Periarticular and systemic osteoporosis: symptoms and treatment. Causes and treatment of systemic osteoporosis Systemic osteoporosis that developed against the background of hypogonadism
Osteoporosis is a disease in which the leaching of calcium and other minerals from the bone tissue prevails over their accumulation, which causes its irreversible modification. The bones become brittle, and in the structure of their tissues there is a “restructuring”, which consists in reducing the number of plates that form it.
Voids and pores are formed, the size of which is sometimes comparable to the size of holes in hard cheeses.
Frequent fractures in osteoporosis
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 is enough to earn a “bedridden” fracture of the femoral neck. Such metamorphoses are caused by a violation of phosphorus-calcium metabolism in the body. Where does calcium “leave” and why does osteoporosis occur, what are its symptoms and how successful is the treatment?
Prerequisites for the development of osteoporosis largely take into account its classification. Let's consider the most common of them.
Let's start with a topographic classification, in which two forms of the disease are distinguished - local and generalized.
With local form the bone substance of a particular bone loses its density due to fractures, displacements, bruises, burns, toxic effects, etc.
Depletion of bone tissue can take the form of round or oval foci of various sizes (spotted osteoporosis).
If the bone is evenly depleted, they speak of uniform local osteoporosis.
Osteoporosis of the hip can lead to severe fractures
Local rarefaction of the bone tissue structure often occurs in the bones that form large joints. A typical case and a common cause of severe, "immobilizing" fractures in the elderly is osteoporosis of the hip joint, in which the disease affects the neck of the femur.
There are also regional osteoporosis, covering an anatomical region consisting of several bones, more often 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 most commonly affected are the hip and knee joints.
If the pathological process also affects the soft tissues of the joint, they talk about periarticular osteoporosis. Periarticular osteoporosis of the hands is a frequent consequence of a decrease in bone density and a violation of their structure, manifested by pain in the joint and its crunching at the time of movement.
Leads to severe consequences diffuse osteoporosis of the spine, in which there is a reduced density of tissue in its vertebrae.
Diffuse osteoporosis of the spine threatens to fracture the spinal column
In addition to stoop, strengthening the lumbar curve and the formation of a hump, this type of disease threatens with severe fractures of the spinal column.
Systemic osteoporosis affects all the bones of the skeleton.
Osteoporosis in children and adults
Also distinguished:
Gender injustice
Although osteoporosis of the bones is diagnosed in almost 100% of men who have crossed the 75-year mark, women still remain the first contenders for “bone porosity”.
Causes of osteoporosis in women:
- Disharmony of hormones caused by menopause. The metabolism of calcium ions is carried out mainly in the constantly renewing bone tissue. It is constantly undergoing metabolic processes. Special cells - osteoblasts - synthesize bone substance, while others - osteoclasts - "resorb" it. Responsibility for the balance in this system is the 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 with a deficiency of calcium, phosphorus and magnesium, proteins and unsaturated fatty acids, vitamin D, which does not at all contribute to strengthening bones;
- A dangerous "couple" - alcohol and nicotine, if they are not separated for a long time, lead to a loss of 25% of bone mass;
- Ovarian dysfunction or removal.
See the video for more details:
The beginning of the disease is very easy to miss - its first symptoms are very blurred.
In the early stages, signs of impaired salt metabolism will help to suspect osteoporosis:
- pain in the bones and neck;
- 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. With a decrease in bone mass, 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 tiptoe, pressure from above on outstretched arms, accompanied by pain in the spine. Often there is a "painful" feeling between the shoulder blades. Bone fractures are on the rise. A further decrease in bone density in some women causes a decrease in height, sometimes significant, up to 10-15 cm.
With similar symptoms, the disease declares itself to the representatives of the opposite sex.
In women who have not reached the menopausal period, the depletion of bone tissue can be the result of significant weight loss. So, rigid 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 exercise - eventually result in a severe degree of bone demineralization, fraught with joint deformity.
For more information on the symptoms of osteoporosis, see the video:
It has been established that blond women with very fair skin are at risk of getting “porosity” of bones more than, for example, dark-skinned representatives of the Negroid race.
What are the complications of disability?
Poorly healed fractures and skeletal deformities associated with osteoporosis with a high degree of bone demineralization often render the patient unable to work and may even be bedridden.
The question is brewing - do they give disability in osteoporosis?
The decision of the special commission depends on the severity of the complications:
- Obtaining a disability of the 3rd group is likely with significant kyphoscoliosis, aggravated by a strong pain syndrome;
- Fracture of the femur or other bone, complicated by the development of the so-called "false joint" - a reason for establishing group 2 disability. The likelihood of getting it increases in the presence of cardiovascular or respiratory failure;
- Disability of the 1st group is established in the critical course of life-threatening and bedridden osteoporosis.
Osteoporosis threatens disability
Sick, come on!
The best way to determine how much bone mass has decreased 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 terms of the level of decrease in bone mineral density.
Among the auxiliary methods for diagnosing osteoporosis are radiography, the study of the levels of such markers of osteoporosis 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, the disease destroys the bones from the inside, turning their strong homogeneous tissue into a fragile structure with gaping voids. Therefore, it is necessary to lay the “foundation” and strengthen the bones without waiting for fractures, starting from the moment of intensive growth, during pregnancy and lactation. How? Compensate for calcium deficiency, which is always accompanied by imperfections in the diet, with products containing mineral salts and vitamin D.
