Osteoporosis is a chronic progressive systemic disease of metabolic bone or a separate clinical syndrome in certain pathologies, which is based on a decrease in bone mineral density and a violation of its normal structure. This leads to increased brittleness of bones and a significant increase in the risk of fractures in people with osteoporosis.
The World Health Organization places osteoporosis on the 4th place among the causes of disability and mortality of the population after cardiovascular diseases, oncological diseases and diabetes mellitus. This once again underscores the seriousness of the problem. Today, osteoporosis takes the form of a quiet epidemic, as with every year the number of new cases of diagnosis of the disease, as well as its complications, among which the most unfavorable are fracture of the femoral neck and compression fractures of the spine. According to WHO estimates, by the year 2050 the number of fractures of the femur will increase from 500 thousand annually to 1 million
The problem is that the population is poorly informed about this disease and underestimates its consequences. Therefore, in our country, such a low detection of osteoporosis at the preclinical stage, that is, before the development of typical signs and complications.
The left side shows the normal structure of the bone tissue, and on the right is its structure in the case of osteoporosis.
Causes and risk factors
. Depending on the causes of development, there are 2 types of osteoporosis:
To date, it is considered a poly-tyological disease, that is, there can be many reasons, and it is very difficult to establish the specific in each case. Therefore, identify risk factors that can lead to a decrease in bone mineral density:
- genetic predisposition and the presence of close relatives of osteoporosis;
- old age;
- belonging to the female sex( women suffer 3 times more often than men);
- low body weight and high growth;
- individual intolerance to dairy products;
- hormonal disorders in the body;
- early menopause;
- absence of menstruation, infertility;
- smoking;Alcohol abuse, coffee;
- inadequate physical activity;
- deficiency in the diet of foods fortified with calcium;
- lack of vitamin D in the body;
- reception of hormonal preparations;
- endocrinological diseases.
There are many medicines that can cause osteoporosis, so people who regularly take them must undergo screening tests on a regular basis.
Medications that can cause osteoporosis:
- glucocorticosteroid hormones;
- L-thyroxine( replacement therapy with reduced thyroid function);
- preparations based on lithium;
- anticonvulsant medications;
- tetracycline antibiotics;
- loop diuretics( furosemide, torasemide);
- cytostatic medications, for example, methotrexate, cyclosporine;
There are 3 subtypes of primary osteoporosis:
- Type 1 , or post-menopausal. It occurs most often. It affects mostly women after 15-20 years of menopause, but it also occurs in men. Associated with a lack of estrogen hormones, and in the stronger sex - testosterone. A special feature is the very rapid progression of bone loss.
- Type 2 , or senile. It occurs with the same frequency in both women and men. It affects mostly people after 70-80 years, develops slowly, is associated with age-related changes in the body, a lack of calcium in food, vitamin D in the body.
- Type 3 , or idiopathic. Diagnosed in cases when the cause is unknown. It affects people of middle age and even adolescents( juvenile).
Lack of calcium in the diet can cause osteoporosis
This type of osteoporosis is not an independent disease, but only one of the symptoms of the underlying pathology. To lead to the development of this state can:
- endocrine diseases( hyperparathyroidism, hypothyroidism, diabetes, increased adrenal function);
- rheumatological diseases( systemic lupus erythematosus, rheumatoid arthritis);
- hematological pathology( myeloma, thalassemia, leukemia);
- tumor lesions of bones( primary and metastatic);
- kidney disease, gastrointestinal tract.
Important! Determining the cause and risk factors for osteoporosis of bones is of great importance, as it underlies the design of the curative program and preventive measures.
Symptoms and consequences of
For a long time, osteoporosis remains unrecognized, and the person does not suspect the danger that is hanging over him. As a rule, the symptoms of the disease appear after the first fractures, which also differ in scant symptoms.
Vertebrae most often suffer. It is there that the first fractures are formed. To get one, you do not need a serious injury, the bones break even because of the awkward movement or lifting of a small load, coughing, sneezing. After the patient has developed a compression fracture of the vertebrae, he begins to feel pain. In most cases, pain sensations are localized in the lumbar region, as these vertebrae suffer most often. Pain is not acute, and patients suffer it, writing off for osteochondrosis or fatigue.
Pain sensations are expressed minimally in the morning after sleep, decrease after resting in a horizontal position. Appears or worsens pain after physical exertion, prolonged stay on legs. Symptoms of compression of the spinal cord or radicular signs( compression of the spinal nerves) are practically not found.
Because of the fractures, the wedge-shaped deformation of their bodies occurs, which leads to disruption of posture, deformation of the spine, reduction of human growth. The most common manifestation of wedge-shaped deformation of the vertebral bodies is the appearance of a hump in the thoracic spine( chest thoracic dilation).
A typical change in posture in osteoporosis, which is called the "hump of the aristocrat"
In some cases, pain in compression fracture can be acute. The symptoms are very similar to lumbago. The pain lasts 2-3 days, after which it is replaced by chronic pain. Patients do not seek medical help because they do not suspect a trauma.
Pain sensations subside after 9-10 months after fracture. Often, dull pains persist for many years. The course of osteoporosis is unpredictable, and the intervals between episodes of fractures are different: it can be several years, and maybe several days.
Symptoms that indicate osteoporotic spine fractures:
- progressive decline in growth;
- pain in the palpation of the spine;
- pathological tension of the muscles of the back;
- development of stoop;
- increased thoracic kyphosis, cervical and lumbar lordosis, the appearance of a hump on the back;
- appearance of asymmetric folds on the sides of the abdomen.
