Osteoporosis is a bone disease in which their tissue becomes thinner, and in humans increases the tendency to frequent fractures.
The main cause of pathology is calcium deficiency in the body. Osteoporosis is most susceptible to women, especially during menopause. The disease is partly hormone-dependent nature, so the lack of estrogen and calcitonin may well lead to its development.
Most often, osteoporosis occurs in women over the age of 50 who have experienced the onset of menopause and are in menopause. It is they who are in the "risk group" who should be especially attentive to their health and take into account all the manifestations of the disease.
What it is?
Osteoporosis is a chronic systemic, metabolic bone disease that is accompanied by thinning of the bone tissue, and has a tendency to develop rapidly.
Also, the pathological process can manifest itself in the form of a syndrome - a condition that aggravates the course of other diseases. In this case, the destruction of the tissue is significantly ahead of the formation of "young", which is why the fragility of the bone increases. The consequence is an increased risk of fracture even with minor injuries.
Osteoporosis refers to the pathologies of the musculoskeletal system and connective tissue (ICD-10).
What happens to bone in osteoporosis?
Depending on the structure, the bones are divided into compact and spongy. For compact tissue characteristic is dense and uniform structure. It is formed from concentrically arranged plates. A compact substance covers the bone from the outside.
The thickest layer of compact substance is in the middle of the tubular structures, which include radial, femoral, peroneal, hip and other bones. Flat and short bones, as well as the heads of all bones without exception, have a thin layer of compact substance. Under its layer is a spongy bone substance.
This structure consists of bone plates, and has the appearance of a porous sponge (hence the name). These plates are placed at a certain angle to each other, and form small cells. The spongy substance of a healthy bone has a small porosity, the plates forming it have a pronounced, distinct structure. The plates are arranged depending on the direction in which the bone receives the highest load (for example, during active muscle contraction).
In osteoporosis, the bone loses most of its mineral components, as a result of which the plates become thinner, their number decreases, or else it disappears completely. As a result, the spongy substance is thinned, and the compact becomes thinner.
As a result of this process, not only mineral bone density is reduced, but also the structure of the tissue. The plates begin to line up randomly, without taking into account compression and stretching. Against this background, bone resistance to stress is significantly reduced.
According to the WHO, almost 35% of women and 20% of men have fractures that occurred on the background of osteoporosis. 75 million people in Europe, America, and Japan suffer from the disease. As of 2009, 3.8 million cases of osteoporotic fractures were recorded in Europe, moreover, 890 thousand patients were taken to the hospital with fractures of the femoral neck.
In Europe, patients die from osteoporotic fractures more often than from cancer. Women in the period of premenopause and menopause enter the hospital with fractures associated with osteoporosis, much more often than with myocardial infarction or diabetes. These figures will increase and, according to experts' forecasts, by 2050 in the countries of Europe there will be no longer 500 thousand, but 1 million patients with osteoporosis.
Why osteoporosis develops: causes
Most of all, women with hormonal disorders accompanying premenopause and menopause are susceptible to osteoporosis. But with a serious imbalance of hormones, the disease can develop even in a young girl.
In old age, the intake of calcium is reduced by the body, which explains the gradual thinning of bone tissue. In addition to hormonal fluctuations, serious errors in nutrition and bad habits, there are several reasons for the development of this disease. These include:
- Race. It is authentically known that representatives of the Negroid race are practically not prone to osteoporosis - it develops mainly in people belonging to the Caucasoid or Mongoloid race.
- Congenital or acquired pathologies accompanied by thinning of the skeletal bones.
- Age category. In people over 65, the body loses calcium almost completely, which explains not only the increased incidence of fractures, but also the impossibility of full-fledged bonding of the damaged bone.
- Genetic conditionality of osteoporosis. Not always, but periodically this disease is fixed in patients whose relatives had a similar problem.
- Belonging to the female. Women are subject to hormonal fluctuations more than men. Menstruation, pregnancy, premenopause, menopause - all these changes in the balance of biologically active substances in 87% of cases lead to the development of osteoporosis.
