What are the precautions for osteoporosis treatment drugs?🦴🦴🦴

Osteoporosis is a systemic metabolic bone disease in which bone mass and
bone density decrease due to different reasons. Osteoporosis is common in postmenopausal women and older men. It is a very common bone disease. It is characterized by increased bone fragility and increased susceptibility to fractures. Osteoporosis can be divided into primary osteoporosis and secondary osteoporosis according to different etiologies.

What is primary osteoporosis?

Primary osteoporosis includes postmenopausal osteoporosis (type I), senile osteoporosis (type II) and idiopathic osteoporosis. Postmenopausal osteoporosis generally occurs within 5 to 10 years after menopause in women. Senile osteoporosis usually occurs after age 70. Idiopathic osteoporosis occurs mainly in adolescents.

What is secondary osteoporosis?

Secondary osteoporosis refers to osteoporosis caused by drugs (such as proton pump inhibitors, antiviral drugs, glucocorticoids, etc.) and/or diseases affecting bone metabolism and other causes.

What medicines are available for the treatment of osteoporosis?

Osteoporosis treatment drugs mainly include basic supplements for bone health, bone resorption inhibitors, bone formation promoters, active vitamin D and its analogs.

Basic supplements for bone health.

The basic supplements for osteoporosis prevention and treatment are calcium and vitamin D.

Calcium: 

• Commonly used are calcium citrate and calcium carbonate. Although calcium citrate has a lower calcium content, its better water solubility can reduce the occurrence of kidney stones. It is suitable for patients who are at risk of kidney stones or who are achlorhydric. Calcium carbonate has a higher calcium content. It is easily soluble in gastric acid and has a high absorption rate by the human body. 
• Epigastric discomfort and constipation are their common adverse effects. Calcium citrate has relatively few gastrointestinal adverse effects. Calcium should be avoided in patients with hypercalcemia and hypercalciuria. High-dose calcium may increase the risk of cardiovascular disease and kidney stones. Fluoroquinolones will complex with calcium ions in calcium. This hinders the absorption of the drug and can easily lead to the failure of anti-infective therapy.

Vitamin D:

• The combination of vitamin D and calcium reduces the risk of osteoporotic fractures. In addition, the efficacy of other anti-osteoporosis drugs can be enhanced by adequate vitamin D supplementation. Elderly osteoporosis patients who are obviously deficient in vitamin D should use vitamin D supplementation, and at the same time, they can use active vitamin D to treat osteoporosis under the guidance of doctors.
• Urinary and serum calcium concentrations should be monitored regularly when taking vitamin D to prevent hypercalcemia and hyperphosphatemia. In addition, taking active vitamin D to correct basal vitamin D deficiency is generally not recommended. Supplemental therapy with larger doses of vitamin D is not recommended for multiple doses within a year.

Bone resorption inhibitors.

Such drugs mainly include bisphosphonates, calcitonins and selective estrogen receptor modulators.

Bisphosphonates:

• Broad-spectrum anti-fracture drugs such as alendronate, risedronate, and zoledronic acid are the preferred drugs. Oral bisphosphonates such as alendronate and risedronate should be the first choice for people with low bone mineral density but no history of fractures and people with low or moderate fracture risk. Injectable forms such as zoledronic acid may be considered in elderly patients with multiple vertebral or hip fractures, as well as in people with high fracture risk, very low bone mineral density, contraindications, or oral intolerance. Lumbar spine and hip bone mineral density in people with osteoporosis can be improved with zoledronic acid. It reduces the risk of vertebral, nonvertebral and hip fractures.
• Their adverse reactions include renal toxicity, osteonecrosis of the jaw, atypical femoral fractures, transient flu-like symptoms, and gastrointestinal reactions. Bisphosphonates should be used with caution in patients with reflux esophagitis, active gastric and duodenal ulcers, and functional esophageal dysfunction. Bisphosphonates are not recommended for patients with severe oral disease or in need of dental surgery. They should also be contraindicated in patients with creatinine clearance <35ml/min. After 3 years of intravenous bisphosphonate use or 5 years of oral bisphosphonates, patients should be reassessed to determine whether continued use of the drug is required.

Calcitonin drugs:

• The biological activity of osteoclasts can be inhibited by calcitonin drugs. They reduce the number of osteoclasts and the loss of bone mass. They also relieve bone pain and increase bone mass. In particular, it can significantly relieve bone pain caused by osteoporosis and fractures.
• Their main adverse reactions are nausea, facial flushing, etc., and occasionally allergic phenomena occur. Because calcitonins have the potential to increase the risk of developing tumors, they should generally not be used continuously for more than 3 months.

Selective estrogen receptor modulators:

• A commonly used selective estrogen receptor modulator is raloxifene. It is indicated for the treatment of postmenopausal osteoporosis and for reducing the risk of vertebral fractures.
• Raloxifene may cause pulmonary embolism and deep vein thrombosis. Therefore, it is contraindicated in those with a history of venous thrombosis and those with thrombophilia (such as those who are sedentary or bedridden for a long time). In addition, the risk of thromboembolism in patients should be strictly assessed before administration.

