Osteoporosis is a disease having progressive systemic whose main symptom is a reduction in the density and impaired bone structure.
Reduced bone density increases the likelihood of fractures. A characteristic feature of osteoporotic fractures is their appearance due to minor exertion. It is the ease of occurrence of fractures is the primary risk for osteoporosis because fractures can be associated with particularly important bone structure of the human body – the spine, femoral neck. Fractures lead to the immobilization of the patient, which in old age is fraught with significant number of complications – from the appearance of bedsores before the development of congestive pneumonia that can be life-threatening. Few people know, but osteoporosis is now the fourth leading cause of death among people – it is second only to cardiovascular diseases, tumours and diabetes. And the main cause of death in patients with this diagnosis is a hip fracture.
Causes of osteoporosis
- postmenopausal osteoporosis in women (associated with low secretion of female hormones after menopause; the vast majority of women after the age of 60 describe his symptoms)
- senile osteoporosis is a broader concept than the climacteric. The aging of the human body accompanied by the disruption of the internal structure of a significant number of organs, including bone tissue. It is the General aging of a person is the cause of decrease in bone strength in old age;
- glucocorticoid osteoporosis develop in patients receiving long-term treatment with glucocorticoids – hormones of the adrenal cortex and their synthetic analogs, one of the side effects which is a violation of funktsionirovania bone tissue;
- secondary called osteoporosis, caused by any severe chronic disease; osteoporosis is one of the symptoms or complications of the primary disease – therefore, it is secondary, he develops the second. The cause of secondary osteoporosis can be diseases such as diabetes mellitus, malignant tumors, chronic kidney disease with development of renal failure, some lung diseases, thyrotoxicosis (excessive thyroid function), hypothyroidism (reduced thyroid function), chronic hepatitis, adenoma of the parathyroid gland (primary hyperparathyroidism). Also the cause of its development may be prolonged deficiency of calcium and vitamin D in the diet – this will disturb the intake of calcium in the blood, therefore satisfying the body’s needs for calcium is met by stocks held in the bones. The result is osteoporosis.
Stages of osteoporosis
In bone tissue is constantly a coexistence of two opposite processes – osteogenesis (formation of bone) and resorption (destruction) of bone tissue. Bone is a living structure, providing the important function of maintaining and streamlining the human body. Bone man is a complex network of interconnected and overlapping bone beams, the direction and strength which can resist mechanical loads acting on the bone as a whole (the weight of the bones and muscles, weight of internal organs and external loads, load due to the position of a body or current of the external acceleration, etc.). The nature of the loads in a person’s life changes – changing the body weight often changes with age growth, changes the nature of the activities – all this makes the bone to adapt to new conditions and to be resilient to forces acting on it. Bone beams are destroyed in one place and are formed in the other – this process is called bone remodeling and occurs constantly.
For the destruction of bone tissue during remodeling are responsible special cells called osteoclasts, which, like the bulldozers, “bite” into the bone tissue and destroy it. The formation of new bone trabeculae is performed by the cells, the”masons”, by osteoblasts that form new bone tissue – bone matrix into which calcium salts are deposited, the strength-built design.
Intensification of resorption processes of bone tissue in combination with the weakening of bone formation are a major cause of osteoporosis. Osteoporosis occurs when old bone is destroyed and new one is formed in insufficient quantities. Also the reason its occurrence may be insufficient intake in the bones of calcium salts – in this case, the bone becomes soft and ceases to perform frame and supporting functions.
It should be remembered that the causes of osteoporosis is always directed against the formation of new bone, or “contributing” to the destruction of bone tissue – both ultimately leads to fractures.
Osteoporosis risk Factors
In childhood and adolescence the process of bone formation predominates over resorption. The older a person becomes, the more the destruction of bone begins to prevail over her education. Especially enhanced the process of bone resorption in women after menopause. That’s why the osteoporosis in women is a typical and very common disease that occurs in old age.
