Symptoms, causes and treatment of osteoporosis
The incidence of osteoporosis around the world and in Russia in particular is quite high. According to modern medicine to 34% of women and 27% of men aged 50 years or older have any signs of osteoporosis. Next we shall consider what the pathology is and how to stop its negative impact on the musculoskeletal system.
General information about pathology
Osteoporosis has the following characteristics:
- has a systemic nature;
- is accompanied by a reduction in the density of bone, its mineralization.
- is accompanied by a change in the structure of the bone;
- usually asymptomatic (or with a few symptoms, while the signs of disease are non-specific)
- signs of osteoporosis often cannot be identified by appearance of the person;
- most often the first signs of osteoporosis are available its complications – pathological fractures.
Here is the healthy bone:
And here is the bone tissue of the patient with osteoporosis:
Given the above features of the disease, should remember:
- Be cautious in relation to osteoporosis should people after age 40 or with risk factors for the development of secondary forms (see etiological factors).
- After 40 years of mandatory annual health examinations at the GP and risk assessment of the development of this pathology, with the necessary diagnostic low (densitometry and laboratory diagnosis) is performed according to testimony.
- In the presence of risk factors of "early" osteoporosis clinical examination should be carried out regardless of age.
Next, we consider the main risk factors of osteoporosis in older people, the influence of which is well studied in medicine. Among them are those that we can influence a person if he wants to, and those that influence is impossible.
It is Possible to reduce the influence of the following risk factors:
- drinking alcohol
- sedentary lifestyle and prolonged immobilization;
- nutritional factors (insufficient intake of dietary calcium, vitamin D deficiency).
And here the factors shown below, unfortunately, can not be influenced:
- age (especially after age 65)
- race (European or Mongoloid);
- prone to falls.
- low IPC (individual characteristics);
- often low weight (BMI less than 18 to 20).
Causes of loss of bone mass
Osteoporosis can act as an independent disease (after age 40, more common in women, primary), and may be a syndrome developing in the presence of some pathologies, regardless of age (also called secondary). In the classification (ICD 10) code has osteoporosis with M80 on М82 (fracture, no fracture and other pathologies).
The Main pathology, which is a cause of osteoporosis (secondary form) that are listed in the table below.
|Postmenopausal osteoporosis (type I)||Endogenous hypercortisolism (disease or syndrome Itsenko-Kushinga). Hypogonadism. Hyperparathyroidism||Rheumatoid arthritis. Systemic lupus erythematosus. Ankylosing spondylitis|
|Senile osteoporosis (type II)||Thyrotoxicosis. Diabetes mellitus (insulin dependent). Hypopituitarism, endocrine insufficiency polyglandular||Status after gastric resection. Malabsorption. Chronic liver disease|
|Juvenile osteoporosis||multiple Myeloma. Thalassemia. Systemic mastocytosis. Leukaemia and lymphoma||Chronic renal failure. Renal tubular acidosis. Fanconi syndrome|
|Idiopathic osteoporosis||Immobilization. Oophorectomy. Chronic obstructive pulmonary disease. Alcoholism. Anorexia nervosa. Eating disorders. Organ transplantation||osteogenesis imperfecta. Marfan Syndrome. Ehlers-Danlos syndrome (an imperfect desmoines). Homocystinuria and lysinuria|
|Corticosteroids. Anticonvulsants. Immunosuppressants. Agonists gonadotropin-releasing hormone. Antacids containing aluminum. Thyroid hormones|
The Main causes primary forms of the disease are shown in the table below.
|Name-type of osteoporosis||Main reasons|
|First type||the Loss of bone mass as a result of deficiency of sex hormones (inparticularly estrogen), increased activity of osteoclasts and bone resorption|
|Second type||Age-related impaired function of osteoblasts, increase the function of the parathyroid glands, a decrease in the rate of synthesis D3|
|Idiopathic in adults||Causes and mechanisms quite unknown|
Symptoms of disease
Next, consider how to manifest degenerative disc disease. Again we emphasize that in the classical manifestation, he has no symptoms, the first complaint of the person arise in the development of complications. What are these complications?
Typically, this pathological fractures with symptoms:
- the pain, the presence of hematoma and edema, limb deformities (if fracture of long bones).
- the Appearance of neurological symptoms (compression syndrome: paresis, impaired physiological functions, pain acute or chronic), loss of height, deformity of the spine (hump) at fracture of the vertebrae.
These Pathological fractures referred to as because the minimal influence of physical factors (small drop, small rise of gravity, strong kick) can cause the violation of the integrity of the bone. The power of this impact under normal conditions (healthy person) such effects will not cause. The most favourite localization of fractures:
- Upper third of the thigh – femoral neck.
- Vertebrae. According to neurologists, compression fractures of the spine in the structure of the back pain is about 4% of all pain. Not so rare, isn't it? The most frequent localization – the 12th thoracic and 1st lumbar vertebrae.
- Distal end of forearm – fracture of COLLES (radial bone).
- Upper third of the humerus.
Other localization of fractures (e.g. rib), the authors associate to a greater extent with the development of secondary forms.
