1 objects and methods
1. 1 object
Residents who choose family doctors in Yanji Street Community Health Service Center in Shanghai. Selection criteria: permanent residents of this community, voluntary, and signed informed consent. Exclusion criteria: all kinds of acute and chronic organic diseases that may affect bone metabolism, such as ovariectomy, rickets, diabetes, thyroid and parathyroid diseases and severe liver and kidney diseases, were excluded by clinical examination; Long-term estrogen supplementation in postmenopausal women. According to the number of eligible objects, the number table method (table 1) was used to randomly select 1 447 people as the survey objects.
1.2 method
1.2. 1 BMD measurement method
The CM-200 ultrasonic bone densitometer produced by Shanghai Merrill Lynch Medical Technology Co., Ltd. was used to input relevant data, and the right foot was sterilized and fixed in the groove. The SOS value of the right heel of all subjects was measured by the same operator.
1.2.2 Diagnostic criteria
According to the standards of the World Health Organization (WHO), the measured bone mineral density is lower than 2.5 standard deviation (T=-2.5SD) of the average peak bone mineral density of the same sex, and it can be diagnosed as osteoporosis in combination with clinic. Severe osteoporosis [2] is lower than 2.5 standard deviations of the average peak bone mineral density of the same sex with fracture, and the bone mineral density decreases between 1 ~ 2.5 standard deviations.
Two results
2. 1 Investigation on the prevalence of osteoporosis among people over 50 years old in Yanji community
According to the diagnostic criteria of WHO, 232 cases of osteoporosis were found in this bone mineral density measurement, accounting for 65438 06.03%. Bone mass decreased by 604 people, accounting for 4 1.74%. Among them, t value -3.0 SD ~ is 232, accounting for16.03%; -2.5 SD ~ is 1 19, accounting for 8.22%; -2.0 SD ~ is 144, accounting for 9.95%; -1.5SD ~ is 149, accounting for10.30%; -1.0 SD ~ is 192, accounting for13.27%; 1.0 SD was above 6 1 1 person, accounting for 42.23%.
2.2 Bone mineral density measurement results of different age groups and genders.
With the increase of age, the proportion of osteoporosis and osteopenia gradually increased, and the proportion of osteoporosis and osteopenia in women was greater than that in men (table 1).
3 discussion
3. 1 Osteoporosis is one of the serious problems endangering public health.
With the aging of the population, the prevalence of osteoporosis is increasing rapidly. According to the information published in the White Paper on Prevention and Treatment of Osteoporosis in China, at least 69.44 million people in China suffer from osteoporosis, and 265.438+10,000 people have reduced bone mass, so there is a risk of osteoporosis. The total prevalence rate of osteoporosis in people over 50 years old is 15.70%, and this proportion will gradually increase with the extension of population life. 70.00% ~ 80.00% of middle-aged and elderly fractures are caused by osteoporosis, among which about 18 10000 cases of new vertebral fractures and 230000 cases of hip fractures occur every year. It is conservatively estimated that the annual expenditure for treating thigh fracture of middle-aged and elderly patients has reached 654.38+004 billion yuan, will exceed 265.438+070 billion yuan in 2020 and 80 billion yuan in 2050 [3], which has caused serious economic burden to society and families and has now become one of the serious problems endangering public health. The total prevalence rate of osteoporosis among people over 50 years old in this community is 16.03%, which is slightly higher than the national prevalence rate. It may be an old community with a high proportion of elderly people. In addition, this survey is mainly aimed at the contracted service of family doctors, which has certain limitations in the sample scope and quantity.
3.2 Bone mineral density examination can detect osteoporosis early.
Osteoporosis can be asymptomatic in the early stage, so some people call it a "silent" epidemic. How to find osteoporosis early? Bone mineral density (BMD) examination is the best quantitative index for early detection of osteoporosis and prediction of fracture risk, especially dual-energy X-ray absorptiometry (DXA), which is recognized as the gold standard for diagnosis of osteoporosis by international academic circles [4]. Due to the hardware limitation of community health service center, ultrasonic measurement of bone mineral density is undoubtedly a method for early diagnosis of osteoporosis. Ultrasonic bone mineral density measurement is a new noninvasive diagnostic technique for osteoporosis, which has the advantage of early display of bone mass changes. It is worth mentioning that, compared with X-ray absorption method, ultrasound method is not necessarily accurate in numerical value, but because it has no radiation, it has its unique benefits for early screening in the community. We suggest that the following people should be tested by bone densitometer: ① women over 65 years old; Men over 70 years old have no other risk factors for osteoporosis; ② One or more risk factors of osteoporosis in postmenopausal women under 65 years old or elderly men under 70 years old; ③ Male and female adults with a history of brittle fracture; ④ Male and female adults with low sex hormone levels due to various reasons; ⑤X-ray film has changed osteoporosis; ⑥ Patients receiving osteoporosis treatment and monitoring the curative effect; ⑦ Patients with diseases affecting bone mineral metabolism and medication history.
3.3 Pay attention to the tertiary prevention of fracture and osteoporosis
The risk factors of osteoporosis include the following points: ① After the bone reaches the maximum density with age (generally at the age of 30), the bone begins to decline with age; ② The risk of osteoporosis in women over 50 years old is greatly increased; ③ Family history heredity is one of the susceptible factors, and it plays a significant role; ④ Fracture Prehistoric fracture is one of the risk factors of osteoporosis; ⑤ Some drugs are used, such as long-term use of corticosteroids (prednisone, prednisone, etc. ) will also increase the risk of osteoporosis. In view of various risk factors, we should pay attention to the tertiary prevention of fracture osteoporosis.
3.3. 1 primary prevention, prevention before disease.
Primary prevention should start with children and adolescents. If you pay attention to reasonable dietary nutrition, eat more foods with high calcium and phosphorus content, such as shrimp skin, kelp and milk. Insist on physical exercise, get more sunshine, and let the body store more bone minerals. At present, there is no effective method to make osteoporosis patients with serious bone loss return to normal. Only on the basis of health education, through the improvement of patients' understanding and the formation of healthy behavior, from passive acceptance to active cooperation treatment [5]. Community health service centers can publicize and educate the knowledge of prevention and treatment of osteoporosis through health education and health promotion, so as to improve the community's understanding of the harm of osteoporosis. Pay attention to actively treat diseases related to osteoporosis, such as diabetes, chronic nephritis, hyperparathyroidism/hyperthyroidism, etc. Do not abuse glucocorticoids, heparin, antiepileptic drugs, etc. To prevent osteoporosis caused by medical behavior.