But do not forget at the same time that the body does not make “reserves” for the future, and therefore, taking the right portion of calcium from the tablet, it will hasten to get rid of the excess, removing them 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 in order for the body to be able to use them “for their intended purpose” during menopause, women during this period often require estrogen replacement therapy, combined with calcium, vitamin D and bisphosphonates, drugs aimed at suppressing bone decay. Fluorine preparations are also effective.
Prevention of osteoporosis will help to avoid the disease
In some cases, the doctor prescribes the wearing of supporting 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 the doctor and exercised with an exercise therapy instructor.
We should not forget about the intrapersonal "underlying reason" of the disease. After all, the psychosomatics of osteoporosis, or its psychological causes, often indicates that a person has a feeling of lack of some kind of support. Therefore, follow the recommendations of the attending physicians - an endocrinologist and a rheumatologist, eat rationally, eradicate bad habits and be sure: you can 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 a violation of the microarchitectonics of bone tissue, leading to an increase in bone fragility and an increased risk of fractures.
There are primary osteoporosis: postmenopausal (type I), senile, or senile (type II); idiopathic (in adults, juvenile) and secondary osteoporosis. Many diseases of the endocrine system, digestive organs, kidneys, blood, rheumatic diseases, genetic disorders, drug treatment (corticosteroids, antacids containing aluminum, thyroid hormones, etc.) lead to secondary osteoporosis.
Osteoporosis is a complex multifactorial disease, which is based on the processes of impaired bone remodeling in the direction of increased bone resorption and reduced bone 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), vitamin D metabolism is important, the development of resistance to it is a deficiency of receptors for vitamin D. For postmenopausal osteoporosis, a trabecular type of bone loss is characteristic, for senile - 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 fracture of the femoral neck and multiple wedge-shaped vertebral fractures.
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 "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 pains in the lower back are disturbing. Moderate or mild back pain may persist due to mechanical compression of the ligaments, muscles, and their attachment sites. A progressive dorsal kyphosis develops, called "widow's hump".
Severe kyphosis and reduced height can cause pain associated with pressure on the ribs, iliac crests, and intervertebral articular surfaces. The waist line is gradually lost, the stomach protrudes forward. In severe cases, the lower ribs practically descend into the pelvic cavity. A progressive change in posture leads to shortening and contraction of the back muscles, which causes muscle strain pain and is one of the leading causes of chronic back pain.
There may be diffuse pain in the bones, pain when tapping on the vertebrae, ribs, pelvic bones. A positive test with an indirect load on the spine: the doctor presses from above on the patient's arms stretched forward with tension, which causes severe pain in the spine. A sharp lowering from a tiptoe position also leads to severe pain in the spine.
With a slow onset of the disease, patients are disturbed by occasional dull back pain. Provoking factors may be the alternation of rest and movement. Over time, the pain becomes stronger and longer, disappearing in the supine position. There is sensitivity to concussion, pain "in all the bones." In the future, there are acute pain attacks associated with the fractures described above.
Diagnostics.
Radiography of the spine, large bones. Despite numerous criteria for the diagnosis of osteoporosis, it is believed that only the detection 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 density. The method of double energy absorptiometry is applied.
Determine the content of calcium, phosphorus in blood serum and urine, blood alkaline phosphatase. However, they often do not deviate from the norm.
To assess bone formation, the content of osteocalcin, carboxyamino-terminal peptides of type I collagen in blood serum (increase in content) is examined. Markers of bone resorption: tartrate-resistant acid phosphatase of platelets, erythrocytes, bone tissue, urine hydroxyproline, etc. (increase in content).
Treatment.
Calcium, vitamin D3, calcitonin. In postmenopausal women - estrogen replacement therapy. Diclofenac, ibuprofen, naproxen, sulindac, ketoprofen, piroxicam, meloxicam, lorioxicam, celecoxib, nimesulide other NSAIDs.
Sources of information:
- 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. Practitioner's Handbook.
- Roitberg 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 the violation of the mechanisms of modeling and remodeling of bone tissue. O. s. can be both the result of exposure to adverse environmental factors and 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, viruses. Risk factors for systemic osteoporosis may include early menopause, adrenal hyperfunction, hyperthyroidism, hypogonadism, excess phosphorus intake, starvation (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 in the pathology of the gastrointestinal tract. More often, several risk factors act simultaneously, so the disease is considered polyetiological multifactorial.
clinical picture. O.'s manifestations with. varied. One of its most persistent 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 deformity of the ankle joints or the appearance of swelling and pain in the area of the feet with its gradual spread to the large joints of the lower and small upper extremities. Subsequently, pain in the pelvic bones, ribs, which increases with physical exertion, joins. Further progression of the process is accompanied by a persistent pain syndrome, which does not disappear at rest and often forces one to take analgesics for a long time. Sometimes the first manifestation of O. with. there is a pathological fracture of the bones of the lower third of the forearm. None of the symptoms are pathognomonic and can be seen in many other metabolic osteopathies, multiple myeloma.