There are factors that increase the risk of osteoporosis:
- female sex (women are far more susceptible to this disease than men);
- osteoporosis blood relatives in the family (genetic predisposition to this disease is very important)
- age (as we mentioned before, with age the probability of developing the disease increases significantly);
- low mobility (immobilization, fixation of the limbs or body of the patient for injuries, the considerable weight of the patient, mental disorders, movement impairing – all of these States are the causes of osteoporosis);
- drug therapy with the use of glucocorticoids, high doses of thyroxine (a synthetic analog of thyroid hormone); bone tissue is also negatively affected by prolonged intake of aluminum-containing drugs such as antacids, are used to reduce the acidity of gastric juice gastritis or peptic ulcer disease;
- overweight or underweight patient.
Not always the patient can make change in the causes of osteoporosis, even if understood, they can be dangerous. Really, neither gender nor age (primary risk factors) cannot be changed. However, there are factors that the patient can and should be modified to reduce the risk of such dangerous diseases. Smoking, excessive consumption of alhocol and kodeinsoderjaschie drinks, lack of exercise, low intake of foods rich in calcium (such as dairy), small time sun exposure, insufficient consumption of vitamin D – all these factors can change, therefore they are called modifiable (changeable) risk factors.
Osteoporosis symptoms and signs
Unfortunately, osteoporosis is a hidden disease for a long period of time flowing without striking symptoms, therefore it often has a delayed diagnosis. Very often the first symptom is a fracture – the fracture only after the patient begins the examination and discovers that the cause of the injury was osteoporosis.
However, there are symptoms that allow still to notice the disease at an earlier stage, before the appearance of fractures. Often patients concerned about the change of the posture, the appearance of stooping, reduced growth, accelerated destruction of dental tissue. Bone pain is one of the important signs that allow to suspect development of osteoporosis. Most often pain occurs in the spine, femurs, the bones of the forearm and wrist. Often the pain increases with prolonged stay in an uncomfortable position, when the mechanical load. At the turn or a sharp decrease in height of vertebrae pain localized in the back, between the shoulders, in the lumbar region. A symptom of calcium deficiency in blood may be the emergence of a convulsive contraction of the muscles.
Osteoporosis – diagnosis and treatment
Currently the diagnosis of osteoporosis does not present any significant difficulties. It is necessary to remember only that conventional radiography is not able to assess the degree of osteoporosis, so for diagnostics using other techniques. Radiography allows us only to suspect the presence of osteoporosis in characteristic changes of bone density on x-ray images, however, for treatment planning and evaluation of dynamics of change of bone density it is necessary to have quantitative information about the state of the bone – i.e. you need to be able to Express digitally bone density.
Quantitative assessment of bone density is the main in the diagnosis of osteoporosis. For this study invented a special term – “densitometry”, i.e. the density measurement. Often written differently – “densitometry”, stressing that the measurement of bone density.
Densitometry can be of three basic types:
- x-ray densitometry (synonyms: DEXA, dual-energy x-ray computed densitometry);
- computed tomography densitometry;
- ultrasound densitometry.
If x-ray densitometry conducted x-rays of bones in a standard point (usually the standard three points: the neck of the femur, lumbar spine, and radial bone). After receiving x-ray image of a special computer program calculates the bone density in the doctor zone and compares it with those observed for a healthy person of the same age (this is called Z-index) or for a healthy person at the age of 40 years (this figure is called T-index).
Osteoporosis is the deviation of T from index normal values:
- from 0 to -1 – bone density is normal.
- from -1 to -2.5 is osteopenia (rarefaction of bone tissue);
- of -2.5 or less is osteoporosis.
When computed tomography densitometry is computed tomography multislice CT scanner with the subsequent calculation of bone density and comparing it with a reference. As a result the calculated density of 1 cubic centimeter of bone in the area of research, as well as calculated T – and Z-indices. The advantage of computed tomography densitometry is a high precision and the possibility of calculating density of bone tissue regardless of patient weight, presence of adhesions, metallic structures, which can make it difficult to get results when conventional x-ray densitometry. The disadvantage densitometry of CT is the increased radiation load on the patient’s body.
Ultrasound densitometry is done by measuring the velocity of ultrasonic waves in bone tissue. It is proved that the decrease in bone density makes it more friable and does not allow the bones conduct the sound waves. The lower the bone density, the slower is the sound wave along the bone surface. The ultrasonic densitometer is equipped with special sensors for the velocity measurement of the ultrasound along the surface of the bone, and built-in software of the device allows to calculate the density of the bone with the definition of T – and Z-indices.