Bone formation promoter.

Parathyroid hormone analog:

• Teriparatide is a parathyroid hormone analog. It stimulates osteoblast activity by intermittently administering small doses. It increases bone density and promotes bone formation. It also reduces the risk of non-vertebral and vertebral fractures.
• Dizziness, headache, nausea and limb pain are its common adverse effects. Because of the risk of osteosarcoma formation after two years of teriparatide use, it should not be given for more than two years. Patients should also be treated with anti-resorptive drugs sequentially after drug discontinuation to maintain or increase the patient's bone density. This continuously reduces the risk of fractures.

Active vitamin D and its analogs.

These drugs are suitable for patients with impaired renal function, reduction or deficiency of 1-alpha-hydroxylase, and the elderly.

Alpha-calcidol, calcitriol:

• Although α-calcidol does not need to be activated by renal metabolism, it needs to be activated by 25-hydroxylase in the liver to have biological activity. Calcitriol itself has biological activity. In addition, the effect of calcitriol to increase blood calcium will be stronger than that of α-calcidol. However, it has a shorter half-life than alpha-calcidol and loses its efficacy about 2 to 3 days after stopping the drug. After you stop taking alpha-calcidol, it takes about 1 week for it to stop working.
• Active vitamin D and its analogs have a significantly higher risk of hypercalciuria relative to vitamin D. The risk of hypercalcemia increases with higher doses, especially when combined with calcium supplements. Therefore, patients' urinary calcium and serum calcium should be monitored during treatment, especially when combined with calcium supplements. Active vitamin D and its analogs are used with caution in patients with kidney stones and are contraindicated in patients with hypercalcemia. It also increases the risk of hypercalcemia when combined with thiazide diuretics. It may cause hypermagnesemia when used with magnesium-containing drugs, especially in patients with chronic renal failure. It can induce cardiac arrhythmias when combined with digitalis.

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How to choose a treatment for knee osteoarthritis❓❓❓

Knee osteoarthritis can be painful and inconvenient for patients. The first symptom of knee osteoarthritis is pain. Pain initially occurs when going up and down stairs, squatting down, or sitting and then standing up. Later, the movement of the knee joint is further restricted, and eventually the patient may not be able to walk a single step. Knee osteoarthritis patients with mild initial symptoms can generally be relieved by non-drug treatment. However, patients with mid-stage knee osteoarthritis generally experience pain. They need medication to relieve the pain. This article will describe how to choose a drug to treat knee osteoarthritis.

Systemic analgesics.

Analgesics for knee osteoarthritis are not just for pain relief, they also have anti-inflammatory effects. Knee pain is caused by inflammation. Inflammation must be eliminated in order to eliminate pain in patients. The inflammatory cause of knee osteoarthritis is not caused by a bacterial or viral infection, so antibiotics or antiviral drugs are not used to treat it. Analgesic and anti-inflammatory drugs can eliminate the inflammation of knee osteoarthritis. Pain relief for knee osteoarthritis can be divided into three levels. Different levels of pain medication are used to treat different levels of pain. In clinical practice, drugs should be selected according to the individual situation of patients and the efficacy of drugs, so as to achieve the purpose of individualized medication.

First-level: Acetaminophen.

Acetaminophen is a drug that has been used for many years. It can be used short-term for mild pain and it has relatively low damage to the gastrointestinal tract, liver and kidneys. However, its anti-inflammatory effect is relatively weak, so it can only be used for mild pain. The total daily dose of acetaminophen should not exceed 4 g. Although its damage to the liver is relatively low, liver damage is still its main side effect, especially when taking the drug, patients should avoid drinking alcohol.

Second-level: Non-steroidal anti-inflammatory analgesics (NSAIDs).

For moderate pain, the most commonly used analgesics are NSAIDs. It can be divided into the following categories: acetic acid derivatives (such as diclofenac, indomethacin), propionic acid derivatives (such as ibuprofen, naproxen, ketobufen), fenamic acid esters (such as methyl chloride sulfonate), enolic acid derivatives (eg, piroxicam), and selective cyclooxygenase-2 inhibitors (eg, celecoxib). The most common side effects of these drugs are increased cardiovascular adverse events, gastrointestinal bleeding, liver and kidney damage.

Third-level: Weak opioids.

Weak opioids such as codeine or tramadol may be considered for patients with severe pain and poor response to first- and second-level drugs. The initial dose of these drugs should be low and then slowly and gradually increased to reduce side effects.

Joint topical medication.

