In human bone tissue, two mutually inverse processes are constantly going on - its formation and destruction. This article describes osteoporosis - what it is and how to treat, symptoms and diagnosis of the disease. This pathology appears when the degradation of old bone tissue and the weakening of the mechanism of new bone formation increase. As a result, the human skeleton ceases to function as a support and frame, which ultimately leads to fractures.
Osteoporosis - what is it?
At its essence, the disease is a metabolic disease of the skeleton, as a result of which the structure of bones is disturbed at the micro level, their density decreases. It is detected in more than a third of women over the age of 50 in Russia. Among men, this disease is less common - 27% of the population. The older the person, the higher the risk of osteoporosis, which entails the occurrence of fractures with minimal trauma. This symptom is the main one in the diagnosis of the disease. A patient with severe osteoporosis may receivefracture with one awkward movement or even with coughing and sneezing.
This problem is especially relevant for the elderly. One of the most formidable complications of osteoporosis is a fracture of the femoral neck, as a result of which the patient is forced to stay in bed for a long time. Movement is life, and forced bed rest for long weeks when the fracture heals leads to an exacerbation of other diseases, the formation of bedsores, and the development of pneumonia. Fractures can also lead to disability and death. Therefore, every man over 50 years of age and a woman whose age is approaching the postmenopausal period needs to know what osteoporosis is and how to treat this pathology.
Given that the formation of bone tissue is completed by the age of 35-40, after which there is a gradual decrease in its density, the prevention of the disease must begin in advance. According to medical statistics, this disease is in 4th place among the causes of death of people.
Types of diseases
There are 2 types of osteoporosis according to the etiology of its occurrence:
- Primary - a decrease in bone density develops as an independent disease. This type of pathology occurs in 95% of sick women in the postmenopausal period (over 45-50 years old). Among men, this figure is slightly lower - 80% of patients over 50 years old. This type also includes idiopathic osteoporosis in women and men under 50 and in children under 18, which is very rare.
- Secondary - resulting from severe chronic diseases, taking somedrugs, malnutrition.
Reasons
The development of this disease depends on many factors:
- lifestyle and physical activity;
- genetic predisposition;
- ratio and level of hormones in the body;
- presence of other pathologies;
- medication;
- individual structural features.
Most women over 60 years of age notice signs of osteoporosis, which is associated with a decrease in the synthesis of sex hormones during this period of life. Due to the lack of estrogens, the balance that existed before is shifted towards the destruction of bone mass. But the lack of sex hormones is not the only reason. The development of osteoporosis in women is also affected by the state of phosphorus-calcium metabolism, lack of vitamin D, calcitonin, and disruption of the thyroid gland.
The causes and risk factors for secondary osteoporosis are as follows:
- long-term treatment with glucocorticoids, in which impaired bone formation is a side effect;
- endocrine diseases: diabetes mellitus, acromegaly, excessive or reduced production of thyroid hormones, hyperprolactinemia;
- pathologies of the gastrointestinal tract and hepatobiliary system: chronic hepatitis, cirrhosis, celiac disease, malabsorption, pancreatitis, inflammatory bowel disease; surgical interventions on the digestive organs;
- genetic abnormalities: cystic fibrosis, hemophilia, impaired metabolism of collagen, copper and otherssubstances, porphyria, thalassemia and some other diseases;
- cancer, leukemia, lymphoma, sarcoidosis;
- kidney disease leading to kidney failure, hypercalciuria;
- dietary disturbances: prolonged lack of calcium and vitamin D in the diet, excess vitamin A, anorexia nervosa;
- neurological diseases: stroke, epilepsy, Parkinson's disease, spinal cord injury;
- autoimmune pathologies: rheumatoid arthritis, systemic lupus erythematosus;
- other conditions and factors: AIDS, alcoholism, muscle atrophy due to a sedentary lifestyle, smoking, parenteral nutrition in seriously ill patients.
Medications
The following drugs can lead to the development of osteoporosis:
- antacids containing aluminum, proton pump inhibitors used in the treatment of the gastrointestinal tract;
- anticoagulants that prevent thrombosis in cardiovascular diseases;
- antineoplastic drugs, cytostatics;
- anticonvulsants;
- antidepressants;
- thyroid hormones;
- sedatives (barbituric acid derivatives);
- glucocorticoids.
Women often have a mixed disease, a combination of hormonal medications and one of the severe diseases listed above. Therefore, it is difficult to determine the true cause of osteoporosis.