The course of the disease is often slow, but progressive. Spontaneous regression has been 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 during lactation). With the progression of the disease, the violation of bone mineralization increases every year, which is accompanied by a decrease in its mechanical strength. As a result, pathological fractures, secondary deformities are noted, which often lead to disability.
Diagnosis. The most important role in O.'s diagnosis with. X-ray examination is assigned, in which a decrease in bone shadow density (osteopenia), increased vertical striation of the vertebral bodies, sclerosis of the subchondral plates, numerous depressed fractures in the central sections of the subchondral plates, fractures of the vertebral bodies (Fig. 1), pelvic bones, femoral necks, other bones of the skeleton. Thinning of the cortical layer of long tubular bones, 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 enlightenment are observed in long tubular bones, as well as in the bones of the skull and hands.
At some forms O. of page. X-ray features are possible. Thus, in the steroid form of the disease, in contrast to the postmenopausal one, the deformity of the vertebral bodies in the fish type is more common (Fig. 3). Wedge-shaped deformity of the vertebral bodies in patients with postmenopausal form occurs without visible trauma, and with O. s. in young and middle-aged people, such a deformation of the vertebral bodies can be detected after lifting weights or falling from a height of their height. Numerous compression fractures of the vertebral bodies, which were previously described as hormonal spondylopathy or osteoporotic spondylopathy, are more appropriately referred to as platyspondylia, given that such an x-ray picture can be observed not only in various forms of O. s., but also in other diseases and metabolic osteopathies. As a rule, there is no connection between such a deformation of the vertebral bodies and endocrine disorders. Fractures of the necks of the femur are more common in patients with senile form O. s., and pelvic fractures - in young and middle-aged people. None of the radiological symptoms is pathognomonic, because similar changes can be noted 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 the 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 the activity of alkaline phosphatase, transient hypercalciuria, increased urinary excretion of hydroxyproline are possible. In cases where hypocalcemia is combined with an increased release 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 the diagnosis of the disease. Non-invasive methods include X-ray densitometry, X-ray morphometry, gamma-photon absorptiometry. X-ray morphometric and X-ray densitometric methods are quite simple, take little time, but they allow you to determine mainly the mass of the cortical part of the bone and measure only in the area of the phalanges or II metacarpal bone, which are affected in O. with. not in the first place. The spine and femoral neck are considered the most vulnerable parts of the skeleton in systemic osteoporosis, so data on the state of these parts of the skeleton are of the greatest value. They can be obtained by two-photon absorptiometry and computed tomography.
An invasive method for assessing bone mass is histomorphometry of the material obtained from a biopsy of the iliac wing. It allows to obtain a quantitative characteristic of such parameters of bone tissue as cancellous bone volume, trabecular width, cortical plate width and porosity.
In all cases when there are difficulties in O.'s diagnosis with. according to the clinical and radiological picture and biochemical data, the patient should be referred to a specialized orthopedic hospital.
Treatment. The use of calcium preparations alone does not stop the progression of the pathological process and does not increase bone mass. The use of anabolic hormones contributes to an increase mainly in muscle mass. Data regarding the therapeutic effect of estrogens are contradictory. Their use, undoubtedly, is pathogenetically justified at O. of page which developed against the background of the Hypogonadism at 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.
Wide application for O.'s treatment of page. found fluorine preparations, tk. their introduction as a result of the substitution of hydroxyl ions in hydroxyapatite leads to an increase in bone volume, improves the structure of the crystal lattice. But the matrix newly formed under the influence of fluorides is poorly mineralized, therefore, treatment with fluoride preparations (ossin, correberon, tridine) must be combined with the appointment of active vitamin D metabolites and calcium preparations. Long-term fluoride treatment, 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, the intake of fluorine and calcium cannot be combined in time, and the interval between their intake should be several hours. With fluorine preparations, it is also impossible to simultaneously take dairy products, cereals cooked in milk. In cases where hypocalcemia is observed in systemic osteoporosis, treatment should be supplemented with the intake of oxydevit (an active metabolite of vitamin D), which improves calcium absorption in the intestine.
Treatment of various forms of systemic osteoporosis with only active vitamin D metabolites is based on evidence of calcium malabsorption in the intestine. There is evidence that the appointment of oksidevit 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 (already after 2 -5 months after the start of treatment), stops the loss of spongy bone, maintains the thickness of the trabeculae and the width of the cortical bone plate. In some patients, during treatment with oxydevit, a significant increase in the width of the trabeculae and cortical plate is noted, which indicates the effect of the drug on the processes of modeling and remodeling. In each case, an individual selection of the dose of the drug and the duration of the course of treatment is necessary. Just as in the treatment with fluoride preparations, biochemical control is necessary at least once every 6 months. Mandatory components of O.'s treatment with. are exercise therapy, massage. With muscle weakness, hydrokinesitherapy is recommended. The therapeutic motor regimen is determined individually, health paths, close tourism or walks are prescribed. The complex of therapeutic measures includes orthotics. Corsets are prescribed according to indications.
Violation of the processes of remodeling and modeling in patients with O. s. excludes the possibility of surgical treatment of fractures of the femoral neck or other fractures without prior and subsequent conservative treatment.
