Periarticular and systemic osteoporosis: symptoms and treatment. Causes and treatment of systemic osteoporosis Systemic osteoporosis developed against the background of hypogonadism
Osteoporosis is a disease in which the leaching of calcium and other minerals from bone tissue prevails over their accumulation, which causes its irreversible modification. The bones become fragile, and the structure of their tissue undergoes a “restructuring”, which consists in reducing the number of plates that form it.
Voids and pores form, the size of which is sometimes comparable to the size of holes in hard cheeses.
Osteoporosis causes frequent fractures
Loose bone tissue is easily destroyed. Fractures cannot be avoided, and they happen not only during winter walks on slippery ice or autumn slush. Sometimes, to break an arm, it is enough to lift a heavy bag, and tripping over a rug in the hallway can result in a bedridden femoral neck fracture. Such metamorphoses are caused by a violation of phosphorus-calcium metabolism in the body. Where does calcium “go” and why does osteoporosis occur, what are its symptoms and how successful is treatment?
The prerequisites for the development of osteoporosis are largely taken into account by its classification. Let's look at the most common of them.
Let's start with the topographic classification, which distinguishes two forms of the disease - local and generalized.
For local form the bone substance of a particular bone loses density due to fractures, displacements, bruises, burns, toxic effects, etc.
Depletion of bone tissue may take the form of round or oval lesions of varying sizes (spotted osteoporosis).
If the bone is depleted evenly, they speak of uniform local osteoporosis.
Osteoporosis of the hip can lead to severe fractures
Local rarefaction of bone tissue structure often occurs in bones that form large joints. A typical case and common cause of severe, “immobilizing” fractures in older people is osteoporosis of the hip joint, in which the disease affects the neck of the femur.
There are also regional osteoporosis, covering an anatomical area consisting of several bones, usually a joint. This form of the disease threatens not only bone fractures.
Osteoporosis of the joints develops, in which the fragility of the surfaces of the articular bones is combined with degenerative processes in the cartilage tissue.
The hip and knee joints are most often affected.
If the pathological process also affects the soft tissues of the joint, they speak of periarticular osteoporosis. Periarticular osteoporosis of the hands is a common consequence of decreased bone density and disruption of their structure, manifested by pain in the joint and crunching during movement.
Leads to serious consequences diffuse osteoporosis of the spine, in which there is a decreased density of tissue in his vertebrae.
Diffuse osteoporosis of the spine threatens fractures of the spinal column
In addition to stooping, increased lumbar curvature and the formation of a hump, this type of illness threatens severe fractures of the spinal column.
Systemic osteoporosis affects all bones of the skeleton.
Osteoporosis in children and adults
Also distinguished:
Gender injustice
Although osteoporosis of bones is diagnosed in almost 100% of men who have crossed the 75-year mark, women remain the first contenders for “porosity of bones.”
Causes of osteoporosis in women:
- Hormone imbalance caused by menopause. The metabolism of calcium ions is carried out mainly in constantly renewed bone tissue. Metabolic processes occur continuously in it. Special cells - osteoblasts - synthesize bone substance, and others - osteoclasts - “resorb” it. Responsibility for balance in this system lies with sex hormones - estrogens and progesterone in women, androgens in men. Menopause, accompanied by a sharp decrease in the production of sex hormones, disrupts the exchange of “building material”;
- Poor diet. A diet based on carbohydrates and refined foods, soda and coffee threatens a deficiency of calcium, phosphorus and magnesium, proteins and unsaturated fatty acids, vitamin D, which does not at all help strengthen bones;
- A dangerous “couple” - alcohol and nicotine, if not separated for a long time, lead to the loss of 25% of bone mass;
- Ovarian dysfunction or removal.
Watch the video for more details:
The onset of the disease is very easy to miss; its first symptoms are very vague.
In the early stages, signs of salt metabolism disorders will help to suspect osteoporosis:
- pain in the bones and back of the head;
- increased fatigue and low performance;
- tearfulness or apathy;
- sleep disturbance, feeling of fear;
- night cramps;
- periodontitis and excess plaque;
- delamination of the nail plate and early gray hair;
- gastrointestinal dysfunction and the onset of diabetes mellitus;
- tachycardia;
- allergy.
Progressive osteoporosis is irreversible, and its symptoms worsen in women. As bone mass decreases, painful sensations appear.
Pain in osteoporosis is aching in nature, often localized in the lower back and sacrum, pelvic bones, ankle and hip joints.
Squatting on tiptoes, pressing from above on outstretched arms is accompanied by pain in the spine. Often there is a “painful” feeling between the shoulder blades. Bone fractures are becoming more frequent. A further decrease in bone density in some women causes a decrease in height, sometimes significant, up to 10-15 cm.
The disease also manifests itself to representatives of the opposite sex with similar symptoms.
In women who have not reached menopause, bone depletion may result from significant weight loss. Thus, strict unbalanced diets, poor in calcium and minerals, in addition to reflecting a slender body in the mirror, can provoke osteoporosis of the knee joint, the first manifestations of which - prolonged aching pain in the knee after physical activity - eventually result in a severe degree of demineralization of the bones, fraught with deformation of the joint.
For more information about the symptoms of osteoporosis, watch the video:
It has been established that blond women with very light skin are at greater risk of developing bone porosity than, for example, dark-skinned representatives of the Negroid race.
What complications cause disability?
Poorly healing fractures and skeletal deformities accompanying osteoporosis with a high degree of bone demineralization often render the patient unable to work and can even be bedridden.
The question is looming: do osteoporosis provide disability?
The decision of the special commission depends on the severity of the complications:
- Receiving disability of the 3rd group is likely with significant kyphoscoliosis, aggravated by severe pain;
- A fracture of the femur or other bone, complicated by the development of the so-called “false joint,” is a reason for establishing disability group 2. The likelihood of getting it increases in the presence of cardiovascular or respiratory failure;
- Group 1 disability is established in case of critical course of life-threatening and bedridden osteoporosis.
Osteoporosis threatens disability
Patient, let's go!
The best way to determine how much bone mass has been lost is densitometry, which allows you to express in numbers the dynamics of changes in bone density.
Such a quantitative assessment will show that the patient has osteopenia or osteoporosis, the difference between which is in the level of decrease in bone mineral density.
Among the auxiliary methods for diagnosing osteoporosis are radiography, testing the levels of osteoporosis markers such as osteocalcin, bone fraction of alkaline phosphatase, etc., biopsy and differential diagnosis.
Instead of a conclusion
The human skeleton is comparable to an architectural structure, the stability of which depends on the strength of its building blocks - the bones. But just as water wears away the strongest foundation, disease destroys bones from the inside, turning their strong, homogeneous tissue into a fragile structure with gaping voids. Therefore, one should lay the “foundation” and strengthen the bones without waiting for fractures, starting from the moment of intensive growth, during pregnancy and lactation. How? Replenish calcium deficiency, which is always accompanied by imperfections in the diet, with products containing mineral salts and vitamin D.
