Osteoporosis bone - Causes, Symptoms and Treatment .MF .
Osteoporosis - is a progressive systemic disease that affects the human skeleton is reduced and the density of broken bone structure.
Violation of the structure of bone tissue in osteoporosis
In osteoporosis, bone is broken complex architecture, bone becomes loose and prone to fracture even at low loads.
- Postmenopausal osteoporosis - osteoporosis is associated with a reduction in the production of female sex hormones.
- Senile osteoporosis - osteoporosis associated with aging and general wear and tear of the body, decrease in skeletal mass and strength after 65 years.
- Corticosteroid Osteoporosis - occur when long-term use of hormones (glucocorticoids).
- Secondary osteoporosis - occurs as a complication of diabetes, cancer, chronic renal nedostatachnosti, lung disease, hyperthyroidism, hypothyroidism, hyperparathyroidism, calcium deficiency, rheumatoid arthritis, ankylosing spondylitis, chronic hepatitis, Crohn's disease, chronic administration of aluminum products.
in the development of osteoporosis plays the role of an imbalance in bone remodeling.In the process of constant renewal of the bone involved cells - osteoclasts and osteoblasts.One osteoclast bone breaks as much as 100 generates osteoblasts.To fill (mineralization) of bone gaps caused by osteoclasts, osteoblasts for 10 days is required 80 days.With an increase in osteoclast activity (for various reasons), bone destruction occurs faster than its formation.Trabecular thinning and perforated plates, there is destruction of horizontal linkages, increased bone fragility, brittleness - that threatens to bone fractures.
Changed osteoporotic vertebrae and compression fracture of the vertebral body.
Normally set of bone mass peaks at the age of 16, bone resorption predominates over formation.In 30 - 50 years of formation and resorption occurs at approximately the same rate.With age, accelerating the processes of bone resorption.The annual loss of bone mass up to 50 years - 0.5 - 1% in the first year after menopause - 10%, followed by 2 - 5%.
Risk factors for osteoporosis:
family history of osteoporosis,
use of corticosteroids, anticonvulsants, heparin, thyroxine, antacids containing aluminum,
modifiable risk factors - (you can influence them):
low consumption of dairy products,
inadequate intake of calcium,
deficiency of vitamin D3,
excessive consumption of meat.
symptoms of osteoporosis
danger associated with clinical or asymptomatic oligosymptomatic onset of osteoporosis, masquerading as osteochondrosis and arthrosis.The disease is often diagnosed when already there is a fracture.A fracture can occur with minimal trauma, weight lifting.
Spotting disease is quite difficult in the early stages, although there are a few signs.For example, changes in posture, pain in the bones with the weather change, brittle nails and hair, tooth decay.The most susceptible to diseases of the spine, femoral neck, bones of the hands and wrist.The first symptoms of osteoporosis can be a pain in the lumbar and thoracic spine during prolonged static load (for example, sedentary work), nocturnal leg cramps, brittle nails, senile stoop, reducing growth (by reducing the height of the vertebrae), the phenomenon of periodontal disease.
Changing posture osteoporosis
Persistent back pain, back pain, interscapular area can be symptoms of osteoporosis.If there is pain, a decrease in growth, change in posture is necessary to consult a doctor, be tested for the presence of osteoporosis.
- X-rays of bones,
spine - osteodensitometry - dual energy X-ray densitometry (DEXA), quantitative computed tomography, ultrasound densitometry.
Radiography for accurate diagnosis will not do, will not be able to detect the initial shape and osteopenia.Bone loss of up to 25 - 30% is not visible on radiographs.
diagnostic standard - DEXA.Bone densitometry - Quantitative non-invasive assessment of bone mass.
measured bone mass and bone mineral density.Z index difference between the density of the bone tissue of the patient and the theoretical density of bone mass in a healthy individual of the same age.Index T - the difference between the density of the bone tissue of the patient and the average value of the index in healthy individuals 40 years of age.
WHO recommends diagnosis is carried out on the basis of the indicator T.
Norma - T minus 1 (-1).
Osteopenia - T between minus 1 and minus 2.5 (-1 and -2.5).
Osteoporosis - less than T minus 2.5 (-2.5).
Established osteoporosis - T minus 2.5 seconds less than the presence of non-traumatic fractures.
indications for densitometry:
estrogen deficiency - early menopause
- long-term secondary amenorrhea
- low body mass index
- family history
- anorexia, malnutrition
organ transplantation - chronic renal failure
- primary hypogonadism
- decreased testosterone levels in men
- prolonged immobilization
- Cushing syndrome - Cushing
- corticosteroid therapy
- diseases associated with osteoporosis - rheumatoid arthritis, spondylitis.
for diagnosing osteoporosis use biochemical markers - various hormones (estrogen, thyroid hormones, parathyroid), vitamin D, calcium, phosphorus, magnesium, formation markers (osteocalcin, specific bone alkaline phosphatase prokollagenovy C-peptide and N-peptide), markers of bone resorption (resistant to tartrate acid phosphatase, pyridinoline, deoxypyridinoline, calcium, glycosides gidroksilina
Treatment of osteoporosis
osteoporosis Treatment -. very complicated issue, which involved immunologists, rheumatologists, neurologists, endocrinologists necessary to achieve stabilization of indicators of bone metabolism.slow bone loss, prevent the occurrence of fractures, decrease pain, expand locomotor activity
- etiological therapy -. it is necessary to treat the underlying disease that led to osteoporosis
- pathogenetic therapy -. pharmacotherapy for osteoporosis.
