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*Only for medical professionals to read and refer to the diagnosis and treatment of osteoporosis.
This article understands that osteoporosis is a progressive metabolic bone disease, which is clinically manifested as a decrease in bone density, which can damage bone structure
.
It usually causes fragility fractures, especially in the thoracic spine, lumbar spine, wrists, and buttocks
.
The diagnosis of osteoporosis is usually established by dual-energy X-ray bone density scan (DXA scan) or the occurrence of fragility fractures.
It can be prevented by improving risk factors, supplementing calcium and vitamin D, physical exercise, etc.
, and using drugs Treatment to maintain bone mass or stimulate new bone formation
.
This time, Professor He Jing from Peking University People's Hospital shared the content of the diagnosis and treatment of osteoporosis at the 2021 American College of Rheumatology (ACR) Annual Meeting
.
DXA scan helps the diagnosis of osteoporosis.
DXA scan is a magic weapon for the diagnosis of osteoporosis.
Clinically, estrogen-deficient women at risk of osteoporosis, patients with pyramidal abnormalities, patients with long-term glucocorticoid therapy, and the original Patients with primary hyperparathyroidism can benefit from this method
.
In addition, DXA also plays an important role in monitoring the condition during the treatment of osteoporosis
.
Just knowing DXA is not enough to make you a master at diagnosing osteoporosis.
The most important core of thinking in clinical practice is to consider the cause of bone loss and the patient's peak bone density
.
Common risk factors for osteoporosis include age, female menopause, and other chronic diseases, and reductions in bone mass and peak bone density can all lead to a decrease in bone density
.
In addition to considering these factors, the diagnosis should also consider the patient's poor bone mass, low bone density, and the risk of falling, and fully consider the prevention of poor prognosis such as fragility fractures during the diagnosis process
.
However, some patients are worried that DXA, as a radiological diagnosis and treatment method, may cause safety issues such as radiation damage
.
In fact, this kind of worry is unnecessary.
The radiation dose of a single bone density test is at most the same as the lowest dose of cosmic background radiation that people receive under natural conditions
.
Therefore, using DXA for diagnosis, condition monitoring and fracture risk assessment of patients with osteoporosis, its safety is guaranteed
.
Figure 1: The eight diagnostic criteria for bone mineral density examination.
There are many treatment options for osteoporosis, which are mainly composed of nutritional supplement prevention and drug treatment
.
▎Nutrition Supplement Prevention Among the nutritional supplements that need to be taken to prevent osteoporosis, calcium and vitamin D are the two essential protagonists
.
The recommended calcium intake for adults is between 1000-1200 mg/day, and dietary supplementation is best; the recommended intake of vitamin D for adults is 600-800 units/day
.
It should be pointed out that the common types of calcium supplements are calcium carbonate, calcium citrate and calcium glucose, and the three types of calcium supplements are used in different ways
.
Among them, calcium citrate can be taken on an empty stomach, calcium carbonate should be taken with food, while the oral absorption of calcium glucose is relatively poor
.
For patients taking proton pump inhibitors, calcium citrate is the preferred calcium supplement; calcium carbonate has the risk of adverse gastrointestinal reactions, so it is recommended to take it with food; and calcium glucose is the most expensive of the three Of calcium
.
In addition, the academic community believes that dietary calcium supplements can reduce the risk of kidney stones compared with calcium supplements, and there is no need to worry about the risk of cardiovascular complications when calcium is used reasonably
.
▎Anti-bone resorption and anabolic drugs Based on nearly 2 years of guidelines and expert opinions, anti-bone resorption drugs for osteoporosis include: first-line drugs: alendronate sodium, risedronate sodium, zoledronic acid, Nozumab (disu), etc.
; high-risk patients: abalotide, teriparatide, Evenity monoclonal antibody, bisphosphonates, testosterone (male only), etc.
; second-line recommendation: ibandronate, raloxifene , denosumab, combined estrogen combination bazedoxifene, intravenous bisphosphonates, teriparatide like; recommended three lines: calcitonin, calcium, vitamin D alone
.
Next, Professor He Jing also explained the commonly used drugs, consolidating the precautions for clinical medication for everyone
.
▎The mechanism of action of bisphosphonates is to combine with hydroxyapatite to inhibit bone destruction.
Except for ibandronate which only acts on vertebrae, other bisphosphonates can reduce vertebral, non-vertebral and In the occurrence of hip fractures, the common side effect is gastrointestinal adverse reactions
.
