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Treatment of osteoporosis

Recently this term often sounds from screens of TVs, is mentioned on pages of editions about health, speak about it also doctors. Why it is actual and what such osteoporosis?

Understand decrease in mineral density of a bone tissue and violation of its structure as osteoporosis.

It is a little anatomy

The bone tissue consists of a proteinaceous basis into which mineral substances – calcium and phosphorus in the form of a hydroxyapatite are skillfully interwoven, and also it is a little magnesium, copper, silicon, fluorine, manganese.

It is dynamic system which is constantly updated thanks to special cages: to the osteoklasta destroying an old bone, and to the osteoblasts synthesizing the new. The regeneration of our skeleton is carried out approximately in 10 years.

Calcium is the basic element giving the hardness and durability to bones. Thanks to it our skeleton is capable to maintain not only the weight of own body, but also considerable loads of stretching, deformation, compression, for example, at transfer of weights or falling. At osteoporosis the balance between destruction of an old bone tissue and synthesis new is broken, calcium is washed away, "support" becomes fragile.

Thus, the main danger of osteoporosis are changes which arise without the reason or at an insignificant trauma, for example, falling from height less the growth. The most typical changes at osteoporosis – a fracture of a beam bone in "a typical place" (wrist); hips, especially hip necks; vertebras in lumbar and chest department. If not so terrible state, spinal fractures or hips – conduct a fracture of a beam bone to ability loss independently to move for long term, and at senile age can have catastrophic consequences. They begin to live very not easy.

Who in group of risk?

First of all - women after approach of a menopause.

On a structure and durability of a bone function of sexual glands, especially at women has a great influence. An estrogen has the protective, strengthening effect on a bone. At reduction of their quantity (menopause) there is a progressive loss of minerals and change of microvery tectonics of a skeleton resulting in the increased fragility and risk of changes. Fading of androgenic function at men works similarly, but to a lesser extent.

Statistically, about 35% of women and 24% of men are more senior than 50 years have osteoporosis (so-called primary).

The earlier there comes the menopause, the bone durability starts decreasing earlier. If owing to an illness operation with removal of appendages at young age was performed, osteoporosis will develop since youth.

Group of the reasons of osteoporosis, the second for prevalence (so-called secondary) – existence of the disease conducting to violation of a structure of a bone or demanding serious therapy by certain preparations. Here some such states:

  1. Diabetes.
  2. Gipogonadizm (underdevelopment and/or the lowered function of sexual glands).
  3. Syndrome and illness of Itsenko-Kushinga (excessive production of own steroid hormones).
  4. Giperparatireoz (the increased function of parathyroid glands).
  5. Diseases of connecting fabric: rheumatoid arthritis, system red wolf cub and so forth. The disease often badly affects bone durability, but also, such patients are often compelled to accept glucocorticoids, one of which side effects - osteoporosis.
  6. Chronic renal failure.
  7. Blood diseases (lymphoma, leukoses, miyelomny illness) and therapy by cytostatics.

And nevertheless, it is the most frequent both doctors and patients deal with primary, "age" osteoporosis. However, it develops not at all. Why one person has a tendency to changes, and another will live to a ripe old age "whole"? How to define, whether you need to take measures of protection and prevention?

The factors provoking development of osteoporosis

Besides age and a female, a set of factors have impact on a structure of a bone tissue.

  1. The healthy nutrition is important. Approximately till 25 years there is a gradual increase of mineral density of a bone (i.e. increase in the content of calcium in it) and strengthening of a skeleton. Then some time of people deals with that "gathered", and after 35-40 years – calcium starts decreasing gradually. That is, from, whether it is enough in food of the child, the teenager contains calcium and vitamin D, depends, whether it "will gain" the maximum weight and density, and consequently, bone fortress. And whether these stocks at advanced age will be enough for it.
  2. Reduce intake of calcium in an organism the excessive contents in food of animal fats (beef, mutton, pork), sugars, carbohydrates. Excess consumption of salt and coffee strengthens calcium removal.
  3. Digestion of salts of calcium is promoted by the bile synthesized by a liver and as required (during food) excreted by a gall bladder in intestines. Chronic diseases of a liver, gall bladder, gastritises, enterita and pancreatitis at any age complicate receipt of this element in an organism and are risk factor of development of osteoporosis.
  4. Vitamin D directly increases absorption of calcium in intestines from food, its embedding in bone structure, reduces removal by kidneys. Vitamin D arrives to us with food (a liver, egg yolks, fish) and is synthesized in skin under the influence of an ultraviolet. Therefore it is important to happen regularly in the fresh air, on the sun, especially at young age.
  5. Physical activity. It is proved that a hypodynamia (a sedentary and lying way of life) and furthermore a long immobilization (bed rest) promote osteoporosis. Walks in the fresh air, charging, fitness classes, a suitable sport (but it is not professional!) strengthen a skeleton at any age.
  6. Normal body weight. Thin people have bone durabilities less.
  7. Smoking. Has an adverse effect on a structure and mass of "our support". The smoking young people do not gather additionally a maximum of bone weight, and at mature and advanced age actively it lose in comparison with non-smoking contemporaries.
  8. Abuse of alcohol also risk factor of development of osteoporosis.