Bibliography: Kon R.M. and Roth K.S. Early diagnosis of metabolic diseases, trans. from English, p. 350, 398, M., 1986; Violation 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
RCHD (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
on the Expert Commission
on health development
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 a violation of the microarchitectonics of bone tissue, leading to increased bone fragility and the appearance 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 growth or lifting a load weighing about 10 kg. Basically, osteoporosis affects women (especially after menopause) and the elderly.
Fractures are the main complication of osteoporosis.
The most common in osteoporosis are: fracture of the radius "in a typical place" (develops when falling on an outstretched arm); fracture of the femoral neck (the most formidable, since about half of the patients after such a fracture remain disabled and need outside care);compression fracture of the spine(develops after falling on the back or lifting a weight, accompanied by severe back pain).
Protocol name: Osteoporosis
Protocol code:
Code (codes) according to ICD-10:
M 80 Osteoporosis with pathological fracture
M80.0 Postmenopausal osteoporosis with pathologic fracture
M80.1 Osteoporosis with pathological fracture after ovariectomy
M80.2 Osteoporosis with pathologic fracture due to immobility
M80.3 Post-surgical osteoporosis with malabsorption pathological fracture
M80.4 Drug-induced osteoporosis with pathologic fracture
M80.5 Idiopathic osteoporosis with pathological fracture
M80.8 Other osteoporosis with pathologic fracture
M80.9 Osteoporosis with pathological fracture, unspecified
M81 Osteoporosis without pathological fracture
M81.0 Postmenopausal osteoporosis
M81.1 Osteoporosis after ovariectomy
M81.2 Osteoporosis due to immobility
M80.3 Post-surgical osteoporosis due to intestinal malabsorption
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 - ultrasonography
DXA - dual energy X-ray absorptiometry
Classification
Distinguish:
A. Primary osteoporosis
B. Secondary osteoporosis
A. Primary osteoporosis
1. Postmenopausal osteoporosis (type 1)
2. Senile osteoporosis (type 2)
3. Juvenile osteoporosis
4. Idiopathic osteoporosis
B. Secondary osteoporosis
I. Diseases of the endocrine system
1. Endogenous hypercortisolism (Itsenko-Cushing's disease and syndrome)
2. Thyrotoxicosis
3. Hypogonadism
4. Hyperparathyroidism
5. Diabetes mellitus (insulin-dependent type I)
6. Hypopituitarism, polyglandular endocrine insufficiency
II. Rheumatic diseases
1. Rheumatoid arthritis
2. Systemic lupus erythematosus
3. Ankylosing spondylitis
III. Diseases of the digestive system
1. Resected stomach
2. Malabsorption
3. Chronic liver disease
IV. kidney disease
1. Chronic renal failure
2. Renal tubular acidosis
3. Fanconi syndrome
V. Blood diseases
1. Myeloma
2. Thalassemia
3. Systemic mastocytosis
4. Leukemias and lymphomas
VI. Other diseases and conditions
1. Immobilization
2. Ovariectomy
3. Chronic obstructive pulmonary disease
4. Alcoholism
5. Anorexia nervosa
6. Eating disorders
7. Organ transplant
VII. Genetic disorders
1. Osteogenesis imperfecta
2. Marfan syndrome
3. Enders-Danlos syndrome
4. Homocystinuria, or sinuria
Diagnostics
Clinical Criteria:
Complaints and anamnesis: The main complaint of patients with OP is pain in the back. The pain may be episodic and associated with either awkward movement or heavy lifting. Often patients 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, the need for repeated rest during the day, preferably in a prone position.
Less common are complaints of pain in the joints, gait disturbances, and lameness. Taking non-steroidal anti-inflammatory drugs does not relieve pain. The severity of it may be different in the same patient at different time intervals.
The causes of back pain in 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 the paraspinal muscles.
With a fresh fracture of the vertebral body, acute pain occurs, radiating in the form of radicular pain to the chest, abdominal cavity or thigh and sharply limiting movement. The pain increases with minimal movements, lasts 1-2 weeks, then gradually subsides over 2-3 months.
Complaints and anamnesis: back pain, feeling of tiredness in the back while sitting or standing. Decreased height (by 2.5 cm per year or 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, falling out of the blue) with localization of fractures typical for osteoporosis: lumbar spine, proximal femur, radius at the wrist (Collis fracture);
2. deformity of the spine: kyphosis, Scheuermann-Mau disease (juvenile kyphosis), reduced growth (due to flattening of the vertebrae);
3. stiffness and soreness of the joints;
4. a series (one after another) of compression fractures of the lumbar and thoracic vertebrae with severe back pain 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 of 2 cm or more at 1–3 years of follow-up and 4 cm compared with height at 25 years of age is a reason for spinal radiography to detect vertebral fractures (B).
Laboratory diagnosis of osteoporosis:
For the biochemical assessment of bone mineral density, the following research methods exist:
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 proves that most often the routine biochemical parameters of phosphorus-calcium metabolism are not changed or change slightly and briefly even in severe osteoporosis with a fracture.
