​When you are older, you are most afraid of breaking your bones. Diet and exercise will give you "spine"!

*Only for medical professionals' reference, the older you are, the more dangerous you are.
178 million people around the world have broken bones a year.
A balanced diet and learning to exercise will help you reduce your risk by half! This article summarizes the global burden of fractures: Osteoporosis and accidental injuries are the main reasons.
China is also not optimistic: Aging and lack of sleep really bring fracture risks.
Diet and exercise to protect bones: listen to the consensus of experts on how to teach you to get rid of fractures.
The global burden of fractures is not light: Will sitting and getting fat cause more fractures? Isn’t a broken bone just a fall, a broken bone, and a plaster cast on its own will heal it? In fact, the burden of disease caused by fractures is not less than that of various chronic diseases
.

As a global public health problem, fractures have not been studied to fully assess its incidence and disease burden
.

Therefore, a study recently published in Lancet Healthy Longev attempts to fill this gap
.

 Figure 1.
1 The study was published in Lancet Healthy Longev.
This study led by the Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, and Zhejiang Provincial Key Laboratory of Orthopedics assessed the incidence, prevalence and disability life span of the world from 1990 to 2019.

.

The study used the data from the 2019 Global Burden of Disease, Injury and Risk Factors Study (GBD) to compare the incidence, prevalence and disability of fractures in 21 GBD-defined regions and 204 countries or regions.
Years of life lost burden
.

 Figure 1.
2 The incidence of fractures in women is higher than that in men.
The number of fracture cases worldwide is increasing, but the actual age-standardized incidence rate has actually decreased
.

There were an estimated 178 million fractures in the world in 2019, an increase of 33.
4% in absolute numbers from 1990
.

This absolute number is equivalent to 9 fractures per person in Beijing, or 7 fractures per person in Shanghai
.

However, after taking into account the changes in the world’s population and age, it was found that the age-standardized fracture incidence rate in 2019 was 2296.
2 cases per 100,000, which is equivalent to 1 in 50 people with a fracture, a decrease of 9.
6 from 1990.
%
.

In 2019, the number of new fractures in women was 76.
4 million, which was less than 102 million in men.
The age-standardized fracture incidence rate for women was 1943.
6 cases per 100,000, which was lower than the 2619.
8 cases per 100,000 in men
.

 Figure 1.
3 Broken hands and feet are really not just talking about these fractures.
The most common parts of these fractures are the patella, tibia and fibula or ankle, ulna and radius, and clavicle, scapula or humerus
.

It is not difficult to imagine that you might kneel and break your knee after a fall, and you can easily fracture your foot if you accidentally twist your foot.
If you don't support the ground with your hands, you will break your arm
.

The older you are, the easier it is to fracture, especially when women are older than men
.

In the oldest group of people aged 95 and over in the study, the incidence of fractures was as high as 15381.
5 cases per 100,000 people, which was almost 6 times the incidence of the entire population
.

Although the overall incidence of female fractures is lower than that of males, the incidence of fractures in women is higher among people aged 64 and over.
For example, among people aged 95 and over, the incidence of females is as high as 17.
465.
3 cases per 100,000 people.
, Which is almost twice the male incidence rate of 9672.
6 cases per 100,000 people
.

Male fractures mainly occur in younger age groups, such as those in the 20-24 and 40-44 age groups.
The incidence of males is more than 50% higher than that of females
.

Figure 1.
4 The older you get, the easier it is for women to fracture.
In addition to the number and incidence of fractures, the study also counts the morbidity and disease burden of fractures.
It is found that fractures are really not that easy
.

In 2019, the number of fractures worldwide was 455 million, an increase of 70.
1% compared to 1990; the annual burden of life loss due to fractures in 2019 was 25.
8 million, an increase of 65.
3 compared with 1990 %
.

However, the age-standardized prevalence rate of fractures worldwide in 2019 was 5614.
3 cases per 100,000 people, which was still a decrease of 6.
7% compared to 1990; the corresponding age-standardized annual burden of life loss due to disability was 319.
0 years per 100,000 people.
This is a decrease of 8.
4% from 1990
.

 Researchers pointed out that during 1990-2019, the global age-standardized incidence, prevalence, and annual burden of disability life loss of fracture decreased slightly, but the absolute number increased significantly, especially in the elderly at a particularly high risk of fracture
.