Diagnosis of osteoporosis

In the presence of two of above-mentioned risk factors or a disease or at achievement of age of 65 years it is very desirable to pass inspection. So you will be able to learn, whether there is at you an osteoporosis and the increased risk of changes.

In this case such methods as a two-power x-ray absorbtsiometriya and densitometry are used. The mineral density of a bone (MDB) decides on their help and is compared to standard MPK of healthy people in your age group. The difference is estimated at more than 1 standard deviation as osteosinging (the lowered MPK), in more than 2,5 – osteoporosis.

In addition, perhaps it is required to hand over blood to define which mechanism of development of osteoporosis prevails: decrease in a kosteobrazovaniye or the increased destruction. Markers of violation of a bone exchange are such indicators of blood as osteokaltsin, alkaline phosphatase, destruction markers – sour phosphatase, fragments of collagen of 1 type, and also oksiprolin urine.

Whether it is possible to determine osteoporosis simply by a x-ray picture?

In principle yes, but changes on the roentgenogram appear late enough when it is lost from 20% of bone weight and more, i.e. this method not really is suitable for early diagnostics and prevention. On the roentgenogram osteoporosis consequences are visible: change of a shape of vertebras, cracks, deformations and changes.

Thus, it is necessary to diagnose osteoporosis and to trace efficiency of treatment by means of specific methods.

Whether osteoporosis clinically, is shown by any symptoms?

Unfortunately, early symptoms of osteoporosis do not exist. Generally symptoms appear late when there are complications.

Pain often accompanies osteoporosis, there is it at deformation of bodies of vertebras, reduction of their height when vertebras and their shoots start poddavlivat nervous backs, and of course, at a change. In this case so-called compression changes when in a vertebra there is a cross line of demolition are characteristic, under weight of weight it is pressed through, gives, getting a wedge-shaped form. The pain syndrome thus can be quite persistent. The spinal cord usually is not injured.

If thus some vertebras are deformed, human height decreases, the waist smoothes out, the back becomes round, edges come nearer to pelvic bones. In hard cases the hump is formed.

Pains accompany neurologic violations: paresteziya, sleep of skin of extremities, spasms.

The most terrible complication of osteoporosis - a hip neck fracture. The femur along with a backbone bears the main loading on weight and, besides, the movement without it is impossible. Elderly people should try to avoid such trauma conducting to an invalidization.

Treatment and prevention of osteoporosis

First, all people should try to gain the maximum bone weight that it was enough for active longevity at young age. For this purpose it is necessary to avoid risk factors of osteoporosis (see above).

However, the healthy nutrition, rational physical activity, a healthy lifestyle are actual at any age. It not only measures of prevention, but also pledge of successful treatment of osteoporosis.

Daily need for calcium - 1000-1500 mg a day. Such quantity it contains approximately in 6 glasses of milk or fermented milk products (fermented baked milk, kefir), 1,5 kg of cottage cheese, 200 g of firm cheese. In fish, nuts, color and sea cabbage also there is a calcium, but it is less and it from them more difficultly, than from milk is acquired.

Not all people transfer milk in such quantity or love cottage cheese. Therefore it is necessary to fill shortage of this important element reception of the corresponding preparations, the combination of calcium and vitamin D is especially effective (kaltsy-D3-nikomed, komplivit-kaltsy-D3).

It must be kept in mind that the favourite gluconate of calcium has very low comprehensibility, polyvitamins will also not approach (concentration is too small for preventive and medical effect there).

In addition, at treatment of osteoporosis it is necessary to accept also other means which are directly slowing down destruction of a bone and improving its synthesis. Now there are many corresponding preparations different in the action mechanism, the price, frequency rate of reception. All of them are rather safe and effective. What medicine is necessary for you, the doctor has to solve!

Groups of preparations for treatment of osteoporosis

  1. Bisfosfonata:
    • alendronat (fosamaks, ostalon, osterepar, tevanat, foroza);
    • ibandronat (bonviva, bondronat);
    • rizedronat (aktonel);
    • zolendrovy acid (blaster);

    They slow down a resorption (rassasyvany) bones, have lasting effect even after the treatment termination.

  2. Strontium renelat (bivalos).

    Strengthens formation of a bone, prevents its destruction.

  3. Calcitonin: synthetic calcitonin of a salmon (miakaltsik, veprena).

    Prevents a resorption, has good analgesic effect.

  4. Paratireoidny hormone (forsteo).

    Stimulates a kosteobrazovaniye.

  5. Denosumab (prolia, eksdzhiva).

    Oppresses a bone resorption.

  6. Estrogenopodobny substances (not hormones!): raloksifen (evist).

Application of replacement hormonal therapy is in certain cases possible (at young women from early, including surgical, a menopause).

In numerous researches at us it is also abroad shown that antirezorbtivny therapy authentically increases the mineral density of a bone by 3-12% in different parts of a skeleton that is followed by reduction of frequency of changes by 37-49%. However, for achievement of so good result it is necessary to observe carefully recommendations of the doctor about a dose, frequency rate, reception duration. Independent reduction of a dose, reception every other day, etc. – nullifies effect of a preparation. recommends - be adjusted on long-term treatment. Result - your cheerfulness, a young bearing, activity and longevity!

Good luck!

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