Among other things, other factors are also capable of becoming an provocateur of this disease, or a catalyst for its progression:
- disorders of the digestive tract;
- pancreatic dysfunction;
- failure of ovarian activity or surgery to remove them;
- menopause period;
- low content in the diet of products enriched with calciferol (vitamin D) and calcium;
- long-term hormone therapy;
- bad habits;
- prolonged use of anticonvulsants;
- diseases of any endocrine gland;
- disorder in the adrenal glands.
A special place in this list should take parathyroid diseases. They are responsible for producing such an important hormone as calcitonin. Due to certain pathological lesions of this organ, the secretion of a substance decreases, resulting in poor calcium absorbability by the cells of the body and the development of osteoporosis.
Symptoms of osteoporosis in women
The disease can be completely asymptomatic over a long period of time. But over time, patients may notice the appearance of some unpleasant symptoms. First of all, there is pain in the spine at the level of the thoracic and lumbar spine. In young people suffering from osteoporosis, growth slows down, gait changes, spinal mobility is impaired.
The most common symptom of osteoporosis in women is fractures. First of all, radial and bone and vertebral bodies are affected. Fractures of the femoral neck, which in 50% of cases are the cause of death, are considered to be extremely dangerous. He comes in the first half after injury. In 45% of cases, severe disability of patients occurs.
In addition, some people with this diagnosis show early gray hair and tachycardia. These are extremely rare, but possible symptoms of osteoporosis.
There are a number of clinical signs that can be suspected of the disease. During its development, patients may complain of:
- constant or frequently occurring severity in the interscapular region;
- increased bone fracture rates;
- strong muscle weakness;
- growth inhibition.
Stages of development
The gradation of osteoporosis depends on how severe the destruction of the bone is. According to this criterion, the disease is divided into 3 degrees of severity:
- The first. The initial stage of the disease is completely asymptomatic, so it is detected completely by accident - during the passage of prophylactic examinations. During this period, a decrease in the density of bone tissue is noted on the X-ray photograph, and the striation of the silhouette of the spine in combination with the transparency of the X-ray shadow is recorded.
- The second. At this time, the patient begins to complain of severe pain in the muscles, joints, bones. The bone tissue continues to thin, and the x-ray image shows the biconcave shape of the vertebrae with the concomitant acquisition of several of them with a wedge-shaped form.
- Third. At the last stage of development, osteoporosis is already noticeable, even without instrumental diagnostics. X-ray examination revealed full transparency of the vertebrae.
Usually, patients go to the doctor when the disease is in an advanced stage. In this case, even after completing the full course of treatment and rehabilitation, it is not possible to restore the absolute functioning of the bones. Although timely initiated therapy helps prevent the dangerous effects of osteoporosis.
Due to the complete absence of symptoms in case of loss of 20–30% of bone mass, people over 40 years old are recommended to periodically be examined by a rheumatologist and take x-rays. Another diagnostic method that helps identify pathology at an early stage of its development is densitometry, the determination of bone mineral density.
Treatment of osteoporosis in women after 50 years depends on its nature. With the secondary origin of the disease, it is important to begin to eliminate its root cause — cardiovascular or immune pathologies, disturbances in the functioning of the gastrointestinal tract, etc.
Primary osteoporosis is associated mainly with the biological aging of the body and a decrease in the levels of certain hormones. Menopausal women are most affected. To prevent the development of pathology, it is necessary to minimize the rate of leaching of calcium from the bones and increase its accumulation. But you can begin therapy only after a detailed study of the patient's hormonal profile.
Therapy for osteoporosis should be comprehensive, and be based on:
- Pharmacotherapy. It includes the use of drugs, the action of which is aimed at the normalization of metabolic processes in the bones. Such treatment is long, continuous and carried out in stages.
- HRT (hormone replacement therapy).
- Symptomatic treatment.