For young people, the prevention of accidental injuries is essential; in order to deal with the risk of fractures in the elderly, the main effort is still to be spent on the screening and treatment of osteoporosis
.

 Jane A Cauley, an epidemiologist at the University of Pittsburgh in the United States, pointed out in a review article that the results of this study reflect the rapid changes in an aging society around the world, and the risk of fractures in the elderly cannot be underestimated
.

At the same time, the annual burden of disability life loss caused by patella, tibia and fibula or ankle fractures is more than 5 times that of hip fractures, suggesting that the fracture risk of working people in the middle of life should also not be ignored
.

 Figure 1.
5 The review article was published in Lancet Healthy Longev.
In addition, the review article cannot circumvent the problem of the new crown.
It is hoped that future GBD studies can assess the impact of the COVID-19 pandemic on fractures-the reduction in life expectancy will reduce the burden of fractures in the elderly NS? Will the pandemic cause more fractures due to a sedentary life>2.
China is also not optimistic: old age and being too fat really bring fracture risk! The world's fracture data scares people a lot, but just looking at the world's data, we still don't know that we have a big fracture risk
.

However, the Chinese actually have their own fracture studies
.

In 2017 and 2021, there were two studies focusing on the incidence of traumatic fractures and osteoporotic fractures and related risk factors in Chinese people, giving us the opportunity to tailor fracture prevention strategies according to the situation in China
.

  In 2017, the results of China's National Fracture Study were published in the journal Lancet Glob Health
.

This study, led by the Third Hospital of Hebei Medical University, comprehensively assessed the incidence, regional distribution, and injury mechanisms of traumatic fractures in China, and analyzed the risk factors for fractures in China
.

The study recruited a nationally representative sample from 24 cities and 24 rural areas in 8 provinces in China, and included more than 512,000 participants, 49% of whom were women
.

The fracture cases in the study were verified by the clinical records, medical history, and X-rays of orthopedic surgeons and radiologists
.

Figure 2.
1 The study published in Lancet Glob Health found that 1763 of these participants had fractures that year, including 990 men and 773 women, with an average age of 48.
2 years; the corresponding number of fracture cases was 1833, of which 177 Children (0-14 years old) had 117 fractures, 1303 young and middle-aged (15-64 years old) had 1350 fractures, and 343 elderly (65 years and older) had 366 fractures
.

 The population-weighted incidence of fractures of the Chinese body and limbs is 3.
21 cases/1000 persons
.

The incidence of fractures in children aged 0-14 is only 0.
70 cases/1000 people, and with the continuous increase of age, the incidence of fractures has also increased from 1.
69 cases/1000 people aged 15-24 to 6.
52 cases/1000 people aged 55-64 years.
1000 people
.

The incidence of fractures in men appeared a small peak at the age of 55-64, reaching 6.
01 cases/1000 people, and the age group with the highest fracture risk for women was also 55-64 years, with an incidence rate of 7.
041 cases/1000 people
.

The incidence of fracture among the elderly is also not low.
It is 5.
89 cases/1000 in people aged 65-74, and 6.
00 cases/1000 in people aged 75 and over
.

 Figure 2.
2 The distribution of fracture sites in people of different ages The analysis shows that sleep less than 7 hours a day is an important risk factor for traumatic fractures
.

Insufficient sleep in children, young and middle-aged people and the elderly will increase the risk of traumatic fractures.
Insufficient sleep in young and middle-aged women increases the risk by 82% (OR 1.
82, 95% CI 1.
52-2.
17).
Insufficient sleep in elderly women can even increase the risk of traumatic fractures.
The risk increased to 2.
81 times (OR 2.
81, 95% CI 1.
90-4.
17)
.

At the same time, past fracture history is a risk factor for the 15-year-old and the population.
The risk of fractures in elderly women has increased to 2.
30 times (OR 2.
30, 95%CI 1.
27-4.
18), and the history of fractures in elderly men is even more related to the risk of fractures again.
The increase to 4.
27 times is relevant (OR 4.
27, 95%CI 2.
72-6.
70)
.

In addition, alcohol consumption is associated with an increased risk of fractures in men aged 15 and over and women aged 15-64
.

