Pathological fracture of the tibia. The occurrence of a pathological fracture

Very great importance It has X-ray method research in the clinic of pathological fractures. A pathological fracture, in contrast to an ordinary traumatic one, is such a violation of the integrity that occurs in a bone that has already been altered by some previous pathological process and which is caused by a relatively minor injury or even by muscle tension alone, i.e., inappropriately weak external, manifesting itself outside the bone impact.

Synonyms for a pathological fracture are widespread designations - spontaneous, spontaneous fracture. These latter terms should be discarded as methodologically unacceptable: it is quite obvious that not a single fracture, like any natural phenomenon in general, can arise autochthonously, spontaneously, spontaneously, that is, from itself, without a specific external cause.

Most bone lesions can lead to this type of pathological damage to the integrity of the bone, and practical interest in the radiodiagnosis of these fractures at the most various diseases It is determined by the relative frequency and nature of both the underlying disease and the fracture complicating it.

The greatest predisposition to a pathological fracture is created by destructive bone processes. But here it must be emphasized that the phenomena of osteosclerosis, as, for example, in marble disease, to no lesser extent capable of depriving the bone of its elasticity, strength and other mechanical properties. Both a decrease and an increase in the amount of mineral salts in the bone lead to its fragility. It would be better to call these bones not marble, but chalk - this would more accurately characterize their mechanical qualities. This will be discussed further ahead.

Most common cause pathological fractures are fibrous osteodystrophy and bone neoplasms. From the group of fibrous osteodystrophies, at least 50-60% of all solitary cysts are complicated traumatic injuries. A little less often, bones break with fibrous bone dysplasia, both with one- and multi-bone forms. Extremely often (up to 40-50%), fractures are also observed in Recklinghausen and Paget's diseases, while a giant cell tumor gives about 15% of pathological fractures. As for tumors, malignant neoplasms are in the first place, and metastatic, secondary ones, much more often give rise to a fracture than primary tumors. An important property pathological fractures in metastatic tumors is their frequent multiplicity, especially in lesions of the vertebral bodies.

Especially bone fractures in multiple myeloma metastases, where fractures are observed in two-thirds of all cases, less often in osteoclastic metastases of cancer and hypernephroma, and even less often in osteoplastic bone carcinosis. Osteoclastic bone sarcoma is almost 10 times more likely to fracture than its osteoplastic type. Among benign tumors chondromas strongly predominate. Almost as a rule, the bone breaks with its echinococcus. It is relatively rare to observe a fracture due to common common inflammatory bone diseases - osteomyelitis, tuberculosis and tertiary syphilis. An obligatory symptom is pathological fragility of bones with osteogenesis imperfecta and osteopsatirosis, there are almost always fractures in osteoarthropathies due to dry patches spinal cord and syringomyelia. They also occur on the basis of changes in the bones of a neurogenic nature after injuries. nervous system. A kind of microscopic pathological fracture with osteochondropathy, almost always with childhood scurvy, often with congenital syphilis. But, contrary to popular belief, a bone breaks very rarely with rickets and osteomalacia. Relatively rarely leads to a pathological fracture and osteoporosis of any origin. Now pathological fractures due to hemophilia have become known. In essence, a fracture of a bone callus that has not yet strengthened is also pathological, i.e., a local recurrence of a conventional traumatic fracture (refractura). Strictly speaking, pathological fractures should also include very peculiar, different from ordinary traumatic fractures ankylosed and atrophied spine in ankylosing spondylitis. Similarly, fractures of various bone growths are also pathological, for example, brackets with disfiguring spondylosis or osteoarthritis, marginal lips of saucer-shaped elevations with pseudoarthrosis, calcaneal or ulna etc. Relatively often we observe pathological fractures in atrophied bones near the joints with ankylosis of the latter, regardless of the cause of immobilization of the joints.