Symptoms
Before the first low-traumatic fracture, there are practically no clinicalmanifestations indicating the development of osteoporosis. What are early warning signs:
- accelerated process of tooth decay;
- bone pain (thigh, forearm, wrist, area between the shoulder blades and other places), in the spine, which increases when in an uncomfortable position or under load;
- deterioration of posture - occurrence of stoop;
- frequent back fatigue;
- muscle cramps, which may indicate a lack of calcium;
- increasing the distance between the back of the head and the wall when pressed against it by more than 5 cm;
- signs of a compression fracture of a vertebra: decrease in height by more than 2 cm in the last 1-3 years, or more than 4 cm when compared with growth at 25 years; the appearance of "extra" skin folds on the back and sides; stool and urination disorders, heart pain, heartburn, heaviness when inhaling due to a sharp decrease in the volume of the chest cavity.
Fracture of the vertebrae often occurs with minimal symptoms, so it can go undiagnosed for a long time. Back pain also manifests itself in other diseases. The risk of fracture increases when combined with one of the following additional factors:
- first occurrence of pain in a postmenopausal patient;
- injury, fall from height or heavy lifting;
- presence of previous fractures;
- taking glucocorticoids.
The main symptoms of osteoporosis in women over 50 are clearly shown in the figure below.
Diagnosis
Preliminary visual assessment of the patient's condition is performed to identify signs of a vertebral compression fracture listed above. Laboratory diagnostics includes the following types of examinations:
- OAK - detection of anemia, elevated ESR may indicate the presence of oncology, rheumatism and other diseases.
- Biochemical blood test - determination of the level of calcium, alkaline phosphatase, phosphorus, magnesium, creatinine and other indicators. This type of study is used to exclude a secondary type of osteoporosis and to identify contraindications when prescribing drugs.
- Urine analysis is also performed to determine the root cause of the development of the disease and differential diagnosis.
From the instrumental methods of examination, the doctor may prescribe the following:
- X-ray of the chest and lumbar to detect a compression fracture of a vertebra, which is a decrease in height of more than 20% compared to other vertebrae;
- Densitometry is the measurement of bone tissue density by X-ray or ultrasound. In a standard examination, 3 areas are irradiated - the lumbar, femoral neck and forearm (radius), where fractures most often occur.
- As additional methods, multislice computed tomography, MRI and skeletal scintigraphy are used. The last method isstudy of tissues by introducing radioactive isotopes into the body.
Indications for diagnosis and treatment
Evaluation of bone density (densitometry and other methods) is indicated for the following categories of patients:
- older people over: 65 for women, 70 for men;
- persons who have already suffered osteoporotic fractures;
- men and women under 70 and 65 respectively who have at least one risk factor for fractures;
- patients with pathologies or medications associated with a high risk of bone loss.
Treatment of osteoporosis in women after 50 years of age is mandatory if there was a fracture with minimal trauma. This is considered sufficient evidence for the diagnosis of this disease, as approximately 20% of these patients experience a second fracture within the next year. However, a full examination in this case is still carried out to exclude other diseases of the skeletal system.
Treatment
Therapy for osteoporosis includes several activities:
- elimination of the underlying disease that caused the decrease in bone density;
- taking bone-building drugs;
- use of drugs to reduce pain.
From the second group, the following drugs are used to treat osteoporosis: bisphosphonates, products containing calcium and vitamin D. In women and menover the age of 50, undergoing therapy with glucocorticoids, the simultaneous use of these drugs is indicated. Diet, moderate exercise, and supportive braces are recommended to prevent osteoporosis and fractures.
Bisphosphonates
Vitamin D and Calcium Medicines promote bone density by increasing calcium intake in the body. Bisphosphonates for osteoporosis, however, have a different effect. They block the function of osteoclasts - cells that dissolve mineral components and are responsible for the destruction of old bone tissue. The most studied of these are those containing alendronate sodium, or alendronic acid. Their advantage is that the drugs need to be taken only once a week, and the new generation means only once a month or even several months.
The table below lists the names of bisphosphonate drugs for the treatment of osteoporosis.
Name, release form |
Active ingredient |
Average price |
| Fosamax tablets | Alendronic acid | 460 |
| Foroza tablets | 550 | |
| Fosavans, tablets | Alendronic acid, cholecalciferol (vitamin D3) | 550 |
| Zometa, concentrate for cookingIV solution | Zoledronic acid | 10 500 |
| "Aklasta", a concentrate for the preparation of a solution for intravenous administration | 17,000 | |
| Bonviva pills | Ibandronic acid | 900 |
These medicines are considered safe even over long periods of time (up to 10 years). Therefore, they are rightfully considered the best for osteoporosis. Bisphosphonates cross the placenta and affect the bones of the fetus, so patients of reproductive age are advised to take contraceptives.