Ultrasound densitometry to determine density is used superficially located bones – the phalanges, the radius bone in the forearm, the anterior surface of the tibia, V metatarsal bone in the foot. Calculated by ultrasound densitometry parameters (T – and Z-indices) can be compared with similar indicators obtained by x-ray densitometry (i.e., if x-ray densitometry was revealed osteoporosis, and ultrasound densitometry will reveal the same changes). However, if the patient in the first study, conducted x-ray densitometry, which revealed osteoporosis and has been prescribed treatment for osteoporosis, then the second study should be conducted using the same evaluation method, that is also x-ray densitometry only in this case it is possible to most reliably evaluate the effectiveness of treatment. Of course, the same rule applies to ultrasonic densitometry – if the treatment is carried out on the basis of the results of the initial ultrasound examination, the treatment should be carried out using ultrasound densitometry.
Diagnosis of osteoporosis using ultrasound densitometry has several advantages – ultrasound densitometry is not accompanied by irradiation, may be carried out at comfortable for the patient environment within a relatively short time. Security studies is so high that ultrasound densitometry may be performed for both children and pregnant women.
In a nutshell, the densitometry allows to completely solve the problem of diagnosis of osteoporosis, with any method densitometry is cheap, painless, accurate.
Densitometry should be performed in all women 65 years of age – compliance with this simple rule could significantly reduce the prevalence of fractures among older women. However, carrying out densitometry absolutely shown to other patient groups, including patients of young age. Among the indications to perform densitometry should note the following:
- early menopause
- hormonal disorders in women, accompanied by shortage of estrogen, the development of amenorrhea (absence of menstruation);
- low body weight (including as a result of the disease, neurogenic anorexia);
- the presence of blood relatives suffering from osteoporosis;
- the presence of primary hyperparathyroidism (adenoma of parathyroid glands);
- the presence of secondary hyperparathyroidism due to chronic renal failure;
- hyperthyroidism (due to diseases such as diffuse toxic goiter, toxic polynodular goiter, toxic adenoma of the thyroid gland);
- decrease the level of testosterone in men;
- prolonged immobilization for fractures or other injuries;
- the syndrome and illness of Itsenko-Kushinga;
- prolonged use of glucocorticoids;
- the presence of rheumatic diseases (spondylitis, rheumatoid arthritis) that are often combined with the development of osteoporosis.
It is important to understand that osteoporosis complicates the treatment of diseases of the joints. Osteoporosis of joints reduces the strength of the mating bones in the joint. In our days the wide spread hip and knee joints if you have arthritis. In this case, instead of the joint the patient is put on a metal implant that attaches to the bones forming the joint. The stability of the resulting structures depends on the strength of the bones, which bear the load of the prosthesis. The presence of osteoporosis joint creates the preconditions for instability of the implant, the fracture in the zone of attachment of the endoprosthesis and the development of severe complications. Therefore, diagnostics aimed at the detection of osteoporosis is mandatory for all patients considering an arthroplasty.
Secondary importance in the diagnosis of osteoporosis are laboratory studies. There are a number of markers (also called “testing for osteoporosis”), allowing to assess the severity of osteoporosis and the dynamics of its progression (osteocalcin, bone fraction of alkaline phosphatase, crosslaps, pyridinoline, etc), but their diagnostic value is lower than the significance of densitometry.
During examination of the patient with suspected impaired bone density also necessarily used important laboratory parameters:
- ionized calcium, parathormone, 25-hydroxyvitamin D;
- of TSH, T4 St. (thyroid hormones);
- to female sex hormones (estradiol, testosterone, etc.)
- for men the level of free testosterone in the blood.
