Treatment of osteoporosis

As mentioned earlier, osteoporosis before fracture in the event of multiple asymptomatic, so the risk factors in patients with pre-determined and take appropriate preventive measures, such as changes in diet and lifestyle is very important. At the same time, drugs can only thickening of trabecular bone thinning, perforation can be repaired, but not enough to have re-connected trabecular bone fracture, bone damage that has been micro-structure can not be fully restored, showing that prevention of this disease is more realistic and important than the treatment . prevention, including the best peak bone mass, osteoporosis intervention in risk factors, reduce bone loss. peak bone mass depends on genetic factors and environmental factors in two ways. genetic factors are the main, about 75%, but so far There is no effective interventions, and environmental factors can be adjusted to control. So the preventive measures of environmental factors should be started from the children and adolescents, including adequate calcium intake, appropriate exercise, especially weight-bearing exercise can increase bone peak. eliminating risk factors for osteoporosis prevention is an effective means, such as quit smoking and avoid alcohol, excessive caffeine, low weight, long-term braking and excessive exercise are due to be avoided. glucocorticoid intake for the need and the other increased risk factors for osteoporosis patients should take certain precautions, use the lowest effective dose possible, if possible, use of hormones by inhalation, or the next day, use of hormone therapy, as well as muscle strengthening exercises. effective prevention measures are the following. 1. Movement of children and adolescents have the rules if the movement, the bone mass than those without regular exercise is higher, a variety of sports is better to weight-bearing exercise can increase BMD, although its exact The mechanism is unclear. In adulthood, many types of exercise helps maintain bone mass. To insist on postmenopausal women 3h per week increase in the movement of the overall calcium, exercise in moderation. But the sports were over-induced amenorrhea, bone loss but faster. exercise can also improve the sensitivity and balance, reduce the risk of elderly falls. to encourage patients with osteoporosis as much as possible activities. 2. Nutrition Good nutrition for the prevention of osteoporosis is important, including adequate amount of calcium, vitamin D, vitamin C and protein. From childhood onwards, the daily diet should have adequate calcium intake, calcium affect the acquisition of peak bone mass. European and American scholars have advocated daily intake of calcium during youth (elemental calcium) is 1,000 ~ 1,200 mg, for adults 800 ~ 1,000 mg, daily in postmenopausal women 1,000 ~ 1,500 mg, 65 men after the age and other risk factors with osteoporosis in patients with recommended calcium intake of 1500mg / d. small size and low protein into the crowd, calcium intake may be lower than the content. calcium carbonate, calcium chloride, calcium lactate and calcium gluconate elements were 40%, 27%, 13% and 9%. If the calcium after taking the meal, while taking 200ml of liquid, can promote calcium absorption, and sub-times taking more than 1 time to take effect. achlorhydria may take calcium citrate, in order to facilitate absorption. Vitamin D, intake of 400 ~ 800U / d. 3. Prevention of wrestling should be to minimize the risk of osteoporosis patients falls, hip fractures and Corus to reduce the fracture. old wrestling occurrence probability increased exponentially with age increase. Shiliang exercise improves the sensitivity and balance, for the prevention of elderly Shuaidao some help. For easy Yinqi wrestling diseases or injuries should be promptly be effective treatment. Avoid using drugs affect the body balance. 4. Drug therapy effective in drug therapy can prevent and treat osteoporosis, including estrogen replacement therapy, calcitonin, selective estrogen receptor modulators, and bisphosphonates, these drugs can prevent the formation of bone resorption, but very small role. Experience slow-release sodium fluoride treatment and found that low doses of PTH can increase bone formation, can prevent estrogen deficiency bone loss in women. The former can also reduce the incidence of vertebral fractures. study confirmed these drugs can improve BMI, for gonadal function male osteoporosis, hypothyroidism testosterone therapy given to maintain bone mass. given calcium and vitamin D are important preventive measures. for the treatment and prevent the development of osteoporosis drugs are divided into two categories, the first category as inhibit bone absorption of drugs, including calcium, vitamin D, active vitamin D, calcitonin, bisphosphonates, estrogen, and isoflavones; second category is the promotion of bone medicine, including fluoride, anabolic steroids, parathyroid hormone, and different flavonoids. So far, all drugs are experiments conducted in women, in addition to estrogen and selective estrogen receptor modulator, the assumption that all of the drugs on the treatment of men is the same. (1) Hormone Replacement therapy (hormone replacementtherapy, HRT): Hormone replacement therapy is considered the treatment of osteoporosis in postmenopausal women the best and most effective methods of treatment problem is hormone replacement therapy may bring adverse effects to other