To determine the state of bone remodeling in blood and urine, highly sensitive biochemical markers of bone metabolism are examined. In a pathological situation, they reflect the predominance of impaired bone formation or bone resorption.
| Biochemical markers of bone remodeling | ||||||||||||||||
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Determination of 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 (in case of glucocorticoid osteoporosis, the bones of the spine).
Typical radiological signs of a decrease in bone mineral density:
1. increase in "transparency", change in the trabecular pattern (disappearance of transverse trabeculae, coarse vertical trabecular striation);
2. thinning and increased contrast of the endplates; a decrease in the height of the vertebral bodies, their deformation in the form of wedge-shaped or "fish" (with pronounced forms of osteoporosis).
Bone demineralization can be detected by radiography in the case of a decrease in density of at least 30%. X-ray studies are of great importance in assessing deformities and compression fractures of the vertebrae.
More accurate quantitative methods for assessing bone mass (densitometry, from the English word density - “density”). Densitometry allows to detect bone loss in the early stages with an accuracy of 2-5%. There are ultrasonic, as well as X-ray and isotope methods (mono- and dual-energy densitometry, mono- and two-photon absorptiometry, quantitative CT).
Indications for the determination of the IPC:
. women aged 65 years and older, men 70 years and older, regardless of clinical risk factors;
. premenopausal women and men aged 50-69 who have clinical risk factors;
.women who have entered the menopause period 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;
. adults with certain conditions (eg, rheumatoid arthritis) or taking certain medications (prednisone ≥ 5 mg/day or equivalent for ≥ 3 months) that result in decreased bone density or bone loss;
. persons who were previously recommended pharmacotherapy for OP;
. patients previously treated with OP (MIC is determined to assess the effect of the therapy);
. individuals who have not received anti-osteoporotic therapy, but who have a bone loss that requires treatment;
. postmenopausal women who have stopped taking estrogen.
The main indicators that determine bone mineral density:
1. mineral content of the bone, expressed in grams of the mineral in the area under study;
2. bone mineral density, which is calculated on the diameter of the bone and expressed in g/cm 2 ;
3. Z-criterion, expressed as a percentage of the age-sex standard and in terms of the standard deviation (standarddeviation) from the average age norm (SD, or sigma). In children and adolescents, only this relative densitometry indicator is used.
4. T-test, which is expressed in terms of standard deviation. This indicator is the main one for assessing the severity of bone demineralization according to WHO criteria in adults.
Diagnostic "instrumental" categories of bone mineral density reduction
Indications for expert advice:
1. exclusion of secondary forms of osteoporosis - rheumatologist, endocrinologist, gastroenterologist
2. differential diagnosis with tumor diseases and tuberculosis - oncologist, phthisiatrician
3. definition of indications and method of surgical treatment of osteoporotic fractures - orthopedist.
The 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. SRP
11. Daily excretion of calcium and phosphorus with urine
12. Osteocalcin (blood)
13. β-cross-links
14. Radiography of the spine
15. Densitometry
List of additional diagnostic measures:
1. Pyridinoline and deoxypyridinoline 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 a group of secondary osteoporosis, as well as differentiate them from osteomalacia, multiple myeloma, metastatic bone lesions in oncological diseases, which are characterized by fractures resembling osteoporotic ones. Differential diagnosis of variants of primary osteoporosis is not difficult, since the age of patients, the time elapsed since the onset of menopause in women, the predominant localization of osteoporosis and bone fractures are of decisive importance here. If juvenile osteoporosis is suspected, variants of congenital osteopenia and Scheuermann's disease should be excluded.
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Treatment
Goals of osteoporosis treatment:
Prevention of bone fractures
slowing down or stopping bone loss;
Normalization of indicators of bone metabolism;
Treatment tactics:
Non-pharmacological treatments:
· Physical activity
Prevention and management of osteoporosis includes personalized exercise programs to maintain bone density and reduce the rate of bone loss with minimal risk. Physical activity in adolescence contributes to peak bone mass, but its effect on slowing BMD loss is very modest, and the incidence of fractures does not change at all. Exercise improves muscle coordination, mobility and stability; they reduce the frequency of falls by 25%. In addition, exercise improves daily functioning and delays disability. Ideally, patients should exercise almost daily, alternating between different types of exercise for the most optimal results and to shorten the recovery period from any exercise-related stress. Encourage patients to choose exercises they enjoy; this will help ensure consistency.
The full program involves a combination of aerobic, strength and flexibility exercises. A comprehensive bone-strengthening program should include exercises that involve moving your own body, such as slow running, walking, ice skating, and tennis. To avoid shock loads on the spine, patients with osteoporosis should avoid exercises such as jumping, aerobics, associated with sudden movements, and fast running.
Muscle strength exercises also strengthen bones. To strengthen the lower legs, hips, back, shoulders, forearms, hands and neck, special exercises should be used (such as leg press, calf raise, “bike”, quad extension, side bends, forward bends, arm rotations, triceps extension, rotation in wrists, shrug). Excessive flexion of the spine (“abs” in the supine position, bending over with sock reaching, exercises on appropriate machines), adduction and abduction of the legs can be dangerous.