Emulsions, ointments and patches of topical pain relievers such as NSAIDs or capsaicin. They can be used outside the body for pain relief. Topical topical analgesics are simply and directly applied to or rubbed on the painful area. Their active ingredients penetrate quickly into the skin and effectively relieve pain. Topical application avoids their irritation of the gastrointestinal tract, reduces side effects and is convenient to use. The following points should be paid attention to when using:

• Adequate amount of use: The dosage of topical drugs must be sufficient to achieve the best pain relief and anti-inflammatory effect.
• The location of the medication should be correct: Anti-inflammatory and analgesic external medicines are used in the acute inflammatory attack period, and the skin will appear red, swollen, hot and painful. Infrared hyperthermia topical medicine is used for chronic injury. There was no redness, swelling and pain at this time. In addition, opioid patches are absorbed through the skin and can be applied to any painful area. Therefore, they should be attached to the shoulders, the upper edge of the chest and the outside of the forearm, and try not to attach to other places.
• Use for less than 12 hours: Most topical analgesics should be used for less than 12 hours. If they are used for more than 12 hours, they may cause adverse effects on the skin.

Intra-articular injection of drugs.

Glucocorticoids: It provides temporary pain relief for patients. However, if high-dose glucocorticoids are used for a long time, patients will experience many adverse reactions such as hypertension, renal impairment, and lower extremity edema. Although the dose of intra-articular glucocorticoid injection is small and generally does not cause the above-mentioned adverse reactions, long-term application will still cause damage to the bones and joints. The bone and cartilage of the joints are damaged by prolonged use of glucocorticoids. This in turn worsens the patient's condition. Therefore, it is recommended that it should not be applied more than 4 times a year.

Sodium Hyaluronate: It is a component of the joint fluid in the joint cavity, which can repair the joints. In patients with knee osteoarthritis, the synovial fluid contains less sodium hyaluronate and becomes thinner. Intra-articular injection of sodium hyaluronate can supplement the lack of sodium hyaluronate in synovial fluid. This increases joint fluid viscosity and reduces joint friction. This can help relieve symptoms and slow the progression of the disease. It is effective in relieving mild to moderate knee osteoarthritis, but it is not very effective in severe advanced knee osteoarthritis. It is generally recommended to use it once a week, with 4 to 6 weeks as a course of treatment.

Disease-modifying drugs and chondroprotective agents.

In patients with knee osteoarthritis, the articular surface cartilage is damaged. These drugs can protect the cartilage and improve the condition. Commonly used drugs are glucosamine and chondroitin sulfate. They are the two major nutrients for articular cartilage.

• Glucosamine: Although it has been widely used in the prevention and treatment of osteoarthritis, its efficacy has been controversial. Osteoarthritis patients with mild or moderate abrasion of articular cartilage are best candidates for glucosamine therapy. It does not work well for people with osteoarthritis who have severely abrasion of articular cartilage. Glucosamine needs to be continuously taken at 1500mg daily for more than 8 weeks to have a certain effect. Taking it for more than one year will have a more stable effect.
• Chondroitin Sulfate: It provides nutrients to cartilage, absorbs and retains water in cartilage. This can help repair articular cartilage. 

Studies have pointed out that the simultaneous application of glucosamine and chondroitin sulfate can obtain a more precise effect.

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Diagnosis and treatment of sarcopenia.🔬🔬🔬

As populations around the world tend to age, sarcopenia has gradually become a public health concern. Recent studies have shown that middle-aged and elderly people with sarcopenia have a higher incidence of cardiovascular disease than the general population. They had a 72% and 33% increase in the incidence of cardiovascular disease and the risk of cardiovascular events, respectively. 

What is sarcopenia?

In clinical practice, sarcopenia generally refers to the continuous decrease in the number, strength and function of skeletal muscle caused by aging. It can make the patient slow and unsteady. It also makes people prone to falls and fractures. Organ function may also be affected. It can lead to heart and lung failure, and even death. Its pathogenesis and etiology are complex. It is currently believed that sarcopenia is associated with the following pathological changes: Autophagy of skeletal muscle stem cells, excessive inflammatory state, oxidative stress, muscle mitochondrial dysfunction, protein breakdown and synthesis disorders, microvascular endothelial dysfunction and metabolic disorders, etc. Risk factors for sarcopenia include physical inactivity and malnutrition.

Diagnosis of sarcopenia.

Appendicular skeletal muscle mass index (ASMI) is a determining index. Appendicular skeletal muscle mass can be measured by dual-energy X-ray absorptiometry and divided by the square of height to calculate the index. The presence of sarcopenia was considered if it was less than 7.0 kg/m2 in men and 5.4 kg/m2 in women. The diagnostic process for sarcopenia is as follows:

If the patient is 65 years or older, perform a pace test.

If the pace is greater than 0.8m/s, measure the patient's grip strength. There is no sarcopenia if the grip strength is >25kg in men or >18kg in women. If the grip strength of men is ≤25kg or the grip strength of women is ≤18kg, ASMI should be measured. Sarcopenia was diagnosed if ASMI < 7.0 kg/m2 in men or ASMI < 5.4 kg/m2 in women.

If the pace is smaller than 0.8m/s, measure ASMI. Sarcopenia was diagnosed if < 7.0 kg/m2 in men or < 5.4 kg/m2 in women.

