Osteoporosis

骨质疏松症一词意味着海绵状（多孔）骨骼。

骨骼由矿物质，主要是钙盐，由较强的胶原蛋白纤维结合在一起。我们的骨头有一个厚的硬外壳（称为皮质或紧凑的骨头），在X射线上很容易看到。在此内，有一个较软，海绵状的骨头（小梁骨），具有类似蜂窝状的结构。

Bone is a living, active tissue that’s constantly renewing itself. Old bone tissue is broken down by cells called osteoclasts and is replaced by new bone material produced by cells called osteoblasts.

The balance between the breakdown of old bone and the formation of new bone changes at different stages of our lives.

• 在童年和青春期，新骨形成很快。这使我们的骨骼变得更大，更坚固（浓密）。到20多岁的中后期，骨密度达到了高峰。
• 此后，新骨的产生与旧骨的分解速度大约相同。这意味着在7 - 10年内，成年骨架已完全更新。
• Eventually, from the age of about 40, bone starts to be broken down more quickly than it’s replaced, so our bones slowly begin to lose their density.

我们都有某种程度的骨质流失,因为我们变老er, but the term osteoporosis is used only when the bones become quite fragile. When bone is affected by osteoporosis, the holes in the honeycomb structure become larger and the overall density is lower, which is why the bone is more likely to fracture.

谁患有骨质疏松症？

Osteoporosis is common in the UK, and the risk increases with age. Anyone can get osteoporosis but women are about four times more likely than men to develop it. There are two main reasons for this:

• 绝经后几年，卵巢停止产生女性性激素雌激素时，骨质流失的过程加快了几年。
• 在骨质流失过程开始之前，男性通常达到较高的骨密度。男性仍会发生骨质流失，但在发生骨质疏松症之前必须更严重。

A number of other risk factors can increase your chances of developing osteoporosis.

Osteoporosis often has no symptoms. The first sign that you may have it is when you break a bone in a relatively minor fall or accident (known as a low-impact fracture). Fractures are most likely in the hip, spine or wrist.

Some people have back problems if the bones of the spine (vertebrae) become weak and lose height. These are known as vertebral crush fractures. They usually happen around the mid or lower back and can occur without any injury. If several vertebrae are affected, your spine will start to curve and you may become shorter. Sometimes vertebral crush fractures can make breathing difficult simply because there’s less space under the ribs.

If you have a vertebral crush fracture you'll also have a greater risk of fracturing your hips or wrists.

Risk factors for developing osteoporosis include:

Steroids (especially if taken by mouth)- 类固醇（皮质类固醇）用于治疗许多包括类风湿关节炎在内的炎性疾病。它们可以通过减少肠道吸收的钙量并通过肾脏增加钙损失来影响骨骼的产生。如果您可能需要类固醇（例如泼尼松龙），则医生可能会建议钙和维生素D片剂，有时甚至是其他药物，以帮助预防骨质疏松症。

Read more aboutsteroid tablets.

Lack of oestrogen in the body– If you have an early menopause (before the age of 45) or a hysterectomy where one or both ovaries are removed, this increases your risk of developing osteoporosis. This is because they cause your body's oestrogen production to reduce dramatically, so the process of bone loss will speed up. Removal of the ovaries only (ovariectomy or oophorectomy) is quite rare but is also linked with an increased risk of osteoporosis.

缺乏体重运动- 运动鼓励骨骼发育，缺乏运动意味着您将更有可能从骨骼中失去钙，从而发展骨质疏松症。肌肉和骨骼健康有联系，因此保持肌肉力量也很重要，这也将降低您的跌倒风险。

However, women who exercise so much that their periods stop are also at a higher risk because their oestrogen levels will be reduced.

Poor diet– If your diet doesn’t include enough calcium or vitamin D, or if you're very underweight, you'll be at greater risk of osteoporosis.

Heavy smoking– Tobacco is directly toxic to bones. In women it lowers the oestrogen level and may cause early menopause. In men, smoking lowers testosterone activity and this can also weaken the bones.

Heavy drinking– Drinking a lot of alcohol reduces the body’s ability to make bone. It also increases the risk of breaking a bone as a result of a fall.

Family history– Osteoporosis does run in families, probably because there are inherited factors that affect bone development. If a close relative has suffered a fracture linked to osteoporosis then your own risk of a fracture is likely to be greater than normal. We don’t yet know if a particular genetic defect causes osteoporosis, although we do know that people with a very rare genetic disorder called osteogenesis imperfecta are more likely to suffer fractures.