Naturally, every disease, affecting in certain age some elements of the skeleton are preferable to others, it is also characterized by a favorite localization and a pathological fracture. For example, a pathological fracture of the proximal metaphysis of the shoulder in school age speaks almost unconditionally in favor of a solitary cyst, the same fracture in a middle-aged man is about myeloma, a pathological fracture of the middle diaphysis of a long tubular bone of the lower limb in an old man makes one think first of all of Paget's disease, etc. Much more often than all other bones breaks in under pathological conditions, the thigh, then in descending order of frequency, the tibia, shoulder, clavicle, ribs, phalanges, etc. follow. Pathological compression fractures of the vertebral body are especially common.

Pathological fractures give a much higher percentage of all kinds of complications than ordinary violations of the integrity of the bone. In most cases, the healing process proceeds effectively even with pathological fractures, and the underlying disease does not prevent the onset of consolidation. Even with fractures on the ground malignant tumors not so rare if successful modern treatment the underlying disease has to observe the formation of callus.

Accurate recognition of a pathological fracture is extremely important, since the treatment of an ordinary traumatic and pathological fracture differs significantly from each other, and, in addition, with each individual disease, complicated by a violation of the integrity of the bone, shows its own special therapeutic measures. IN clinical picture the signs of the underlying disease, the signs of a fracture come to the fore, and accurate diagnosis without x-rays is usually difficult. Each of the symptoms of a fracture - pain, limitation of function, displacement of fragments, hemorrhage, crepitus - can be only very mildly expressed or even completely absent. X-ray diagnostics is simple and reliable, along with signs of a fracture, symptoms of the main lesion are also detected. X-ray examination, therefore, provides an opportunity not only to establish the fact of a fracture and its details, but also to find out the nature of the underlying process, its distribution, the degree of bone destruction, etc. In addition, and this is especially important, it is not uncommon for a fracture to be the first manifestation the underlying disease that was hidden before the x-ray examination, and the radiologist suddenly and for the first time discovers, due to a fracture, the true nature of the disease.

In some cases, a surprise in the X-ray room is the underlying disease, for example, a cyst or Paget's disease, with an unidentified fracture, but, on the contrary, with an already clinically recognized underlying disease, it is the pathological fracture that complicates this disease. This is especially true for cystic bone fractures in the so-called fractures in the form spyglass when a thinned cortical cylinder moves at the site of a transverse fracture to the end of another fragment and is thus fixed. Often they don't give one. clinical symptom and large cracks, folds and depressions pathological bones. In every doubtful clinical case, the radiologist must think about the possibility of a pathological fracture, because to take such a fracture for an ordinary traumatic one means to make a gross mistake.

pathological fractures occur in children with diseases of the bones of the skeleton when exposed to a slight traumatic force. The cause of such fractures can be imperfect bone formation, fibrous and cartilaginous osteodysplasia, beriberi (rickets, scurvy), inflammatory diseases (osteomyelitis, tuberculosis), etc. Imperfect bone formation is congenital bone fragility unknown etiology. In this disease, fractures are possible with a slight force effect: in children early age- when swaddling) shifting them, in older children - when trying to sit down, stand up - etc. Fractures are accompanied by soreness, pathological mobility and deformity, swelling and crepitus. There are subperiosteal fractures and fractures with complete displacement. Fractures are more common lower extremities, then top and ribs.

Clinically, imperfect bone formation is manifested by the curvature of the limbs due to multiple repeated fractures or fractures of the bones, muscle hypotrophy, the presence of blue sclera, sometimes "amber teeth" and hearing loss. At congenital form already in a newborn, attention is drawn to the curvature of the limbs with the deflection of the bones outwards or anteriorly. In the area of fractures, dense callus is often palpated. The number of fractures in such "glass children" is significant. Despite the fragility of the bones, fractures quickly grow together, however, as a result of muscle hypotrophy, incomplete adaptation of bone fragments, and “elasticity” of the callus, bone deformities occur. The disease is characterized by softness and compliance of the skull bones in young children, which is the cause of head deformity in older children (mainly in the anteroposterior direction).