systems. Hormone replacement therapy be avoided in patients with breast disease, and those who can not tolerate the side effects. For these patients, the choice of other drugs. Hormone Replacement Therapy drugs in the estrogen, estrone can be pregnant horses (conjugated estrogen) , 0.3 ~ 0.625mg / d, for the removal of the uterus is not, it is recommended that estrogen cycle, 1 time a day, once every 3 weeks, and then disabled for 1 week. reported that estrogen therapy can reduce cardiovascular disease in postmenopausal women increased risk, which may be due to drugs improve plasma lipid levels (high density lipoprotein increased, lowering cholesterol and low density lipoprotein), and the direct effect of drugs on the arterial. If you disable estrogen, then the l 2 years, recurrence of rapid bone loss, the loss of estrogen at the same time bring the cardiovascular protective effect. of the drug allergies, breast cancer, diagnosis is not clear vaginal or uterine bleeding, active thrombophlebitis, thrombosis, diseases and Past use of this hormone cause similar symptoms were banned. Estrogen can reduce the effect of anticoagulant drugs, and barbiturates, rifampicin, and other hepatic microsomal enzymes induced by the drug combination can reduce serum levels of estrogen. Estrogen also can reduce the hepatic P450 enzyme activity, associated with glucocorticoid use may therefore affect the role of glucocorticoid and toxicity. some patients taking estrogen can stimulate the emergence of symptoms of estrogen excess, such as abnormal uterine bleeding or large, Breast pain can also occur in some patients fluid retention. long-term use of estrogen therapy increased the risk of endometrial hyperplasia, progesterone was added to offset the side effects, the uterus has been removed by the addition of progestin is not required. taking estrogen hormones, including gynecological patients should receive regular comprehensive physical examination, including examination and breast examination and photography. jaundice, and beyond the control of high blood pressure should be discontinued. should be discontinued 2 weeks before surgery, to avoid blood clots. Although hormone replacement therapy osteoporosis is effective, but in July 2002 a U.S. study showed that estrogen plus progestin hormone replacement therapy to prevent cardiovascular disease more harm than good, for the U.S. National Institutes of Health (NIH) proposal to scrap the purpose of prevention estrogen replacement therapy. the United States under the NIH National Heart, Lung and Blood Institute conducted a named women's health initiative estrogen plus progestin used to prevent the purpose of hormone replacement therapy study, the study is a randomized, controlled a prevention research, since 1993, the original plans to continue to 8.5 years, is expected to end in March 2002. For security reasons, the average follow-up of 5.2 years, the study on May 31, 2005 termination. WHI were included the 16,608 persons aged 50 to 79-year-old postmenopausal women with an intact uterus, in which 8,506 women were randomly assigned to receive estrogen and progesterone combination therapy, 8,102 women were randomized to receive placebo. Research in the United States conducted 40 clinical centers. The test uses combined estrogen plus progestin therapy (pregnancy horse estrone 0.625mg / d, medroxyprogesterone acetate 2.5mg / d), day 1. So far the WHI showed that compared with placebo, estrogen and progesterone The prognosis for the combination therapy: stroke increased 4l%; heart disease increased by 29%; vein thrombosis rate of doubling; total cardiovascular disease increased by 22%, 26% of breast cancer, colon cancer by 37%, hip fractures reduced by 1 / 3, the total fractures decreased by 24%, no difference in overall mortality between the two groups. The results of the risk / benefit ratio does not meet the need for primary prevention of chronic disease interventions. WHI results suggest that the method of cardiovascular disease and breast cancer may exceed the actual disadvantages of the benefits of prevention of osteoporosis. In view of this, the choice of estrogen plus progestin treatment of osteoporosis should be careful, the situation must be weighed against the combination of patients. estradiol (estradio1): can reduce bone increased absorption of bone cell activity, a number of studies have shown that estrogen can prevent spine and hip bone loss, it is recommended to start taking after menopause, in the case of tolerance to take life. Adult 0.1mg / d, cycle taking that use 3 weeks, disabling for 1 week. can be used through the skin film, the amount of daily release of estradiol is not less than 0.05mg, if necessary, adjust the dose to control menopausal symptoms. allergies, breast cancer, thrombophlebitis and the diagnosis of obscure bleeding disabled. while ethinyl estradiol (ethinylestradio1) and norethisterone (norethindrone) is progesterone, used to treat moderate to severe menopause-related and vasomotor symptoms, 1 tablet / d. androgen: Research shows that the sex hormones caused a serious lack of male patients with osteoporosis, given testosterone replacement therapy can increase spine BMD, but the hip appears to be invalid, it can be seen as an anti-androgen drug resorption. Testosterone (testosterone): intramuscular injection every 200mg, every 2 to 4 weeks 1, for the treatment of hypogonadism in patients with decreased BMD. elderly