In case of ostoryoporotic lesion of the knee or hip joint, the only way out is surgery. With the ineffectiveness of pharmacotherapy, the patient is replaced with the artificial joint by the artificial prosthesis. This approach helps to improve the patient's quality of life, as well as significantly extend it, since it prevents spontaneous fracture of the femoral neck.
The main treatment regimen
For the treatment of osteoporosis prescribed drugs that regulate calcium-phosphorus metabolism. They slow down the parathyroid glands by inhibiting the activity of hormones they produce. The following medications are used for this purpose:
- Calcitonins. They regulate the production of the hormone calcitonin, which is responsible for the formation and maintenance of bone strength. A frequently prescribed drug is Miacalcic, based on salmon calcitonin. Osteover, Alostin and Veprén also belong to this group of drugs.
- Bisphosphonates. These remedies prevent bone loss, as well as contribute to its recruitment in developing osteoporosis. This category of medications includes Risedronat, Bonefos, Sindronat, Aredia, Pamir devin, Pamifos, etc.
- Osteogenone. It is a combination drug that prevents the production of osteoclasts and activates the work of osteoblasts.
- Fluorine derivatives. Such funds contribute to the formation of bone tissue. These are: Fluocalcic, Kaltsyk, Osin, etc.
- Forsteo. This is a drug made on the basis of the parathyroid hormone teriparatide. It is used in the form of injections.
Any medication used to treat osteoporosis can be prescribed exclusively by a doctor. Throughout the entire therapeutic course, it is important to monitor blood counts, which will help, if necessary, adjust the treatment regimen.
To prevent further development of the disease will help calcium supplements. They work much more efficiently than the "calcium" diet and any folk remedies. To cope with osteoporosis or prevent its development, doctors prescribe:
- Multivitamin complexes - Elevit, Calcemin, Complivit, Nutrimaks, etc. Such agents are more suitable for the prevention of osteoporosis than for its treatment, because they contain many different components. They often cause inhibition of calcium absorption into the blood.
- Monocomponent calcium preparations containing it in the form of salts. Calcium glycerophosphate, Lactate or Calcium Chloride, and similar agents have good efficacy.
- Calcium preparations in combination with vitamin D3 (calciferol): Calcium D3 Nicomed (or Calcium D3 Nicomed Forte), Calcium, Vitamin D3 plus Vitrum calcium.
You can not take drugs without a prescription. If you overdo it with a dose or exceed the allowable duration of therapy, you can provoke the development of hypercalcemia. This is a condition in which the calcium level significantly exceeds the permissible norms. Such a deviation is fraught with deposition of the substance in the bones, followed by damage to the kidneys, joints, and heart.
For the symptomatic treatment of osteoporosis prescribe:
- analgesics and muscle relaxants to help eliminate muscle aches and cramps;
- nonsteroidal anti-inflammatory drugs that alleviate the patient's condition for arthritis;
- surgery for fractures;
- physiotherapy, exercise therapy;
- diet therapy with the use of products enriched with calcium, magnesium and phosphorus;
- elimination of carbonated drinks.
Hormone replacement therapy
HRT in osteotoporosis is appointed quite often. It helps not only in the treatment, but also in the prevention of this disease. Women in the period of premenopause or menopause are prescribed funds belonging to the group of estrogen receptor modulators. These include drugs such as Raloxifene, Keoxifen, Evista, and others. Taking these drugs helps to stop or significantly slow down the process of bone destruction.
Often prescribed and preparations based on synthetic or herbal estrogen. It may be medicines Femoston or Kliogest, which is advisable to take along with calcium supplements. However, it is important to bear in mind that a certain risk of developing cancer is associated with these drugs. They affect, above all, the organs of the reproductive system of women.
Acceptance of hormonal drugs for osteoporosis should be long. Usually, the treatment is stretched for a long 5 years, during which, periodically, research is necessarily conducted on the hormonal profile. After the time allotted for the therapy has expired, the prescribed medications are canceled. This is done gradually, in stages.
Estrogens in osteoporosis are not prescribed to women who have a predisposition to cancer or thrombosis. In addition, HRT is an auxiliary, rather than a separate method of treatment, because the drugs used in this case do not contribute to the replenishment of calcium in the body.