Other factors that may affect your risk include:

• ethnicity
• low body weight
• previous fractures
• medical conditions, such as coeliac disease (or sometimes treatments) that affect the absorption of food.

您可以在生活中的不同阶段做很多事情，以帮助保护自己免受骨质疏松症。

Exercise

进行骨骼以携带身体重量的任何运动，例如行走，都可以加快新骨生长的过程。

您从小就进行体重越多，这将越降低骨质疏松症的风险。

如果您确实患有骨质疏松症，那么进行体重运动将最大程度地减少骨质流失并增强肌肉。

但是，所有形式的运动都将有助于改善协调并保持肌肉力量。这很重要，因为随着年龄的增长，肌肉也会变得较弱，这是跌落和骨折的危险因素。

太极can be very effective in reducing the risk of falls. Doing T’ai Chi regularly will strengthen muscles in the upper body, lower body and the core. It also improves balance.

Walking is a good exercise to improve bone strength and it is also good for keeping thigh and hip muscles strong, which is important to help people have good balance and prevent falls.

High-impact exercise such as skipping, aerobics, weight-training, running, jogging and tennis are thought to be useful for the prevention of osteoporosis. These exercises might not all be suitable if you have osteoporosis.

For more support, motivation and advice talk to your doctor, a physiotherapist or a personal trainer at a gym about your condition and the best exercise for you.

Diet and nutrition

钙

The best sources of钙are:

• 乳制品，例如牛奶，奶酪和酸奶（低脂产品最好）
• 富含钙的牛奶，由大豆，大米或燕麦制成
• fish that are eaten with the bones, such as tinned sardines.

钙的其他来源包括：

• leafy green vegetables such as cabbage, kale, broccoli, watercress
• 豆类豌豆
• 一些坚果，种子和干果。

If you don't eat many dairy products or calcium-enriched substitutes, then you may need a calcium supplement. We recommend you discuss this with your doctor or a dietitian.

下表列出了某些常见食物的近似钙含量。

Food	钙content (mg)
115 g (4 oz) whitebait (fried in flour)	980
60g (2 oz) sardines (including bones)	260
0.2升（⅓品脱）半脱脂牛奶	230
0.2升（⅓品脱）全牛奶	220
3 large slices brown or white bread	215
125 g (4½ oz) low-fat yogurt	205
30 g (1 oz) hard cheese	190
0.2升（⅓品脱）钙富含大豆牛奶	180
125 g（4½盎司）钙富含大豆酸奶	150
115 g（4盎司）干酪	145
3个大片全麦面包	125
115 g (4 oz) baked beans	60
115 g (4 oz) boiled cabbage	40

注意：以盎司或品脱显示的度量仅是近似转换。

维生素D

人体需要维生素D吸收和加工钙，并且有一些证据表明，在没有足够的人中，关节炎进展得更快vitamin D.

维生素Dis sometimes called the 'sunshine vitamin' because it's produced by the body when the skin is exposed to sunlight. A slight lack (deficiency) of vitamin D is quite common in the UK in winter.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance on safe sunlight exposure which aims to balance the benefits of vitamin D against the risks of skin cancer from too much exposure to sunlight.

维生素Dcan also be obtained from some foods, especially from oily fish, or from supplements such as fish liver oil. However, it's important not to take too much fish liver oil.

Because we don't get enough sunshine all year round in the UK, and because it's difficult to guarantee getting enough vitamin D from what we eat, Public Health England recommends that everyone should take a 10 microgram supplement of vitamin D every day during the autumn and winter.

鼓励某些群体中有没有足够接触阳光的人，或者鼓励其皮肤无法从英国的阳光水平吸收足够的维生素D，全年每天每天获得10微克的每日补充。

For many people, calcium and vitamin D supplements are prescribed together with other osteoporosis treatments.

What else might help?

It's important to try to prevent falls. Simple things you can do at home include:

• 马上擦溢出
• making sure walkways are free from clutter or trailing wires.

Some hospitals also offer falls prevention clinics or support groups – ask your doctor if there's one in your area.

吸烟会影响您的激素，因此可能会增加骨质疏松症的风险。我们强烈建议您停止吸烟。如果您想停止，可以提供支持。

Drinking a lot of alcohol can affect the production of new bone, so we recommend keeping within the maximum amounts (14 units per week) suggested by the government.

