Osteoporosis: what is it, symptoms, diagnosis and treatment

Two mutually inverse processes are constantly going on in the human bone tissue - its formation and destruction. This article describes osteoporosis - what it is and how to treat it, symptoms and diagnosis of the disease. This pathology appears when the degradation of the old bone tissue and the weakening of the mechanism of new bone formation increase. As a result, the human skeleton ceases to fulfill the function of support and frame, which ultimately leads to fractures.

Osteoporosis - what is it?

In essence, the disease is a metabolic disease of the skeleton, as a result of which the structure of bones at the micro level is disturbed, 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 greater the person’s age, the higher the risk of osteoporosis, which entails the occurrence of fractures with minimal trauma. This symptom is the main in the diagnosis of the disease. A patient with a severe degree of osteoporosis can get a fracture with one awkward movement or even with coughing and sneezing.

This problem is especially relevant in the elderly. One of the most formidable complications of osteoporosis is a hip fracture, 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 exacerbation of other diseases, the formation of pressure sores, the development of pneumonia. Fractures can also lead to disability and death. Therefore, every man over 50 years old and a woman whose age is approaching the postmenopausal period, you need to know what it is - osteoporosis, and how to treat this pathology.

Given that the formation of bone tissue is completed by 35-40 years, after which there is a gradual decrease in its density, the prevention of the disease must be started in advance. According to medical statistics, this disease is in 4th place among the causes of death.

Types of disease

There are 2 types of osteoporosis according to the etiology of its occurrence:

1. 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 (older than 45-50 years). Among men, this indicator is slightly lower - 80% of patients older than 50 years. This type also includes idiopathic osteoporosis in women and men under 50 and in children under 18, which is very rare.
2. Secondary - resulting from severe chronic diseases, taking certain medications, malnutrition.

Causes

The development of this disease depends on many factors:

• lifestyle and physical activity;
• genetic predisposition;
• the ratio and level of hormones in the body;
• the presence of other pathologies;
• taking medication;
• individual structural features.

Most women over 60 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 a deficiency of sex hormones is not the only reason. The development of osteoporosis in women is also affected by the state of phosphorus-calcium metabolism, a lack of vitamin D, calcitonin, and a malfunction of the thyroid gland.

The causes of secondary osteoporosis and risk factors are as follows:

• long-term treatment with glucocorticoids, in which a violation of bone formation is a side effect;
• endocrine diseases: diabetes mellitus, acromegaly, excessive or decreased production of thyroid hormones, hyperprolactinemia;
• gastrointestinal tract and hepatobiliary system pathologies: chronic hepatitis, cirrhosis, celiac disease, malabsorption, pancreatitis, inflammatory bowel disease; digestive surgery;
• genetic abnormalities: cystic fibrosis, hemophilia, metabolic disorders of collagen, copper and other substances, porphyria, thalassemia and some other diseases;
• malignant neoplasms, leukemia, lymphoma, sarcoidosis;
• kidney disease leading to renal failure, hypercalciuria;
• disorders in the diet: a prolonged lack of calcium and vitamin D in the diet, an excess of vitamin A, anorexia nervosa;
• neurological diseases: stroke, epilepsy, Parkinson's disease, spinal cord injuries;
• 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.

Medication

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;
• antitumor drugs, cytostatics;
• anticonvulsants;
• antidepressants;
• thyroid hormones;
• sedatives (derivatives of barbituric acid);
• glucocorticoids.

Women often have a mixed nature of the disease, a combination of hormonal medication and one of the serious diseases listed above. Therefore, it is difficult to determine the true cause of osteoporosis.

Symptoms

Before the onset of the first low-traumatic fracture, there are practically no clinical manifestations indicating the development of osteoporosis. What are the warning signs at an early stage:

• accelerated tooth decay process;
• bone pain (thigh, forearm, wrist, the area between the shoulder blades and other places), in the spine, which intensifies when in an uncomfortable position or when exerted;
• poor posture - the occurrence of stoop;
• frequent fatigue in the back;
• muscle cramps, which may indicate a lack of calcium;
• an increase in the distance between the back of the head and the wall when the back is pressed against it by more than 5 cm;
• signs of a compression fracture of the vertebra: a decrease in growth of more than 2 cm in the last 1-3 years or more than 4 cm, when compared with growth of 25 years; the appearance of "extra" folds of skin on the back and sides; disorders of stool and urination, heart pain, heartburn, heaviness when inhaling due to a sharp decrease in the volume of the chest cavity.

Vertebral fracture often occurs with minimal symptoms, so it may remain undetected for a long time. Back pain is also manifested in other diseases. The risk of developing a fracture increases when combined with one of the following additional factors:

• the first occurrence of pain in the patient in the postmenopausal period;
• injury, fall from a height or lifting of gravity;
• the presence of previous fractures;
• taking glucocorticoids.

The main symptoms of osteoporosis in women after 50 years are clearly shown in the figure below.

Diagnostics

A preliminary visual assessment of the patient's condition is performed to identify the signs of a compression fracture of the vertebra listed above. Laboratory diagnostics includes the following types of examinations:

1. KLA - the detection of anemia, elevated ESR may indicate the presence of oncology, rheumatism and other diseases.
2. 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 the secondary type of osteoporosis and to identify contraindications in the prescription of drugs.
3. OAM - urine analysis is also carried out to determine the root cause of the development of the disease and differential diagnosis.