But do not forget that the body does not make “reserves” for future use, and therefore, having taken the required portion of calcium from the tablet, it will hasten to get rid of the excess, removing it through the kidneys. Therefore, the presence of calcium, minerals and vitamin D in the diet is the most important point in the prevention and treatment of osteoporosis. And so that the body can use them “as intended” during menopause, women during this period often require estrogen replacement therapy, combined with taking calcium supplements, vitamin D and bisphosphonates - drugs aimed at suppressing bone breakdown. Fluoride preparations are also effective.
Preventing osteoporosis will help avoid the disease
In some cases, the doctor prescribes the wearing of support corsets - you should not neglect such a recommendation, but it is better to take care of strengthening your own muscle corset. Therefore, do not neglect physical activity. However, in old age, physical activity should not only be dosed, but also “correct” - incorrect exercises can lead to fractures, so the nature of the sports load should be discussed with a doctor and practiced with a physical therapy instructor.
We should not forget about the intrapersonal “background” of the disease. After all, the psychosomatics of osteoporosis, or its psychological causes, often indicate that a person has a feeling of lack of some kind of support. Therefore, follow the recommendations of your treating doctors - an endocrinologist and a rheumatologist, eat rationally, eradicate bad habits and be sure: you will be able to protect yourself, because life can sometimes support you in the most unexpected way! Be healthy!
Systemic osteoporosis. Osteoporosis is a systemic skeletal disease characterized by a decrease in bone mass and disruption of the microarchitecture of bone tissue, leading to increased bone fragility and an increased risk of fractures.
Primary osteoporosis is distinguished: postmenopausal (type I), senile, or senile (type II); idiopathic (in adults, juvenile) and secondary osteoporosis. Secondary osteoporosis is caused by many diseases of the endocrine system, digestive organs, kidneys, blood, rheumatic diseases, genetic disorders, drug treatment (corticosteroids, antacids containing aluminum, thyroid hormones, etc.).
Osteoporosis is a complex multifactorial disease, which is based on the processes of impaired bone remodeling in the direction of increased bone resorption and decreased bone tissue formation.
The basis for the development of primary osteoporosis in women is estrogen deficiency and local factors - hyperproduction of cytokines. As the body ages (senile osteoporosis), a disturbance in the metabolism of vitamin D is important, and the development of resistance to it is a deficiency of vitamin D receptors. Postmenopausal osteoporosis is characterized by a trabecular type of bone loss, for senile osteoporosis - trabecular and cortical, which determines the location of the most characteristic fractures in patients - in the first case, the spine, the distal part of the forearm of the radius, in the second case - a femoral neck fracture and multiple wedge-shaped fractures of the vertebrae.
Osteoporosis progresses slowly and is often asymptomatic. The first manifestation of the disease may be the development of bone fractures after minimal trauma - atraumatic fractures. The most common localization of osteoporotic fractures in the “weight-bearing” vertebrae is the middle and lower thoracic and upper lumbar spine, primarily the 12th thoracic and 1st lumbar vertebrae.
In addition, patients with osteoporosis may experience pain associated with a decrease in the height of the vertebral bodies (the so-called vertebral collapse). Pain is a consequence of an increase in lumbar lordosis, compensating for an increase in anteroposterior curvature at the fracture site.
With multiple compression fractures of the vertebrae, chronic, constant dull pain in the lower back is bothersome. Moderate or mild back pain may persist due to mechanical compression of ligaments, muscles, and their attachment points. A progressive dorsal kyphosis develops, called “widow’s hump.”
Severe kyphosis and decreased height can cause pain associated with pressure on the ribs, iliac crests, and intervertebral articular surfaces. The waist line is gradually lost and the stomach protrudes forward. In severe cases, the lower ribs practically descend into the pelvic cavity. Progressive changes in posture lead to shortening and contraction of the back muscles, which causes pain from muscle strain and is one of the leading causes of chronic back pain.
Diffuse bone pain and pain when tapping on the vertebrae, ribs, and pelvic bones may occur. The test with indirect loading of the spine is positive: the doctor presses from above on the patient’s arms, which are stretched forward with tension, which causes severe pain in the spine. Sudden lowering from a tiptoe position also leads to severe pain in the spine.
With a slow onset of the disease, patients are bothered by occasional dull pain in the back. Provoking factors may be alternation of rest and movement. Over time, the pain becomes stronger and longer lasting, disappearing in a lying position. There is sensitivity to shaking, pain “in all the bones.” Subsequently, acute pain attacks occur associated with the fractures described above.
Diagnostics.
X-ray of the spine and large bones. Despite numerous diagnostic criteria for osteoporosis, it is believed that only the identification of one or more vertebral fractures (with the exclusion of other causes) reliably allows a diagnosis, although this is a late diagnosis. The most reliable method for diagnosing osteoporosis is densitometry - a quantitative assessment of bone tissue density. The method of dual energy absorptiometry is used.
The content of calcium, phosphorus in blood serum and urine, and blood alkaline phosphatase are determined. However, they often do not deviate from the norm.
To assess bone formation, the content of osteocalcin and carboxyamino-terminal peptides of type I collagen in the blood serum is examined (increased content). Markers of bone resorption: tartrate-resistant acid phosphatase of platelets, erythrocytes, bone tissue, urine hydroxyproline, etc. (increased content).
Treatment.
Calcium, vitamin D3, calcitonin. In postmenopausal women - estrogen replacement therapy. Diclofenac, ibuprofen, naproxen, sulindac, ketoprofen, piroxicam, meloxicam, lorioxicam, celecoxib, nimesulide other NSAIDs.
Information sources:
- Harrison's Handbook of Internal Medicine
- Fedoseev G.B., Ignatov Yu.D. Syndromic diagnosis and basic pharmacotherapy of diseases of internal organs.
- Borodulin V.I., Topolyansky A.V. Handbook of a practicing physician.
- Roytberg G.E., Strutynsky A.V. Laboratory and instrumental diagnostics of diseases of internal organs.
Systemic osteoporosis
a disease belonging to the group of metabolic osteopathies. In the development of the disease, the leading role is assigned to disruption of the mechanisms of modeling and remodeling of bone tissue. O. s. may be the result of exposure to unfavorable environmental factors or genetic defects. The latter is confirmed by cases of systemic osteoporosis, which are observed in several members of the same family. Active mutagenic factors are ionizing radiation, some chemical compounds, and viruses. Risk factors for the development of systemic osteoporosis may include early menopause, hyperfunction of the adrenal cortex, hyperthyroidism, hypogonadism, excess phosphorus intake, fasting (insufficient calcium intake), long-term use of drugs such as heparin, barbiturates, alcohol, smoking, excessive coffee consumption, physical inactivity and etc. In some cases, the disease develops during pregnancy and lactation, as well as with pathology of the gastrointestinal tract. More often, several risk factors act simultaneously, so the disease is considered to be polyetiological multifactorial.