patients with impaired renal function, and testosterone with caution, to avoid increasing the risk of benign prostatic hyperplasia; testosterone can subclinical increase in the growth of prostate cancer, so the medication should be monitored prostate-specific antigen (PSA); need to monitor liver function, blood and cholesterol; such as edema and jaundice should be discontinued. medication should ensure that during the supply of calcium and vitamin D . Another topical testosterone available. (2) selective estrogen receptor modulators (selective estrogen receptor modulators, SERMs): these drugs in certain organs with weak estrogen-like effect, while in other organs can be antagonism from estrogen. SERMs can prevent osteoporosis, but also to reduce cardiovascular disease, breast and endometrial cancer incidence. these drugs raloxifene (raloxifene, trade name Evista), a non- steroids benzo thiophene (nonsteroidal benzothiophene), is the estrogen agonist, can inhibit bone resorption, increased spine and hip BMD, fracture risk can cone dropped 40% to 50%, but the effects of estrogen than poor. do not want to take the drug for illness can not take estrogen or estrogen with a moderate risk of osteoporosis for women, particularly those with vasomotor menopausal syndrome (such as hot flashes, flushing) of women and with cardiovascular disease and breast cancer risk in women. premenopausal women, disabled and is not recommended and estrogen replacement therapy, Evista dose of 60mg / d. The drug has antagonistic effect of warfarin, prohibition and anion exchange resin ( such as the test to enamine) while taking, and diazepam (stability), diazoxide, lidocaine and other high protein binding of drugs combined with caution. long-term braking and disabled 3 days before surgery in order to avoid thrombosis. (3) two phosphate (Bisphosphonates): two phosphate hydroxyapatite in bone with a combination of synthetic analogues of pyrophosphate, can specifically inhibit osteoclast-mediated bone resorption and increase bone density, the specific mechanisms are not yet entirely clear, consider regulating osteoclast function and activity. banned from pregnant women and women planning pregnancy. first named sodium hydroxyethyl phosphonate (etidronate disodium) called for by Sodium phosphate, therapeutic doses to inhibit bone mineralization of adverse reactions, so stand intermittent, periodic administration, the beginning of a row to take a week hydroxyethyl phosphonate sodium for 2 weeks 400mg daily for 10 weeks and then disable each for a period of 12 weeks. hydroxyethyl phosphonate sodium to be taken while taking calcium, such as to adhere to use 3 years, will enable patients with vertebral osteoporosis, estimate an increase of 5.7% increase in femoral neck bone mass is relatively smaller. Bone biopsy results showed that this cycle of therapy did not affect bone mineralization. in recent years a new generation of phosphate used clinically, such as the amino-bisphosphonates (alendronate, alendronate Qu ester), risedronate acid (risedronate sodium phosphate) (risedronate sodium, commodity Actonel), Lin acid chloride (Cl A diphosphate) (coldronate, commodity bonefos, bone phosphate) and sodium pamidronate (pamidronate, trade name Aredia, Aredia), etc. exceptionally strong inhibition of bone resorption, therapeutic doses do not affect bone mineralization. alendronate (alendronate, brand name fosamax, Fosamax) can reduce bone resorption confirmed lower spine, hip and wrist fracture rates 50% in pre-menopausal hormone use can prevent glucocorticoid-related osteoporosis. prevention dose 5mg / d, healing 10mg / d or 70mg / week. taking the drug need to stand or remain sitting after 30min, blood calcium disease, esophageal dysfunction, drugs that affect the emptying of the esophagus. and calcium and other multivalent cations drugs when taken together, it is recommended to take apart, separated by at least 30min. while taking aspirin and NSAIDs may increase gastrointestinal reactions. There upper gastrointestinal disease, renal insufficiency (creatinine clearance 35ml/min) when used with caution; medication to ensure adequate calcium and vitamin D intake. as a serious gastrointestinal reactions, such as difficulty swallowing, swallowing pain, chest increased pain and burning sensation in the stomach should be discontinued. bisphosphonates are the current domestic solid state, taking the approach with simvastatin alendronate. risedronate acid can prevent bone resorption, increase bone density in the spine and 5% of the femoral neck and 1.6% respectively. postmenopausal women taking risedronate acid 3 consecutive years, vertebral fractures and vertebral fractures outside the decreased incidence of 41% and 39%. risedronate dose of acid 5mg / d, newly listed 35mg dosage form, taking 1 for the week, efficacy and 5mg / d very. phosphine major role in bone tissue in the bone, and its mechanism is to prevent the dissolution of hydroxyapatite crystals and direct inhibition of osteoclast activity, thus inhibiting bone absorption. osteoclastic bone phosphorus can lead to morphological changes of cells containing objects such as cell loss (such as lysosomes), and wrinkle-like margin contraction. there is evidence that phosphine can inhibit bone of different mediators, such as the inhibition of acid fluid production, prostaglandin synthesis and release of lysosomal indirectly reduce the activity of osteoclasts. physicochemical