Of the instrumental examination methods, the doctor can prescribe the following:

1. X-ray of the chest and lumbar region to detect compression fracture of the vertebra, which represents a decrease in height of more than 20% compared with other vertebrae;
2. Densitometry - measurement of bone tissue density by X-ray or ultrasound. In a standard examination, 3 areas are irradiated - the lumbar, the neck of the femur and the forearm (radius), where fractures most often occur.
3. As additional methods, multispiral computed tomography, MRI and bone scintigraphy are used. The last method is the study of tissues by introducing radioactive isotopes into the body.

Indications for diagnosis and treatment

Assessment of bone density (densitometry and other methods) is shown for the following categories of patients:

• older people whose age exceeds: for women - 65 years old, for men –70 years old;
• persons who have already suffered osteoporotic fractures;
• men and women under 70 and 65 years of age, respectively, who have identified at least one risk factor for fractures;
• patients whose pathology or medication is associated with a high risk of bone loss.

Treatment of osteoporosis in women after 50 years of age is necessarily carried out if there was a fracture with minimal trauma. This is considered a sufficient basis for the diagnosis of this disease, since approximately 20% of such 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 measures:

• elimination of the underlying disease that caused a decrease in bone density;
• taking drugs to build bone mass;
• the use of drugs to reduce pain.

From the second group, the following drugs are used to treat osteoporosis: bisphosphonates, agents containing calcium and vitamin D. In women and men over the age of 50 undergoing therapy with glucocorticoids, the simultaneous use of these agents is indicated. To prevent the development of osteoporosis and fractures, it is recommended that you follow a diet, moderate exercise and wearing supportive corsets.

Bisphosphonates

Medicines with vitamin D and calcium help increase bone density by increasing calcium intake. But bisphosphonates for the treatment of osteoporosis 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 them are those that contain sodium alendronate, or alendronic acid. Their advantage is that medicines should be taken only once a week, and new generation products - only once a month or even several months.

The table below shows the names of the bisphosphonate preparations for the treatment of osteoporosis.

Taking these medicines is considered safe even for a long period of time (up to 10 years). Therefore, they are rightly considered the best for osteoporosis. Bisphosphonates cross the placenta and adversely affect the bones of the fetus, so patients of reproductive age are advised to take contraceptives.

Bisphosphonates in osteoporosis: patient reviews

Reviews about taking bisphosphonates from patients are mostly good. The course reception shows an improvement in densitometric indicators during the control examination. Usually, the doctor prescribes the simultaneous administration of calcium-containing drugs.

Because of the side effects, patients often experience pain in the stomach due to irritation of its mucosa. Gastroprotective drugs (Omez, De-Nol and others) are used to reduce it.

Vitamin D and Calcium

In addition to bisphosphonate preparations, osteoporosis is also treated with preparations containing vitamin D (Aquadetrim, Vigantol), its activated forms (Alfacalcidol, Alfadol, Alpha D3-Teva, Etalfa), and also with calcium :

• calcium carbonate, citrate or lactate;
• "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 indicator is 1000-1200 mg / day. Vitamin D promotes better absorption of calcium in the intestines and saturation of bones with minerals.

Food

Simultaneously with the use of bisphosphonates for the treatment of osteoporosis, the names of which are listed above, it is recommended to adjust your diet in order to increase the number of products 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 preparations with fish oil in liquid form or in capsules. As for calcium, in domestic medicine there is a “golden rule”: the use of at least 3 dairy products per day significantly reduces the risk of developing this pathology. In one of the medical studies, it was shown that this recommendation in patients observed over 3 years led to an overall decrease in the number of fractures by 12%.

Hormone therapy in women

Hormone therapy is also used to prevent osteoporosis during menopause. Long-term use of estrogen can significantly reduce the risk of fractures of the vertebrae and femoral neck. In medical practice, the following hormonal drugs are used for osteoporosis and for its prevention:

1. “Raloxifene” (“Evista”) - reduces the probability of vertebral fracture in patients without previous fractures by 55% when taken within 3 years. For those women who have already had an osteoporotic fracture, the risk is reduced by 30%. This medicine is also effective for the prevention of breast cancer, however, side effects may include diseases of the circulatory system - thrombosis, pulmonary vein embolism and others.
2. Bazedoxifene (Conbrisa) - reduces bone loss in the spine and neck of the thigh. Reduces the risk of fractures by 42% when taken within 3 years. As in the previous case, thromboembolic complications are possible.

Hormone treatment in women after 60 with osteoporosis is not carried out. This is due to the fact that elderly patients significantly increase the risk of cardiovascular complications.

ethnoscience

Treatment of osteoporosis with folk remedies is carried out using the following recipes:

1. 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 strengthens the skeletal system. You can take the mummy in the form of tablets commercially available in pharmacies, but it is better to use it in bags. To do this, 5 g of the substance is dissolved in ½ tbsp. warm boiled water. The composition is taken in 1 tsp. half an hour before meals 2 times a day.
2. The shell of eggs 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, cleaned, removed, and the inner films removed and pulverized. Pour it with freshly squeezed lemon juice so that it completely covers the shell. Insist 1 day, then strain through cheesecloth and take juice 3 times, diluting 1 dessert spoon in boiled water. This recipe can not be used with increased acidity of the stomach or inflammation of its mucous membrane.
3. Herbal treatment: mix horsetail, wild rosemary and knotweed, taken in equal amounts. 200 g of raw material pour 1 liter of boiling water and simmer on fire for half an hour. You can add honey to the broth, and you need to drink it at ½ tbsp. 3 times a day before meals.

We hope this article will help you understand the problem and be healthy.