没有明显的骨质疏松症的物理迹象，并且可能不会在一段时间内引起任何问题。如果您的医生认为您可能患有骨质疏松症，他们可能建议您进行DEXA（双能X射线吸收计）扫描以测量骨骼的密度。

The scan is readily available and involves lying on a couch, fully clothed, for about 15 minutes while your bones are x-rayed. The dose of x-rays is very small – about the same as spending a day out in the sun. The possible results are:

Normal– Your risk of a low-impact fracture is likely to be low.

Osteopenia- 您的骨骼变得越来越弱，但是您患低冲击骨折的风险相对较小。您可能需要或可能不需要治疗，具体取决于您的其他风险因素。您应该与医生讨论如何减少风险因素。

Osteoporosis- 您患有低影响性骨折的风险更大，可能需要治疗。您应该与您的医生讨论。

Who should have a scan?

没有很好的证据表明，筛查所有人的骨质疏松症会有所帮助。但是，如果以下任何一个适用于您，则应与您的医生谈论进行扫描：

• you’ve already had a low-impact fracture
• 您需要3个月或更长时间的类固醇治疗
• 您的更年期早期（45岁之前）
• either of your parents has had a hip fracture
• you have another condition which can affect the bones – for example, coeliac disease, inflammatory bowel disease (Crohn’s disease or ulcerative colitis),rheumatoid arthritis，糖尿病和甲状腺功能亢进（甲状腺过度活跃）
• you have a body mass index (BMI) of less than 19.

How to work out your body mass index:

• Multiply your height in metres by itself – e.g. 1.7 (m) x 1.7 = 2.89
• Divide your weight in kilograms (kg) by the number you got in stage 1 – e.g. 53 (kg) ÷ 2.89 = 18.3
• 结果是您的BMI，例如18.3

对于大多数人来说，健康的BMI在19到25之间。

您的医生可能会使用由世界卫生组织（WHO）开发的名为FRAX®的在线评分工具，以帮助评估您的骨折风险，并帮助您确定是否应该进行DEXA扫描或治疗骨质疏松症。

If you’re diagnosed with osteoporosis following a low-impact fracture, then the fracture will need to be treated first. The next step is to begin treatment to reduce your risk of further fractures.

治疗of fractures

大多数骨折首先在A＆E中进行治疗，通常您会在骨折诊所进行后续约会，以了解情况如何。

除非您有椎骨压缩裂缝，否则您可能会在受影响的区域上放置一个铸件，以阻止其移动并允许骨折愈合。在某些情况下，可能需要在施放演员阵容之前由专家操纵骨折。这可以在A＆E中完成，或者您可能被送往医院。如果骨折需要手术治疗，您也很可能会被送进医院。

例如，您可能需要缓解疼痛药物：

• 止痛药（镇痛药），例如扑热息痛，可待因和偶尔吗啡
• non-steroidal anti-inflammatory drugs (NSAIDs), such asibuprofenor naproxen.

Prevention of fractures

Self-help measures such as diet and weight-bearing exercise can help to reduce your risk of fractures, but a number of specific treatments are also available.

You're likely to have a bone density scan before you start treatment, although this may not be needed, for example if you're 75 or over. Once you've started treatment your bone density may be monitored in one of the following ways:

• 骨密度通常扫描，通常是脊柱和/或臀部，每2 - 5年，具体取决于您的个人情况。
• 血液和尿液测试以表明您的骨骼更新本身的效果 - 这些并不像骨密度扫描那样广泛使用。

If you're taking hormone replacement therapy (HRT), you'll also have regular blood pressure checks and breast scans (mammograms).

Your bone density should start to improve after 6–12 months, although you may need longer-term treatment to further reduce your fracture risk.

Bone renewal is a slow process so it's important to continue treatment as your doctor advises – even though you won't be able to feel whether it's working.

因为长期治疗有时可能会产生副作用，您的医生可能会在3 - 5年后从治疗中休息。骨质疏松治疗的好处持续很长时间，因此，如果您的医生确实暗示了“治疗假期”，则不会丢失。

你的治疗将取决于你的个人保监会umstances, and you should discuss this with your doctor. Types of treatment include:

• 钙和维生素D
• 双膦酸盐（alendronate，risdronate，Ibandronate，etidronate，唑来膦酸盐）
• 甲状腺素和甲状旁腺激素
• r氧酮
• calcitonin
• denosumab
• strontium ranelate
• hormone replacement therapy (HRT).

Strontium ranelate

这种药物是按照Protelos品牌生产的，在2017年停产，但现在再次以Aristo品牌生产。我们将尽快获得有关该药物的进一步信息。

If you were previously taking Protelos, you may want to speak to your doctor about Aristo.