On the x-ray, the bones appear delicate and thin, especially the thin cortical layer: the spongy substance is transparent and has a barely noticeable pattern. Fused fractures are clearly visible. Due to multiple fractures the limbs are deformed and shortened.

With imperfect bone formation, the treatment of fractures is reduced mainly to careful reposition, reliable immobilization until complete consolidation. The terms of fixation of the fracture are somewhat lengthened, despite the fact that the formation of callus occurs quickly and at normal age, but it remains “elastic” for a long time, as a result of which the possibility of deforming the limb with a fused fracture remains. Except local treatment fracture, general strengthening treatment is carried out: ultrasound irradiation, multivitamins, ergocalciferol (vitamin D), fish fat, calcium preparations, of hydrochloric acid with pepsin. It is advisable to prescribe the anabolic hormone methandrostenolone (nerobol), a hormone thyroid gland thyrocalcitonin intramuscularly. Treatment can also be outpatient settings in compliance with all the recommendations of the attending physicians of the hospital.

In case of frequently recurring fractures with severe and significant deformity of the limbs, surgical treatment is recommended, which mainly consists of corrective osteotomy, intramedullary osteosynthesis, and bone auto- or alloplasty to stimulate reparative regeneration. bone tissue. In addition to imperfect bone formation, pathological fractures are observed in diseases that disrupt the normal anatomical structure of the bone.

A pathological fracture in most cases is the first symptom of a bone cyst and osteoblastoclastoma. As a result of a minor injury in the area of the most frequent localization of the pathological focus: the proximal metaphysis of the humerus, the proximal and distal metaphyses of the femur and the proximal metaphysis of the tibia, pain occurs, moderate swelling and hemorrhage, and deformity are noted. There is a loss of function. Big displacement bone fragments, as a rule, are not observed; therefore, pathological mobility and crepitus are uncharacteristic of fractures in children with a bone cyst or osteoblastoclastoma. The diagnosis of a pathological fracture is established after an x-ray examination (Fig. 14.10).

Bone cyst formation is essentially a dystrophic process. The type of cyst depends on the biomechanical conditions in a particular part of the musculoskeletal system, on the hemodynamic disturbances in the bone that occur acutely during aneurysmal or solitary cysts stretched over time.

Most solitary cysts are localized in the proximal tubular bones. The humerus (56%) and femur (23%) bones are most commonly affected. The destruction process develops slowly, asymptomatically and is manifested by a pathological fracture. Most aneurysmal cysts are localized in spongy bones with a rich arterial blood supply (vertebrae; pelvic bones; ends of bones that form knee-joint). All patients have a history of trauma. The first symptoms are slight pain feeling of discomfort, stiffness. Clinical and radiological manifestations of bone cysts require differential diagnosis solitary cysts with fibrous dysplasia, non-osteogenic fibroma, hyperparathyroidism, eosinophilic granuloma. Aneurysmal cysts must be distinguished from chondromyxoid fibroma, osteosarcoma. Indications for conservative or surgical treatment phase dependent pathological process, the extent of the lesion and the data of cystography, angiography, radioisotope research, biopsy, etc.

With a lack of vitamins D and C, pathological fragility of bones occurs. With rickets and scurvy, fractures are observed in young children. A minor injury or awkward movement is enough for a child with rickets to have a fracture. These fractures usually occur in lower third femur and on the bones of the forearm. Often they are subperiosteal. Complaints of pain are insignificant, and the fracture is often visible; in such cases, only with the development of calluses and curvature of the limb, a former fracture is detected, which is confirmed by an x-ray.

Complete rachitic fractures grow slowly and require, along with reliable immobilization, vigorous anti-rachitic general treatment.