properties of bone and hydroxyethyl phosphonic acid disodium (EHDP) is similar, but the potential inhibition of osteoclast active function is 10 times higher than EHDP, Er absorbed without impact on bone mineral. Kuangwu Zhi bone phosphate of calcium and has a strong adsorption, the main role in the bones. Bone phosphine are capsules, tablets and injection liquid available. pamidronate is dissolved bone osteoclast inhibitor, can firmly adsorbed on the surface of trabecular bone, forming a protective film to prevent absorption of osteoclast precursor cells in the bone, and the subsequent transformation into mature osteoclasts process. pamidronate for intravenous use. These drugs, alendronate is most commonly used to treat and prevent osteoporosis. (4), calcitonin (Calcitonin): Calcitonin is a peptide hormones, you can quickly inhibit osteoclast activity, the slow effect can reduce the number of osteoclasts, with pain, increase mobility and improve the calcium balance function, pain relief for patients with fractures of the role of bisphosphonates and estrogen for hormone contraindications or intolerant patients. agents are commonly used in China calcitonin (Miacalcin, salmon calcitonin) and by calcitonin (calcium benefits Ning). calcitonin with parenteral and intranasal administration to drug 2 ways, the role of parenteral drug delivery time of up to 20 months sustainable. calcitonin (Miacalcic) every day to use spray 200U, alternate use of two nostrils, or intramuscular injection or subcutaneous injection of 100U or intravenous administration can be. acceptable in patients treated with calcitonin nasal administration of the nasal cavity should be regularly inspected and, if severe nasal ulcer drug should be discontinued; long-term intravenous administration in patients with hypocalcemia should be prevented due to the foot convulsions and urinary sediment should be checked regularly. (5) of vitamin D and calcium: vitamin D and its metabolites can promote intestinal calcium absorption and bone mineralization, active vitamin D (such as Rocaltrol, alfacalcidol) can promote bone formation, increased osteocalcin production and alkaline phosphatase activity. taking active vitamin D than simply taking calcium can reduce osteoporosis in patients with vertebral and vertebral fracture rate outside. Another vitamin D and The joint preparation of calcium available, treatment is more reliable. (6) Fluoride: Fluoride is an effective stimulant of bone formation, can increase vertebral and hip bone mineral density and reduce the incidence of vertebral fractures. Every day 15 small dose of 20 mg of fluoride, which can be effective in stimulating bone formation and side effects. single fluoride phosphate (Monoflurophospate, MFP) the role of hydrolytic enzymes by slow release in the small intestine, sustainable 12h. special music set (Tridin) of the active ingredient single-glutamine and glucose phosphate calcium fluoride, fluoride per tablet 5mg, elemental calcium 150mg, 3 times / d, with meals Juefu. the drug development stages of children and the disabled. for treatment of osteopenia, and bone quality of osteoporosis patients, recommended every 1 to 2 years BMD a review. If the update detection indicators of bone is high, drugs should be reductions. for long-term prevention of bone loss, it is recommended in postmenopausal women estrogen replacement therapy after the beginning, at least for 5 years, preferably 10 to 15 years. If patients are diagnosed illnesses known to cause osteoporosis, or use of specific drugs can cause osteoporosis, recommend simultaneous administration of calcium, vitamin D and bisphosphonate therapy. 5. only in the surgical treatment of fractures due to osteoporosis only after the required surgical treatment, with the aim of treatment of fractures, early resumption of normal function. (b) prognosis is the main factor affecting the prognosis after fracture-related complications each year in the United States about 37,500 patients died of complications of osteoporosis-related fractures. Although osteoporosis can not be completely prevented, but given a certain preventive measures, such as adequate intake of calcium, vitamin D, exercise, etc., to a large extent reduce the bone osteoporosis, to prevent serious complications. In addition, a risk factor for osteoporosis, people with high-risk situations lead to osteoporosis, a disease and the use of drugs can cause osteoporosis patients, timely removal of risk factors, given appropriate prevention and treatment of drug is particularly important. can lead to osteoporosis disease risk factors, including age, gender and race; family history of bone fractures in osteoporosis; reproductive factors, particularly premature menopause; and decreased bone density-related lifestyles of smoking, alcohol abuse, and lack of exercise, resulting in amenorrhea high intensity exercise (eg marathon runners); dietary factors, especially the influence of calcium and vitamin D intake (to increase both the lack of osteoporosis risk), and eating disorders, such as anorexia nervosa; other diseases and medication, especially glucocorticoids; in order to reduce the incidence of fractures, elderly patients should be alert to easily fall risk factors, including impaired balance, postural low blood pressure, lower extremity muscle strength decreased, unresponsive, medication (such as sedatives), visual impairment and cognitive impairment.