Bisphosphonates for osteoporosis: patient feedback
Reviews from patients about taking bisphosphonates are mostly good. Course reception shows an improvement in densitometric parameters during the control examination. Usually, the doctor prescribes the simultaneous administration of calcium-containing drugs.
Of the side effects, patients often experience pain in the stomach due to irritation of its mucosa. To reduce it, gastroprotective drugs are used ("Omez", "De-Nol" and others).
Vitamin D and calcium
In addition to bisphosphonates for the treatment of osteoporosis, drugs containing vitamin D (Aquadetrim, Vigantol), its activated forms (Alfacalcidol, Alfadol, Alpha D3-Teva, Etalfa) are used and also with calcium:
- carbonate, citrate or lactatecalcium;
- Calcium Sandoz Forte;
- "Vitacalcin";
- "Calcium D3 Classic"
- "Complivit Calcium D3 forte" and others.
The need for vitamin D in people over the age of 50 is 800-1000 IU / day, and for calcium this figure is 1000-1200 mg / day. Vitamin D promotes better absorption of calcium in the intestines and saturation of bones with minerals.
Food
At the same time as using the bisphosphonates for osteoporosis listed above, it is recommended to adjust your diet to increase the amount of foods containing the most important substances:
- vitamin D: salmon, herring, catfish, canned sardines, mackerel, tuna, milk, sour cream, cheese, beef liver, cheese, eggs;
- calcium: cheese, cottage cheese, milk, kefir, acidophilus, cream, yogurt and other dairy products.
Eating fish can be replaced with fish oil preparations in liquid form or in capsules. As for calcium, there is a “golden rule” in domestic medicine: eating at least 3 dairy products a day significantly reduces the risk of developing this pathology. One medical study showed that this recommendation in patients followed up for 3 years resulted in an overall reduction in fractures by 12%.
Hormone therapy for women
Hormone therapy is also used to prevent osteoporosis during menopause. Long-term use of estrogens can significantlyreduce the risk of vertebral and hip fractures. In medical practice, the following hormonal drugs are used for osteoporosis and for its prevention:
- "Raloxifene" ("Evista") - reduces the likelihood of vertebral fracture in patients without previous fractures by 55% when taken for 3 years. Women with a history of osteoporotic fracture have a 30% reduced risk. This medicine is also effective for the prevention of breast cancer, however, side effects may include diseases of the circulatory system - thrombosis, pulmonary embolism, and others.
- "Bazedoxifen" ("Konbriza") - reduces bone loss in the spine and femoral neck. Reduces the risk of fractures by 42% when taken for 3 years. As in the previous case, thromboembolic complications are possible.
Hormonal treatment in women over 60 with osteoporosis is not carried out. This is due to the fact that the risk of cardiovascular complications increases significantly in older patients.
Traditional medicine
Treatment of osteoporosis with folk remedies is carried out using the following recipes:
- Mummy. This substance of natural origin contains in its composition more than 80 minerals and trace elements necessary for the body, in an easily digestible form. It improves tissue regeneration and helps strengthen the skeletal system. You can take the mummy in the form of tablets available in pharmacies, but it is better to use it in sachets. To do this, 5 g of the substance is dissolved in ½ tbsp. warm boiled water. Composition accept1 tsp half an hour before meals 2 times a day.
- Chicken eggshell is rich in trace elements (phosphorus, sulfur, copper and others), as well as calcium, which is well absorbed by the human body. To prepare a therapeutic agent, boiled eggs must be thoroughly washed in advance, cleaned, the inner films removed and crushed into powder. Pour it with freshly squeezed lemon juice so that it completely covers the shell. Infuse for 1 day, then strain through gauze and take the juice 3 times, diluting 1 dessert spoon in boiled water. This recipe should not be used if the stomach is acidic or inflamed.
- Herbal treatment: horsetail, wild rosemary and knotweed, taken in equal amounts, mixed. 200 g of raw materials pour 1 liter of boiling water and simmer on fire for half an hour. Honey can be added to the broth, and you need to drink it in ½ tbsp. before meals 3 times a day.
We hope this article will help you understand the problem and be he althy.