Sometimes osteonecrosis of the mandible can be seen, so bisphosphonates are not recommended for patients undergoing periodontal disease or multiple dental operations
.
At the same time, because bisphosphonates may accumulate in patients, in order to prevent adverse effects of bisphosphonates, clinical use is often evaluated after 3-5 years of use in patients, and the drug will be stopped if necessary , In order to consume the bisphosphonates accumulated on the bones
.
This special usage is called "bisphosphonate medication holiday"
.
▎ Calcitonin Calcitonin is a commonly used drug in clinical practice with relatively few side effects, but the duration of use is generally no more than 1 month
.
▎The mechanism of action of Dino (disu) monoclonal antibody is to competitively inhibit the nuclear factor kappa B receptor activator ligand (RANK-L) that activates osteoclasts, which can reduce the risk of vertebral, non-vertebral and hip fractures.
Occurs and is well tolerated.
A common adverse reaction is transient hypocalcemia.
Rare adverse reactions can also be seen in mandibular osteonecrosis
.
Therefore, special attention should be paid to the patient's oral disease during application
.
▎The mechanism of teriparatide/abapatide [parathyroid hormone (PTH) analogue] is to activate osteoblasts, increase calcium reabsorption and phosphate excretion, and is often used clinically for severe bone in postmenopausal women Porosity, and the curative effect is better than bisphosphonates, suitable for patients with bisphosphonates or poor first-line treatment
.
▎Evenity monoclonal antibody is effective by activating the wnt signaling pathway and combining with sclerostin that prevents bone formation.
It can reduce the incidence of secondary fractures in women with fragility fractures (better than alendronate), but it can increase Cardiovascular risk and prohibit the use of recent cardiovascular events or those with high cardiovascular risk
.
▎Raloxifene (combined hormone replacement therapy) This drug works by reducing the activity of osteoclasts through estrogen receptor agonists.
It can only be used clinically for cone fractures
.
Clinically, the efficacy of the application for patients with postmenopausal bone pain is determined
.
How to grasp the precautions during the application of these drugs? In this regard, Professor He Jing specially shared a table, which is recommended to be collected and memorized: Figure 2: The usage, dosage, adverse reactions and precautions of commonly used prevention and treatment drugs for osteoporosis.
Summary The diagnosis and treatment of osteoporosis is very common in clinical practice.
, DXA bone density scan is the iron standard for diagnosis, disease monitoring and risk assessment.
The clinical thinking of osteoporosis should include the content shown in Figure 3: Figure 3: The clinical thinking map of osteoporosis diagnosis and treatment is adopted During drug prevention and treatment, clinicians must pay attention to the precautions of different drugs in order to benefit patients with osteoporosis
.
Expert Profile Professor Jing He, Chief Physician, Professor, and Doctoral Supervisor, Department of Rheumatology and Immunology, Peking University People’s Hospital
.
Deputy Director of the Institute of Rheumatology, Peking University People's Hospital, Beijing Science and Technology Rising Star, National Young and Middle-aged Science and Technology Innovation Leader, National Ten Thousand Winner, Mao Yisheng Beijing Youth Science and Technology Award
.
Clin Rheum Youth Associate Editor, Youth Committee Member of Chinese Society of Rheumatology, Youth Committee Member of Chinese Society of Immunology
.
Main research results: As a research physician with outstanding clinical and scientific research capabilities, Professor Jing He has long been committed to clinical and basic research on autoimmune diseases such as systemic lupus erythematosus and Sjogren’s syndrome
.
Precursor follicular helper T cells and their pathogenic mechanisms have been discovered in patients with rheumatoid arthritis; the application of low-dose interleukin-2 in the treatment of systemic lupus erythematosus has been successful, and studies have found that this new immunotherapy method can effectively control patients with lupus erythematosus And research has proved the mechanism of interleukin-2 to regulate immune balance and treat autoimmune diseases
.
As the first author, his research results have been published in Nature Medicine (IF 30.
357), Immunity (IF 19.
7), Ann Rheum Dis, Rheumatism Yearbook (IF 14.
29) and Lancet Rheum.
He has published more than 60 SCI papers, and has been invited to write reviews for journals such as Nat Rev Rheum and Clin Rheum, and has spoken at many international conferences
.
Pay attention to the video number of the rheumatism and immunity channel in the medical field.
Here are the most professional and interesting texts.