A modern method of treating osteoporosis
A new approach in the treatment of osteoporosis is based on:
- accurate determination of affected areas of bone;
- cleansing bone lacunae using the shock-wave method;
- administering animal tissue extract and ionized calcium under the periosteum;
- conducting a standard course of therapy.
Scientists at Auckland University, located in New Zealand, have been researching a new drug for several years. He promises to be a real breakthrough in the treatment of osteoporosis. This tool is called Zometa, and is produced by the Swiss company Novartis AJ. The drug is based on the content of zoledronic acid.
The drug is administered 1 time per year, with no other medication is not necessary. In the course of numerous experiments, it was revealed that such therapy stops the process of bone tissue decay for exactly one year. During this time, the bone has time to significantly strengthen. To date, research continues, since experts say that Zometa helps to completely prevent bone fractures, experts can not yet.
Diet and nutritional rules
In osteoporosis, the nutrition of the patient is of paramount importance. It should be based on:
- The use of foods containing high concentrations of calcium and vitamin D3. For women in the postmenopausal period and men over 50 years of age, the daily rate of this macrocell is 1200 - 1500 mg. Doctors approach the prescription of drugs with vitamin D to elderly patients with extreme caution, since their use increases the risk of developing atherosclerotic disease.
- Minimization or complete abandonment of alcohol and tobacco, as well as salty food. Such products of industry and cooking excrete calcium in elevated rates and quantities.
- The use of fermented milk food. However, vegans claim that it only accelerates the development of osteoporosis. Their point of view, these people justify the fact that animal fats lead to acidosis - acidification of bones. And this, in turn, leads to the forced removal of calcium from the bones in order to neutralize this process.
- A careful ratio of the proportions of fat and calcium. It is 1:10, where 1 g is the amount of fat, and 10 g is the dose of calcium. Displacement of these indicators in any direction can lead to impaired calcium absorption.
- The inclusion in the diet of products containing magnesium, potassium and phosphorus. They promote better absorption of calcium by the body.
Equally important for the state of the bones play and substances such as silicon, boron, zinc, manganese, copper, ascorbic acid and vitamin K. Therefore, patients with osteoporosis or prone to its development need to use as many products containing these elements in their composition.
Physiotherapy for osteoporosis
Patients with osteoporosis are encouraged to conduct sports. A special place is given to walking, which, creating a moderate load on the bones, contributes to their strengthening. Swimming lessons are not appropriate because the body is in a state of weightlessness during them. Therefore, the bones do not receive the required load.
There is a set of exercises that doctors recommend performing systematically. Here is one of them.
Stand on your knees, straighten your arms, lean on them and maximally draw your stomach. The back should remain straight. Raise your right hand and look at her hand. Stay in this position for a few seconds, then repeat the same thing, but in the other direction. Breathing should be smooth and deep. Repeat the exercise in both directions several times.
After the end of the training, you need to lower the pelvis on the feet, straighten the arm and lower the head down. The body should be completely relaxed, breathing even. Such classes should be carried out 2-3 times a week. They need to be combined with diet and regular walking. She, in turn, need to do at least half an hour.
Prognosis and prevention
The prognosis depends on the nature of the disease and the cause of its development. Prevention of osteoporosis must be practiced from a young age and continue throughout life. Particular attention to the calcium content in the body should be paid to parents whose children are in puberty, as well as women in the postmenopausal period.
It is important to eat foods enriched with calcium and phosphorus every day, as well as to maintain full physical activity. Coffee, alcohol and nicotine should be minimized. Older people need to timely identify risk factors for osteoporosis. Calciferol-based drugs or calcium supplements may be prescribed to prevent the disease in this category of patients. If necessary, auxiliary hormone therapy.
Women in the premenopausal period or late menopausal period are encouraged to use products richly enriched with calcium. Without exception, all patients over 50 need to undergo annual preventive studies to determine the state of the bone tissue and assess the risk of osteoporosis.