Nutritional interventions for sarcopenia.

Nutritional interventions for sarcopenia require adequate supplementation of these three.

Protein: Human skeletal muscle stores large amounts of various forms of protein. An important solution for the treatment of sarcopenia is to supplement high-quality protein. It improves muscle mass. Among them, leucine whey protein is widely believed to stimulate muscle protein synthesis, thereby it can maintain muscle mass. Therefore, foods rich in whey protein such as eggs, soy products and milk are recommended.

Vitamin D: Vitamin D plays a key role in the process of bone mineralization. It regulates the absorption of calcium and phosphorus in the body. Maintaining healthy bones and muscles depends on vitamin D. Therefore, vitamin D supplementation is great significance for improving and strengthening the muscle function of the elderly.

Omega-3 Fatty Acids: Studies have shown that both muscle mass and synthesis of muscle protein can be improved by omega-3 fatty acids. 

Exercise intervention for sarcopenia.

While muscle mass in older adults declines with age, exercise can slow or even reverse the decline in muscle function and mass. Since sarcopenia also increases the risk of cardiovascular disease, many patients with sarcopenia have cardiovascular disease. Moderate exercise can reduce the incidence of adverse cardiovascular events and help prevent cardiovascular disease. However, patients with cardiovascular disease also have certain risks when exercising. Their exercise should be done after evaluation and advice. 

• For healthy people: Get at least 150 minutes of moderate-intensity physical activity per week, or 75 minutes of vigorous-intensity physical activity per week, or a combination of the two. Studies have shown additional benefits of increasing moderate-intensity exercise to 300 minutes per week, or high-intensity exercise to 150 minutes per week. It is recommended to exercise several times a week, and daily exercise would be more recommended.
• For those with other medical conditions: Patients should be diagnosed and treated for their disease, as well as undergo a cardiopulmonary exercise test to assess exercise capacity. According to the patient's physical condition, cardiopulmonary capacity, disease, etc. to develop an individualized exercise program. The patient's Borg Scale of Perceived Exertion can be used to determine whether the intensity of exercise is appropriate.

Medical treatment of sarcopenia.

Medications for sarcopenia include hormones, omega-3 fatty acids, osteocalcin, stem cell transplantation, and more. They are of great help in the prevention and treatment of sarcopenia.

The basis of sarcopenia prevention and treatment lies in diet and exercise, and then combined with drug treatment depending on the patient's condition. A healthy diet and exercise can also reduce the risk of cardiovascular disease. Seniors and their families should pay more attention.

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Some things can cause rhabdomyolysis.💪💪💪

In recent years, there have been reports of rhabdomyolysis caused by the consumption of a large amount of fish, seafood and crayfish. This brings rhabdomyolysis into the spotlight. Although the main cause is unknown, it may be caused by a biological toxin. Under normal circumstances, fish and shrimp do not contain this toxin. The toxin may enter the body of fish and shrimp under special circumstances, such as the waters where the fish and shrimp are contaminated by certain viruses and bacteria. In fact, only a few people suffer from rhabdomyolysis due to eating seafood. There are a variety of other causes, such as excessive exercise, muscle squeezing, excessive heat and cold temperatures, drugs and heavy drinking, and other bacterial or viral infections that can lead to rhabdomyolysis.

What is Rhabdomyolysis?

Rhabdomyolysis refers to a series of striated muscle damage caused by a variety of inherited or acquired diseases that affect the striated muscle cell membrane, membrane channels and their energy supply. Rhabdomyolysis is often accompanied by acute renal failure and metabolic disorders.

Excessive exercise causes rhabdomyolysis.

The vast majority of young patients with rhabdomyolysis are caused by exercise. It is common in people who do not exercise regularly and suddenly exercise. Most people think that excessive exercise will only cause backache and leg pain the next day, and it will be fine after a rest. However, in recent years, as more and more people exercise and weight training, the incidence of exercise-induced rhabdomyolysis has been increasing, and 48% of patients require hospitalization. Rhabdomyolysis can be mild or severe. Mild patients only need appropriate rehydration. In severe cases, acute kidney injury, multiple organ failure and even sudden death can occur. Therefore, exercise should be moderate, and must pay attention to observation after exercise. When there is muscle swelling and pain, the pain cannot be relieved after rest, and there is oliguria, no urine or even soy sauce-colored urine, be sure to seek medical attention in time.

Be sure to drink enough water before and after exercise. Because only the adequate amount of water intake can ensure that the metabolites, toxins and contents caused by cell destruction produced in the body are excreted through the urine. It will not lead to the accumulation of toxins in the body and produce some adverse reactions. In addition, the exercise intensity should be reasonably arranged according to the individual physical condition. Exercise should gradually increase the amount of exercise, avoid sudden excessive exercise.

What drugs can cause rhabdomyolysis?