Typically, osteoporosis contribute:
- Annual medical examinations after age 40 the doctor-the therapist with assessment of risk factors.
- clinical Examination of patients with comorbidities (see above), or receiving drugs from the group of "provoking".
- the Occurrence of fractures, typical for this disease.
- examination of the patient with back pain, if you have symptoms of shortening of the vertebral column.
- evaluation of the FRAX index (frax).
To what doctor to address for the initial diagnosis of the disease? In the first place this disease can be diagnosed by the physician, after diagnosis, the patient may remain under his observation or be transferred to the rheumatologist. In practice, with pathology often encountered by neurologists, chiropractors and osteopaths, because of the specific localization compression fractures.
The First signs of osteoporosis are detected only when using methods of laboratory and instrumental diagnostics.
The Main methods for diagnostics of osteoporosis are:
- Densitometry (ultrasound (US) and x-ray (dual-energy absorptiometry a)), the bone density can also be determined using quantitative CT method.
- Laboratory methods:
- Aimed at clarifying the metabolism of phosphorus and calcium (parathyroid hormone, ionized or total calcium and phosphorus plasma, the daily loss of calcium and phosphorus urine levels of vitamin D and its metabolites).
- Definition of indicators of bone metabolism.
Medicinal and adjuvant therapy
Next, consider whether osteoporosis is treated and when the doctor, the decision about the treatment of this pathology? Treatment in the following cases:
- When performing densitometry in the adult patient revealed a decrease in T-scores or Z-scores (children, young people).
- When the patient has a fracture, which is typical for this disease. Or the occurrence of the fracture in another place, but with minimal impact force or spontaneously.
- evaluation of the FRAX index confirms the high probability of pathological fracture in the next 10 years.
Effective treatment of osteoporosis involves a combination of drug and adjuvant therapy. Drugs the following apply:
- Bisphosphonates – inhibit bone resorption by inactivating osteoclasts, allow to stop the further progression of the disease.
- HRT-estrogen, which is the principle of action is the inhibition of bone resorption, as well as the drugs group SMER.
- Denosumab based on monoclonal antibodies – mechanism of action consists in reducing the functions of bone decayfabric.
- Teriparatide – acceleration of bone formation.
- Strontium ranelate is the mechanism of action includes effects on both stages: resorption and bone formation.
In addition to one appointed by the doctor of medicines are added to adequate doses of calcium (1000-1500 mg per day including food) and vitamin D (800-2000 IU / day). Treatment of osteoporosis is long-term, take drugs, generally requires 3-5 years mandatory medical supervision every 1-3 months for the well-being of the patient. The table below shows the main drugs for therapy of the disease, and also their dosage and ways of use.
Patients often wonder whether it is possible to cure osteoporosis? Let's try to answer this question. On the background of the therapy the attending physician determines its effectiveness, and the assessment is made on the basis of laboratory and instrumental examination.
The Criteria for the effectiveness of the treatment of the following:
- the Definition of markers of bone metabolism at 3 months shows an increase (in the case of therapy with teriparatide) or decrease in the case of therapy of antiresorptive drugs.
- Densitometry (axial only) in a year (or a year) shows the preservation of the IPC at the same level or increase. Axial densitometry is a method of determining the measure BMD in the femoral neck or the lumbar vertebrae (L1-L4). Peripheral densitometry has not been used for evaluation of treatment effectiveness.
- a Decrease in MPK requires specialist work with the patient (refuse treatment) or revision drugs.
On the other hand, in patients with pain in osteoporosis (and hence the violation of the integrity of bone tissue), as well as other symptoms associated with the development of complications, despite ongoing therapy and its efficiency, the complaints may persist for a long time. In fact, the likelihood of relief of pain in the back due to a compression fracture, even while maintaining the density of bone tissue without a further reduction is minimal.
This osteoporosis threat, it is easier to prevent than to deal with the consequences.
Prevention and consequences of the disease
Additional activities in osteoporosis of any degree of severity are:
- Food with high content of calcium, phosphorus and magnesium, sufficient intake of vitamin D.
- Maintain an active lifestyle, frequent walking and physical activity by age and comorbidity.
- avoiding alcohol and Smoking.
- Intake of calcium and vitamin D.
- Waiver of kodeinsoderjaschie products and coffee (coke).
- Wearing special protectors and corsets.
- Prevention of falls, disorders of coordination need to be assisted by another person (family member, medical staff).
The possible consequences of this disease include:
- persistent pain;
- impaired function of the extremities
- violation of pelvic functions, paresis of extremities, sensory disturbance
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- Clinical practice guidelines. Osteoporosis. Diagnosis, prevention and treatment / edited by O. M. Lesnyak, L. I., Benevolenska. – M.: GEOTAR-Media, 2009. – 272.
- Osteoporosis. Riggs B. L., Melton III L. J. TRANS. Angl. M. – SPb.: JSC "Publishing BINOM", "Nevsky dialect", 2000. – 560 p.
- Osteoporosis. Rational pharmacotherapy of rheumatic diseases / edited by V. A. Nasonova, E. L. Nasonova, 2003. – S. 246.
- Osteoporosis: diagnosis and treatment. S. O. Mazurenko.