·
Educational programs
The existing clinical guidelines do not cover the role and effectiveness of educational programs. As a result of the additional search, no studies were found on the impact of educational programs on quality of life and the risk of subsequent fractures. There are only indications that teaching patients to exercise can positively affect their health outcomes, and pain analysis of individuals with vertebral fractures, conducted in small group sessions, can help reduce back pain. Several studies have shown that osteoporosis education programs encourage patients to take preventive and curative measures and increase adherence to treatment. No studies were found evaluating the cost-effectiveness of educational programs.
1. Educational programs on osteoporosis (OP) encourage patients to take preventive and therapeutic measures and increase adherence to treatment.
2. Teaching patients with vertebral fractures about pain analysis and pain management interventions can lead to a reduction 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. Patients with back pain due to vertebral fractures are recommended to study measures to reduce back pain.
Prevention of falls
The importance of falling predisposition 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 medication, decreased vision, muscle weakness, lack of coordination and mobility. Monitor your patients' medications, especially sedatives and hypnotics, and screen them for alcohol abuse.
Advise patients at risk of fractures to assess the safety of their home. They may need to install safe railings, get rid of mats and potential obstructions, make sure lighting is adequate, and repair cracked pavement surfaces.
Additional protection for patients with a very high risk of falls can be clothing with padding in the thigh area.
· Smoking cessation.
Bone health is another reason for smoking cessation recommendations: the relative risk of developing osteoporosis is 5 times higher for smokers than for nonsmokers.
Diet.
Rational nutrition is necessary for the optimal condition of the skeletal system in all age periods. 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 the patient's history or physical examination indicates the need for calcium supplementation for the prevention or treatment of osteoporosis, individual dosage OTC forms are recommended. Calcium absorption is optimal when a single dose does not exceed 600 mg. The most effective and affordable source of calcium is calcium carbonate. A sufficient level of absorption is also desirable. Chewable tablets may be the means 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: stay in the sun for 10-15 minutes 3 times a day; eating foods such as milk, egg yolk, or fortified foods; taking multivitamins.
The recommended dose is 500 IU/day for persons 19 to 50 years of age and 800 IU/day for persons aged 51 years and over.
Recommended dose:
Calcium preparations in a prophylactic dosage for persons under 50 years of age: calcium carbonate 1250 mg (equivalent to elemental calcium 500 mg), cholecalciferol 5.5 μg (200 IU of 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 prevention, take 2 times a year for 3 months. Children from 3-5 years old 1 tablet per day, 6-11 years old 1-2 tablets per day.
Calcium preparations in a prophylactic dosage in persons over 50 years of age and in a therapeutic dosage are recommended: calcium carbonate 1250 mg (equivalent to elemental calcium 500 mg), cholecalciferol 11 mcg (400 IU of 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.
Medical treatment of osteoporosis:
Pathogenetic treatment includes the appointment 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 probable vitamin D deficiency).
List of main drugs:
Pathogenetic therapy (first-line drugs that slow down bone resorption):
1. Denosumab - human monoclonal antibody 60mg/ml
2. Estrogens, selective estrogen receptor modulators
3. Calcitonins - nasal spray 200 IU or IM 100 IU continuously or intermittently
4. Bisphosphonates: alendronic acid 35mg/s once a week
Ibandronic acid 150mg/s once a month
Zoledronic acid 5 mg/100 ml once a year IV, drip
5. Calcium and vitamin D preparations -
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:
- Denosumab - human monoclonal antibody 60mg/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 | Preparations |
| Slowing down bone resorption |
Estrogens, selective estrogen receptor modulators Denosumab is a human monoclonal antibody. Calcitonins Bisphosphonates |
| Stimulating bone formation |
Fluorides Parathormone A growth hormone Anabolic steroid Androgens |
|
Acting on both links of bone tissue remodeling |
Calcium and vitamin D preparations Active metabolites of vitamin D Ossein hydroxyapatite complex Ipriflavon Substances containing phosphates, strontium, silicon, aluminum Thiazides |
Preparations of the latest generation of bisphosphonates (salts of alendronic, zoledronic, risedronic acids) are the most powerful in their effect on bone tissue, they not only increase BMD, but also reduce the risk of fractures, including vertebrae. Bisphosphonates have been successfully used to treat not only postmenopausal but also glucocorticoid osteoporosis.
The agents 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 vial) 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 in osteoporosis of the spine than in osteoporosis of other bones, and intranasal calcitonin is reported to be less effective in affecting spinal BMD. However, the spray is more convenient to use, especially in children.
Despite the long-term use in practice of calcitonin in the form of a nasal spray, there are no unified recommendations on the mode of its use. Some authors provide data on its positive effect when administered daily for one year and even 5 years. Others insist on various intermittent schemes, for example, 1 month - "on" (assign), 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, therefore, when using it, there is a high risk of developing hypercalcemia and hypercalciuria. Alfacalcidol preparations are the safest in this regard. Alfacalcidol has a multifaceted effect on bone tissue, acts quickly, is easily dosed, is quickly excreted from the body, does not require hydroxylation in the kidneys to carry out its metabolic effect. The peculiarity of this form is that for the transformation into the final product (alpha-25-OH-D., (calcitriol) only hydroxylation in the liver at position 25 is necessary. The rate of this transformation 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 active vitamin D metabolites actually increase BMD and reduce the risk of bone fractures.Alfacalcidol is the only anti-osteoporotic agent that can be used without calcium supplements.However, the addition of calcium salts to the therapy of osteoporosis increases the effectiveness of the basic drug (to a greater extent, bone loss slows down, the frequency of bone fractures decreases).Alfacalcidol in combination with calcium carbonate has been successfully used to treat glucocorticoid osteoporosis. ol "freight lift", delivering calcium to the "place of demand".