Changes in bones at a scurvy meet less often. With a lack of vitamin C in the second half of the first year of a child's life, rarely after a year, hemorrhages may occur in the epiphyseal line, which spread under the periosteum. Usually, hemorrhages occur in the region of the upper or lower end of the femur, the upper end of the tibia, in the ribs and humerus. At the site of the hemorrhage, the bone beams are destroyed and the integrity of the bone is broken. Clinically, there is swelling in the area of the limb, sharp pain during movement and palpation of the limb, thickening. Sometimes it is possible to palpate fluctuation under the muscles. The skin over the site of the most painful swelling is tense and shiny. The limb is in a forced position. On the skin - small petechiae, the gums swell and become bluish in color, in the presence of teeth there is gingivitis. On the radiograph, a shadow is found around the diaphysis, which gives a hemorrhage, and sometimes the separation of the epiphysis from the metaphysis. The separation of the epiphysis, in addition, is determined on the radiograph by a change in the position of the ossification nucleus: the shadow of the ossification nucleus does not lie along the midline, but shifts away from the axis of the limb.

Scurvy disease with bone lesions occurs with improper and malnutrition, directed artificial feeding. Sometimes children with bone disease due to beriberi C have a "well-fed" appearance; there are no signs of malnutrition, since the children have maintained their body weight, although they receive the same malnutrition.

Diagnosis is difficult when there is still no large hematoma and the child's complaints are vague. During this period, carers of the child note that touching him and shifting causes crying. With the appearance of swelling, sharp local pain, an increase in body temperature, there is a suspicion of inflammatory process- epiphyseal osteomyelitis, phlegmon. An error in diagnosis leads to the fact that an incision is made to the patient, during which only a hemorrhage is detected, and after surgery, the true nature of the disease is revealed.

General treatment of beriberi C, proper nutrition, the creation of rest of the pronounced limb quickly improves the condition of the child. In inflammatory diseases, bone tissue can be destroyed, which leads to a pathological fracture. Such diseases in children include osteomyelitis and tuberculosis. Significant destruction of bone tissue in osteomyelitis may be accompanied by a pathological fracture. They are most often observed in the lower metaphysis of the femur and in the region of its neck or in the upper third of the humerus. Bone altered by a pathological process may break under the influence of minor violence, often almost imperceptible. Therefore, this type of fracture is called spontaneous (spontaneous).

Recognition of a pathological fracture in osteomyelitis is not difficult. Often children begin to complain of increased pain in the limb. With complete fractures with displacement, pathological mobility, deformity and shortening of the limb are determined. Often a fracture is discovered by chance, during dressings. Clarifies the diagnosis x-ray examination. Pathological fractures in osteomyelitis are sometimes accompanied by an exacerbation of the inflammatory process, with insufficient immobilization, deformities and shortening of the limb occur, in rare cases false joints are formed.

With tuberculous lesions, pathological fractures are possible not only due to bone destruction, but also as a result of the development dystrophic processes in the bones of the entire affected limb - osteoporosis and atrophy.

Traumatology and Orthopedics
Edited by corresponding member RAMS
Yu. G. Shaposhnikova

A pathological fracture is a bone fracture that has occurred from the impact of a slight force or from a physiological load on a bone that has been altered by some pathological previous process. It can be inflammatory, dystrophic, tumor, dysplastic, infectious, etc. processes. The occurrence of pathological fractures mainly falls on the areas of pathological bone remodeling.

How are so-called pathological fractures treated?

To prescribe the right treatment for the patient, specialists conduct a thorough diagnosis of the disease in the patient in a variety of ways. Treatment of pathological bone fractures There are medical and surgical. Medical treatment is the application antibacterial agents and other chemotherapy drugs, vitamin D preparations. Surgical treatment depends on the underlying disease, on its nature, on the prevalence of the pathological process.

In general, the treatment of fractures of this type practically does not differ much from the treatment of ordinary fractures. But, as a rule, with pathological fractures, the periods of immobilization are lengthened. Orthopedic devices are used whenever possible for pathological fractures. special methods. For example, the Shevtsov-Matsukatov apparatus, the Ilizarov apparatus. These devices allow you to keep the patient's capacity even if the consolidation is very slow.