Hypolipidemic drug:

HMG-CoA reductase inhibitors (Statins): Such as simvastatin, pravastatin, atorvastatin, etc. These drugs are effective in lowering total cholesterol and low-density lipoprotein. Statins can cause myopathy. It includes myalgia, myositis and rhabdomyolysis. The incidence of muscle discomfort varies among statins. It is generally around 5%, so this type of drug is also called a muscle poisoning drug.

Fibrates: Such as fenofibrate, bezafibrate, etc. These drugs mainly lower triglycerides and very low density lipoproteins. The combination of statins and fibrates increases the incidence of myopathy and rhabdomyolysis.

Anti-infective drugs:

Quinolone antibiotics (eg, ciprofloxacin, levofloxacin) can increase the risk of tendonitis and tendon rupture. It can worsen muscle weakness in people with myasthenia gravis. Minors under the age of 18 should avoid use.

Anti-hepatitis virus drugs:

Such as lamivudine and telbivudine. These drugs can cause damage to the musculoskeletal system. It manifests as myalgia, arthralgia, elevated creatine phosphokinase, rhabdomyolysis and spasticity.

β2 receptor agonists:

Such as terbutaline, salbutamol, etc. This class of drugs is the first-choice treatment for asthma. They can selectively stimulate airway β2 receptors, dilate bronchi and improve respiratory function. About 30% of the cases of oral administration of terbutaline consistently have varying degrees of muscle tremor. Its mechanism is related to the excitation of β2 receptors in slow-twitch fibers of skeletal muscle. This accelerates muscle contraction and disrupts the fusion between fast and slow twitching fibers. Severe overdose may develop rhabdomyolysis and renal failure.

Medications that can cause hypokalemia:

Such as furosemide, hydrochlorothiazide, indapamide, amphotericin B, etc. Hypokalemia is a trigger for muscle dissolution. Therefore, the long-term application of potassium-scavenging drugs can cause rhabdomyolysis.

Narcotic psychotropic drugs:

Such as opioids, barbiturates, phenothiazines, succinylcholines, etc. These drugs can cause coma when taken in large quantities. This can damage the muscles under prolonged pressure, which can lead to rhabdomyolysis.

Other:

Such as theophylline, amiodarone, donepezil, colchicine, diphenhydramine, etc. These drugs can also cause rhabdomyolysis.

Rhabdomyolysis, regardless of the cause, should be treated as soon as possible to avoid delays in treatment.

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There are something which harm from your bone health.😖😖😖

Bones are an important part of the human body. They have important functions such as support, movement and protection of internal organs. However, bone health will get worse with age. In addition to the inevitable bone loss with age, there are also some foods which harm from your bone health. 

1. Sugar

Although sugar is an important source of human energy and an essential component of the human body, excessive sugar is the source of many diseases. Excessive intake can directly or indirectly lead to following major problems: obesity, diabetes, cerebrovascular and cardiovascular diseases and dental caries. In addition, excessive intake of sugar can also harm the bones. 

• When sucrose is metabolized in the body, it needs to consume a variety of minerals and vitamins, calcium is also one of them.
• Excessive sugar intake will directly affect the intake of other nutrients such as vitamins, dietary fiber, protein and minerals. It results in potassium deficiency, vitamin deficiency and calcium deficiency.
• Children who eat too much sweets are also one of the important reasons for the increase in their fracture rate.

In addition to obvious high-sugar foods such as candy, ice cream, and beverages, there are other foods that actually contain high sugars. Such as: yogurt, nutritious oatmeal, biscuits, nuts, potato chips, various sauces such as ketchup, salad dressing.

2. Salt

The main component of salt is sodium chloride which is mainly distributed in the human body in the form of ions. It content a large number and has a various effect in the human body.

When a person consumes too much salt, it will increase the concentration of sodium ions in the body. There is a competitive relationship between sodium ions and calcium ions in the human body. The increase of sodium ions will accelerate the loss of calcium ions. With the increase of urinary calcium excretion, the amount of bone calcium will decrease. It results in bone diseases such as osteoporosis and fractures. If the calcium content in the diet is low and high-salt food is taken, it will cause negative calcium balance and stimulate the parathyroid glands to increase the secretion of calcitonin. It causes bone loss and leading to hypocalcemia. A long-term high-salt diet will not only harm bones, but also cause different diseases such as cardiovascular and kidney diseases.

In addition to cooking with less salt, also pay attention to eating less high-sodium foods such as seasonings (such as soy sauce, chili sauce), processed foods (such as ham, sausage), and preserved foods (such as kimchi).

3. Alcohol

In addition to hurting the stomach and liver, drinking alcohol can also hurt bones. Drinking too much alcohol can increase the body's cortisol level. Cortisol can directly inhibit bone formation and indirectly stimulate bone resorption. It leads to bone loss. In addition, drinking too much alcohol will also cause an imbalance in the body's calcium nutrition metabolism. This will not only affect the absorption of calcium in food, but also make bone calcium be removed and the amount of calcium excretion greatly increased. It results in severe bone calcium deficiency and ultimately osteoporosis. Long-term heavy drinking will also affect the absorption and utilization of calcium and phosphorus in the intestines. This will reduce bone formation. 