If you are tired, just take a look at the video to ensure that you will open the door to a new world.
This article understands that osteoporosis is a progressive metabolic bone disease, which is clinically manifested as a decrease in bone density, which can damage bone structure
.
It usually causes fragility fractures, especially in the thoracic spine, lumbar spine, wrists, and buttocks
.
The diagnosis of osteoporosis is usually established by dual-energy X-ray bone density scan (DXA scan) or the occurrence of fragility fractures.
It can be prevented by improving risk factors, supplementing calcium and vitamin D, physical exercise, etc.
, and using drugs Treatment to maintain bone mass or stimulate new bone formation
.
This time, Professor He Jing from Peking University People's Hospital shared the content of the diagnosis and treatment of osteoporosis at the 2021 American College of Rheumatology (ACR) Annual Meeting
.
DXA scan helps the diagnosis of osteoporosis.
DXA scan is a magic weapon for the diagnosis of osteoporosis.
Clinically, estrogen-deficient women at risk of osteoporosis, patients with pyramidal abnormalities, patients with long-term glucocorticoid therapy, and the original Patients with primary hyperparathyroidism can benefit from this method
.
In addition, DXA also plays an important role in monitoring the condition during the treatment of osteoporosis
.
Just knowing DXA is not enough to make you a master at diagnosing osteoporosis.
The most important core of thinking in clinical practice is to consider the cause of bone loss and the patient's peak bone density
.
Common risk factors for osteoporosis include age, female menopause, and other chronic diseases, and reductions in bone mass and peak bone density can all lead to a decrease in bone density
.
In addition to considering these factors, the diagnosis should also consider the patient's poor bone mass, low bone density, and the risk of falling, and fully consider the prevention of poor prognosis such as fragility fractures during the diagnosis process
.
However, some patients are worried that DXA, as a radiological diagnosis and treatment method, may cause safety issues such as radiation damage
.
In fact, this kind of worry is unnecessary.
The radiation dose of a single bone density test is at most the same as the lowest dose of cosmic background radiation that people receive under natural conditions
.
Therefore, using DXA for diagnosis, condition monitoring and fracture risk assessment of patients with osteoporosis, its safety is guaranteed
.
Figure 1: The eight diagnostic criteria for bone mineral density examination.
There are many treatment options for osteoporosis, which are mainly composed of nutritional supplement prevention and drug treatment
.
▎Nutrition Supplement Prevention Among the nutritional supplements that need to be taken to prevent osteoporosis, calcium and vitamin D are the two essential protagonists
.
The recommended calcium intake for adults is between 1000-1200 mg/day, and dietary supplementation is best; the recommended intake of vitamin D for adults is 600-800 units/day
.
It should be pointed out that the common types of calcium supplements are calcium carbonate, calcium citrate and calcium glucose, and the three types of calcium supplements are used in different ways
.
Among them, calcium citrate can be taken on an empty stomach, calcium carbonate should be taken with food, while the oral absorption of calcium glucose is relatively poor
.
For patients taking proton pump inhibitors, calcium citrate is the preferred calcium supplement; calcium carbonate has the risk of adverse gastrointestinal reactions, so it is recommended to take it with food; and calcium glucose is the most expensive of the three Of calcium
.
In addition, the academic community believes that dietary calcium supplements can reduce the risk of kidney stones compared with calcium supplements, and there is no need to worry about the risk of cardiovascular complications when calcium is used reasonably
.
▎Anti-bone resorption and anabolic drugs Based on nearly 2 years of guidelines and expert opinions, anti-bone resorption drugs for osteoporosis include: first-line drugs: alendronate sodium, risedronate sodium, zoledronic acid, Nozumab (disu), etc.
; high-risk patients: abalotide, teriparatide, Evenity monoclonal antibody, bisphosphonates, testosterone (male only), etc.
; second-line recommendation: ibandronate, raloxifene , denosumab, combined estrogen combination bazedoxifene, intravenous bisphosphonates, teriparatide like; recommended three lines: calcitonin, calcium, vitamin D alone
.
Next, Professor He Jing also explained the commonly used drugs, consolidating the precautions for clinical medication for everyone
.
▎The mechanism of action of bisphosphonates is to combine with hydroxyapatite to inhibit bone destruction.
Except for ibandronate which only acts on vertebrae, other bisphosphonates can reduce vertebral, non-vertebral and In the occurrence of hip fractures, the common side effect is gastrointestinal adverse reactions
.