A kind of "breakthrough" in the treatment of osteoporosis in the XXI century. was the emergence of a dosage form of parathyroid hormone. It has a dual effect on the bone - it reduces resorption and has an anabolic effect (stimulates osteogenesis). In terms of effectiveness, it surpasses all known anti-osteoporotic drugs.
But the injection method of administration for 1-1.5 years daily limits its use. In addition, there is evidence that with prolonged use of parathyroid hormone in rats, osteosarcomas can occur. The drug is very promising, but further study is needed, especially in children.
Denosumab is a human monoclonal antibody (IgG2) that targets RANKL, to which the drug binds with high affinity and specificity, preventing the activation of its RANK receptor on the surface of precursors, osteoclasts and osteoblasts. Prevention of the RANKL/RANK interaction inhibits the formation of osteoclasts, impairs their functioning and viability, thus reducing the resorption of both tubular and cancellous bones. The recommended dose of Denosumab is 1 sc injection of 60 mg once every 6 months, which is injected into the thigh, abdomen, or outer surface of the upper arm
Prevention
Prevention is conventionally divided into primary and secondary.
Primary prevention is the prevention of the development of OP in patients who are planned to be treated with systemic glucocorticoids for more than 3 months.
Secondary prevention - prevention of bone loss and fractures with reduced BMD (from 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 should be carried out using two approaches: promotion of a healthy lifestyle 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 impaired calcium metabolism.
The main measures for the prevention of osteoporosis and fractures in childhood, and therefore in working age and in old age, include the provision of good nutrition. Adequate calcium intake is the most important factor for achieving optimal bone mass and size.
Optimal calcium intake in different periods of a person's life.
Further management
- Dispensary observation
- Pathogenetic treatment (includes the appointment of drugs aimed at various components of the bone remodeling process) - permanent anti-osteoporotic therapy.
Information
Sources and literature
- Minutes of the meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
- List of references: 1. Rheumatology: Clinical guidelines / ed. Acad. RAMS E.L. Nasonova. - 2nd ed., Rev. and additional - M.: GEOTAR-Media, 2010. - 752 p. 2. Rheumatology: national leadership / 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: SpecLit, 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, GV Dzyak, 2005. 6. Actual nutrition of cardiology and rheumatology - Ed. V.G. Bidny, K.M. Amosova, O.B. Yaremenka, N.O. Karelian. - Kiev: Navchalna book, 2003. - 106 p. 7. Rheumatic diseases: nomenclature, classification, diagnostic and treatment standards - V.N. Kovalenko, N.M. Fur coat - K .: OOO "Katran group", 2002. - 214 p. 8. Osteoporosis: clinical guidelines. 2nd ed., Revised. and additional (Series "Clinical recommendations"), 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. Problem approach, Pyle K., Kennedy L. Translated from English. / Ed. ON THE. Shostak, 2011 12. Pain in the joints. 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. Problem approach, Pyle K., Kennedy L. Translated from English. / Ed. ON THE. Shostak, 2011
Information
ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION
Evaluation criteria for monitoring and auditing the effectiveness of the implementation of the protocol (a clear listing of criteria and the presence of a link with indicators of treatment effectiveness and / or the creation of indicators specific to this protocol)
Reviewers: Kushekbayeva A.E., Candidate of Medical Sciences, Associate Professor of the Department of Rheumatology, AGIUV
External review results: rating is positive, 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 Module of Rheumatology of the Kazakh National Medical University named after S.D. Asfendiyarov,
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. Asfendiyarov,
5. Omarbekova Zh.E. - chief freelance rheumatologist in 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 revising the protocol: the availability of new methods of diagnosis and treatment, the 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 bone density of the vertebrae. The name "metabolic" clearly indicates that the cause of the disease is some hidden metabolic processes that are invisible to our eyes, occurring in our body. Osteoporosis of the spine develops almost asymptomatically, but its consequences are one of the most tragic. Therefore, knowing the signs of this disease is extremely important for timely diagnosis and treatment.
Osteoporosis of the spine: symptoms and treatment
The main distinguishing features of osteoporosis:
- It is a disease predominantly in the elderly.
- 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 a compression fracture that occurs at the slightest provoking factors - falls and bruises, unsuccessful movements and loads. In old age, such fractures become the causes of disability and early death.
- Not only are gradually destroyed, but also large joints: especially the hip and knee
Causes and factors of osteoporosis
Osteoporosis of the spine can be divided into primary and secondary due to its causes..
