Interviewee: Department of Orthopedics, Zhongshan Hospital, Fudan University
Li Xilei is the chief physician
In the popular mind, osteoporosis is often associated with fractures, "shrinking" and other conditions, but few people know that this disease can also cause various pains. Li Xilei, chief physician of the Department of Orthopedics of Zhongshan Hospital affiliated to Fudan University, said in an interview with reporters that many patients come to the clinic for pain in the clinic, but it is difficult to think of osteoporosis. Recently, the Chinese Expert Consensus on the Diagnosis and Treatment and Management of Osteoporotic Pain in the Elderly (2024 Edition) was released, which specifically pointed out that attention should be paid to the pain identification and management of elderly patients with osteoporosis. Because, it may be that long before the height becomes significantly shorter, the whole body has begun to "warn".
Pain in the middle of the night. For generalized pain for which the cause cannot be identified, bone mineral density testing is often recommended. Because osteoporosis is often accompanied by deformities of the skeletal system, it can cause pain, often in the second half of the night or early morning, and it is difficult to determine the exact location. Bone pain can occur when bone mass is lost by more than 12%, and the faster or lower the bone mass, the more severe the bone pain. Many elderly patients with osteoporosis, especially after fractures, often suffer from anxiety and depression, and the pain will be further aggravated.
Low back pain. Elderly patients with osteoporosis will have obvious lesions in the bone structure, even a slight external force may cause injury, especially the lower back with more weight, and the shoulder and neck with more activity, which are the parts of patients who often suffer pain, and will be aggravated when they move. However, osteoporosis, with low back pain as the main manifestation, is easily confused with low back myofasciitis, lumbar disc herniation, lumbar spinal stenosis, etc., and needs to be carefully identified.
Turning over painfully. When the bone is "loose", the shape of the bone can change slightly, and the surrounding muscles will inevitably be affected, causing pain. This pain is mostly position-related, such as when turning over, sitting ups, or resting pain in a certain position.
Acute pain. When a fracture occurs in an elderly patient with osteoporosis, acute and severe pain will occur in the corresponding part, such as thoracolumbar vertebral compression fracture, which can cause thoracolumbosacral or buttock pain, which is aggravated when turning over, so it is necessary to pay attention to it and seek medical attention as soon as possible.
After the age of 35, bone loss begins and bones begin to age naturally. The prevalence of osteoporosis in people over 50 years old and 32% in people over 65 years old in mainland China is 19.2%. Experts say that once any of the above pain occurs in middle-aged and elderly people, it is best to see a doctor in time to check the severity of osteoporosis through physical examination, bone density test and other relevant imaging and laboratory tests. After diagnosis, clinical intervention is generally divided into 3 steps.
Step 1: Life Therapy. Pay attention to a balanced diet, strengthen nutrition, quit smoking and limit alcohol, and avoid excessive consumption of coffee and carbonated drinks; Ensure regular exercise to avoid falls; Reduce the use of drugs that affect bone metabolism, such as glucocorticoids, phenytoin, etc.; Follow your doctor's advice to supplement calcium and vitamin D, etc.; Avoid standing and sitting for long periods of time, and need bed rest if you experience severe pain.
Experts emphasize that adequate sun exposure is particularly important, and the elderly should not be "fully armed" when walking outdoors, and try to expose part of the skin such as hands, arms, feet, and back to the sun, so as to receive ultraviolet rays, promote the synthesis of vitamin D, and effectively prevent and control osteoporosis.
Step 2: Anti-osteoporosis therapy. Patients can use anti-osteoporotic drugs such as calcitonin and bisphosphonates under the guidance of a doctor, and if bone density increases, acute and chronic pain will also be relieved. In addition, minimally invasive interventional surgery, acupuncture, physiotherapy, etc. can also help improve pain symptoms. Nonsteroidal anti-inflammatory analgesics can be used to relieve a variety of mild to moderate osteoporotic pain.
Compared with men, women tend to have more severe osteoporosis due to decreased hormone levels after menopause and may need to use "more advanced" drugs, such as raloxifene hydrochloride tablets and parathyroid hormone analogues.
Step 3: Exercise therapy. Elderly patients with osteoporosis have increased bone fragility and are often accompanied by sarcopenia, resulting in abnormal posture, which can cause serious injuries such as traumatic fractures once they fall. In addition to medication to control bone loss, exercise not only helps increase bone density, but also improves muscle strength and balance.
Experts say that there is a "Woolf's law" in clinical practice, which refers to the increase in bone density and hardness when the bone is subjected to external pressure for a long time. The simplest stimulus is walking, and the elderly may even choose to walk with appropriate weights, but they need to do what they can; Strength training can also provide longitudinal stimulation of bones to improve bone density, but start with small weights and gradually increase them. It should be reminded that when patients with severe osteoporosis exercise in the early stage, it is best to be accompanied or supported by family members to avoid accidents.
Source: Global Times Health Client
Editor: Liu Shaoyu
Review: Yu Bo
Producer: Lin Ying
Shenyang News Comprehensive Channel
Premiere time: 16:50 daily
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