Osteoporosis is a disease characterized by a decrease in bone mass and a change in bone structure. Bones become abnormally thin and the spongy structure of the bone is often broken, resulting in increased susceptibility to fractures. The most frequent injuries in this disease are cracks in the base of the vertebrae, fractures of the bones of the forearm, wrist and neck of the thigh. Fractures occur even in those situations that for people with healthy bones do not pose any threat.
Suffer from osteoporosis, both women and men, but in men it happens at times less often. In Russia, this disease affects about 35% of women and 10% of men over 60. Data on the population as a whole is not yet available, but it is already clear that at this time osteoporosis is one of the largest social problems. But this disease can be prevented! In addition, it can be treated in the initial stages - it is only necessary to seek help from a doctor in time.
Essence of the question
The clinic of osteoporosis consists in the fact that the bone is a living tissue that is constantly renewed. It consists mainly of collagen protein, which is a soft base, and minerals (mainly calcium phosphate), giving hardness and resistance to mechanical stress. In the body, more than 99% of calcium is contained in bones and teeth, the remaining 1% is contained in the blood and soft tissues. Bones not only perform a supporting function, but they are a "storehouse" from which the body attracts calcium and phosphorus as needed.
During life, the bones grow old, die and resume in parts. There is a so-called "bone resorption". In the course of it, obsolete cells - osteoclasts are replaced with new ones. Osteoporosis occurs when bone resorption occurs too quickly or if recovery, on the contrary, is too slow. In childhood and early adolescence, a new bone is formed faster than the old bones are destroyed, so that the bones grow, they become heavier and stronger. Natural resorption lasts for about 35 years. Then "peak" bone mass is achieved. There is a maximum density of bone tissue, resistant to mechanical injuries. After 35-40 years, the death of bone cells slowly begins to predominate over their creation. Rapid bone loss occurs in women during the first few years after menopause, and then usually begins osteoporosis. Manifestation of the disease is also often observed in people who have not yet reached optimal bone mass during the growth period.
Symptoms of Osteoporosis
This disease is called a "silent killer", because it often develops without any symptoms. They can appear only when one day a sharp pain in the chest or back will be a signal about a fracture of the ribs or vertebrae. Or, if you fall flat, your wrist or neck will be broken. The examples given are the most common in osteoporosis. This can also happen even with a cough or careless movement - all this in a patient with osteoporosis will lead to the destruction of the rib or the fracture of the vertebrae.
Osteoporosis is sometimes accompanied by severe pain, but not always. Often the silhouette changes gradually, growth decreases. Loss of growth is due to compression fractures (for example, "crushing" the vertebrae), bending of the bones, rounding of the back, the appearance of a "hump" on the front of the abdomen. All these are characteristics that allow an unaided eye to recognize osteoporosis. In addition to back pain, the patient can irritate the gastrointestinal tract, abdominal pain (due to abdominal pain from the ribs) and shortness of breath due to the lack of space for the lungs in the deformed chest.
Diagnosis of Osteoporosis
Diagnosis is carried out using various imaging techniques: X-rays, ultrasound, magnetic resonance imaging. Ordinary X-ray images show bone loss only when it is already significant. This is a very important study to assess the complications of osteoporosis or fractures. A more sensitive test is bone densitometry, after which it can be concluded that the patient has osteopenia - a reduction in bone mass. This is a state of the risk of osteoporosis. In this case, the mineral density of bone tissue decreases, which represents the risk of fractures in the test section of the bone (for example, the lumbar spine or thigh). Bone densitometry can also track the impact of treatment for this disease. In addition to densitometry, biochemical tests are important to assess the mineral balance of the system. This is important for complete diagnosis, as well as for determining the type and dose of the medication. This method is also used to monitor treatment effects.
In no case should we treat the loss of bone mass without adequate control of biochemical parameters. This can actually lead to complications such as kidney stones. With an erroneous diagnosis, at best, you will not have the effects of treatment with expensive drugs. At worst, irreversible degeneration of the bones of the skeleton as a result of uncorrected metabolic disorders of calcium, magnesium and phosphorus.