 Researchers pointed out that the implementation of specific public health policies such as reducing alcohol consumption, prohibiting drunk driving, advocating quitting smoking, encouraging individuals to get enough sleep, and maintaining a healthy weight will help reduce the risk of traumatic fractures
.

At the same time, education and intervention to prevent falls and other traumas need to be emphasized, especially for the elderly and people who have suffered fractures
.

In addition, we should also pay attention to injuries at work and avoid traumatic fractures in people of working age
.

 In 2021, the results of the study on the prevalence of osteoporosis in China will be published in JAMA Netw Open
.

This study, led by Peking Union Medical College Hospital and the China Center for Chronic Noncommunicable Disease Prevention and Control, evaluated the epidemiological characteristics of osteoporosis and osteoporotic fractures in communities across the country, and assessed China’s osteoporosis, The prevalence of clinical fractures and vertebral fractures
.

This study included 20,416 participants who had X-ray absorption measurements and completed the questionnaire.
Women accounted for 56.
7%.
8423 participants with spine X-rays were further evaluated for vertebral fractures
.

 Figure 2.
3 Research published on JAMA Netw Open According to the results of X-ray absorption measurement, the prevalence of osteoporosis in Chinese men aged 40 or over is 5.
0%, while the proportion among women is 20.
6%
.

Among them, the prevalence of osteoporosis in men aged 50 years and above was 6.
9%, and the prevalence of osteoporosis in postmenopausal women was 32.
1%
.

At the same time, it was also found that BMD had a gradual decline with age
.

 Figure 2.
4 The BMD of Chinese gradually declines with age.
According to the results of spine X-rays, the prevalence of vertebral fractures in Chinese men is 10.
5%, while in women it is 9.
7%
.

If only the more severe vertebral fractures are considered, the prevalence of severe vertebral fractures is 3.
8% for men and 4.
8% for women
.

In the past 5 years, 4.
1% and 4.
2% of men and women had fractures
.

At the same time, it was also found that the prevalence of vertebral fractures continued to increase with age
.

 Figure 2.
5 The prevalence of vertebral fractures among Chinese people continues to rise with age.
The analysis shows that females, older people, lower body mass index, former smokers, difficulty in standing with eyes closed, and rural residents have lower lumbar spine BMD levels
.

Among adults 40 years of age and older, men, older, lower femoral neck BMD, and closed eyes are more likely to have severe vertebral fractures.
Among them, people older than 80 years have a risk of vertebral fractures up to 40.
-More than 5 times that of the 49-year-old population (OR 5.
21, 95% CI 1.
30-20.
98)
.

In addition, lower femoral neck BMD, being overweight, drinking alcohol, using glucocorticoids for more than 3 months, and longer sitting up time are associated with an increased risk of fractures in the past 5 years, and the risk of using glucocorticoids is significant (OR 3.
06 , 95%CI 1.
20-7.
83)
.

  The researchers pointed out that the prevalence of osteoporosis and vertebral fractures in Chinese is very high.
Not only women need to pay attention to the risk of osteoporosis and fractures, but also men cannot be ignored
.

In the future, in the guidelines for screening and treatment of osteoporosis and fractures, men and women should be given equal attention
.

At the same time, there is a link between impaired muscle function and increased risk of fractures in Chinese people
.
It may be possible to avoid fractures by reducing accidental falls in people at high risk of osteoporosis .

 Three, diet and exercise to protect the bones: listen to the consensus of experts on how to teach you to get rid of fractures! The established gender is difficult to change, no one can avoid getting older, and it may not be easy to sleep for a long time, but we are not helpless with fractures
.

Stronger bones can keep us away from fractures.
In order to keep bones healthy, both diet and exercise are necessary
.

A healthy and balanced diet is the basis for maintaining fracture health and preventing osteoporosis.
Good exercise habits throughout children and adolescents to old age can delay the occurrence of osteoporosis
.

 In terms of diet, the 2020 "Expert Consensus on Nutrition and Exercise Management for Patients with Primary Osteoporosis" gives the following recommendations: (1) Diversified diets: On average, eat more than 12 kinds of food per day and more than 25 kinds of food per week.
, Including cereals and potatoes, vegetables and fruits, livestock, poultry, fish, eggs, milk, soybeans, nuts and other foods, of which cereals are the mainstay
.