Etiology of primary osteoporosis
- Hormonal changes during menopause in women over 50:
The decrease in estrogen during menopause causes women to lose approximately 50% of their bone mass 10 years after menopause. The bones of women literally melt with age, and weight, also due to hormonal disruptions, on the contrary, tends to increase. This contradiction leads to the risk of involuntary fractures. - Senile age changes:
Tissue nutrition, the supply of essential elements to the bones due to a slowdown in metabolism inevitably falls in old age - Pathologies of the development of the bone skeleton in adolescents:
The rapid growth of children in the period from 10 to 12 years, deviations of the hormonal plan are the cause of the so-called juvenile osteoporosis
Juvenile osteoporosis is mostly a transient phenomenon of adolescence, and its treatment is most successful.
- The development of the disease can take place without obvious reasons in young people of both sexes. In this case, it is defined in the group of idiopathic pathologies.
Etiology of secondary osteoporosis
- Hereditary genetic factors
- Taking hormonal and other medications:
- corticosteroids, thyroid hormones
- immunosuppressants
- anticoagulants
- antacids to neutralize stomach acid
- 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, heavy lifting increases the load on the skeleton and accelerates the bone destructive process
- A sedentary lifestyle leads to a slowdown in internal metabolism
Symptoms of osteoporosis of the spine
Osteoporosis can manifest itself in outwardly smoothed out symptoms, and in acute ones:
- Aching periodic pain may be the only symptom of an incipient disease
Sudden sharp pain indicates what happened. In this case, the pain increases with the slightest movement and even during periods of coughing, sneezing, laughter
- Subsequently, at the site of fusion of the vertebrae, if the fracture went unnoticed and without treatment, a curvature is formed
Clinical symptoms of the disease as it develops:
In the chest:
- Discomfort and feeling of heaviness between the shoulder blades
- Primary posture changes
- The formation of kyphosis (stoop) of the thoracic region
- The appearance of the "senile" hump
- Shortening of the chest (due to a decrease in the distance between the vertebrae) and the appearance of a visual imbalance between the trunks and arms (they seem too long)
- 10-12 vertebrae are predominantly affected
Osteoporosis of the lumbar spine:
- Moderate (with a fracture - acute), increasing with bending over 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
- Most often fractures of the first and second lumbar vertebrae
Both thoracic and lumbar osteoporosis have common symptoms that make it possible to suspect the disease.:
- Feeling the diseased area leads to pain
- Human height decreases, and the difference can reach ten to fifteen centimeters
- Increased tension and soreness
- Posture deteriorates, and the figure looks bent
- Indirect additional symptoms appear:
- Leg cramps at night
- Periodontitis and tooth loosening
- early gray hair
An important symptom that distinguishes osteoporosis from other pathologies:
Radicular syndrome or myelopathy is not characteristic of this disease, with the exception of a compression fracture due to trauma
Diagnosis of osteoporosis
Applied methods:
- x-ray
- Bone radioisotope scanning
- Densitometry
- Laboratory tests:
- General blood and urine
- Biochemical analysis (calcium, phosphates, bilirubin, urea, etc.)
- Hormonal (thyroid, ovarian, etc.)
X-ray reveals osteoporosis quite late, when bone density decreases by 30%. The pictures show:
- Transparency of the vertebrae
- Greater clarity of the vertical bony septa of the vertebral bodies compared to the horizontal ones
- The vertebrae decrease in height, their wedge-shaped deformation appears due to compression of the anterior wall
However, the most verification 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 thinning and prevent its destruction. For these purposes, you need to completely adjust your life and nutrition.
Diet
You need to include in your diet foods that contain large amounts of calcium, phosphorus and vitamin D:
- Dairy and sour-milk products (cottage cheese, kefir, butter)
- Fish of the following varieties:
pink salmon, salmon, Atlantic herring, pollock - Dried fruits
- Sesame
- Carrot
- Black bread
- Women are advised to take products with natural estrogen content.:
Beans, soybeans, nuts, greens
If there is a shortage of calcium and vitamin D in food, then the deficiency is compensated by pharmacy mineral-vitamin complexes.
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 intake should not be more than 600 mg.
Weight control
Weight loss also has a beneficial effect and slows down the development of the disease. Therefore, it is extremely important to keep a diet prone to overweight people:
Do not consume flour products, sweet foods, carbonated water
Pain treatment
Osteoporosis can also be treated with conventional pain medication.:
- With the help of 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 medicines:
- - drugs that temporarily stop the pathological destructive process necessary for bone synthesis
- Calcitonin is a peptide hormone produced by the thyroid gland that is responsible for the concentration of calcium in the blood.
- HRT (hormone replacement therapy) preparations, namely: estrogen, which improves bone metabolism
- Complexes of vitamins CA + D
Calcitonin and Vitamin D are needed to improve calcium absorption and absorption by the body
Difficulties in treatment
- The "other side of the coin" in the treatment of osteoporosis is the complications of long-term use of calcium-containing drugs and bisphosphonates:
.
Ca intake in high doses over a long period leads to hypercalcemia
.
Biophosphonates cause:- kidney failure
- digestive problems
- dental difficulties
- Women should also be warned against the irrepressible use of synthetic hormonal drugs containing estrogen due to the risk of cancer, especially breast cancer (breast cancer)
The treatment of osteoporosis often becomes a dead end precisely because the most effective treatments can become the breeding ground for even more serious diseases.