Sometimes osteonecrosis of the mandible can be seen, so bisphosphonates are not recommended for patients undergoing periodontal disease or multiple dental operations
.
At the same time, because bisphosphonates may accumulate in patients, in order to prevent adverse effects of bisphosphonates, clinical use is often evaluated after 3-5 years of use in patients, and the drug will be stopped if necessary , In order to consume the bisphosphonates accumulated on the bones
.
This special usage is called "bisphosphonate medication holiday"
.
▎ Calcitonin Calcitonin is a commonly used drug in clinical practice with relatively few side effects, but the duration of use is generally no more than 1 month
.
▎The mechanism of action of Dino (disu) monoclonal antibody is to competitively inhibit the nuclear factor kappa B receptor activator ligand (RANK-L) that activates osteoclasts, which can reduce the risk of vertebral, non-vertebral and hip fractures.
Occurs and is well tolerated.
A common adverse reaction is transient hypocalcemia.
Rare adverse reactions can also be seen in mandibular osteonecrosis
.
Therefore, special attention should be paid to the patient's oral disease during application
.
▎The mechanism of teriparatide/abapatide [parathyroid hormone (PTH) analogue] is to activate osteoblasts, increase calcium reabsorption and phosphate excretion, and is often used clinically for severe bone in postmenopausal women Porosity, and the curative effect is better than bisphosphonates, suitable for patients with bisphosphonates or poor first-line treatment
.
▎Evenity monoclonal antibody is effective by activating the wnt signaling pathway and combining with sclerostin that prevents bone formation.
It can reduce the incidence of secondary fractures in women with fragility fractures (better than alendronate), but it can increase Cardiovascular risk and prohibit the use of recent cardiovascular events or those with high cardiovascular risk
.
▎Raloxifene (combined hormone replacement therapy) This drug works by reducing the activity of osteoclasts through estrogen receptor agonists.
It can only be used clinically for cone fractures
.
Clinically, the efficacy of the application for patients with postmenopausal bone pain is determined
.
How to grasp the precautions during the application of these drugs? In this regard, Professor He Jing specially shared a table, which is recommended to be collected and memorized: Figure 2: The usage, dosage, adverse reactions and precautions of commonly used prevention and treatment drugs for osteoporosis.
Summary The diagnosis and treatment of osteoporosis is very common in clinical practice.
, DXA bone density scan is the iron standard for diagnosis, disease monitoring and risk assessment.
The clinical thinking of osteoporosis should include the content shown in Figure 3: Figure 3: The clinical thinking map of osteoporosis diagnosis and treatment is adopted During drug prevention and treatment, clinicians must pay attention to the precautions of different drugs in order to benefit patients with osteoporosis
.
Expert Profile Professor Jing He, Chief Physician, Professor, and Doctoral Supervisor, Department of Rheumatology and Immunology, Peking University People’s Hospital
.
Deputy Director of the Institute of Rheumatology, Peking University People's Hospital, Beijing Science and Technology Rising Star, National Young and Middle-aged Science and Technology Innovation Leader, National Ten Thousand Winner, Mao Yisheng Beijing Youth Science and Technology Award
.
Clin Rheum Youth Associate Editor, Youth Committee Member of Chinese Society of Rheumatology, Youth Committee Member of Chinese Society of Immunology
.
Main research results: As a research physician with outstanding clinical and scientific research capabilities, Professor Jing He has long been committed to clinical and basic research on autoimmune diseases such as systemic lupus erythematosus and Sjogren’s syndrome
.
Precursor follicular helper T cells and their pathogenic mechanisms have been discovered in patients with rheumatoid arthritis; the application of low-dose interleukin-2 in the treatment of systemic lupus erythematosus has been successful, and studies have found that this new immunotherapy method can effectively control patients with lupus erythematosus And research has proved the mechanism of interleukin-2 to regulate immune balance and treat autoimmune diseases
.
As the first author, his research results have been published in Nature Medicine (IF 30.
357), Immunity (IF 19.
7), Ann Rheum Dis, Rheumatism Yearbook (IF 14.
29) and Lancet Rheum.
He has published more than 60 SCI papers, and has been invited to write reviews for journals such as Nat Rev Rheum and Clin Rheum, and has spoken at many international conferences
.
Pay attention to the video number of the rheumatism and immunity channel in the medical field.
Here are the most professional and interesting texts.
If you are tired, just take a look at the video to ensure that you will open the door to a new world.
