Transcriber: 佑澤 林 Reviewer: Helen Chang
Not a long time ago, an old lady came to my clinic,
set in front of me as in pain, she said, “Doctor, I’ve been coughing these days.
My chest dosen’t hurt, but my waist and my back are killing me.”
So, I tapped on her most painful spot. The old lady cried in pain,
so i immediately stopped my check,
and told her that she probably gets a fracture.
She looked at me in great surprise.
“How? How is it possible?
Such strong bone just broken just because of a cough?”
Most of you might have the same question—
how is it possible such strong bone of us could break because of a cough?
So I carried on with some examinations,
and here we can see a very clear acute compression fracture
on her second lumbar vertebral body.
So why she had a fracture?
It is because her bone is so weak that it can’t even stand a cough.
So let’s talk about bones.
The human skeleton is made up of 206 bones.
It is fundamental structure of the human body.
That’s put it this way.
Almost all our vital organs and tissues are attached to the bones.
When we are young, we have smaller and lighter bones.
As we grow older, our bones grow larger,
under the influence of different kinds of hormones,
and they reach...
and ultimately reach a peak stage, which we called peak bone mass.
An average person reaches their peak bone mass
between the age twenty to thirty years old.
The peak bone mass is very important
that determines our bone health in the future.
I often use an analogy to explain peak bone mass to my patients.
Think of it as your savings.
When you are young, the more your saving
the more affluent you are when you grow older.
Individual genes determine 70% of peak bone mass,
then the other 30% is closely related to
regular life, diets, disease, medication.
Since we can’t alter our genes, if you want your bone,
you need to maintain regular exercise, less illness, less medication
and eat more food that promotes bone strength, like milk.
As I told before, we reach peak bone mass around the age of thirty.
Then what happens after thirty?
Is our bone mass declining? Actually, no.
This is another important concept.
Bone reconstruction comes in.
Bone reconstruction consists two parts: Bone absorption and bone formation.
It seems be little change to our skeletons,
but bone absorption and bone formation take place every second.
Bone reconstruction is a continuous process.
Old bone are absorbed. New bone are formed.
However, bone reconstruction is not always constant.
Sometimes bone formation exceeds bone absorption,
the bones grow.
The typical time period is during the puberty,
like the age 10 years old to 18 years old,
we grow taller.
After we reach the thirties,
we have reach the average stage of peak bone mass.
At this stage, bone absorption and bone formation reaches an equilibrium,
and the bone mass maintains an equilibrium, too.
However, as our age increases,
the bone absorption gradually exceeds bone formation,
we are going to face bone lose.
It’s most common among the female,
especially after the year of fifty years old,
when they gone they gone through the menopause.
Decrease in bone mass and decrease in bone cartilage
that become so dominant, slight impact can cause fracture.
This is a symptom of osteoporosis.
We often hear about those three disease, shock, attack, breast cancer,
but osteoporosis is less familiar for us,
but is more common then these three disease.
In fact, the instance of osteoporosis along
is higher than the sum of those three disease.
Every three seconds, there was a new case of osteoporotic fracture in the world.
If we don’t take action by the year of 2015,
there will be 6 million new cases in China.
It’s a huge number.
Meanwhile, osteoporotic fracture is the main cause of
disability and death for the old people.
Let’s take hip fracture as an example.
If an old man experience an hip fracture,
the mortality will be 20% within one year.
30% of the old people will suffer permanent disability,
which will cause huge expense of resource and fundings.
By the year of 2015, the government of China need to spend
163 billion Yuan to treat osteoporotic fracture along.
This is a huge number,
like 10% of the total expense of the national health insurance for all disease.
It’s a huge number.
The serious part is this,
once your experience an osteoporotic fracture-
recurrence is above average population,
especially for the patients who missed the early diagnosis and test.
For half of those patients,
they will face another osteoporotic fracture
within 1-2 years.
To tackle this problem, the international osteoporosis foundation
has proposed a program called capture the fracture.
They aim to provide a standard service —
Fracture Liaison Service (FLS) -- for the patients.
Our hospital is one of the first hospitals to start FLS China,
Once an osteoporotic fracture occurs in the hospital,
we will provide a standard FLS for the patient.
Here is a figure.
As we can see, the rates of osteoporosis diagnosis and treatment
before we start FLS and two years later.
As we can see, the rate for the diagnosis
is increased from less than 50% to 80%.
The rate of treatment is increased from less than 30% to 90%.
As we discuss about the osteoporotic fracture,
but how much do we know about this disease?
I’m wondering how many of us knows this is disease
before we talk about this disease.
In China, the rate of osteoporosis above the age of 50 is 19.2%,
for the female is 32.1%.
This means 3 in 10 females are osteoporotic patients.
The rate increase to 32%
for the population over 65.
For the female is 51.6%.
This means one in two females is a osteoporotic patient,
Your mom or my mom could all be of them. Sounds terrifying.
But how much do we know about this disease?
So a national health commission carried out a survey among adults,
only 11.7% of the people knew it,
and only 3.7% of the people above 50 years old
have had a bone density test,
which is the most important test of all osteoporosis.
This means the majority of the patient missed the test or treatment or diagnosis.
The consequence is fracture after another fracture.
Sounds terrible.
It’s unfair to blame everyone, because in the beginning
there’s no clinical symptoms for the early osteoporosis.
Its unobservable nature gives its name, the silent disease.
But as the osteoporosis develop further, if we are still unable to identify it,
then you need to face continuous pain all over your body
and along with body deformity, humpback and the recurrence of fractures.
So what shall we do?
First of all, I will insist that the osteoporosis
is preventable and curable.
The most important steps are early screening and identification.
So I advise the following groups to book an examination:
people over 60 years old,
people who accept the osteoporotic risk factors
like menopause before 45
and has family history and long time Medication
on glucocorticoid like Prednisone
and decrease with heights after 40.
The sooner, the better.
So the key point is the early treatment for osteoporosis
is easy and unexpensive,
but very effective.
But how do we treat osteoporosis?
Let’s go back to the concept— bone reconstruction.
As we know, when bone absorption exceeds bone formation,
we are facing to lose our bone.
So as long as we identify this trend in time,
intervene with adjusting lifestyle,
or exercise, or with assistance of medication,
we are able to reduce the rates of bone absorption
and increased the rate of bone formation, then our bone grow again.
I was on 24 hour duty yesterday.
An old lady came to me.
She was diagnosed with osteoporosis at the age of 65.
After one year treatment,
she was so happy with the results of her report.
She told me, “Doctor, I’ve recovered. My bones grow again.”
Finally, I would like to use this picture to the end of my presentation.
This picture symbolizes different groups of osteoporosis.
The first group has osteoporosis,
has gone through, has been through with osteoporotic fracture
but never received any treatment or take any medication.
What’s in their fates is one factor after another,
just like jumping of a cliff without a parachute.
It’s not going to end well.
The second group who has osteoporosis,
who have been through osteoporotic fracture,
but they have received thorough treatment.
Even though they jump off a cliff,
we have equipped them with a parachute to secure a soft landing.
However, what matters most, I think,
is to understand our bones
and try our best to prevent ourselves from jumps.
Thank you very much.