Treatment of osteoporosis
Now we can confidently assert that treatment of osteoporosis must be performed in specialized centers with extensive experience in the management of patients with this pathology. Osteoporosis is a complex multifactorial problem, the development of which is responsible endocrine, age, behavioral factors, so often in the treatment of osteoporosis, attended by several doctors (endocrinologist, rheumatologist, cardiologist, neurologist). However, one physician should be chief must be a “conductor” of the orchestra, must know how to treat osteoporosis and to determine the tactics of examination and also decide which specialists should be consulted if necessary. Most frequently this type of doctor is an endocrinologist – endocrinologists most often the treatment of osteoporosis these days.
Doctors-endocrinologists center to independently perform ultrasound densitometry patients, it is possible to establish the diagnosis and to determine how to treat osteoporosis, as well as to objectively assess the results of the therapy.
The main objectives in the treatment of osteoporosis are the bone mass (due to the increased deposition of new bone and reduce the fracture, if present), prevention of fractures, reduction or complete elimination of pain, ensuring optimal motor mode for patients.
Treatment of osteoporosis consists of several important and interrelated stages:
- in the first place with the treatment of the major diseases causing osteoporosis (hyperthyroidism, hypothyroidism, syndrome and illness of Itsenko-Cushing’s, hypogonadism, etc.)
- therapy aimed at increasing bone mass (calcium supplements, vitamin D, medications from the group of bisphosphonates – fosamax, Forosa, fosavance, zometa, aklasta, Bonviva, etc.)
- drugs aimed at reducing the pain intensity.
In this article we will not describe therapies aimed at treatment of the underlying disease, if any, this will take too much time. Let’s discuss the modern concept of treatment of osteoporosis, which increases bone mass.
Currently, the most effective is combined treatment of osteoporosis using:
- vitamin D (aquadetrim, vigantol) or activated forms of vitamin D (alfacalcidol, alpha D3-Teva, etalpha);
- calcium (containing calcium carbonate or calcium citrate)
- of drugs group of bisphosphonates.
If the first two groups of drugs (vitamin D and calcium) aims to increase bone formation by increasing the amount of calcium entering the body of a patient, the second group (bisphosphonates) are intended to suppress bone resorption (disintegration of bone). The main effect of bisphosphonates is blocking the work of osteoclasts – cells responsible for destroying bone tissue. At the present time is considered to be safe even very long, up to 10 years, the bisphosphonates. The cheapest and most studied drug in this group is considered as alendronate sodium (fosamax, porosa), which is taken once a week. Other drugs that appeared later, allow you to take them once a month or once every few months. Bisphosphonates for osteoporosis – the main “strike force” of doctors, due to their efficacy and safety.
Correctly chosen treatment of osteoporosis can improve bone density by 5-10% per year, which greatly reduces the risk of fractures. You only have to remind you that this therapy is long lasting, designed for years of use. Do not think that the treatment for one to two months will yield any noticeable results.
What is the necessary diet for osteoporosis?
Special secrets diet for osteoporosis has not – you just have to ensure sufficient intake of vitamin D and calcium necessary for the formation of new bone. The most calcium rich dairy products, fish, cabbage (including broccoli), different nuts. The main source of vitamin D in the body is fish (or fish oil). A significant amount of vitamin D produced in the skin upon exposure to sunlight.
However, planning nutrition for osteoporosis, remember that one only the diet “exercise” is not able to resolve any deficiency of calcium or a deficiency of vitamin D. In most cases dieting is only one element in the treatment of osteoporosis and must be accompanied by supplemental calcium and vitamin D in pill form is the only way to resolve a long-evolving chronic deficit of vitamin D.
Complications of osteoporosis
The main and most dangerous complication of osteoporosis are fractures. The most dangerous fractures are vertebral fractures, hip. At the moment, because of the femoral neck fractures osteoporosis is the fourth leading cause of death of people in the world (giving the palm only vascular diseases, Oncology, diabetes). Osteoporosis of the spine leads to the development of compression fractures even when exposed to minor loads (such as falling from standing height or landing after a jump). It is important to understand that following the fracture of the spine or the femoral neck stiffness in a significant number of cases ends with pressure sores, congestive pneumonia, infectious complications, thrombosis. Only early surgical treatment can reduce mortality from femoral neck fractures, but it, unfortunately, cannot be conducted in many elderly patients due to the presence of severe comorbidities. Osteoporosis of the spine cannot be surgically corrected. That is why the only effective method of treatment of osteoporosis is early diagnosis and combined conservative therapy is the only way to avoid development of fractures.
