Osteoporosis of bones - Causes, symptoms and treatment. MF.
Osteoporosis is a progressive systemic disease in which the human skeleton is affected, the density decreases and the structure of bone tissue is disturbed.
Disturbance of bone structure in osteoporosis
In osteoporosis, a complex bone structure is broken, the bone becomes loose and prone to fractures, even with minor stresses.
- Post-menopausal osteoporosis - osteoporosis, associated with a decline in the production of female sex hormones.
- Osteoporosis is an osteoporosis associated with general aging and deterioration of the body, a decrease in the mass and strength of the skeleton after 65 years.
- Corticosteroid osteoporosis - occurs with prolonged use of hormones( glucocorticoids).
- Secondary osteoporosis - occurs as a complication in diabetes mellitus, oncological diseases, chronic renal insufficiency, lung diseases, hyperthyroidism, hypothyroidism, hyperparathyroidism, calcium deficiency, rheumatoid arthritis, Bechterew's disease, chronic hepatitis, Crohn's disease, long-term intake of aluminum preparations.
Causes of Osteoporosis
In the development of osteoporosis, an imbalance in the remodeling of bone tissue plays a role. In the process of constant renewal of bone tissue involved cells - osteoclasts and osteoblasts. One osteoclast destroys as much bone mass as it forms 100 osteoblasts. To fill( mineralize) the bone lacuna caused by osteoclasts for 10 days, osteoblasts require 80 days. When the activity of osteoclasts increases( for various reasons), the destruction of bone tissue occurs faster than its formation. Thinning and perforating trabecular plates, the destruction of horizontal bonds occurs, the fragility of the bone increases, fragility - which threatens with fractures of the bones.
Changes in osteoporosis of the vertebra and compression fracture of the vertebral body.
Normally, the peak of the bone mass set is 16 years, bone formation predominates over resorption. In 30 - 50 years, formation and resorption occurs at approximately the same rate. With age, the processes of bone resorption are accelerated. The annual loss of bone mass to 50 years is 0.5 - 1%, in the first year after menopause - 10%, further 2 - 5%.
Risk factors for osteoporosis:
female sex,
family cases of osteoporosis,
elderly age,
menstrual disorder,
sedentary lifestyle,
use of corticosteroid hormones, anticonvulsants, heparin, thyroxine, antacid agents containing aluminum,
low growth,
thin bones,
low weight.
Modifiable risk factors -( can be affected):
smoking,
alcohol abuse,
caffeine,
sedentary lifestyle,
low consumption of dairy products,
insufficient intake of calcium,
deficiency of vitamin D3,
excessive consumption of meat.
Symptoms of osteoporosis
The risk of a clinical picture is associated with an asymptomatic or low-symptomatic onset of osteoporosis, masked for osteochondrosis of the spine and arthrosis of the joints. The disease is often diagnosed already in the presence of a fracture. A fracture can occur with minimal injury, lifting the gravity.
It is difficult to detect the disease at an early stage, although there are several signs. For example, changes in posture, bone pain when weather changes, fragile nails and hair, tooth decay. The spine, the hip neck, the bones of the hands and the wrist are most sensitive to the disease. The first symptoms of osteoporosis can be pain in the lumbar and thoracic spine with prolonged static load( for example, sedentary work), night cramps in the legs, brittle nails, senile stoop, decrease in height( due to a decrease in the height of the vertebrae), the phenomenon of periodontitis.
Changes in posture in osteoporosis
Constant pain in the back, waist, interblade area may be symptoms of osteoporosis. In the presence of pain, reduced growth, changes in posture, you should consult a doctor, be examined for osteoporosis.
Diagnosis of Osteoporosis:
- radiography of bones, spine
- osteodensitometry - dual-energy x-ray densitometry( DEXA), quantitative computed tomography, ultrasonic densitometry.
Radiography for accurate diagnosis is not good, the initial forms and osteopenia can not be detected. The loss of bone mass in the amount of up to 25 - 30% on radiographs is not visible.
The diagnostic standard is DEXA.Bone densitometry is a quantitative non-invasive assessment of bone mass.
The bone mass and bone mineral density are measured. Z is the difference between bone density in a patient and the theoretical density of bone mass in a healthy person of the same age. The T-score is the difference between the bone density in the patient and the average value of the indicators in healthy individuals aged 40 years.
According to WHO recommendations, diagnostics is performed based on T.
Norm-T minus 1( -1).
Osteopenia - T between minus 1 and minus 2.5( -1 and -2.5).
Osteoporosis - T less than minus 2.5( -2.5).
Established osteoporosis - T less than minus 2.5 with the presence of non-traumatic fractures.
Indications for densitometry:
-
estrogen deficiency - early menopause
- long-term secondary amenorrhea
- low body mass index
- family history
- anorexia, malnutrition
- hyperparathyroidism
-
organ transplantation - chronic renal failure
- hyperthyroidism
- primary hypogonadism
- reduced testosterone level in men
- prolonged immobilization
- Itenko-Cushing syndrome
- corticosteroid therapy
- diseases associated with osteoporosis - rheumatoid arthritis, spondyloarthritis.
For the diagnosis of osteoporosis, biochemical markers are used - various hormones( estrogens, thyroid hormones, parathyroid), vitamin D, calcium, phosphorus, magnesium, formation markers( osteocalcin, specific bone alkaline phosphatase, procollagen C-peptide and N-peptide), resorption markers( acid-tolerant acid phosphatase, pyridinoline, deoxypyridinoline, calcium, hydroxylamine glycosides.