In addition to bone damage, alcohol can also damage the brain, cardiovascular, esophagus, gastrointestinal, liver, prostate and other organs. It can induces diseases of related organs and cause acute and chronic alcoholism and cancer. Therefore, it is better to drink less alcohol.

👉The health of the bones is very important. Poor bone quality will affect people's quality of life, and may even endanger lives. Therefore, we must protect our bones. In addition to supplementing calcium with calcium supplements, you should also pay more attention to your own lifestyle habits.

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Let's learn more detail about the calcium supplementation.😎😎😎

In today's society, more and more people know the importance of calcium supplementation. However, calcium supplementation actually has many confusing points. Calcium supplementation is not solved simply by just taking calcium tablets. This time, let us learn more about the knowledge of calcium supplementation.

Can bone soup supplement calcium?

Although the bones contain a lot of calcium, they do not dissolve out of the soup easily. Studies have shown that when bone soup is boiled in a pressure cooker for two hours, the calcium content in the soup is still very small.

Is soy milk high-calcium food?

The calcium content of soy milk is only about 1/20 of that of soybeans, which is about 25 mg of calcium per 100 grams of soy milk. This value is only 1/5 of milk.

Is liquid calcium easier to absorb?

A large number of studies have shown that the absorption of calcium is not directly related to the form of calcium. There is no significant difference in the absorption rate of solid calcium and liquid calcium.

Only supplement calcium without vitamin D.

Vitamin D can help calcium absorption. Vitamin D is required for calcium to be transported into the human body. Therefore, vitamin D should be supplemented while supplementing calcium.

Calcium can only be supplemented by taking calcium tablets?

Many people only supplement calcium by taking calcium tablets. In fact, dietary calcium supplementation should be the first choice for calcium supplementation. It is better to take food as the main source of calcium supplementation than taking calcium tablets.

Is more and more calcium supplemented better?

Excessive calcium supplementation can easily cause hypercalcemia. It may leads to kidney stones and vascular calcification. Calcium supplementation should also be small amount and frequent. Calcium should not be took too large at a time.

Can calcium supplements cure osteoporosis?

Osteoporosis is one of the manifestations of human aging. Even if the elderly supplemented with a large amount of calcium, the trend of bone loss cannot be reversed. Therefore, calcium supplementation cannot cure osteoporosis, but can only delay the progression of the disease.

The effect of drinking beverages on calcium supplementation.

Most beverages contain phosphate. Phosphate will obstruct the body from absorbing calcium. Therefore, people with calcium supplements should drink less beverages.

Signs of calcium deficiency

Children:

• Difficulty in falling asleep, sweating after falling asleep, easy to wake up, knock knees, bowleg, gray nails, delayed teething, sparse or irregular teeth arrangement, etc.
• Babies can be supplemented with appropriate amount of vitamin D 15 days after birth. 3-11 years old should intake 600-800mg of calcium per day. Calcium can be obtained by consuming 250-500g of milk a day and outdoor activities for more than 1 hour.

Teenager:

• Obvious growth pain, weak legs, easy cramps, easy tiredness, irritability, inattention, anorexia, dysplasia of teeth, tooth decay, decreased immunity, etc.
• Adolescents between 11-18 should consume 1000 mg of calcium per day. It is best to supplement with food and eat more foods with high calcium content such as shellfish and dairy foods. Early calcium supplementation in youth is a good way to prevent middle-aged and elderly osteoporosis.

Pregnant women and middle-aged people:

• Frequent fatigue, sore back, cramps, easy get sick, loose teeth, etc., may be the signs of calcium deficiency, especially in middle-aged women.
• For women after 40-year-old, it is best to have 1 glass of milk in the morning and evening. In the early pregnancy, calcium can be supplemented with rich foods. In the second trimester, calcium supplements can be taken under the guidance of a doctor. Breastfeeding women should take 1200mg of calcium per day which can be divided into two doses.

Elderly:

• Heel pain, waist and neck pain, loose or falling teeth, obvious hunchback, decreased height, decreased appetite, constipation, irritability, insomnia, etc.
• Calcium supplementation for the elderly should also be based on food supplements and calcium tablets should be used carefully and control the amount. The general diet can be supplemented with about 400mg of calcium and an additional 400mg from calcium supplements. Because the gastrointestinal function of the elderly is weak, it is better to choose liquid organic calcium and take it after meals.

Tips of supplement calcium:

High-calcium foods: Nuts, green vegetables, dairy products and soy products are the best sources of calcium in foods. Such as cashew nuts, hazelnuts, spinach, broccoli, milk, tofu, etc.

Sun exposure: Stay outdoors for 20-30 minutes every day with as much exposed area as possible. Do more exercises that strengthen your bones, such as jogging and cycling.