The most important for the treatment of pathological fractures is the identification of the cause of the painful restructuring of the bone, its elimination. For example, in oncological diseases, the task of getting rid of the tumor (by surgery, radiation, chemotherapy, or a combination of these methods) undoubtedly comes to the fore. In pathological fractures caused by osteomyelitis, antibiotics are prescribed to the patient. Surgery is necessary for a bone abscess. If the cause of this disease is osteoporosis, then treatment is needed. metabolic disorders tissues (bone) with the help of drugs that improve the microarchitectonics of bones and mineral composition bones.

The purpose of surgical treatment is to eliminate the pain syndrome, reduce the duration of treatment in the hospital, transfer the patient to ambulatory treatment. Also, the impact on the mental and emotional condition patient, promoting the use of other methods of treatment, facilitating patient care. Early activation possibility of formation of hypercalcemia, trophic ulcers and thrombophlebitis prevents.

In order to stabilize pathological fractures, surgical methods treatments should be selected individually for each patient, depending on the specific qualities of the affected bone, the involvement of soft tissue structures and localization.

Among various damage long bones in most cases, fractures of the humerus and femur are observed, and they require stable permanent intraosseous osteosynthesis. The load on the long bones must be resisted by such fixation. Against the backdrop of cancer bone lesion surgery a pathological fracture serves, one might say, to improve the quality of the patient's life in the remaining time period, but not to increase the patient's life expectancy.

Surgical treatment of these fractures that occurred against the background of malignant processes, both primary and secondary, with damage to the articular end currently involves arthroplasty. If the diaphyseal part of long bones is affected, then segmental resection is used using bone grafting or bone cement and fixation of bone fragments. Fixation is carried out by internal or external metal structures, and can be used different techniques transosseous osteosynthesis.

With these fractures that have arisen against the background of tumor-like lesions and benign tumors, it is necessary to adhere to surgical active tactics and carry out bone resection, combined with osteosynthesis in the very first days after the appearance of the fracture, without waiting for the fragments to grow together.

A pathological fracture of the spine is a process localized in one or more vertebrae of any part spinal column which is not preceded by the fact of mechanical injury. That is this disease not preceded by impacts or collisions with hard surfaces, falls from heights, etc. A pathological fracture of the spine occurs spontaneously, it would seem, against the background of perfect health bone tissue of the body.

With this disease, there is tissue destruction of the vertebral body, that is, its direct destruction. The destruction affects both the bone part of the vertebra itself and the periosteum (the tissue that lines the outside of the body, all the processes and openings of the vertebra and contains all the vessels that feed the vertebra and innervates the small branches of the nerves).

Most often, this pathological process is localized in places that take on the largest part of the load of the entire column. These places are the lumbosacral region and to a lesser extent thoracic region spine. Other areas are more rare, but also quite likely to become sites of pathological fractures.

Causes of the disease

The causes of this pathological process are very numerous. Such a fracture of the spine may be the result of the following pathological and physiological conditions:

thyroid disease and/or parathyroid glands (hyperthyroidism, hypothyroidism, autoimmune thyroiditis, nodular goiter, solitary and multiple brushes and malignant neoplasms of these organs. With all these diseases, a violation of the metabolism of calcium and its salts in the bones is possible)
Malignant neoplasms of bones with localization in the spine.
Metastases of malignant neoplasms into the spine of other organs (this is most often observed on late stages breast oncology, prostate, central or peripheral cancer lung, malignant diseases blood).
Osteomyelitis of the bones of the spine(this is an inflammatory process involving bone tissue and Bone marrow, which further leads to purulent-necrotic fusion of these structures with the formation of sequesters containing detritus).
Bowel disease(diseases that result in impaired absorption of calcium and vitamins in various departments intestines).
Age-related changes in the body.
Changes in a woman's body during pregnancy and lactation.

Despite the presence of an abundance of conditions that can cause a pathological fracture of the spine, the immediate root cause is always only one factor. And this factor is a decrease in bone density, that is, osteoporosis. Physiological osteoporosis can be during pregnancy and period breastfeeding, as well as in the second half of life (mainly also women).