Treatment of osteoporosis
Treatment of osteoporosis is a very complex problem that is dealt with by immunologists,rheumatologists, neurologists, endocrinologists, it is necessary to achieve stabilization of bone metabolism, slow bone loss, prevent fractures, reduce pain, and increase motor activity.
Used
- drugs with a predominant suppression of bone resorption - natural estrogens, calcitonin, bisphosphonates( pamidronate, alendronate, ibandronate, risedronate, zoledronic acid).Drugs are taken for a long time, for years. There is a difference in taking medications - once a week( ribis), once a month( bon viva), once a year( aclast).
- preparations stimulating bone formation - salts of fluoride, calcium, strontium, vitamin D3, bioflavonoids.
Treatment is prescribed by a doctor!
To cure the discovered osteoporosis completely, perhaps, it is impossible. You can only improve the condition of the osseous system with drugs that affect the absorption and absorption of calcium, and the calcium preparations themselves.
Diet for osteoporosis
For proper nutrition, first of all, you need to eat foods containing calcium and vitamin D. These are various dairy products( allergic can use soy, goat or nut milk), fish, greens, cabbage, broccoli, nuts. Vitamin D is found in fish, fish oil, yolk. In addition, the rays of the sun also contribute to the production of vitamin D.
Physiotherapy for osteoporosis
Physical activity should include walking, which gives a load on the bones. It is important to note that swimming does not help strengthen the bone, because the weightless state of the body in the water does not result in the necessary effort on the bone structures.
One of the exercises to strengthen the bones, which must be performed systematically:
Stand on your knees and leaning on your straightened arms, pull your stomach inside. The back is in the forward position. Raise your right arm up, chest opens, look in the direction of the hand. Hold in such a static position for a few seconds. Breathe exactly. Then lower your hand and do the same in the opposite direction. Repeat the exercise several times in both directions.
After completing the exercise, lower the pelvis to the feet, straighten your arms, lower your head down. Body relax, keep even breathing. This exercise can be performed 2-3 times a week. Combine it with proper nutrition and add walking 2 times a week, at least for half an hour.
Osteoporosis complications
The most common fractures of vertebral bodies, the neck of the hip, and the radius of the bones. According to WHO, fractures of the thigh bone place osteoporosis on the 4th place among all causes of disability and mortality. Osteoporosis reduces the expected life expectancy by 12 - 20%.The first fracture of the spine in 4 times increases the risk of repeated fractures of the spine and 2 times the fracture of the hip. Prolonged bed regimen promotes the development of pneumonia, pressure sores, thromboembolism.
Prevention of osteoporosis
Use of sufficient amounts of calcium - foods rich in calcium( low-fat dairy products, broccoli, cauliflower, salmon, cheese, reduce foods containing phosphorus( red meat, sweet fizzy drinks), limit alcohol and caffeine, sufficient physical activityThe recommended dose of calcium is 1000 mg per day to 65 years and 1500 mg per day after age 65.
If it is impossible or not effective for conventional disease prevention measures, doctors are always advised to consult the facilityIn the situation with the prevention of osteoporosis, it is not so easy to find an effective remedy. The fact is that the presence of calcium alone in the preparation can not solve the problem of its deficiency in the body. It will hardly be absorbed.drug of the necessary ratio of calcium and vitamin D.
Prevention of osteoporosis is a healthy lifestyle, HRT in the menopause( in the menopause for the prevention of osteoporosis, estrogen is prescribed- orally or in the form of subcutaneous implants), regular physical activity feasible. After 40 years, all women without exception should check the functioning of their thyroid gland and, if necessary, conduct treatment.
The Russian Association for Osteoporosis( www.osteoporoz.com) systematically conducts a free screening of people at risk for osteoporosis in various cities of Russia, for more information about the Centers for Osteoporosis and the free diagnosis of osteoporosis, see the website of the Russian Association for Osteoporosis.
Consultation of a doctor for osteoporosis
Question: In all the recommendations for the treatment of osteoporosis, one of the priorities of nutrition is calcium. But what about those who have stones in kidneys and calcium that are contraindicated?
Answer: Taking calcium supplements, high calcium intake with food prevents the formation of kidney stones. Low calcium intake in postmenopausal women is a risk factor for urolithiasis. In men under 60 years of age, calcium deficiency is a risk of urolithiasis. It is believed that the protective mechanism of calcium is due to the calcium binding of oxalates and phosphates in the intestine, preventing its excessive excretion in the urine, and hence also reducing the risk of developing stone formation. Calcium should be taken with food. When stones in the kidneys of calcium are not contraindicated .Even with recurrent oxalate stones, calcium is indicated. The intake of calcium in maximum doses leads to minimal excretion of oxalates. The use of calcium in a dose of less than 800 mg / day leads to a calcium imbalance. The main factors of stone formation are hypercalciuria, hyperoxaluria, hyperuricosuria, deficiency of stone formation inhibitors and pH change in urine. Each of them or their combination in combination with other pathogenetic mechanisms - disorders of urodynamics, circulatory disorders in the renal parenchyma, inflammatory processes in the urinary tract - can cause the formation of stones. The restriction of calcium intake from food or additional calcium intake into the human body in the form of calcium and vitamin D preparations plays a negative role in the pathogenetic mechanisms of preventing stone formation in the urinary tract and the course of urolithiasis.
Doctor neurologist Kobzeva S.V.