Clinical picture. Manifestations of O. s. varied. One of its most constant symptoms is pain in the lumbar region, sacrum, and hip joints. Patients usually note a feeling of heaviness between the shoulder blades, general muscle weakness and gait disturbance. In some forms, the first manifestation of the disease may be pain and deformation of the ankle joints or the appearance of swelling and pain in the feet with its gradual spread to the large joints of the lower and small upper extremities. Subsequently, pain occurs in the pelvic bones and ribs, which intensifies with physical activity. Further progression of the process is accompanied by persistent pain, which does not disappear with rest and often forces one to take analgesics for a long time. Sometimes the first manifestation of O. s. There is a pathological fracture of the bones of the lower third of the forearm. None of the symptoms are pathognomonic and can be observed in many other metabolic osteopathies and multiple myeloma.
The course of the disease is often slow but progressive. Spontaneous reverse development is described only in some patients with a transient form of systemic osteoporosis (for example, in young men with idiopathic juvenile osteoporosis, in women during pregnancy or lactation). As the disease progresses, the disturbance of bone mineralization increases every year, which is accompanied by a decrease in its mechanical strength. As a result, pathological fractures and secondary deformations are noted, which often lead to disability.
Diagnosis. The most important role in O.'s diagnosis. are assigned to an X-ray examination, in which a decrease in the density of the bone shadow (osteopenia), increased vertical striation of the vertebral bodies, sclerosis of the subchondral plates, numerous depressed fractures in the central parts of the subchondral plates, fractures of the vertebral bodies (Fig. 1), pelvic bones, femoral necks are noted, other bones of the skeleton. Thinning of the cortical layer of long tubular bones and restructuring processes similar to Looser’s zones in the necks of the femurs (Fig. 2) and pelvic bones are also characteristic. In some cases, granular foci of clearing are observed in long tubular bones, as well as in the bones of the skull and hands.
In some forms of O. s. Possible features of the X-ray picture. Thus, in the steroid form of the disease, in contrast to the postmenopausal form, fish-like deformation of the vertebral bodies is more common (Fig. 3). Wedge-shaped deformation of the vertebral bodies in patients with the postmenopausal form occurs without visible trauma, and with O. p. In young and middle-aged people, such deformation of the vertebral bodies can be detected after lifting something heavy or falling from a height. Numerous compression fractures of the vertebral bodies, which were previously described as hormonal spondylopathy or osteoporotic spondylopathy, are more appropriately designated as platyspondyly, taking into account the fact that a similar X-ray picture can be observed not only in various forms of OS, but also in other diseases and metabolic osteopathies. As a rule, there is no connection between such deformation of the vertebral bodies and endocrine disorders. Fractures of the necks of the femurs are more common in patients with the senile form of OS, and of the pelvic bones - in young and middle-aged people. None of the radiological symptoms is pathognomonic, because similar changes can be observed in osteomalacia, osteoporotic form of myeloma, etc. In this regard, radiological changes, like clinical ones, should be considered only in conjunction with other data.
The results of laboratory tests are of great importance for establishing a diagnosis. With O. s. hypocalcemia, an increase in the level of phosphorus in the blood while maintaining its normal excretion and tubular reabsorption, a decrease or increase in alkaline phosphatase activity, transient hypercalciuria, and increased urinary excretion of hydroxyproline are possible. In cases where hypocalcemia is combined with increased secretion of hydroxyproline and a slight increase in the level of alkaline phosphatase, it is necessary to carry out a differential diagnosis with osteomalacia (Osteomalacia).
Often, invasive and non-invasive methods for determining bone mass are used in diagnosing the disease. Non-invasive methods include X-ray densitometry, X-ray morphometry, and gamma photon absorptiometry. X-ray morphometric and X-ray densitometric methods are quite simple, take little time, however, they make it possible to determine mainly the mass of the cortical part of the bone and measure only in the area of the phalanges or the second metacarpal bone, which are affected by O. s. not in the first place. The most vulnerable parts of the skeleton in systemic osteoporosis are the spine and the neck of the femur, so data on the condition of these parts of the skeleton are of greatest value. They can be obtained by two-photon absorptiometry and computed tomography.
An invasive method for assessing bone mass is histomorphometry of material obtained from a biopsy of the iliac wing. It allows one to obtain quantitative characteristics of such parameters of bone tissue as the volume of cancellous bone, the width of trabeculae, the width of the cortical plate and porosity.
In all cases when there are difficulties in diagnosing O. s. Based on the clinical and radiological picture and biochemical data, the patient should be sent to a specialized orthopedic hospital.
Treatment. The use of calcium supplements alone does not stop the progression of the pathological process and does not increase bone mass. The use of anabolic hormones helps to increase mainly muscle mass. Data regarding the therapeutic effect of estrogens are conflicting. Their use is undoubtedly pathogenetically justified in cases of OS that developed against the background of Hypogonadism in women. Calcitonin has a pronounced analgesic effect, but does not stop the progression of the process. In addition, long-term use of calcitonin can lead to secondary hyperparathyroidism and increased bone resorption.
Widely used for the treatment of O. s. found fluoride preparations, because their introduction as a result of the replacement of hydroxyl ions in oxyapatite leads to an increase in bone volume and improves the structure of the crystal lattice. But the matrix newly formed under the influence of fluorides is poorly mineralized, so treatment with fluoride preparations (ossin, correberone, tridine) must be combined with the administration of active metabolites of vitamin D and calcium preparations. Fluoride treatment is long-term, at least 2 1/2 years. The daily dose of calcium gluconate is 1.5 g. Due to the fact that fluorine forms insoluble compounds with calcium, fluoride and calcium intake cannot be combined in time, and the interval between their intake should be several hours. You should also not take dairy products or cereals prepared with milk at the same time with fluoride preparations. In cases where hypocalcemia is observed with systemic osteoporosis, treatment must be supplemented with oxidevit (an active metabolite of vitamin D), which improves calcium absorption in the intestine.
Treatment of various forms of systemic osteoporosis only with active metabolites of vitamin D is based on data on impaired absorption of calcium in the intestine. There is evidence that the administration of oxydevit for 1 year in patients with the postmenopausal form of the disease, with osteoporosis in young and middle-aged people, as well as with osteoporosis that has developed against the background of diabetes mellitus, stabilizes the X-ray picture, eliminates pain (after 2 -5 months after the start of treatment), stops the loss of cancellous bone, maintains the thickness of the trabeculae and the width of the cortical plate of the bone. In some patients, during treatment with oxidevit, a significant increase in the width of the trabeculae and cortical plate is observed, which indicates the effect of the drug on the processes of modeling and remodeling. In each specific case, individual selection of the dose of the drug and the duration of the course of treatment is necessary. Just as with treatment with fluoride preparations, biochemical monitoring is required at least once every 6 months. Mandatory components of O.'s treatment. are exercise therapy and massage. For muscle weakness, hydrokinesitherapy is recommended. A therapeutic motor regimen is determined individually, and a health path, short-range tourism or walks are prescribed. The complex of treatment measures includes orthotics. According to indications, wearing corsets is prescribed.
Disruption of remodeling and modeling processes in patients with O. s. excludes the possibility of surgical treatment of femoral neck fractures or other fractures without previous and subsequent conservative treatment.
Bibliography: Cohn R.M. and Roth K.S. Early diagnosis of metabolic diseases, trans. from English, p. 350, 398, M., 1986; Disorders of calcium metabolism, ed. D. Heath and S.J. Marx, trans. from English, M., 1985.
