1. Movement
In adulthood, various types of exercise help to maintain bone mass. Postmenopausal women insist on exercising for three hours a week, and the overall calcium increases. However, in the case of amenorrhea caused by excessive exercise, bone loss is accelerated. Exercise can also improve sensitivity and balance, and encourage osteoporosis patients to exercise as much as possible.
2. Nutrition
Good nutrition is important to prevent osteoporosis, including adequate calcium, vitamin D, vitamin C and protein. From small to large, you should have enough calcium intake in your daily diet, and calcium affects the acquisition of bone peaks. European and American scholars claim that the calcium intake is 800 ~ 1 000 mg for adults, 1 1,000 ~ 1 1,500 mg/day for postmenopausal women, and11,500 mg/day for men and other patients with osteoporosis risk factors after the age of 65. The intake of vitamin d is 400 ~ 800 u/ day.
Prevent wrestling
We should try our best to reduce the fall probability of osteoporosis patients, so as to reduce hip fractures and Colles fractures.
4. Drug therapy
Effective drug therapy can prevent and treat osteoporosis, including estrogen replacement therapy, calcitonin, selective estrogen receptor modulator and diphosphate, which can prevent bone resorption but have little effect on bone formation. Drugs used to treat and prevent the development of osteoporosis fall into two categories. The first category is drugs that inhibit bone resorption, including calcium, vitamin D and active vitamin D, calcitonin, diphosphate, estrogen and isoflavones; The second category is drugs that promote bones, including fluoride, synthetic steroids, parathyroid hormone and isoflavones.
(1) Hormone replacement therapy is considered as the best choice and the most effective treatment for postmenopausal women with osteoporosis. The problem is that hormone replacement therapy may bring adverse reactions to other systems. Patients with breast diseases and patients who can't tolerate their side effects should avoid using hormone replacement therapy. ① Estradiol is recommended to be taken immediately after menopause and for life under the condition of tolerance. Take it regularly, that is, for 3 weeks, and stop using it 1 week. Allergies, breast cancer, thrombophlebitis and undiagnosed vaginal bleeding are prohibited. In addition, ethinylestradiol and norethindrone are progestogens, which are used to treat moderate to severe vasomotor symptoms related to menopause. ② Androgen research shows that testosterone replacement therapy can increase the BMD of the spine, but it seems ineffective for the hip bone, so androgen can be regarded as an anti-bone absorption drug. ③ intramuscular injection of testosterone, 1 time /2 ~ 4 weeks, can be used to treat patients with hypogonadism and decreased BMD. Renal function is impaired, so the elderly patients should use testosterone with caution to avoid increasing the risk of prostatic hyperplasia; Testosterone can increase the growth of subclinical prostate cancer, so it is necessary to monitor prostate specific antigen (PSA) when taking drugs. It is also necessary to monitor liver function, blood routine and cholesterol; If there is edema and jaundice, stop taking the medicine. Ensure the supply of calcium and vitamin D during medication. Another external testosterone is available.
(2) Selective estrogen receptor modulators have weak estrogen-like effects in some organs, but can play an antagonistic role in other organs. SERMs can prevent osteoporosis and reduce the incidence of cardiovascular diseases, breast cancer and endometrial cancer. This kind of drug is raloxifene, and the non-steroidal drug benzothiophene is an agonist of estrogen, which can inhibit bone resorption, increase BMD of spine and hip, and reduce the risk of vertebral fracture by 40% ~ 50%, but the curative effect is not as good as estrogen. It is forbidden for premenopausal women.
(3) Diphosphate diphosphate is a synthetic analogue of pyrophosphate combined with hydroxyapatite in bone, which can specifically inhibit osteoclast-mediated bone resorption and increase bone density. The specific mechanism is not clear, which is related to regulating the function and activity of osteoclasts. Pregnant women and women who plan to get pregnant are prohibited. The first generation was named sodium hydroxyethyl phosphonate or etidronate, and the therapeutic dose had adverse reactions of inhibiting bone mineralization. Therefore, it advocates intermittent and regular administration. At the beginning of each cycle, sodium hydroxyethyl phosphonate was taken continuously for 2 weeks, and the drug was stopped for 10 week, and every 12 week was a cycle. Taking sodium hydroxyethyl phosphonate requires taking calcium at the same time.
In recent years, a new generation of phosphate has been applied in clinic, such as amino diphosphate (alendronate), risedronate (risedronate sodium), chlorophenol acid (chlorophenol phosphate) and pamidronate sodium. It has a particularly strong inhibitory effect on bone resorption and does not affect bone mineralization at therapeutic dose. Alendronate (trade name Fushanmei) has been proved to reduce bone resorption, reduce the incidence of fractures of spine, hip and wrist by 50%, and prevent postmenopausal glucocorticoid-related osteoporosis.
(4) Calcitonin Calcitonin is a peptide hormone, which can rapidly inhibit the activity of osteoclasts, and slow action can reduce the number of osteoclasts. It has the effects of relieving pain, increasing activity function and improving calcium balance, and has analgesic effect on fracture patients, and is suitable for those who are contraindicated or intolerant to bisphosphate and estrogen. Commonly used preparations in China are calcitonin (procalcitonin, salmon calcitonin) and ikanin (ikanin). Calcitonin can be administered parenterally and intranasally, and the action time of parenteral administration can last for 20 months.
(5) Vitamin D, calcium vitamin D and its metabolites can promote calcium absorption and bone mineralization in small intestine, while active vitamin D (such as Lagerstroemia, alfacalcidol) can promote bone formation, increase the production of osteocalcin and the activity of alkaline phosphatase. Taking active vitamin D can reduce the incidence of vertebral and extravertebral fractures in patients with osteoporosis more than simply taking calcium. In addition, the combined preparation of vitamin D and calcium can be selected, and the curative effect is reliable.
(6) Fluoride Fluoride is an effective bone formation stimulator, which can increase the bone density of vertebral body and hip and reduce the incidence of vertebral fracture. Small doses of fluoride every day can effectively stimulate bone formation with little side effects. The active ingredients of Tridin are glutamine monofluorophosphate and calcium gluconate, which can be chewed with meals. This drug is prohibited in children and during development.
For patients with osteopenia and osteoporosis, it is suggested to review BMD every 1 ~ 2 years. If the bone turnover index is high, drugs should be reduced. In order to prevent long-term bone loss, it is suggested that women should start estrogen replacement therapy at least 5 years after menopause, preferably 10 ~ 15 years. If the patient is diagnosed with a disease that is known to cause osteoporosis, or has used drugs that clearly cause osteoporosis, it is recommended to give calcium, vitamin D and diphosphate at the same time.
5. Surgery is needed only after fracture caused by osteoporosis.