Some patients may have common bone pain, which is worse when they are beaten, but this is rare.
In the second place among the manifestations and complications of osteoporosis is a fracture of the femoral neck. This is a very serious trauma, which is associated with a high degree of disability and the risk of premature death. It's very easy to get such a break. It's enough to stand upright, fall on one's side, jump, etc.
Fracture of the neck of the hip is a severe consequence of osteoporosis, which leads to disability and premature death
In third place are the fractures of the radius of the upper limb in a typical place that develops when the fallon an outstretched hand. In women, multiple fractures of the ribs are typical.
Diagnostic procedures for osteoporosis have two objectives:
- Determine the presence of osteoporosis.
- To identify the consequences of reducing bone mineral density( diagnosis of fractures).
Methods that are used for this:
- General examination of the patient and identification of typical changes characteristic of osteoporosis. Detailed collection of anamnesis and finding out the risk factors for the disease, the presence of trauma, albeit not serious.
- Radiography, MRI or CT to identify the species and locate fractures, to identify reduced bone density.
- Densitometry is the "gold standard" for the diagnosis of osteoporosis. This test evaluates the structure of bone tissue and reveals all abnormalities. If the radiography shows only far-reaching changes, then the densitometry can catch the initial stages of the pathology even at the stage of ospeopenia( the minimal decrease in bone density, which has not yet reached the degree of osteoporosis).
- Biochemical markers of osteoporosis: the determination of the concentration of calcium and phosphorus in the blood, their daily excretion in the urine, the study of the level of hormones that participate in the mineral metabolism, parathyroid hormone, vitamin D, calcitonin.
- Biopsy of bone tissue( crest of the iliac bones) is performed only if there are suspicions of tumor processes( malignant diseases of the blood system, for example, multiple myeloma).
Important! Densitometry is the screening method of examination. It is safe, painless, does not require preparation, time and a lot of money. Therefore, all people who have risk factors for osteoporosis should regularly undergo this examination.
Densitometry - the "gold standard" for the diagnosis of osteoporosis
Therapy for osteoporosis is conservative. Surgical treatment may be needed for patients with consequences of the disease, that is, with fractures. There are 2 directions of therapy: dietary nutrition and medication. You can not neglect one of them.
The main goal of the diet is the complete provision of the body with calcium and improving its absorption by bone tissue, as well as the exclusion of products that disrupt the absorption of trace elements from the digestive tract.
In addition to calcium and vitamin D, the diet of people with osteoporosis should include a number of other substances that will help restore the structure of bones( vitamins and trace elements).
Basic principles of a diet for osteoporosis:
- The amount of calcium in foods should not be below the norm for a particular patient.
- It is mandatory to introduce foods with vitamin D, A, C, B, K and folic acid into the diet.
- The diet and culinary processing of food are not so important, everyone can choose an acceptable option for themselves.
- It is necessary to limit the intake of proteins with food, since their increased amount delays the absorption of calcium from the intestine.
- It is forbidden to drink alcohol, coffee, salty foods, carbonated drinks, marinades, canned food, sweets, fast food, mayonnaise, fatty foods.
- Enrich your diet with dairy products, fish and seafood, fresh vegetables, fruits, herbs, nuts, seeds, berries, eggs, cereals and cereals.
Calcium content in food
Compliance with such a diet allows not only to improve the bone tissue in osteoporosis, but also to prevent it. Therefore, this diet is suitable for all people aged 45-50 years, especially women.
In modern medicine, only those drugs that have proven effective in large-scale clinical trials are used to treat osteoporosis medically. All medicines can be divided into three groups:
- Drugs that have a multifaceted effect on the process of bone formation.
- Remedies that slow bone resorption.
- Drugs that stimulate the formation of bone mass.
The first group includes preparations of calcium and vitamin D, which are used for both treatment and prevention. Also included are flavonoids, which inhibit the resorption of bones and stimulate their formation, and the ossein-hydroxyapatite complex, which can be used even in pregnant women and nursing mothers.
Calcium and vitamin D intake rates, depending on age
The second group includes:
- Estrogens that can be used in women for hormone replacement therapy.
- Selective modulators of estrogen activity( tibolone).
- Calcitonin is a hormone that is synthesized by the thyroid gland and inhibits bone resorption.
- Bisphosphonates, which slow the resorption of bones.
- Strontium preparations.
The third group includes:
- Fluoride salts.
- Growth Hormone Growth Hormone.
It is important to understand that the treatment of osteoporosis is a complex task, the decision of which depends on the individual characteristics of the patient, as well as on the specific cause of the disease. As a rule, one calcium is not enough for a good effect, but you need to take the above medicines in strict combinations and dosages. Therefore, only a specialist should treat osteoporosis.
Basic preventive measures:
- Refusal from smoking, alcohol and coffee abuse.
- Regular physical activity, mandatory morning gymnastic exercises.
- Spend several hours a day in the open air for the production of vitamin D in the skin under the influence of ultraviolet radiation.
- Complete sleep.
- Monitor the amount of calcium that enters the body, if necessary, take mineral supplements and drugs prescribed by a doctor.
- Support for body mass index within normal values.
- Avoid taking medications that cause a decrease in bone mineral density.
- Complete nutrition.
- Regular screening of people at risk.
With adequate treatment and compliance with all preventive recommendations, the progression of osteoporosis can be slowed down and even stopped. Remember that, despite the minimal symptoms of the disease, its complications can lead to disability and even death. Therefore, regularly monitor your body's condition and seek medical help on time.
- Causes and risk factors
- Symptoms and consequences