Encyclopedic Dictionary of Medical Terms M. SE-1982-84, PMP: BRE-94, MME: ME.91-96.
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2013
Osteoporosis with pathological fracture, unspecified (M80.9)
Rheumatology
general information
Short description
Approved
at the Expert Commission
on health development issues
Ministry of Health
Republic of Kazakhstan
Osteoporosis is a systemic disease that affects all bones of the skeleton, characterized by a decrease in bone mass and disruption of the microarchitecture of bone tissue, leading to increased bone fragility and the occurrence of fractures. A decrease in bone density and strength leads to a high risk of fractures even with minimal trauma, such as a fall from a height height or lifting a load weighing about 10 kg. Osteoporosis mainly affects women (especially after menopause) and older people.
Fractures are a major complication of osteoporosis.
The most common cases of osteoporosis are: a fracture of the radius “in a typical place” (develops when falling on an outstretched arm); femoral neck fracture (the most dangerous, since about half of patients after such a fracture remain disabled and require outside care);vertebral compression fracture(develops after falling on your back or lifting a heavy object, accompanied by severe back pain).
Protocol name: Osteoporosis
Protocol code:
ICD-10 code(s):
M 80 Osteoporosis with pathological fracture
M80.0 Postmenopausal osteoporosis with pathological fracture
M80.1 Osteoporosis with pathological fracture after spayectomy
M80.2 Osteoporosis with pathological fracture caused by immobility
M80.3 Post-surgical osteoporosis with pathological fracture caused by malabsorption in the intestine
M80.4 Drug-induced osteoporosis with pathological fracture
M80.5 Idiopathic osteoporosis with pathological fracture
M80.8 Other osteoporosis with pathological fracture
M80.9 Osteoporosis with pathological fracture, unspecified
M81 Osteoporosis without pathological fracture
M81.0 Postmenopausal osteoporosis
M81.1 Osteoporosis after oophorectomy
M81.2 Osteoporosis caused by immobility
M80.3 Post-surgical osteoporosis caused by malabsorption in the intestine
M80.4 Drug-induced osteoporosis
M80.5 Idiopathic osteoporosis
M81.6 Localized osteoporosis (Lequena)
M80.8 Other osteoporosis
M80.9 Osteoporosis, unspecified
M82* Osteoporosis in diseases classified elsewhere
M82.0* Osteporosis in multiple myelomatosis (C90.0+)
M82.1* Osteoporosis in endocrine disorders (E00-E34+)
M82.8* Osteoporosis in other diseases classified elsewhere
Abbreviations used in the protocol:
ALT-alanine aminotransferase
AST-aspartate aminotransferase
GC-glucocorticosteroids
QCT-Quantitative Computed Tomography
BMD - bone mineral density
MRI-magnetic resonance imaging
OP - osteoporosis
PTH - parathyroid hormone
CRP-C-reactive protein
ESR - erythrocyte sedimentation rate
ECG-electrocardiogram
Ultrasound - ultrasound examination
DXA - dual-energy x-ray absorptiometry
Classification
There are:
A. Primary osteoporosis
B. Secondary osteoporosis
A. Primary osteoporosis
1. Postmenopausal osteoporosis (type 1)
2. Senile osteoporosis (2 types)
3. Juvenile osteoporosis
4. Idiopathic osteoporosis
B. Secondary osteoporosis
I. Diseases of the endocrine system
1. Endogenous hypercortisolism (Itsenko-Cushing disease and syndrome)
2. Thyrotoxicosis
3. Hypogonadism
4. Hyperparathyroidism
5. Diabetes mellitus (type I insulin dependent)
6. Hypopituitarism, polyglandular endocrine insufficiency
II. Rheumatic diseases
1. Rheumatoid arthritis
2. Systemic lupus erythematosus
3. Ankylosing spondylitis
III. Digestive diseases
1. Resected stomach
2. Malabsorption
3. Chronic liver diseases
IV. Kidney diseases
1. Chronic renal failure
2. Renal tubular acidosis
3. Fanconi syndrome
V. Blood diseases
1. Myeloma
2. Thalassemia
3. Systemic mastocytosis
4. Leukemia and lymphoma
VI. Other diseases and conditions
1. Immobilization
2. Ovariectomy
3. Chronic obstructive pulmonary diseases
4. Alcoholism
5. Anorexia nervosa
6. Eating disorders
7. Organ transplantation
VII. Genetic disorders
1. Osteogenesis imperfecta
2. Marfan syndrome
3. Enders-Danlos syndrome
4. Homocystinuria, or isinuria
Diagnostics
Clinical criteria:
Complaints and anamnesis: The main complaint of patients with AP is back pain. The pain may be episodic and associated either with awkward movement or with lifting heavy objects. Patients often complain of “fatigue and aching back pain” after being forced to stay in one position or walk. They are concerned about the “feeling of heaviness” between the shoulder blades and the need to rest repeatedly during the day, preferably in a lying position.
Complaints of joint pain, gait disturbances, and lameness are less common. Taking non-steroidal anti-inflammatory drugs does not relieve pain. Its severity may vary in the same patient at different periods of time.
The causes of back pain due to osteoporosis can be:
1. compression fracture of the spine or partial fracture with periosteal hemorrhage;
2. mechanical compression of ligaments and muscles;
3. kyphosis of the thoracic spine;
4. decreased growth and shortening of paraspinal muscles.
With a fresh fracture of the vertebral body, acute pain occurs, radiating like radicular pain into the chest, abdominal cavity or thigh and sharply limiting movements. The pain intensifies with minimal movement, lasts 1-2 weeks, then gradually subsides over 2-3 months.
Complaints and anamnesis: back pain, feeling of tiredness in the back when sitting or standing. Decrease in height (by 2.5 cm per year or by 4.5 cm or more over a lifetime, which may be associated with vertebral compression fractures).
Physical examination:
Symptoms of progressive osteoporosis:
1. frequent fractures due to inadequate injuries (mild blow, fall out of the blue) with fracture localization typical for osteoporosis: lumbar spine, proximal femur, radius at the wrist (Collis fracture);
2. spinal deformation: kyphosis, Scheuermann-Mau disease (juvenile kyphosis), decreased height (due to flattening of the vertebrae);
3. stiffness and pain in joints;
4. a series (one after another) of compression fractures of the lumbar and thoracic vertebrae with sharp pain in the back, radiating along the spinal roots (menopausal spondylopathy - severe osteoporosis of the axial skeleton);
5. compression fractures of the spine in the absence of external influence (as a result of the load created by the body’s own weight).
Anthropometric method. It is used only for the purpose of making a presumptive diagnosis. A decrease in height by 2 cm or more over 1 to 3 years of observation and by 4 cm in comparison with height at 25 years is a reason for radiography of the spine to detect vertebral fractures (B).
Laboratory diagnosis of osteoporosis:
For the biochemical assessment of bone mineral density, the following research methods are available:
1. characteristics of phosphorus-calcium metabolism;
2. determination of biochemical markers of bone remodeling.
