Risk Evaluation And Health Management For The Youth With Primary Osteopenia

Background and ObjectiveIt is widely recognized that lifestyle changes influence people's health significantly, that's why the disease spectrum change. Although reports about bone mineral density (BMD) keep increasing, there focus more on hyperostosis. In recent years, osteopenia and osteoporosis, which belongs to BMD decrease, are the most common phenomena. Osteoporosis is defined by the World Health Organization (WHO) as a disease of bones that leads to an increased risk of fracture. The development of osteoporosis was often latent, there is no symptoms or mild symptoms in the early stage.Symptoms, such as bone pain, joint dysfunction, or hump, and fractures, which was serious impact on quality of life,will arise until middle and late period of this disease. Osteoporosis,which is a serious stage of bone mineral density (BMD) abnormalities more, is irreversible, so the treatment of osteoporosis and health interventions in this phase is relatively passive. Study found that there is a pathophysiology process of osteopenia before osteoporosis. Bone loss is pre-clinical osteoporosis status, bone quality and bone fracture resistance ability decreased, that is, the decline in bone strength. According to the theory of health management, to prevention and treatment osteoporosis should pay attention to the effective intervention in phase of bone loss, through a balanced diet, active exercise and other positive health measures, can effectively slow bone loss and prevent osteoporosis. The intervention in phase of bone loss is in accord with health management philosophy, so the study of this has more significant meaning. Traditionally, it is said that decreased bone density is a physiological phenomenon among the elderly. However, recently, health report of domestic first-tier cities shows that the proportion of youth groups rise rapidly. According to reports in the literature,primary bone density decrease may associate with a series of factors, including family history, diet, exercise, etc. But how these factors impact on lowering primary bone mineral density? Similar studies lacks. Exclusion of secondary diseases, medical factors that cause bone loss, namely primary osteopenia. Our previous observation regarding physical examination of bone density data in a hospital health management center, we found that lots of people are attacked by decreased bone density, especially young people under 45 years (Youth Definition of World Health Organization in 1992). Therefore, the aim of this study was to explore the major risk factors causing primary osteopenia for the youth, and to make health management for them based on the factors.Data and Methods1 Pre-surveyThrough access to physical examination in health management center in one hospital from October 2008 to April 2009,1000 patients examination data was randomly selected, from which 191 were found to have bone density examination underwent physical examination, include the head, spine and whole body check. Exclusion of secondary diseases, medical factors that cause bone loss, among the 191 persons's examination data,56 persons have bone mineral density examination abnormalities, including 34 cases of bone osteopenia, while 22 cases belonging to osteoporosis. According to the age standard for youth under the age of 45, issued by WHO in 1992,16 persons named youth fell upon 34 cases of osteopenia, and 11 persons named youth among 22 cases of osteoporosis. Namely,27 persons named youth among 56 cases of osteopenia and osteoporosis, which account for 48.21%. According to the information found in the occupational distribution, patients were registered the white-collar workers represented by the mental suffering from osteoporosis or bone loss are most. In addition, according to the health examination recorded, symptoms were found in the joints, bone pain, so are combined fatigue, insomnia, gastrointestinal discomfort and other symptoms. Through literature search, combined with pre-survey and traditional Chinese medicine concept of disease prevention, we initially identified the following 25 factors may be associated with osteopenia, including "sex, age, height, weight, body mass index, type of occupation, physical or brain labor type, lack of exercise, partial eclipse,for a long time to face the computer, sedentary, calcium intake, smoking, drinking, staying up late, physique, with a family history of osteoporosis, the joints, back pain, hip pain, fatigue, dizziness, insomnia, stomach Intestinal discomfort, afraid cold".2 SubjectsThrough prospective cohort study, access to physical examination in health management center in a hospital from June 2009 to March 2010, make 300 patients with osteopenia and 300 health people as subjects. Excluded patients with osteopenia caused by other disease and incomplete data, and ultimately determine the osteopenia study in 99 cases, bone mineral density in normal subjects (control group) of 111 cases.3 Forms design and information collectionThe details of collection table, including design of job classification, physical or brain labor type, physiological information, bone density, clinical symptoms and other aspects of the 25 risk factors.4 Information CollectionThe 25 risk factor number of each object were typed into the SPSS database, use 0 for negative,1 for positive. In particular:1) Gender:1 for male and 2 for women; age, height, weight and body mass index for quantitative data.2) occupation (or status) and physical type of brain work:the "white-collar workers, teachers, civil servants and other intellectual workers (including medical personnel, etc.), students, workers, self-employed, other occupations" are assigned to 1,2,3,4,5,6; the mental, physical labor mild, medium and heavy manual labor were assigned to 1,2,3.3) The life and eating habits:lack of exercise (X1,0:no,1:yes), the partial eclipse (X2,0: no,1:yes), long time to face the computer (X3,0:no,1:yes), Sedentary (X4,0:no, 1:yes), calcium (X5,0:moderate,1:few), smoking (X6,0:no,1:yes), drinking (X7, 0:No,1:is), stay up all night (X8,0:little or