Calcium supplementation at night: Night is the time when the blood concentration is lower and the absorption effect of calcium supplementation will be better at this time. It is generally recommended to take calcium supplements within 1 hour after dinner or about 2 hours before going to bed.

Vitamins supplement: Vitamin D can promote calcium absorption and it can be ingested from foods such as mushrooms and eggs. Vitamin K can activate osteocalcin and promote calcium deposition to the bones. Green vegetables such as broccoli and spinach are rich in vitamin K.

Magnesium supplementation: When calcium is absorbed into the blood, magnesium will transport calcium to the bones until the bones no longer lack calcium. Foods rich in magnesium include seaweed, peanuts and green vegetables.

Eat meat in moderation: Studies have shown that for every extra 50g of protein intake, calcium excretion will increase by 60mg. Therefore, eating too much meat will obstruct the absorption of calcium. It is recommended that the daily meat intake of adults should be 50-75g.

Light diet: Studies have shown that for every 2300mg of sodium (about 6g of salt) excreted by the kidneys, 40-60mg of calcium will be excreted at the same time. Therefore, the intake of salt must be controlled. The intake of coffee, strong tea, etc. should also be controlled.

👉The recommended calcium intake for adults is 800 mg per day. If you need to take calcium supplement once a day, it is recommended to take it before going to bed. If you take it twice a day, the other can be took 1-2 hours after breakfast. This prevents the interaction of food with calcium. Calcium supplement with vitamin D, minerals such as magnesium, potassium, zinc, etc., will be better effect. If you want to drink milk, you can take calcium supplement 0.5-1 hour after drinking. You should get appropriate exposure to the sun and exercise reasonably. 

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Why the bone densities of women still declines as they keep taking calcium tablets?😵😵😵

Do you have a habit of taking calcium tablets to prevent osteoporosis? Do you know what ingredients your calcium tablets contain? Do you think your calcium tablets are able to prevent or cure osteoporosis? Actually, it is not simply to prevent osteoporosis as only taking calcium tablets. Let's learn some knowledge about calcium supplement together.

What is osteoporosis?

Osteoporosis is a disorder of bone metabolism. The patient's bone density decreases and makes the bone structure fragile. It can easily lead to fractures and cause pain and other complications. Osteoporosis reduces the patient's ability to take care of itself. Normally, osteoporosis does not have any symptoms. If patient feel pain, it is usually caused by a fracture. The most common fracture sites include the spine, forearm bones and femur. The patient with osteoporosis may fractures due to a slight collision or fall. Even if there is no collision, the spine will also collapse progressively and cause the back bending. It will form hunchback and becomes short. Some patients may also have back pain.

There are some people buy and take the calcium tablets to prevent osteoporosis by themselves. However, their bone density may still decrease and they eventually have osteoporosis. Especially in women, they are easy to have osteoporosis.

There is a patient keep taking the calcium tablets everyday for more than 5 years. She check her bone density in the hospital after she fall down and has fracture. Her bone density has still declined since she started taking the calcium tablets. Her lumbar spine bone mineral density is almost achieved osteoporosis (T-score is -2.1, when T-score <-2.5, it can define to osteoporosis.). Her T-scores of other parts are also at osteopenia level (T-score <-1). 

Why the calcium tablets can't prevent bone loss?

Women are more likely to have osteoporosis than men, but why and why the calcium tablets can't prevent bone loss? The estrogen level is related to osteoporosis. After women enter the perimenopausal period, the  levels of estrogen are declined rapidly. The activity of osteoclasts is enhanced and the bone loss is significantly accelerated. To delay bone loss in postmenopausal women, the key is not to supplement calcium, but to inhibit osteoclast activity as soon as possible. Therefore, the calcium tablets are not enough for women. They may need to use selective estrogen receptor modulators (such as raloxifene) or bisphosphonates (such as alendronate). 

What situations are calcium supplements enough to be taken alone?

Women are before entering to perimenopausal period: The estrogen in the body has not decreased significantly. The activity of osteoclasts is not strong and the bone loss is slow. At this time, taking calcium supplements will help maintain their bone health.

In the interval between bisphosphonate medications or during their medication holidays, they can take calcium supplements: For example, zoledronic acid injection is generally injected once a year and calcium tablets can be taken alone during the interval between two injections. In addition, with the prolonged use of bisphosphonates, the bone density will no longer increases, but adverse effects gradually increase. Therefore, the use of bisphosphonate drugs should be suspended after 3 to 5 years and enter the medication holiday. During the medication holiday, calcium supplements can be taken alone.

👉When taking calcium supplements, combined with active vitamin D is better than only calcium. It can help increase the absorption of calcium, increase bone density and reduce the risk of fractures. Adults need to supplement 800 mg of calcium per day and 1000 mg for over 50-year-old.  

