Osteoporosis is called a ‘silent bone thief’ and is difficult to detect unless it is accompanied by complications such as fractures. Most of them progress without symptoms for a long time, and without even realizing it, they lose their height due to compression fractures of the spine, or the lower back is gradually curved, and there are many cases where they go to the hospital for back pain. In women, it usually occurs after menopause.
Je-ho Han, a professor of endocrinology at Catholic University of Korea Incheon St. Mary’s Hospital, said, “Osteoporosis patients tend to accept osteoporosis as a natural phenomenon of their bones weakening and bending of the back due to osteoporosis. Diagnosis and treatment are very important.”
No recovery after a compression fracture of the spine… 70% of osteoporosis is genetically influenced
An irreversible fracture caused by osteoporosis is a vertebral fracture. The spine of osteoporotic patients bent by vertebral compression fractures cannot be straightened again. With just one vertebral compression fracture, each bone can be reduced by about 5 mm. When several vertebrae are fractured, the lower back is bent and the height is reduced, and the upper body is shortened, which can lead to indigestion and deterioration of lung function. People who have had fractures in the past, people who are less than normal in weight, and people whose parents have osteoporosis are considered high-risk groups.
Patients who take rheumatoid arthritis or hyperthyroidism medications or have chronic diseases are also at increased risk for osteoporosis. In particular, women are more likely to have poor bone condition if their menstruation is not regular or if menstruation ends before the age of 40. Of course, osteoporosis can occur in anyone without these characteristics.
Professor Han Je-ho said, “Recently, the incidence of osteoporosis is gradually increasing due to the increase in the amount of time spent indoors and the use of sunscreens during outdoor activities due to less sunlight and less physical activity. %, so if any of your parents have weak bones, you need to look at yourself more carefully than other people and have regular checkups.”
If the T value is less than -2.5, osteoporosis… Z value –2.0 or less Bone loss less than the age expectation
Osteoporosis test is a test to measure the bone density of bones, and is performed for the diagnosis or progress observation of metabolic bone diseases such as osteoporosis and osteomalacia. In osteoporosis patients, the amount of bone decreases, and the purpose of this study is to evaluate how much bone mass has decreased compared to the bone density of a normal person, and then to evaluate whether treatment is needed to prevent fractures.
A commonly used test is dual-energy radiation absorptiometry. It is a method of calculating the bone density by calculating the data obtained by taking two images of the area to be tested with high-energy radiation and low-energy radiation.
Bone density and bone quality must be considered for the diagnosis of osteoporosis. Since bone quality cannot be quantified, it is diagnosed as osteoporosis if the T value is -2.5 or less through the BMD, which can be quantified as a T value. For men before the age of 50 or premenopausal women, the Z value is used. If the value is -2.0 or less, it is classified as bone loss below the age-expected value and secondary osteoporosis must be differentiated.
Professor Han Je-ho said, “If the blood pressure exceeds 140/90 mmHg, it is classified as a high blood pressure patient with a high probability of developing cardiovascular disease, and if the blood sugar exceeds 150 mg/dL, it is regarded as a diabetic patient and treated to prevent diabetic complications or cardiovascular disease. “Every time the T value goes down, the risk of fracture increases exponentially, and appropriate treatment is needed,” he said.
After administration of bone resorption inhibitors, drug rest is required… Resting follow-up is important
Osteoporosis drugs are divided into bone resorption inhibitors and bone formation promoters. Among the bone resorption inhibitors, the most commonly used bisphosphonates are oral medications and injections. In the case of injections, they are more effective than oral drugs, so they are administered every 3 months or a year. Osteogenesis-promoting agents are injected for 1 year or 2 years, and then changed to bone resorption inhibitors.
Professor Han Je-ho said, “The treatment of osteoporosis is in the form of creating and maintaining bones using a bone resorption inhibitor and an osteogenesis-promoting agent. Bisphosphonate preparations vary depending on the drug, but may require a drug rest period of 3 to 5 years, up to 10 years, after which the drug must be discontinued.”
Active follow-up is required during drug off-season. Periodic bone density tests should be performed and, based on the results, a decision to resume administration should be made to prevent deterioration of fracture risk. If the observation period is neglected during the drug rest period, the risk of fracture may increase again.
A paradigm shift in osteoporosis treatment… Prevention through regular check-ups
A paradigm shift in therapeutics has recently been highlighted as an issue in osteoporosis treatment. As the primary treatment for osteoporosis, the administration of a osteogenesis promoter is gradually increasing, and a method of sequentially administering a bone resorption inhibitor and a osteogenesis promoter is also being tried.
Professor Han Je-ho said, “Bone resorption inhibitors have been widely used as the first-line treatment for osteoporosis. “If you look at it, you can see that the bone formation of patients who first used the osteogenesis-promoting agent and then the bone resorption inhibitor was much better than that of the opposite patient,” he said.
In addition, the phenomenon related to sarcopenia has recently attracted attention. As for the relationship between sarcopenia and osteoporosis, the decrease in growth hormone and IGF-1 (insulin-like growth factor-1) is associated with visceral obesity, muscle loss, and decreased bone density.
Along with osteoporosis medications, calcium and vitamin D supplementation is also necessary. Get enough calcium and vitamin D through a proper diet and frequent outdoor activities. In particular, since vitamin D can be synthesized by the skin, high-dose vitamin D preparations can be rather harmful unless there is a shortage.
For calcium preparations, it is recommended to take the medicine that requires a doctor’s prescription as much as the amount of calcium contained in some products on the market is not appropriate, and also contains substances harmful to the human body. Adequate intake of milk and protein through a balanced diet and avoid alcohol and tobacco. Exercise is also important. Weight-bearing exercises and walking exercises that do not put excessive strain on the joints are good for preventing osteoporosis.
Professor Han Je-ho said, “To prevent osteoporosis, it is most important to perform a bone density test through regular check-ups. It is good to take advantage of it.”