Symptoms

The main symptom of a pathological fracture of the vertebrae is discomfort at the fracture site. Most of the time these feelings are acute pain, even sometimes unbearable, forcing the patient to rush about and grab onto the sore spot in search of a location that facilitates pain syndrome(usually this happens when oncological diseases).

With osteomyelitis, the pain is also very sharp, but its intensity is lower than in the previous case, there may often be visible defects on the skin with a characteristic discharge from this defect. In other cases, the pain may not be so strong and sharp.

It is worth noting that the pain syndrome occurs immediately at the moment of violation of the integrity of the periosteum, since it is in its thickness that the supply vessels and sensitive nerve endings pass.

Often there are general symptoms associated with impaired calcium metabolism in the body. These include:

General weakness.
Malaise.
Drowsiness or, conversely, increased excitability.
fatigue.
Feeling of lack of sleep.
Sensation of interruption in the work of the heart.

May also be observed:

Various paresis.
radicular syndromes.
Dysfunction of the pelvic organs.
Stiffness of movements.

Diagnostics

The main method for diagnosing a pathological fracture of the spine is radiography. X-rays are taken in two projections (frontal and lateral). Usually the most informative is the combination of radiographs of a particular section of the spine, giving clinical symptoms, and a sighting picture of any several vertebrae (in which, according to palpation examination and anamnestic data, there is most likely a focus of bone tissue destruction). In addition, research is being carried out venous blood for calcium content.

To clarify the diagnosis in doubtful and difficult cases foreseen CT scan or magnetic resonance imaging of the spine. This study is mandatory in cancer patients to clarify the stage and extent of the tumor process.

Treatment of a pathological fracture of the spine

Treatment of this condition involves the primary treatment of the underlying disease, but the impact directly on the bone tissue that has undergone resorption is also an integral part of therapy. Almost always required surgical intervention.

Currently widely used various ways vertebroplasty. Vertebroplasty with special bone cement is one of the newest, simplest and safest methods.

Perfectly complements surgical operation drug correction of the disease, involving the use of various calcium preparations (Sea Calcium, Calcemin Advance, etc.). In some cases, it is advisable to wear special supporting corsets.

Almost every adult person in one way or another encountered pathological fractures - either on their own sad experience, or on the example of relatives and friends. And now we ourselves begin to say: “The most important thing is not to break the neck of the hip and not lie bedridden in old age” or “I, like many women of my age (over 50), broke my wrist.” Alas, along with vertebral fractures, a fracture of the femoral neck and distal epiphysis radius Indeed, they are among the most common pathological fractures. The good news, however, is that these injuries are now largely preventable.

Pathological fracture: understanding the problem and its signs

A pathological fracture is a violation of the integrity of the bone at the site of its pathological restructuring. Most often, a pathological fracture occurs “out of the blue” - that is, in the case when the impact force (in case of a bruise or fall) is clearly insufficient to damage healthy bone tissue. At the same time, a typical story about an injury looks something like this: “Yes, it seems that I didn’t hit hard, but I broke my arm.” Or: “Every year in winter I fall 1-2 times, like all people. And this year, it seems to have fallen quite lightly and received a fracture, in fact, out of the blue.

At the same time, the clinical signs of a pathological fracture completely coincide with those of ordinary fractures. In fact, the only distinguishing feature of this injury is that a pathological fracture most often occurs with minor trauma. Therefore, patients often seek medical care too late, without even realizing that they might have a fracture.

Pathological fractures of the spine (which in the vast majority of cases are compression fractures localized in the vertebral body) are especially often “missed”. It is easiest for a non-medical person to imagine the essence of this damage by drawing an analogy between the spongy bone of a vertebra and a chunk fresh bread. If you squeeze the bread with your fingers, the crumb will crumble - the body of the vertebrae also “crumples” when compression fracture. The healing of this injury will be somewhat similar to the restoration of the shape of not too much “crumpled” bread, only very stretched in time.