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Inventory of various new discoveries of metformin😎😎😎

Metformin is an anti-diabetic drug and a classic oral hypoglycemic agent. Since its inception in 1957, it has been used clinically for more than 60 years. It is currently one of the most widely used oral hypoglycemic drugs in the world. Even though there are many new hypoglycemic drugs, metformin is still the primary drug for type 2 diabetes.

Metformin was born in 1929 and originated from galega officinalis. In 1957, French diabetologist professor Jean Sterne first used metformin for clinical hypoglycemic reduction. Then its application value is still being discovered. Let us take a look at what new discoveries have been made recently.

1. Cancer

Acidic phospholipids play an important role in regulating electrostatic membrane association of programmed cell death ligand 1 cytoplasmic domain (PD-L1-CD). Metformin can competitively dissociate PD-L1-CD from the membrane and affect the stability of PD-L1. This revealed that the molecular mechanism of metformin's anti-tumor effect and provided new ideas for related immunotherapy targeting PD-L1.

There are many studies that supporting metformin can decrease the risk or improve the symptoms of cancer patients. Such as esophageal squamous cell cancer, pancreatic cancer, primary bone cancer.

2. Obstetrics & Gynecology

a. Improve neonatal obesity

    Metformin has many benefits for mother's blood glucose and neonatal obesity, including improved blood glucose, reduced caesarean section, reduced mother's weight, lower insulin requirements,  lower birth weight and obesity measurements of newborns.

b. Prevent adverse pregnancy outcomes in patients with polycystic ovary syndrome

    Metformin can prevent late period abortion and premature birth in women with polycystic ovary syndrome.

3. Metabolic diseases

Metformin can improve the metabolic status of patients treated with systemic glucocorticoids. It can not only reverse the metabolic complications caused by the use of systemic glucocorticoids, but also reserve the anti-inflammatory effects of glucocorticoids. It benefits many patients taking systemic glucocorticoids.

4. Cardiovascular System

 a. Heart failure

    Non-diabetic heart failure patients with reduced ejection fraction (HFrEF) use metformin to reduce myocardial oxygen consumption and improve myocardial efficiency.

b. Left ventricular hypertrophy

    Metformin treatment significantly reduced the left ventricular mass index. Patients taking metformin reduced left ventricular thickening by two time less. In addition, metformin also reduced blood pressure, oxidative stress, and weight. Metformin has the potential to improve cardiovascular health.

c. Air-pollution-induced thrombosis

    Atmospheric particulate matter can induce alveolar macrophages to release pro-inflammatory factors including interleukin 6 (IL-6), leading to arterial thrombosis and death.

    Metformin blocks the mitochondrial electron transport and inhibits the production of reactive oxygen species, thereby blocking the release of IL-6 and inhibiting the formation of arterial thrombosis. This confirms that metformin can be used as a potential therapeutic drug to prevent cardiovascular diseases caused by air pollution.

5. Nervous system

a. Cognitive and nerve recovery after brain tumor surgery

    For children with brain tumor patients who have received craniocerebral radiotherapy, metformin can significantly improve their statement memory and working memory function, repairing white matter damage. Metformin is also safe and tolerable in this population.

b. Multiple Sclerosis

    After treatment with metformin, oligodendrocyte precursor cells can restore their response to the signal of promoting-differentiation, promote the regeneration of nerve myelin. This is useful for the treatment of central nerve demyelination such as multiple sclerosis.

c. Cognitive decline and dementia

    Patients with type 2 diabetes who take metformin have slower cognitive decline and a lower risk of dementia.

6. Locomotor system

a. Osteoarthritis

    Metformin can prevent the occurrence and development of osteoarthritis, alleviate the pain sensitivity associated with osteoarthritis in mice. Its protective effect on cartilage is mainly through the activation of AMPK signals.

b. Intervertebral disc degenerative disease

    Metformin can promote the release of small extracellular vesicles of mesenchymal stem cells, increase the level of proteins that regulate cell proliferation in the vesicles, and can optimize the application effect of extracellular vesicles in the regeneration and repair of intervertebral discs.

7. Digestive system

Metformin stimulates bile secretion in the intact liver, but this drug can also cause severe damage to bile acid secretion.

8. Infection

a. COVID-19

   Metformin inhibits the activation of NLRP3 inflammasomes and the production of IL-1β in cultured macrophages and alveolar macrophages, as well as the secretion of inflammasome-independent IL-6, thereby attenuating lipopolysaccharide and COVID-19 induced acute respiratory distress syndrome. Metformin can be a potential treatment for severely patients with COVID-19 and other induced acute respiratory distress syndrome.

b. HIV

    Metformin reacted on mitochondrial respiratory chain complex-I and inhibit the oxidative phosphorylation (OXPHOS) pathway. It inhibited the replication of human CD4⁺ T cells and HIV-1 virus in humanized mouse models. It revealed that metformin and others OXPHOS pathway inhibitors may be an adjunct to treat AIDS.

👉Metformin has also anti-aging effect. Most effects still are at the research stage and may not be used on treatment. Therefore, metformin still deserves more in depth research.

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