When assessing biochemical parameters, routine research methods are required: determination of the content of calcium (ionized fraction) and phosphorus in the blood, daily excretion of calcium and phosphorus in the urine, as well as excretion of calcium in the urine on an empty stomach in relation to the concentration of creatinine in the same portion of urine.
A large number of studies on osteoporosis in childhood prove that most often routine biochemical indicators of phosphorus-calcium metabolism are not changed or change slightly and briefly, even with severe osteoporosis with a fracture.
To determine the state of bone remodeling, highly sensitive biochemical markers of bone metabolism are examined in the blood and urine. In a pathological situation, they reflect the predominance of impaired bone formation or bone resorption.
| Biochemical markers of bone remodeling | ||||||||||||||||
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Determining biochemical markers of bone metabolism is important not only for characterizing bone metabolism, but also for choosing a drug that increases bone mineral density, monitoring the effectiveness of therapy, and optimal prevention of osteoporosis.
Instrumental methods
The most accessible method of instrumental diagnosis of osteoporosis is a visual assessment of bone radiographs (for glucocorticoid osteoporosis - spinal bones).
Characteristic radiological signs of decreased bone mineral density:
1.increased “transparency”, change in trabecular pattern (disappearance of transverse trabeculae, rough vertical trabecular striations);
2. thinning and increased contrast of the end plates; decreased height of the vertebral bodies, their wedge-shaped or “fish” deformation (in severe forms of osteoporosis).
Bone demineralization can be detected by X-ray if there is a decrease in bone density of at least 30%. X-ray studies are of great importance in assessing deformities and compression fractures of the vertebrae.
More accurate are quantitative methods for assessing bone mass (densitometry, from the English word density - “density”). Densitometry can detect bone loss in the early stages with an accuracy of 2-5%. There are ultrasound, as well as X-ray and isotope methods (mono- and dual-energy densitometry, mono- and two-photon absorptiometry, quantitative CT).
Indications for determining MIC:
. women's age is 65 years and older, men are 70 years and older, regardless of clinical risk factors;
. premenopausal women and men 50-69 years old who have clinical risk factors;
.women who have entered menopause and have specific risk factors associated with an increased risk of fractures (low body weight, previous low-traumatic fractures, taking medications that increase this risk);
. adults who had fractures after 50 years of age;
. adults with certain conditions (eg, rheumatoid arthritis) or taking certain medications (prednisolone ≥ 5 mg/day or equivalent for ≥ 3 months) that cause decreased bone density or loss of bone mass;
. persons who were previously recommended pharmacotherapy for AP;
. patients who have previously undergone treatment for AP (MIC is determined to assess the effect of the therapy);
. persons who have not received anti-osteoporotic therapy, but who have identified bone loss requiring treatment;
. Postmenopausal women who have stopped taking estrogen.
The main indicators that determine bone mineral density:
1. bone mineral content, expressed in grams of mineral in the area being examined;
2. bone mineral density, which is calculated by bone diameter and expressed in g/cm2;
3. Z-criterion, expressed as a percentage of the age-sex norm and in standard deviation values (standard deviation) from the average age norm (SD, or sigma). In children and adolescents, only this relative densitometry indicator is used.
4. T-criterion, which is expressed in standard deviation values. This indicator is the main one for assessing the severity of bone demineralization according to WHO criteria in adults.
Diagnostic “instrumental” categories of decreased bone mineral density
Indications for consultation with specialists:
1. exclusion of secondary forms of osteoporosis - rheumatologist, endocrinologist, gastroenterologist
2. carrying out differential diagnosis with tumor diseases and tuberculosis - oncologist, phthisiatrician
3. determination of indications and method of surgical treatment of osteoporotic fractures - orthopedist.
List of basic and additional diagnostic measures:
1. OAK
2. OAM
3. Total and ionized calcium
4. Phosphorus
5. Alkaline phosphatase
6. Creatinine
7. ALT
8. AST
9. Glucose
10. SRB
11. Daily excretion of calcium and phosphorus in urine
12. Osteocalcin (blood)
13. β-cross-links
14. X-ray of the spine
15. Densitometry
List of additional diagnostic measures:
1. Pyridinoline and deoxypyridinoline in urine.
2. Parathyroid hormone
3. Ultrasound of the abdominal organs and kidneys
4.Quantitative computed tomography
5. Magnetic resonance imaging
Differential diagnosis
First of all, it is necessary to distinguish between primary osteoporosis and the group of secondary osteoporosis, as well as differentiate them from osteomalacia, multiple myeloma, metastatic lesions of bone tissue in cancer, which are characterized by fractures resembling osteoporosis. Differential diagnosis of variants of primary osteoporosis is not difficult, since the age of the patients, the time elapsed since the onset of menopause in women, the predominant localization of osteoporosis and previous bone fractures are decisive. If juvenile osteoporosis is suspected, variants of congenital osteopenia and Scheuermann's disease should be excluded.
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Treatment
Treatment goals for osteoporosis:
· prevention of bone fractures;
Slowing down or stopping bone loss;
· normalization of bone metabolism indicators;
Treatment tactics:
Non-pharmacological treatments:
· Physical activity
Prevention and management of osteoporosis involves individualized exercise programs to maintain bone density and reduce the rate of bone loss with minimal risk. Physical activity in youth increases peak bone mass, but its effect on slowing BMD loss is modest and does not change fracture rates at all. The exercises improve muscle coordination, mobility and stability; they reduce the incidence of falls by 25%. In addition, exercise improves daily functioning and helps delay disability. Ideally, patients should perform exercise almost daily, alternating between different types of exercise to achieve the most optimal results and shorten the recovery period from any exercise-related stress. Encourage patients to choose exercises that they enjoy; this will help ensure consistency.
The full program involves a combination of aerobic, strength exercises and flexibility development. A comprehensive bone-strengthening program should include exercises that involve moving your own body, such as slow running, walking, skating and tennis. To avoid shock loads on the spine, patients with osteoporosis should avoid exercises such as jumping, aerobics involving sudden movements, and fast running.
Exercises to develop muscle strength also strengthen bones. To strengthen the legs, hips, back, shoulders, forearms, hands and neck, you should use special exercises (such as leg press, calf raises, bicycle, quadriceps extension, side bends, forward bends, arm rotation, triceps extension, rotations). wrists, shrugging). Excessive bending of the spine (“press” in a lying position, bending over while reaching for your toes, exercises on appropriate machines), adduction and abduction of the legs can be dangerous.
·
Educational programs
The role and effectiveness of educational programs are not covered in existing clinical guidelines. As a result of an additional search, no studies were found on the impact of educational programs on quality of life and the risk of subsequent fractures. There are indications that teaching patients to exercise can have a positive impact on their health outcomes, and small group pain assessments for people with vertebral fractures can help reduce back pain. Several studies have shown that osteoporosis education programs encourage patients to engage in preventive and treatment interventions and improve adherence to treatment. No studies were found that assessed the cost-effectiveness of educational programs.
1. Educational programs on osteoporosis (OP) stimulate patients to carry out preventive and therapeutic measures and increase adherence to treatment.