Despite the fundamental ability of the vertebral body to restore the structure with relatively minor damage, any fracture of the spine (including compression) is very dangerous. If the height of the vertebra is violated, the spine is deformed (kyphosis occurs), which contributes to damage to other vertebrae and the progression of kyphosis. In the case of concomitant injury compression nerve endings, there is pain, paresis (numbness, "goosebumps") and muscle weakness in the corresponding zone of innervation.

With a pathological fracture, when interviewing a patient, in some cases it is possible to identify complaints of pain and discomfort in the anamnesis in the area where the fracture subsequently occurred.

The final diagnosis of a pathological fracture can be confirmed (or refuted) after X-ray or computed resonance imaging.

Pathological fracture: causes

The causes of pathological fractures are conditions leading to the destruction of bone tissue. Thus, the demineralization of bone tissue is promoted by excessive formation of the hormone of the parathyroid glands (parathormone), which occurs in hyperparathyroidism, including that caused by parathyroid adenoma.

Another cause of a pathological fracture is a tumor lesion of the bone. If there is a primary tumor or metastasis in the bone tissue malignant neoplasm, its structure changes, the bone becomes more fragile, and with the slightest damage in the affected area, a pathological fracture occurs. That is why, if there are suspicions of an oncological process, it is necessary to start diagnostic measures in particular, appoint a biopsy of bone tissue from the area of damage.

Osteomyelitis - another cause of pathological fractures - is most often found in children, as well as in the area of arthroplasty, comparison of bone fragments, as well as bone injuries of any origin, complicated by infection (in the vast majority of cases - Staphylococcus aureus). The most typical localization of osteomyelitis is the bones of the lower leg, femur and brachial bone, upper jaw, vertebrae. There are also pathological fractures caused by a bone abscess that has developed as a result of trauma.

Finally, the most common cause of pathological fractures is osteoporosis.

Fractures in osteoporosis

Osteoporosis is a widespread pathology that occurs, on average, in every third woman and every fifth man over 50 years of age. We can say that in the world there is an epidemic of osteoporosis in people in the second half of life! What is this terrible disease?

Osteoporosis is a metabolic bone disease in which bone mass decreases and its structure changes in such a way that the bones become more fragile and therefore more prone to pathological fractures. In the vast majority of cases, osteoporosis is spoken of in connection with menopausal restructuring. female body. This connection is understandable: in fertile (that is, childbearing) age, female sex hormones (estrogens) maintain bone strength, and during the change associated with menopause hormonal background the amount of estrogen decreases, and the bones become especially fragile. Although older men, osteoporosis is also not uncommon. That is why pathological fractures are much more common in older people.

Osteoporosis is confirmed by bone densitometry (primarily bone mineral density) and by biochemical markers of osteoporosis. Most often, a blood test is performed for osteocalcin, bone alkaline phosphatase, acid phosphatase, pyridinoline, collagen degradation products, procollagen peptides. Sometimes some of these markers are determined in the urine.

But such a mandatory study for any fracture as radiography can not always help in the diagnosis of osteoporosis: x-ray its signs are visible only when at least 30% of bone mass is lost.

That's why experienced doctors Osteoporosis (and, as a result, a pathological fracture) is often suspected not so much by the changes in the affected bone recorded on the X-ray, but by the site of the fracture. Thus, the most typical localization of pathological fractures in osteoporosis is the distal epiphysis of the radius (Collis fracture), the femoral neck, and vertebrae. At the same time, fractures in osteoporosis tend to become “cascading”: the first fracture increases the risk of the second by 2 times, the second fracture increases the risk of the third by 5 times, and so on.

Actually, a fracture in a person over 50 years of age should, in principle, arouse suspicion regarding the pathological nature of the damage. In this regard, it is necessary to clarify whether the force of the fall (impact) was adequate to the injury received and to find out if the patient (patient) had other fractures during last years whether she (he) was examined for osteoporosis, did not receive (a) anti-osteoporosis drugs. After all, it is at this age that the clinic of osteoporosis makes itself felt, which, without treatment, will only worsen over time.

