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symptoms of osteoporosis in the elderly, early symptoms and signs of osteoporosis in the elderly

symptoms of osteoporosis in the elderly, early symptoms and signs of osteoporosis in the elderly

Symptoms of osteoporosis in the elderly

Typical symptoms: Cancellous bone is as loose as cortical bone, and fractures are more common in femur, vertebrae and radius and ulna

Related symptoms: Diffuse osteoporosis, bone pain, chest tightness, vitamin C deficiency, back pain, hypopituitarism

1. Symptoms

The clinical types can be divided into two categories: primary and secondary according to the cause:

1. Primary osteoporosis

Primary osteoporosis refers to systemic skeletal changes characterized by bone loss per unit volume and deterioration of the fine structure of bone tissue, including postmenopausal osteoporosis and senile osteoporosis. The former is more common. Primary osteoporosis can be divided into 2 subtypes.

Osteoporosis Type I:

Also known as postmenopausal osteoporosis, the age of onset is mostly from postmenopausal to 70 years old. Mainly seen in women, the ratio of female to male is 6:1. Osteoporosis is dominated by cancellous bone, and the most common fracture sites are the vertebral body and the distal radius. The main pathogenic factor is estrogen deficiency.

Osteoporosis Type II:

Also known as senile osteoporosis, the age of onset is more than 70 years old, and there are slightly more women than men. Female: Male is 2:1. Cancellous bone is as loose as cortical bone, and fractures are more common in femurs, vertebrae, and ulna and radius. The main cause is aging.

2. Secondary osteoporosis

Refers to those with a clear primary disease or a secondary cause leading to osteoporosis. The main causes are as follows:

(1) Endocrine diseases:

①Adrenal cortex diseases: Cushing's disease, Addison's disease.

② Gonadal diseases: hypergonadotropin, abnormal menopausal osteoporosis, hypogonadism.

③Pituitary disease: acromegaly, hypopituitary function.

④ Thyroid disease: hypothyroidism, hyperthyroidism.

⑤ Parathyroid disease: hyperparathyroidism.

⑥ Pancreatic disease: diabetes.

(2) Bone marrow disease:

Bone marrow disease, leukemia, lymphopathy, metastases, Gaucher disease, anemia (sickle cell, thalassemia, hemophilia), mast cell disease.

(3) Kidney disease:

Renal failure, renal insufficiency, renal tubular acidosis, renal bone disease.

(4) Rheumatic diseases:

Rheumatoid arthritis, ankylosing spondylitis, chronic inflammatory polyarthropathy.

(5) Gastrointestinal diseases:

Gastrointestinal malabsorption syndrome, gastrectomy, intestinal bypass, etc.

(6) Liver disease:

Cirrhosis (primary biliary or idiopathic).

(7) Congenital connective tissue disease:

Osteoblast deficiency, homocystinuria, Ehlers-Danos syndrome and Marfan syndrome.

(8) Drug factors:

Steroids, heparin, anticonvulsants, immunosuppressants, thyroid preparations, antacids (aluminum preparations).

(9) Nutritional factors:

Vitamin C deficiency, vitamin D deficiency, too much vitamin AD, calcium deficiency, and protein deficiency.

(10) Disuse factors:

Limb paralysis caused by long-term bed rest, weightlessness caused by space flight, after fracture.

3. Idiopathic osteoporosis

(1) Juvenile osteoporosis.

(2) Osteoporosis in young adults and adults.

(3) Osteoporosis in women during pregnancy and lactation.

Primary osteoporosis can be divided into 2 types. Type I is high-conversion osteoporosis, that is, both bone resorption and bone formation are active, but bone resorption is the main form, which is common in postmenopausal osteoporosis. Type Ⅱ

It is low-conversion osteoporosis, that is, bone resorption and bone formation are not active, but bone resorption is still the main cause, which is common in senile osteoporosis.

2. Diagnosis

It is not difficult to diagnose osteoporosis through medical history, clinical manifestations, bone density determination, and bone resorption and bone formation.

In postmenopausal women or the elderly, there is a risk of osteoporosis, such as aging, ethnic inheritance, living habits, reduced exercise, smoking, drinking, long-term coffee intake, etc. The clinical manifestations of osteoporosis are related to the degree of osteoporosis and fractures. In the early stage, people with mild osteoporosis often have no obvious discomfort, which is called a "quiet disease." However, in the middle and late stages, local or whole body bone pain occurs, the height becomes shorter, the back is hunched, there is external force or slight external force that is broken, and even breathing disorders.

1. Bone pain

Bone pain is the most common and main symptom of osteoporosis. There are three main reasons for this: ① Too fast bone turnover, increased bone resorption leads to bone trabecular absorption, fracture, bone cortex thinning, perforation, which causes body pain; ② Under stress, the bone strength decreases significantly, resulting in vertebral spine Body wedge deformation or fishtail-like deformation causes pain; ③Due to bone deformation, the tension of the muscles attached to the bone changes. Muscles are prone to fatigue and cramps, resulting in muscular pain. The most common areas of pain are the lower back, ribs and iliac areas. When the chest and back are severely deformed, there is pain everywhere in the body.

2. Shortened body length and hunched back

Among the bones composed of cancellous bone and cortical bone, cancellous bone is more prone to osteoporotic changes. The vertebral body is mainly composed of cancellous bone and supports the entire body, which is prone to symptoms such as shorter height.

The average height of the vertebral body is about 2 cm. When osteoporosis, the trabecular bone is destroyed, the number is reduced, and the strength is weakened. It is easy to cause deformation of the vertebral body. In severe osteoporosis, the entire spine can be shortened by about 10 to 15 cm. The study found that women gradually shortened their height after the age of 60 and men after the age of 65. Women are about 4cm shorter when they are 65 years old, and about 9cm when they are 75 years old. The vertebral body is compressed, but the posterior structures such as the spinous process, lamina, and pedicle are not compressed, resulting in the entire spine flexion and kyphosis. The heavier the kyphosis, the symptoms of low back pain are also obvious. Due to the force, some patients are also accompanied by scoliosis.

3. Fracture

Studies have confirmed that every time the bone density decreases by 0.1g/cm2 (or 2SD below the peak bone mass), the risk of fracture increases by 1.5 to 2.5 times. The occurrence time is usually 5 to 8 years after menopause, and the main symptom of fracture is pain. Mild cases often have no obvious sensation, and severe compression fractures have immediate pain, which lasts for about 3 to 4 weeks and then gradually relieves. Later, there is a hunchback and a decrease in height.

Primary osteoporosis first occurs in the cancellous bone area, causing the trabecular bone to be absorbed, broken, and decreased in number. At the same time, perforation occurs in the cortical bone area and the cortex becomes thinner, which causes osteoporotic fractures to easily appear in the rich The thoracolumbar vertebrae, hips, distal radius of cancellous bones, and metaphyses of long tubular bones. Common thoracolumbar compression fractures, femoral neck and intertrochanteric fractures, Colles fractures, humeral neck, humeral supracondylar fractures, ankle fractures, tibial plateau fractures, femoral supracondylar fractures, etc. The characteristics of osteoporotic fractures: it can occur under slight external forces such as twisting the body, holding objects, opening windows, indoor daily activities, and falling.

4. Respiratory disorders

Respiratory disorders caused by osteoporosis are mainly caused by spinal deformities and thoracic deformities. Although the symptoms of chest tightness, shortness of breath, dyspnea, and cyanosis are less common, pulmonary function tests can reveal reduced vital capacity and maximum ventilation volume.

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