- Symptomatic therapy - removal of pain.
- drugs with preferential inhibition of bone resorption - the natural estrogen, calcitonin, bisphosphonates (pamidronate, alendronate, ibandronate, risedronate, zoledronic acid).Preparations are made for a long time, for years.There is a difference in the reception of drugs - once a week (Ribisi), once a month (Bonviva), once a year (Aklasta).
- drugs that stimulate bone formation - fluoride salts, calcium, strontium, vitamin D3, bioflavonoids.
prescribe a doctor!
cure osteoporosis found fully, perhaps, impossible.We can only improve the state of the bone system drugs, affecting the uptake and absorption of calcium, and calcium preparations themselves.
For proper nutrition, especially, you need to eat foods that contain calcium and vitamin D. This is a variety of dairy products (allergies, you can use soy, goat or nut milk), fish, greens, cabbage, broccoli,nuts.Vitamin D is found in fish, fish oil, yolk.In addition, the sun's rays also contribute to the production of vitamin D.
Exercise therapy for osteoporosis
Physical activity should include walking, which put a strain on the bones.It is important to note that swimming is not conducive to the strengthening of bones, weightless as the state of the body in the water does not result in the necessary effort to bony structures.
One of the exercises for strengthening bones, which is to be performed regularly:
Kneeling and leaning on hand straight, pull your stomach in.The back is in the upright position.Raise your right hand up, the chest opens, look toward the hand.Hold this static position for a few seconds.Breathe evenly.Then lower the arm and do the same in the opposite direction.Repeat the exercise several times in both directions.
After completing the exercise, lower pelvis to the feet, straighten your arms, lower your head down.The body relax, maintain regular breathing.This exercise can be done 2-3 times a week.Combine it with a proper diet and add walking 2 times a week, for at least half an hour.
complications of osteoporosis
most common fractures of the vertebral bodies, hip, radial bone.According to WHO femur fractures osteoporosis put on the 4th place among the causes of disability and mortality.Osteoporosis reduces life expectancy by 12 - 20%.The first spinal fracture increases by 4 times the risk of recurrent vertebral fractures and hip fractures 2 times.Prolonged bed rest contributes to the development of pneumonia, pressure sores, thromboembolism.
Drinking enough calcium - foods rich in calcium (low-fat dairy products, broccoli, cauliflower, salmon meat, cheese, reduce foods that contain phosphorus (red meat, sugary soft drinks), limit alcohol and caffeinesufficient physical activity. The recommended dose of calcium 1000 mg per day to 65 years and 1,500 mg per day after 65 years.
If it is impossible or low efficiency of conventional disease prevention measures, doctors always recommend to apply to the means of drug prevention. in the case of the prevention of osteoporosis pickeffective agent is not so simple. the fact that the presence of only calcium in the preparation of its deficiency problem can not be solved in the body. it is hardly absorbed. the optimal solution in this case is the presence of calcium in the drug required ratio and vitamin D.
prevention of osteoporosis is a healthy lifestyle, hormone replacement therapy during menopause (during menopause to prevent osteoporosis is prescribed estrogen - inside or in the form of subcutaneous implants), regular physical activity feasible.After 40 years without exception, all women should check their thyroid funkktsionirovanie and treat if necessary.
Russian Association on Osteoporosis (www. Osteoporoz. Ru) regularly holds free screening of people at risk for osteoporosis in various cities of Russia, more about osteoporosis centers and conduct a free diagnosis of osteoporosis, you can visit the website of the Russian Association on Osteoporosis.
Consultation of osteoporosis
Q: In all the recommendations in the treatment of osteoporosis, one of the priorities of the power-calcium.But what about those who have kidney stones and calcium is contraindicated?
A: calcium supplementation, a high calcium intake from food to prevent the formation of kidney stones.Low calcium intake in women in postmenopausal period is a risk factor for urolithiasis.In men younger than 60 years of lack of calcium - the risk of kidney stones.It is believed that the protective mechanism is due to binding of calcium oxalate and calcium phosphate in the intestine to prevent its excessive excretion in the urine, and hence reduce the risk of stone formation.Calcium should be taken with food. When kidney stones calcium is not contraindicated .Even with recurrent calcium oxalate stones shows the reception.calcium Reception at the highest dose results in minimal excretion of oxalate.The use of calcium in a dose of 800 mg / day results in the calcium imbalance.The main factors of stone formation - hypercalciuria, hyperoxaluria, hyperuricosuria deficit inhibitors of stone formation and changes in urinary pH.Each one of them or a combination thereof in conjunction with other pathogenetic mechanisms - urodynamics disorders, circulatory disorders in the renal parenchyma, inflammation in the urinary tract - may lead to the formation of stones.Restricting calcium dietary intake or additional calcium entry into the human body in the form of calcium and vitamin D play a negative role in pathogenetic mechanisms of prevention of stone formation in the urinary tract and the flow of urolithiasis.
neurologist Kobzev SV