It is also important to note the fact that pathological fractures, which quite easily occur against the background of osteoporosis, do not heal well. Speaking in "medical language", a distinctive feature of pathological fractures is their poor consolidation, which often leads to disability of patients. And this is understandable: until the factor that caused the pathological restructuring of the bone is not eliminated, the restoration of its structure during the healing of damage is also extremely difficult. In addition, prolonged immobilization of patients with pathological fractures leads to the development of complications, including fatal ( congestive pneumonia, PE (thromboembolism pulmonary artery), bedsores, thrombophlebitis, etc.).

For this reason, a doctor who diagnoses a fracture in an elderly patient is obliged to prescribe an adequate examination that can detect osteoporosis: only the elimination of the influence of the cause of a pathological fracture makes it possible to achieve not only successful treatment injury, but also to prevent its complications. And, of course, to serve as a hope for the prevention of subsequent pathological fractures!

Treatment of pathological fractures - general principles

The treatment of pathological fractures in general is practically the same as the treatment of ordinary ones. However, as a rule, the terms of immobilization in case of pathological fractures are lengthened. Therefore, in case of pathological fractures, if possible, special orthopedic methods are used (for example, the Ilizarov apparatus, the Shevtsov-Matsukatov apparatus), which allow maintaining the person's legal capacity even if the consolidation is very slow.

What is most important in the treatment of pathological fractures is the identification of the cause of painful bone remodeling and its elimination. So, in oncological diseases, of course, the issue of eliminating the tumor (by surgery, with the help of chemotherapy, radiation, or a combination of these methods) comes to the fore. With a pathological fracture caused by osteomyelitis, it is necessary to prescribe antibiotics. In some cases, surgery may also be required (for example, with a bone abscess).

Well, if osteoporosis has become the cause of a pathological fracture, it is necessary to treat metabolic disorders of bone tissue with the help of drugs that improve the mineral composition and microarchitectonics (a specific “device”) of bones.

Bonviva to prevent pathological fractures in osteoporosis

The dangers of osteoporosis have been known for so long that this topic has not been ignored by many popular media. In particular, the widest distribution received information about the leading role of calcium in the prevention of pathological fractures.

However, the authors of most of these materials overlook the fact that pathological changes in the bone tissue that occur in osteoporosis are caused not so much by calcium deficiency in the body as by the inability of the bones to absorb and retain it. Therefore, with the help of calcium supplements alone, it is impossible to cope with osteoporosis: it is also necessary special means, which will act only in bone tissue, helping to restore its structure and increase mineralization. Otherwise, it is almost impossible to prevent the pathological restructuring of bones. Therefore, at present, drugs from the group of bisphosphonates, powerful modulators of bone metabolism, capable of suppressing the resorption (“resorption”) of bone tissue, for which special cells, osteoclasts, are “responsible”, are of the greatest interest among anti-osteoporosis drugs.

One of the most studied (and, most importantly, clinically tested) drugs in this group is ibandronic acid. It is on the basis of this active substance Bonviva was created - a modern, highly effective tablet preparation that is well tolerated and designed to enhance bone mineralization and reduce the risk of pathological fractures.

It is noteworthy that Bonviva is recognized as the "gold standard" for the treatment of osteoporosis, not only because of the highest efficiency, but also due to ease of use: in order to prevent and treat osteoporosis, including those complicated by pathological fractures, the drug is taken 1 tablet (150 mg) 1 time per day. month.

The exceptional convenience of using Bonviva significantly increases the adherence of patients to treatment: in other words, they do not stop therapy because they are tired of complying with all the requirements for the regularity and frequency of taking the medicine (which, alas, is not uncommon). Well, adherence to treatment is a very important criterion for the success of therapeutic measures for osteoporosis, since anti-osteoporosis drugs must be taken for years. So, after 3 years of regular use with Bonviva reduces the likelihood of a fracture by more than 50%.