2.Educating patients with vertebral fractures in the analysis of pain syndrome and measures that influence pain can lead to a decrease in back pain. Educational programs on OP are recommended for people both without osteoporosis and with osteoporosis, since knowledge about osteoporosis stimulates the implementation of preventive and therapeutic measures and increases adherence to treatment.
3. For patients with back pain due to vertebral fractures, classes with training in measures to reduce back pain are recommended.
· Prevention of falls
The importance of fall susceptibility as a risk factor for fractures is often underestimated. Living conditions that increase the risk of fractures include slippery floors, uncomfortable bathtubs, small rugs, various obstacles in the living space, and uncomfortable shoes. Medical conditions that increase the risk of falls include postural hypotension or altered sensation due to medications, decreased vision, muscle weakness, and poor coordination and mobility. Monitor your patients' medications, especially sedatives and hypnotics, and screen them for alcohol abuse.
Advise patients at risk of fractures to evaluate the safety of their home. They may need to install safety railings, handrails, eliminate rugs and various potential obstructions, make sure lighting is adequate, and repair cracked walkway surfaces.
For patients at very high risk of falls, clothing with padding in the thigh area may provide additional protection.
· Stop smoking.
Bone health is another reason for smoking cessation recommendations: the relative risk of osteoporosis for smokers is 5 times higher than for non-smokers.
· Diet.
A balanced diet is necessary for the optimal condition of the skeletal system at all ages. The most important nutrient for achieving peak bone mass during growth is calcium. A rational combination of calcium and vitamin D in the diet reduces the incidence of fractures of the hip and other bones (excluding the spine).
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Calcium preparations. When a patient's medical history or physical examination indicates the need for calcium supplementation for the prevention or treatment of osteoporosis, individual doses of over-the-counter forms are recommended. Calcium absorption is optimal when a single dose does not exceed 600 mg. The most effective and accessible source of calcium is calcium carbonate. A sufficient level of absorption is also desirable. Chewable tablets may be the medication of choice. Absorption can be enhanced by taking calcium with food.
Vitamin D. This nutrient facilitates the absorption of calcium. The minimum recommended dose is 400 IU/day. This level can be achieved in the following ways: exposure to sunlight for 10-15 minutes 3 times a day; consuming foods such as milk, egg yolk, or fortified foods; taking multivitamins.
The recommended dose is 500 IU/day for persons aged 19 to 50 years and 800 IU/day for persons aged 51 years and older.
Recommended dose:
Calcium preparations in prophylactic dosage for persons under 50 years of age: calcium carbonate 1250 mg (equivalent to elemental calcium 500 mg), cholecalciferol 5.5 mcg (200 IU vitamin D3) in the form of cholecalciferol concentrate 2.0 mg. Adults and children over 12 years old: 1 tablet 2 times a day; for preventive purposes, take for 3 months 2 times a year. Children from 3-5 years old 1 tablet per day, 6-11 years old 1-2 tablets per day.
Calcium preparations in prophylactic dosage for persons over 50 years of age and in therapeutic dosage are recommended: calcium carbonate 1250 mg (equivalent to elemental calcium 500 mg), cholecalciferol 11 mcg (400 IU vitamin D3) in the form of cholecalciferol concentrate 4.40 mg. For course prevention of osteoporosis, 1 tablet 2 times a day, for at least 3 months, 2 times a year. For the treatment of osteoporosis, 1 tablet 2 times a day, for at least 6 months.
Drug treatment of osteoporosis:
Pathogenetic treatment includes the prescription of drugs aimed at various components of the bone remodeling process:
.suppression of increased bone resorption;
.stimulation of bone formation;
.normalization of both these processes;
.normalization of mineral homeostasis (elimination of possible vitamin D deficiency).
List of main drugs:
Pathogenetic therapy (first-line drugs that slow down bone resorption):
1. Denosumab - human monoclonal antibody 60 mg/ml
2. Estrogens, selective estrogen receptor modulators
3. Calcitonins - nasal spray 200IU or IM 100IU continuously or intermittently
4. Bisphosphonates: alendronic acid 35 mg/s once a week
Ibandronic acid 150 mg/s once a month
Zoledronic acid 5 mg/100 ml once a year IV, drip
5. Calcium and vitamin D supplements -
calcium carbonate 1250 mg (equivalent to elemental calcium 500 mg) + cholecalciferol 11 mcg (400 IU vitamin D3), chewable tablets with lemon flavor, 1 tablet 2 times a day.
6. Active metabolites of vitamin D - alfacalcidol 0.5-1 mcg/day
First-line drugs are considered:
- Denosumab - human monoclonal antibody 60 mg/ml
Bisphosphonates of the latest generation (salts of alendronic, zoledronic, risedronic, pamidronic acids);
. calcitonin;
. estrogens, selective estrogen receptor modulators;
. active metabolites of vitamin D.
Pathogenetic drugs for the treatment of osteoporosis
| Drug classes | Drugs |
| Slowing down bone resorption |
Estrogens, selective estrogen receptor modulators Denosumab - human monoclonal antibody Calcitonins Bisphosphonates |
| Bone formation stimulating |
Fluorides Parathyroid hormone A growth hormone Anabolic steroid Androgens |
|
Acting on both levels of bone tissue remodeling |
Calcium and vitamin D supplements Active metabolites of vitamin D Ossein hydroxyapatite complex Ipriflavone Substances containing phosphates, strontium, silicon, aluminum Thiazides |
The latest generation of bisphosphonates (salts of alendronic acid, zoledronic acid, risedronic acid) are the most powerful in their effect on bone tissue; they not only increase BMD, but also reduce the risk of fractures, including vertebral ones. Bisphosphonates are successfully used to treat not only postmenopausal, but also glucocorticoid osteoporosis.
The drugs with the fastest antiresorptive and analgesic effect include calcitonin (salmon calcitonin is most often used). It has a strong effect on bone tissue. The drug has 2 dosage forms - injection (in a bottle) and nasal spray. The effect of calcitonin, including analgesic, when used parenterally is more pronounced than when installed in the nasal passage. Injectable calcitonin is more effective for osteoporosis of the spine than for osteoporosis of other bones, and intranasal calcitonin, according to some data, is less effective in terms of its effect on spinal BMD. However, the spray is more convenient to use, especially in children.
Despite the long-term use of calcitonin in the form of a nasal spray, there are no uniform recommendations on the mode of its use. Some authors provide data on its positive effect when administered daily for one year or even 5 years. Others insist on various intermittent schemes, for example, 1 month - “on” (prescribe), 1 month - “off” (do not prescribe) or 2 months - “on”, 2 months - “off”. They recommend repeating the cycle at least 3 times.