 (2) Ensure the intake of cereals and potatoes: 250-400g of cereals and potatoes per day, including 50-150g of whole grains and miscellaneous beans, 50-100g of potatoes; 300-500g of vegetables, of which dark vegetables should account for 1/2 ; Fresh fruit 200-350g
.

Juice cannot replace fresh fruit
.

(3) Ensure protein intake: choose fish and poultry as a priority every day, and consume 280-525g fish, 280-525g livestock and poultry meat, and 280-350g eggs every week, with an average daily intake of 120-200g; 1 day One egg, do not discard the yolk; eat soy products regularly, and eat nuts in moderation; ensure the intake of milk and dairy products, and the intake is equivalent to 300g (about 300mL) of liquid milk per day
.

 (4) Drink plenty of water: 7-8 cups (1500-1700mL) per day for adults.
Drinking boiled water and light tea is recommended; not or less sugary beverages, coffee and carbonated beverages
.

(5) Light diet: eat less high-salt and fried foods
.

Adults should not exceed 6g of salt per day, and older persons should not exceed 5g.
The cooking oil should be 25-30g per day.
Food should be cooked thoroughly
.

 (6) Control the intake of added sugar: daily intake should not exceed 50g, and should be controlled below 25g
.

 (7) Eat less smoked and cured meat products
.

(8) Stop smoking and limit alcohol
.

(9) If you encounter difficulties in food procurement, or reduce your food intake due to long-term loss of appetite, illness, etc.
, nutritional preparations can be used for supplementation (balanced enteral nutrition preparations, protein supplements, vitamin and mineral supplements, etc.
)
.

  In terms of exercise, the 2020 "Expert Consensus on Nutrition and Exercise Management for Patients with Primary Osteoporosis" pointed out: For the elderly or patients with osteoporosis, it is recommended to reduce sedentary and at least 150-300 minutes of moderate intensity per week.
Exercise, or high-intensity aerobic exercise for 75-150 minutes a week, or a combination of moderate-intensity and high-intensity aerobic exercise with equivalent effects
.

At the same time, you should also engage in moderate-intensity or higher-intensity muscle-strengthening activities 2 days a week or more
.

 However, for the elderly, whether it is outdoor or home activities, they must do what they can, and the degree of physical effort should be determined according to their own health level
.

If you can't reach the corresponding sports goals, you can do your best to carry out physical activities
.

Elderly and frail patients with osteoporosis must decide their exercise mode and intensity according to their physical condition and site conditions
.

As they grow older, older people need to spend more energy to complete the same task than young people, and relative intensity can guide older people’s activities more than absolute intensity
.

 The moderate-intensity exercise recommended by the consensus of experts is equivalent to talking but not singing during exercise.
In the engineering of high-intensity exercise, you have to say a few words and stop breathing
.

 For patients with severe osteoporosis, activities that cause fractures and other sports injuries should be avoided
.

  Experts agree to encourage a combination of multiple exercises, including (1) aerobic exercises: such as walking, dancing, bone aerobics, jogging, running on the ground, aerobics, Tai Chi, cycling, household labor and gardening activities; (2) ) Muscle-strengthening physical activity: the representative is the barbell; (3) Balance activity: walking from heel to toe, stepping in a straight line, walking in balance with a book, and practicing from sitting to standing
.

 References: [1] GBD 2019 Fracture Collaborators.
Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019.
Lancet Healthy Longev.
doi: 10.
1016 / S2666-7568(21)00172-0.
[2] Jane A Cauley.
The global burden of fractures.
Lancet Healthy Longev.
doi: 10.
1016/ S2666-7568(21)00183-5.
[3] Chen W, Lv H , Liu S, et al.
National incidence of traumatic fractures in China: a retrospective survey of 512187 individuals.
Lancet Glob Health.
2017 Aug;5(8):e807-e817.
doi: 10.
1016/S2214-109X(17)30222- X.
[4] Wang L, Yu W, Yin X, et al.
Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study.
JAMA Netw Open.
2021 Aug 2;4(8):e2121106.
doi: 10.
1001/ jamanetworkopen.
2021.
21106.
[5] Expert consensus on nutrition and exercise management for patients with primary osteoporosis[J].
Chinese Journal of Osteoporosis and Bone Mineral Diseases,2020,13(05):396-410.