Clinical calcium
-
World Health Organization (WHO) has proposed the use of 10-year absolute risk for fracture (calculated based on incidence and life span) using clinical risk factors as new intervention thresholds. Eight risk factors to be included in the fracture assessment risk tool are age, bone mineral density or body mass index (BMI) when bone density is not available, steroid use, parental history of femoral neck fracture, history of osteoporotic fracture, smoking, excessive alcohol consumption, and rheumatoid arthritis. WHO has proposed that a treatment-intervention threshold be established in accordance with the medical situation in each country.
-
Although vitamin D improves bone mineral density 0.66% per year at spine site and 1.23% per year at femoral neck site, respectively, vitamin D is useful for preventing osteoporotic fractures, especially hip fractures in the elderly. Vitamin D affects microstructure and bone turnover for osteoporotic bone to become strong bone. And vitamin D improves muscle function to prevent falls in the elderly. Moreover the appropriate amount and treatment target of vitamin D must be considered for the elderly with many different diseases.
-
Osteoporosis is the most frequent adverse effect observed during glucocorticoids therapy. The 2004 edition of the guideline on the management and treatment of glucocorticoid-induced osteoporosis has been proposed by The Japanese Society for Bone and Mineral Research. ⋯ The Bisphosphonates have been recommended as first-line drugs. Active vitamin D3 and vitamin K2 have been recommended as second-line drugs.
-
In oriental medicine, not only the local pathological state but also disharmony within the body and the stagnation of Ki are examined. For this purpose, diagnoses in modern western medicine are also used as references. The pathological condition is evaluated by the 4 diagnostic methods as original methods of oriental medicine, treatment points are decided, and acupuncture and moxibustion are performed. If meridians and reactive points that appear with Ki stagnation impairing natural healing ability can be determined, not only low back pain but also symptoms such as constipation disappear, resulting in harmony of the body and improvement in constitutional symptoms.
-
There are various causes of low back pain, but if the cause of low back pain was determined as a discogenic pain, anterior lumbar interbody fusion was indicated. The surgical treatment should be determined after MRI and other radiological imaging studies and pain response, and also it is important to examine the social factor and psychological status. Extra-peritoneal approach is selected for above L(4)-L(5) level, and trans-peritoneal approach is selected for L(5)-S(1). Recent endoscopic approaches to the anterior lumbar spine is also presented.