Less accessible in Russia is the so-called test of "bone markers in the blood or urine." This allows you to monitor the process of bone resorption and its updating. In the case of osteoporosis of unknown nature, such as in young people who do not have typical risk factors, no significant violations in the field of biochemistry, a diagnostic biopsy is not performed. Only a histomorphometric study of collected wastes is conducted, an assessment of the activity of cells in the creation of a new bone and in the mineralization of bones. This allows for rapid treatment with a focus on specific disorders in bone tissue.
Treatment of osteoporosis
In the treatment of osteoporosis, pharmacological preparations are mainly used. Adequate intake of calcium and vitamin D or its active metabolites, drugs that inhibit bone resorption (for example, calcitonin) - all this significantly reduces the risk of fractures of the spine and femurs. It is recommended that they be used also for the prevention of the disease. For women under 65, sex hormones (estrogens) are the main medical aid.
There are many other drugs for osteoporosis, but they are all being tested and very advanced in the world. The treatment is aimed at inhibiting excessively destroyed bone, increasing overall health and improving digestion. The effect of these drugs is to increase the mineral density and reduce the risk of fractures.
Risk factors
Some factors are not associated with the onset of the disease and do not affect the probability of its occurrence, and some directly indicate that a person is susceptible to this disease. In some patients with osteoporosis, many such factors accumulate, some do not. Elimination of risk factors is the basis for the prevention of osteoporosis. On some of them, doctors have no influence. These are factors such as female gender, age, physique, race, heredity. The fact that osteoporosis is more common in women, explains their lower bone mass. Osteoporosis is more likely to occur in people with a thin build or small bones. The greatest risk of this disease exists among Asian women and Caucasians, and blacks and Latinos are less at risk of osteoporosis.
Propensity to fractures of bones can occur in the family. For people whose parents have undergone bone fractures, the risk of fractures often increases. The main risk factors that can be called:
1. Sex hormones. Menstrual irregularities, low estrogen levels after menopause, or low testosterone levels in men;
Anorexia;
3. Insufficient intake of calcium and vitamin D;
4. Use of certain medications, such as glucocorticoids and antiepileptic drugs;
5. Inactive lifestyle or prolonged bed rest due to illness;
6. Smoking;
7. Abuse of alcohol.
Prevention of osteoporosis
The most reasonable option is the prevention of osteoporosis - in the clinic, diagnosis and treatment then there simply will not be any need. Diet is a very important element of prevention. A key role in achieving an adequate peak in bone mass and preventing the rapid disappearance of bones in the body is calcium. In many countries, including Russia, calcium intake is too low. Often it is about 1 / 3-1 / 2 of the norm recommended by nutrition specialists. Depending on sex, age and health status, a person should take 800 mg of calcium for children, 1500 mg for adults and 2000 mg for the elderly, pregnant and lactating women per day.
It is enough to drink 4 glasses of milk a day or consume 150 g of cheese. This is not much, but many people do not eat a lot of dairy products every day. In addition to milk, you need to eat yoghurt, cheese, ice cream and other foods rich in calcium. This is important for those who do not tolerate milk. These products include: green leafy vegetables such as cabbage, broccoli, spinach, rhubarb, dill, as well as sardines (along with bones), salmon, tofu, almonds. You can take foods artificially fortified with calcium, such as orange juice and some types of bread.
Always make sure to choose low-fat foods, such as skim milk, yogurt with fewer calories. Dairy products have a different fat content and density. So 4 tablespoons of Parmesan cheese contain as many calories as 1/2 cup of granulated cheese, but in Parmesan there are five times more calcium.
If for some reason a person can not consume enough calcium - the deficit should be replenished with pharmacological drugs (for example, in pharmacies there are calcium-magnesium tablets containing the appropriate dose of calcium). Vitamin D also plays an important role in the absorption of calcium and, consequently, the formation of healthy bones. It occurs in the skin under the influence of sunlight. Although many people are able to "get" into vitamin D in a natural way, however - as can be seen from the research - production is decreasing in elderly people permanently living at home. It also reduces its production during the fall and winter. It is in such situations in addition to the "own" vitamin should take drugs in a dose of 400-800 units. Large doses are not recommended - it is desirable to monitor biochemical indicators that confirm the effectiveness of this supplement.