caused many patients to miss the opportunity for early intervention, and they do not realize the harm of osteoporosis until they suffer fractures or even secondary or multiple fractures. Osteoporosis is an aging disease that requires not only early intervention and early treatment, but also long-term treatment, especially fracture risk assessment and high fracture risk management.

In China, about one-third of women over 50 and more than half of women over 65 suffer from osteoporosis[2]. The risk of a woman suffering from a fragility fracture in her lifetime is higher than the combined risk of breast cancer, endometrial cancer, and ovarian cancer. Once a postmenopausal woman suffers her first fragility fracture due to osteoporosis, her risk of another fracture within one year is five times that of a normal person [3].

Among men, one-fifth of men over the age of 50 will suffer from osteoporotic fractures, and nearly 30% of hip fractures occur in men. The consequences of osteoporotic fractures in men are more serious, with significantly higher disability and mortality rates than in women [4].

Worse still, fragility fractures are one of the main causes of disability and death in elderly patients . Within one year of a hip fracture, approximately 20% of patients will die from various complications, and approximately 50% of patients will become disabled[2].

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02

Bone density screening is required after age 40

Osteoporosis is a relatively hidden disease, and many patients often only pay attention to it after a brittle fracture occurs. In fact, the solution is to start with the main cause of osteoporosis. The "Guidelines for the Diagnosis and Treatment of Primary Osteoporosis 2022 Edition" points out that the prevention and treatment of osteoporosis cannot rely solely on tertiary hospitals. Community hospitals and county-level central hospitals need to participate in the entire osteoporosis education, screening, referral and treatment process. For example, community hospitals need to screen out high-risk patients from risk factors for bone density examinations.

"Unfortunately, there are obvious differences between urban and rural areas in bone density screening. The situation in big cities is relatively better, but in rural areas, due to the shortage of medical resources and inadequate equipment, few people have bone density tests, and some people don't even know about this test in their entire lives." Director Zhang Zhenlin emphasized that bone density should be checked after the age of 40. Ultrasound of the hands and feet can be used for preliminary screening, but this test cannot diagnose whether a person is ill, but can only indicate whether there is a risk of low bone mass. If a diagnosis is to be made, dual-energy X-ray absorptiometry (DXA) is required to test the bone density of the vertebral body and hip.

After age 40: Have a bone density test every 2 to 3 years

After 50 years old: bone density test should be done every year, especially for menopausal women.

In the examination results, pay attention to whether the T value is ≤-2.5 (the normal reference value is between 1 and -1). That is, when the bone density is 2.5 standard deviations lower than the normal bone peak value of young people of the same gender, it is osteoporosis. At this time, you should go to the hospital for further examination to determine whether it is primary or secondary osteoporosis, as well as the risk of fracture, and receive anti-osteoporosis drug treatment.

If the results are good, you should continue to maintain a healthy lifestyle; if your bone mass has decreased slightly, you should give appropriate intervention. In addition to lifestyle intervention, you should also increase exercise and increase your intake of nutrients such as calcium and vitamin D under the guidance of a doctor, and follow up on bone density regularly.

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These groups of people are the focus of investigation:

1. The height has become significantly shorter, or a hunchback deformity has appeared;

2. Pain, often pain in waist and legs;

3. Patients who have suffered at least one fragility fracture;

4. Overweight, long-term excessive drinking, long-term use of glucocorticoids (>3 months), and increased time from sitting to standing are all risk factors;

5. People with other diseases, such as those who take epilepsy drugs for a long time and AIDS patients are at high risk.

03

Preventing fragility fractures

Early drug intervention

For people at high risk of osteoporosis, it is not enough to just take some medicine or get a diagnosis. Instead, like other chronic diseases, regular follow-up, intervention, evaluation, and treatment are required to avoid complications such as new fractures .

Many people only take calcium and vitamin D after being diagnosed with osteoporosis. These are helpful for bones, but they are only basic treatments and are not enough to increase bone density and reduce fracture rates. Anti-osteoporosis drugs should also be used scientifically.

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In addition, Director Zhang Zhenlin reminded that after a brittle fracture occurs, anti-osteoporosis drugs should be used according to the patient's condition to prevent the fracture from happening again. At present, osteoporosis treatment drugs are divided into 6 categories: basic treatment, bone resorption inhibitors, bone formation promoters, dual-action drugs, other mechanism drugs and Chinese patent medicines.

The "Guidelines for the Diagnosis and Treatment of Primary Osteoporosis 2022 Edition" recommends precise stratified treatment according to fracture risk. At the same time, RANKL monoclonal antibodies and romosuzumab (not available in my country) have been newly added. Among them, the RANKL monoclonal antibody denosumab has been included in medical insurance and approved for the treatment of osteoporosis in postmenopausal women at high risk of fracture. This year, it was approved for a new indication for the treatment of osteoporosis in men at high risk of fracture, which can help patients improve bone mass and reduce the risk of fractures.

References:

[1] Chinese Center for Disease Control and Prevention, Chinese Medical Association Osteoporosis and Bone Mineral Disease Branch. Epidemiological Survey Report on Osteoporosis in China (2018)［M］. Beijing: People's Medical Publishing House, 2021.

[2] Chinese Medical Association Osteoporosis and Bone Mineral Disease Branch, Guidelines for the diagnosis and treatment of primary osteoporosis (2022). Chinese Journal of Osteoporosis and Bone Mineral Disease. 2022, 15(6): P573-P611.

[3]Lindsay, Robert, et al. (2001). Risk of new vertebral fracture in the year following a fracture. Jama, 285(3), 320-323.

[4] Chinese Medical Association Osteoporosis and Bone Mineral Disease Branch. Guidelines for the diagnosis and treatment of osteoporosis in men. Chinese Journal of Osteoporosis and Bone Mineral Disease, 2020, 13(5): 381-395. doi:10.3969/j.issn.1674-2591.2020.05.001

Expert in this article: Zhang Zhenlin, Chairman of the Osteoporosis and Bone Mineral Disease Branch of the Chinese Medical Association, Director of the Osteoporosis and Bone Disease Department of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Source: Health Times