How is the prevention of osteoporosis?
Prevention should include several areas that address previously listed risk factors for osteoporosis.
It is important to ensure adequate intake of calcium and vitamin D from food – you have to use dairy listed above and other calcium-rich foods. Should reduce the consumption of alcohol and caffeine-containing beverages and foods.
There are a number of scientific studies proving that prolonged intake of calcium and vitamin D for prevention reduces the risk of osteoporosis. Receiving moderate doses of calcium with vitamin D for 3-4 years does not cause side effects, but can improve bone density. Enough calcium carbonate at a dose of 500 mg with 200 IU vitamin D twice a day (for example, calcium D3 Nycomed 1 tablet 2 times a day; or calcemin-advance also 1 tablet 2 times a day). Intake of calcium and vitamin D is safe even in the presence of urolithiasis. However, the question of preventive therapy should be decided after consultation of the endocrinologist.
Physical activity is the next factor that prevents the development of osteoporosis. Prevention using physical activity can increase the load on the bone and stimulate its strengthening.
For women in menopause important factor in the prevention of osteoporosis is the use of hormone replacement therapy, which allows for a long time “to simulate” normal ovarian function and to reduce the risks associated with the fading of the natural hormonal function of the ovaries. This therapy is also an effective factor in the treatment of osteoporosis, if it has already occurred. Of course, that selection of treatment is carried out by an endocrinologist.
You should not forget about the need to control thyroid function if you suspect the development of osteoporosis. It is enough to perform thyroid ultrasound and pass a basic set of tests (usually for the first examination enough to donate blood for TSH, T4 St, antibodies to thyroid peroxidase). When testing don’t forget about the need to annually monitor the level of ionized calcium! Time revealed the increase or decrease of blood calcium level considerably facilitates treatment.
Treatment of osteoporosis in the centre of endocrinology
The osteoporosis centre is not just a Cabinet, where it is receiving a doctor who understands how to treat osteoporosis and how it can be identified. Under center osteoporosis specialists typically involve an integrated clinic, in which doctors are required to treat osteoporosis specialties. If you think You have osteoporosis and are looking for what kind of doctor You need – contact your endocrinologist. It was the endocrinologist – the doctor who treats osteoporosis most often and most effectively.
The endocrinologists of the Northwest centre for endocrinology has two unique features: each of them independently performs ultrasound densitometry and independently performs ultrasound of the thyroid gland. This allows already at the initial reception physician to diagnose osteoporosis and to determine what tests and treatment should be further appointed. The endocrinologist may prescribe hormone replacement therapy during menopause, normalize thyroid function, prescribe bisphosphonates and calcium supplements for osteoporosis. The ability to perform densitometry on the right intake is also important because that allows the doctor to check out the quality of care, without leaving your office – in experienced hands densitometry is performed for 15 minutes and immediately provides information on the responsiveness of bone tissue to the prescribed treatment.
Ultrasound densitometry is performed using the OmniSense 8000S device manufacturing company BeamMed (Israel). The study defines all the standard features of the bone and calculated T – and Z-criteria.
Endocrinologists Medical of the centre of endocrinology prescribed drugs for osteoporosis in accordance with the most current recommendations of the USA Association on osteoporosis, European and American associations of endocrinologists. The cure of osteoporosis is unlikely to be the only – we have already discussed earlier that the most effective is combination therapy, which includes calcium supplements, vitamin D, bisphosphonates, proper nutrition.
Treatment of home remedies – this is not our profile. Unfortunately, the development of traditional medicine (i.e., medicine based on tradition, including herbal medicine) for a long time looked for such diseases as osteoporosis. Folk remedies for violation of bone density was used because before the invention of densitometry and people did not know that bone density may decrease! So now when a doctor treats osteoporosis, but it’s not used – we simply don’t have in the Arsenal of effective and safe means of section of folk.
Treatment of osteoporosis is a long process that takes several years. However, all modern researches indicate that bone density can effectively increase and significantly reduce the risk of fractures.