none,1:yes), physical (X9,0:good 1: bad), with family history of osteoporosis (X10,0:No,1:Yes).4) The value of bone mineral density (quantitative values):use the rapid whole body bone mineral density diagnostic machine of XR-36 dual-energy X-ray produced by U.S. Norland, to measurement the application site and obtained the bone Density value, when-2.5<T <-1.0 diagnosis of osteopenia, T>-1.0 for the normal bone density.5) symptoms:the "clicking of joint, back pain, hip pain, fatigue, dizziness, insomnia, gastrointestinal discomfort, afraid cold" symptoms were assigned to 1,2,3,4,5,6,7,8. Symptoms assigned to "1" and asymptomatic is assigned "0".5 Statistical Methods5.1 Regression AnalysisThe above 25 factors are independent variables, "whether there is bone loss, " as the dependent variable, the dependent variable is binary data, so the above analysis of the data can be used Binary logistic regression analysis (Binary Logistic) were screened for risk factors. The occupation (or status) and physical types of the brain were 6 and 3 levels, which does not belong to binary or quantitative data, so these two factors as covariates selected.5.2 Other statistical methodsAge, height, weight, etc. quantitative data was compared by two independent sample t test; type of occupation and physical or brain labor type compared by chi square test. The change of health indicators before and after management interventions using self-paired t test, the quantitative data between two groups compare by independent samples t test. Count data adoption rates, rates of change before and after intervention compare by their own matchingχ2 test, compare rates between the two groups by two independent samplesχ2 test. Analysis using statistical software package SPSS 13.0, data to P<0.05 as statistically significant difference.6 Health management and evaluationAccording to the screening risk factors, to make targeted health management measures. Young patients with primary osteopenia were divided into primary health management group and the control group randomly; Patients of the two groups were followed up one year, compared risk factors for bone mineral density and the changes of above risk factors.Results1 Physiologic indexesThere is no significant difference of gender, age and height between the two groups; but the weight of bone loss group was significantly greater than the healthy group (P=0.003,P=0.000).2 Types of occupational and physical brainOccupational structure in the two groups are significantly different(χ2=30.678, P=0.000), the observation group has higher proportion of white-collar workers and teachers; as for the types of physical or brain labor, there are also significant differences between the two groups (χ2=7.743, P=0.021), higher proportion of both groups are mental.3 Regression analysis of risk factorsVerification of regression models were divided into 8 steps, each step of the test equations has significant (all P=0.000); regression analysis of the final confirmation of the lack of movement in the joints, for a long time to face the computer, the partial eclipse, staying up late, alcohol consumption, type of occupation, a total of eight factors on cold young bone loss has significant effects (all P<0.05, and OR>1.0).4 Health management and evaluation4.1 Changes in bone mineral density and T valueBone mineral density and the T values in patients between two groups before intervention were not statistically different, bone mineral density and T values health management after the intervention increased significantly compared with that before the intervention itself (P=0.026, P=0.018); while the control group in 2010 Bone mineral density and T values has no significant changes, both significantly lower than the health management group (P=0.031, P=0.023).4.2 Eclipse and alcohol interventionPartial eclipse and alcohol consumption in patients between two groups before intervention were not statistically different, after the intervention it was reduced significantly compared with that before the intervention itself (P=0.003, P=0.000); while the control group in 2010, eclipse and alcohol has no significant changes, both significantly higher than the health management group (P=0.029, P=0.012).4.3 Exercise InterventionExercise time per week in patients between two groups before intervention were not statistically different, after the intervention it was reduced significantly compared with that before the intervention itself (P=0.010), and significantly longer than the control group (P=0.022); while the control group, each of 2010 Weekly exercise time was no statistical difference compared with 2009.4.4 Habits of interventionBefore the intervention, the time of face the computer per day and the number times of up to late per week has no significant difference between both groups, which was obvious reduced compared with before intervention (P=0.016, P=0.022), And significantly less than the control group (P=0.018, P=0.031); while the control group has no significant changes.4.5 Symptoms of interventionBefore the intervention, cold and joint snapping has no significant difference between both groups, which was obvious reduced compared with before intervention (P=0.002, P=0.023), And significantly less than the control group (P=0.038, P=0.025); while the control group has no significant changes.4.6 Incidence of osteoporosisFor 1 year follow-up, there were only 2 cases (3%) had osteoporosis in health management group, while the control group,11 patients (21%), the morbidity in health management of osteoporosis group were significantly lower than that in the control group (χ2=8.206, P=0.006).Conclusion1 Lack of exercise, joint snapping, long facing to the computer, the partial eclipse, staying up late and drinking are risky factors of primary decreased bone density to the young. 2 Primary osteopenia is an important stage of the health interventions to prevent osteoporosis.3 According to major risk factors of primary osteopenia of young, to development of personalized health and health management interventions can prevent bone loss, increase bone density and prevent osteoporosis.