Calcitriol has a good rapidity of action and a narrow therapeutic range, so its use poses a high risk of developing hypercalcemia and hypercalciuria. The safest drugs in this regard are alfacalcidol. Alfacalcidol has a multifaceted effect on bone tissue, acts quickly, is easily dosed, is eliminated from the body fairly quickly, and does not require hydroxylation in the kidneys to achieve its metabolic effect. The peculiarity of this form is that to convert into the final product (alpha-25-OH-D., (calcitriol), only hydroxylation in the liver at position 25 is necessary. The rate of such conversion is regulated by the physiological needs of the body, which to a certain extent prevents the risk of developing hypercalcemia. Alfacalcidol may also be effective in kidney disease, since the impaired renal hydroxylation step is not involved. Thus, only the active metabolites of vitamin D actually increase BMD and reduce the risk of bone fractures. Alfacalcidol is the only anti-osteoporetic drug that can be used without calcium supplements. However, the addition of calcium salts to the treatment of osteoporosis increases the effectiveness of the basic drug (bone loss slows down to a greater extent, the incidence of bone fractures decreases). Alfacalcidol in combination with calcium carbonate is successfully used to treat glucocorticoid osteoporosis. It acts as a “freight elevator”, delivering calcium to the “ place of requirement."
A kind of “breakthrough” in the treatment of osteoporosis in the 21st century. was the emergence of a dosage form of parathyroid hormone. It has a dual effect on bone - it reduces resorption and has an anabolic effect (stimulates osteogenesis). It is more effective than all known anti-osteoporetic drugs.
But the injection method of administration for 1-1.5 years daily limits its use. In addition, evidence has emerged that with long-term use of parathyroid hormone, osteosarcomas can occur in rats. The drug is very promising, but further study is necessary, especially in children.
Denosumab is a human monoclonal antibody (IgG2) that targets RANKL, to which the drug binds with high affinity and specificity, preventing activation of its receptor RANK on the surface of precursors, osteoclasts and osteoblasts. Prevention of RANKL/RANK interaction inhibits osteoclast formation, impairs their function and viability, thereby reducing resorption of both tubular and cancellous bone. The recommended dose of Denosumab is 1 subcutaneous injection of 60 mg of the drug once every 6 months, which is injected into the thigh, abdomen or outer upper arm.
Prevention
Prevention is conventionally divided into primary and secondary.
Primary prevention is to prevent the development of AP in patients who are planned to be treated with systemic glucocorticoids for more than 3 months.
Secondary prevention is the prevention of bone loss and fractures with reduced BMD (1 to 1.5 standard deviations from peak bone mass) and/or a history of fractures.
The patient is given recommendations on lifestyle and nutrition.
Prevention of bone loss requires two approaches: healthy lifestyle promotion and pharmacological intervention.
The state of the bone mass of a growing organism will largely depend on the risk of developing and the severity of osteoporosis in adults during physiological periods of life (pregnancy, lactation, aging), with possible diseases associated with calcium metabolism disorders.
The main measures to prevent osteoporosis and fractures in childhood, and therefore both in working age and in old age, include ensuring adequate nutrition. Adequate calcium intake is the most important factor for achieving optimal bone mass and size.
Optimal calcium intake at different periods of human life.
Further management
- Dispensary observation
- Pathogenetic treatment (includes the prescription of drugs aimed at various components of the bone remodeling process) - constant anti-osteoporetic therapy.
Information
Sources and literature
- Minutes of meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
- List of used literature: 1. Rheumatology: Clinical recommendations / ed. Academician RAMS E.L. Nasonova. – 2nd ed., rev. and additional - M.: GEOTAR-Media, 2010. – 752 p. 2. Rheumatology: national guide / ed. E.L. Nasonova, V.A. Nasonova. - M.: GEOTAR-Media, 2010 - 711 p. 3. Diffuse connective tissue diseases: a guide for doctors / ed. prof. IN AND. Mazurova. – St. Petersburg: SpetsLit, 2009. 192 p. 4. Osteoporosis. Clinical recommendations. 2nd ed., L.I. Benevolenskaya, 2011. 5. Diseases of the joints in the practice of a family doctor, G.V. Dzyak, 2005. 6. Current nutrition in cardiology and rheumatology - Ed. V.G. Bidnogo, K.M. Amosova, O.B. Yaremenka, N.O. Karelian. - Kiev: Navchalna kniga, 2003. - 106 p. 7. Rheumatic diseases: nomenclature, classification, standards of diagnosis and treatment - V.N. Kovalenko, N.M. Shuba - K.: Katran Group LLC, 2002. - 214 p. 8. Osteoporosis: clinical recommendations. 2nd ed., revised. and additional (Series "Clinical Guidelines"), Ershova O.B., Evstigneeva L.P., Chernova T.O. and others / Ed. O.M. Lesnyak, L.I. Benevolenskaya, 2010 9.. Osteoporosis + CD: school of health, O.M. Lesnyak, 2008. 10. Belousov Yu.B. - Rational pharmacotherapy of rheumatic diseases, 2005. 11. Diagnosis and treatment in rheumatology. Problematic approach, Pyle K., Kennedy L. Translation from English. / Ed. ON THE. Shostak, 2011 12. Joint pain. Differential diagnosis, Filonenko S.P., Yakushin S.S., 2010 13. Rheumatology, Ed. ON THE. Shostak, 2012 14. West S.J. - Secrets of rheumatology, 2008 15. Diagnosis and treatment in rheumatology. Problematic approach, Pyle K., Kennedy L. Translation from English. / Ed. ON THE. Shostak, 2011
Information
ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION
Evaluation criteria for monitoring and auditing the effectiveness of protocol implementation (clear listing of criteria and linkage with indicators of treatment effectiveness and/or creation of protocol-specific indicators)
Reviewers: Kushekbaeva A.E., Ph.D., Associate Professor, Department of Rheumatology, ASIUV
External review results: positive rating, recommended for use
List of developers
1. Togizbaev G.A. - Doctor of Medical Sciences, chief freelance rheumatologist of the Ministry of Health of the Republic of Kazakhstan, head of the Department of Rheumatology, AGIUV
2. Seisenbaev A.Sh. Doctor of Medical Sciences, Professor, Head of the Rheumatology Module of the Kazakh National Medical University named after S.D. Asfendiyarova,
3. Aubakirova B.A. - chief freelance rheumatologist in Astana
4. Sarsenbayuly M.S. - chief freelance rheumatologist of the East Kazakhstan region of the Kazakh National Medical University named after S.D. Asfendiyarova,
5. Omarbekova Zh.E. - chief freelance rheumatologist of Semey
6. Nurgalieva S.M. - chief freelance rheumatologist of the West Kazakhstan region
7. Kuanyshbaeva Z.T. - chief freelance rheumatologist of Pavlodar region
Indication of the conditions for reviewing the protocol: the presence of new diagnostic and treatment methods, deterioration of treatment results associated with the use of this protocol.
Attached files
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Osteoporosis refers to metabolic systemic diseases of the spine associated with a decrease in the density of bone tissue in the vertebrae. The name “metabolic” clearly indicates that the disease is caused by some hidden metabolic processes occurring in our body, invisible to our eyes. Spinal osteoporosis develops almost asymptomatically, but its consequences are among the most tragic. Therefore, knowing the signs of this disease is extremely important for timely diagnosis and treatment.
Spinal osteoporosis: symptoms and treatment
The main distinguishing features of osteoporosis:
- It is a disease predominantly of old age
- Women get sick more often. Disease levels:
- Among women - up to 33%
- Among men - up to 20%
- Osteoporosis is the most traumatic disease:
An increase in bone porosity leads to compression fractures, which occur with the slightest provoking factors - falls and bruises, unsuccessful movements and loads. In old age, such fractures become causes of disability and early death.
- Not only the joints, but also large joints are gradually subject to destruction: especially the hip and knee
Causes and factors of osteoporosis
According to its causes, osteoporosis of the spine can be divided into primary and secondary.
Etiology of primary osteoporosis
- Hormonal changes during menopause in women over 50 years of age:
The decrease in estrogen during menopause causes women to lose approximately 50% of their bone mass 10 years after menopause. Women's bones literally melt with age, and weight, also due to hormonal imbalances, on the contrary, tends to increase. This contradiction leads to the danger of involuntary fractures - Senile age changes:
Tissue nutrition, the supply of essential elements to the bones, due to a slowdown in metabolism, inevitably decreases in old age. - Pathologies of skeletal development in adolescents:
Rapid growth of children between 10 and 12 years of age and hormonal abnormalities are the cause of so-called juvenile osteoporosis
Juvenile osteoporosis is a largely transient phenomenon of adolescence, and its treatment is most successful
- The development of the disease can occur without clear reasons in young people of both sexes. In this case, it is defined in the group of idiopathic pathologies
Etiology of secondary osteoporosis
- Inherited genetic factors
- Taking hormonal and other medications:
- corticosteroids, thyroid hormones
- immunosuppressants
- anticoagulants
- antacids to neutralize gastric juice
- narcotic drugs
- Endocrine diseases (thyroid and parathyroid glands, adrenal glands, hypothalamus)
- Rheumatism
- Diseases of the circulatory and urinary systems and digestive organs
Factors accelerating the development of osteoporosis
- Lack of calcium and vitamin D in human nutrition is one of the main factors contributing to osteoporosis.
- Frequent consumption of alcohol, coffee, and smoking contribute to the leaching of calcium from the body
- Heavy weight and heavy lifting increases the load on the skeleton and accelerates the bone destruction process
- A sedentary lifestyle leads to a slowdown in internal metabolism
Symptoms of osteoporosis of the spine
Osteoporosis can manifest itself both in externally smoothed symptoms and in acute ones:
- Aching periodic pain may be the only symptom of an incipient disease
Sudden sharp pain indicates something has happened. In this case, the pain increases with the slightest movement and even during periods of coughing, sneezing, laughing
- Subsequently, at the site of fusion of the vertebrae, if the fracture went unnoticed and without treatment, a curvature forms
Clinical symptoms of the disease as it develops:
In the thoracic region:
- Discomfort and feeling of heaviness between the shoulder blades
- Primary changes in posture
- Formation of kyphosis (stooping) of the thoracic region
- The appearance of a “senile” hump
- Shortening of the chest (due to a decrease in the distance between the vertebrae) and the appearance of visual disproportion between the torso and arms (they seem too long)
- The 10th - 12th vertebrae are predominantly affected
Osteoporosis of the lumbar spine:
- Moderate (acute in case of a fracture), increasing with bending or prolonged sitting
- Increased lumbar lordosis
- The distance between the edge of the superior iliac bone of the pelvis and the lower edge of the costal arch is reduced, which can lead to pain in the side
- Characteristic folds appear on the sides
- The first and second lumbar vertebrae are more susceptible to fractures.
Both thoracic and lumbar osteoporosis have common symptoms that allow one to suspect the disease:
- Feeling the sore area causes pain
- A person’s height decreases, and the difference can reach ten to fifteen centimeters
- Increased tension and pain
- Posture deteriorates and the figure looks bent
- Indirect additional symptoms appear:
- Cramps in the leg muscles at night
- Periodontal disease and loose teeth
- Early gray hair
An important symptom that distinguishes osteoporosis from other pathologies:
Radicular syndrome or myelopathy is not typical for this disease, with the exception of a compression fracture caused by trauma
Diagnosis of osteoporosis
Methods used:
- X-ray
- Bone radioisotope scan
- Densitometry
- Lab tests:
- General blood and urine
- Biochemical analysis (calcium, phosphates, bilirubin, urea, etc.)
- Hormonal (hormones of the thyroid gland, ovaries, etc.)
X-rays reveal osteoporosis quite late, when bone density decreases by 30%. The photographs show:
- Vertebral transparency
- Greater clarity of the vertical bone partitions of the vertebral bodies, in comparison with horizontal ones
- The vertebrae decrease in height, their wedge-shaped deformation appears due to compression of the anterior wall
However, the most verifiable diagnostic method today is densitometry..
It is a study of bone mineral density, namely the calcium content in them, using one of four methods:
- Ultrasound examination
- X-ray absorptiometry
- Quantitative magnetic resonance imaging
- Quantitative computed tomography
Treatment of osteoporosis
The main treatment is to slow down the process of bone loss and prevent its destruction. For these purposes, you need to completely adjust your life and diet.
Diet
You need to include in your diet foods containing large amounts of calcium, phosphorus and vitamin D:
- Dairy and fermented milk products (cottage cheese, kefir, butter)
- The following types of fish:
pink salmon, salmon, Atlantic herring, pollock - Dried fruits
- Sesame
- Carrot
- Black bread
- Women are recommended to take products containing natural estrogen:
Beans, soybeans, nuts, greens
If there is a lack of calcium and vitamin D in food products, then the deficiency is compensated by pharmacy mineral-vitamin complexes.
The daily intake of vitamins D and calcium should be as follows:
- Vitamin D – 800 IU
- Calcium – 1000 – 1500 mg
When taking calcium, you need to remember that a single dose of Ca should not be more than 600 mg
Weight control
Weight loss also has a beneficial effect and slows down the progression of the disease. Therefore, it is extremely important to keep a diet for people prone to obesity:
Do not consume flour products, sweet foods, carbonated water
Pain treatment
For osteoporosis, traditional pain medication can also be used.:
- Using non-steroidal anti-inflammatory drugs, which can also be applied externally in the form of ointments or gels
- Using selective second-generation NSAIDs with fewer side effects:
, Nise, etc. - Taking calcitonin for seven to ten days can also reduce pain
Basic medicinal drugs:
- - drugs that temporarily stop the pathological destructive process necessary for bone synthesis
- Calcitonin is a peptide hormone produced by the thyroid gland, responsible for the concentration of Ca in the blood.
- HRT (hormone replacement therapy) drugs, namely estrogen, which improves bone metabolism
- Vitamin CA + D complexes
Calcitonin and vitamin D are necessary to improve calcium absorption and absorption by the body
Treatment difficulties
- “The other side of the coin” in the treatment of osteoporosis is complications with long-term use of calcium-containing drugs and biosphosphonates:
.
Ingestion of calcium in large doses over a long period leads to hypercalcemia
.
Biosphosphonates cause:- renal failure
- digestive problems
- dental difficulties
- It is also necessary to warn women against incessant use of synthetic hormonal drugs containing estrogen due to the risk of cancer, especially breast cancer (breast cancer).
Treatment of osteoporosis often becomes a dead end precisely because the most effective medications can become the basis for even more serious diseases.
