Contents
Osteoporosis
– a disease of the musculoskeletal system, manifested by loss of bone density and disruption of bone structure.
Symptoms of osteoporosis
In the literature, osteoporosis has been dubbed a “silent epidemic” due to the fact that its early stages are asymptomatic, and the diagnosis is often made after a fracture has occurred.
Main symptoms of osteoporosis
- pain in the back and limbs
- increased risk of bone fractures.
Risk factors for osteoporosis
Osteoporosis is most common among older people, but there are forms of the disease that affect children, adolescents (juvenile osteoporosis) and middle-aged people (idiopathic osteoporosis). Osteoporosis has the highest prevalence among postmenopausal women.
Development of osteoporosis
Human bone tissue is a depot of mineral substances for the body, in which the main stages of mineral metabolism are carried out, in particular the processes of calcium metabolism.
The following are involved in the regulation of calcium metabolism:
- parathyroid hormone (parathyroid hormone),
- vitamin D and its metabolites,
- calcitonin (hormone of the thyroid and parathyroid glands).
Under the influence of these substances, there is a delay in the leaching of calcium and phosphorus in the kidneys, absorption of calcium in the intestines, and increased formation and resorption of bone matter.
In the course of its life, bone tissue is constantly destroyed and created anew, however, at different age periods these processes occur at different rates: the highest bone density is normally characteristic of young people aged about 25 years, and in men it is initially higher than in women. This gender (inter-sex) difference is 10-15%.
With the onset of premenopausal age (40-45 years), a gradual decrease in bone density begins. After menopause in women, this process accelerates and can account for 2% of bone mass per year. In men, the dynamics of bone mass loss occurs according to a constant schedule until old age – about 0,5% per year.
Types of osteoporosis
All bone density loss conditions are classified into primary and secondary.
The reason secondary osteoporosis is a disease or treatment that leads to loss of bone density.
Primary osteoporosis develops without any obvious reason.
Primary osteoporosis is the most common condition, accounting for at least 80% of all osteoporosis.
Among primary osteoporosis, the following forms are distinguished:
- juvenile,
- idiopathic,
- presenile (postmenopausal)
- senile osteoporosis.
Among secondary osteoporosis, hormonally caused osteoporosis is distinguished (for example, with increased production of adrenal hormones; treatment with corticosteroids, hyperthyroidism, hypogonadism, hyperprolactinemia, etc.), osteoporosis in diseases of the gastrointestinal tract (after operations on the small intestine, with anorexia nervosa and other disorders nutrition, with prolonged immobilization and bed rest, after chemotherapy and immunotherapy during organ and tissue transplantation; with chronic intoxication (alcoholism, etc.); drug-related (corticosteroid, heparin, with long-term antiepileptic treatment; etc.).
Diagnosis of osteoporosis
Osteoporosis can be asymptomatic for a long time, but can also have an acute presentation.
In the first case, the patient may complain of non-localized pain in the back and legs, which is especially suspicious for osteoporosis in postmenopausal women or after artificial menopause.
With an acute onset, intense back pain occurs, often after falling or lifting something heavy. Complaints of intense pain, which can radiate to the chest or hypochondrium, often lead to diagnostic errors and hospitalization of the patient in the cardiology or surgical department.
A painful attack can develop gradually – over a day or two, often – without previous injury. Deformation of the spine gradually develops – increased thoracic kyphosis (hump), lordosis in the lumbar and cervical spine.
For objective imaging diagnostics, radiography of skeletal bones and densitometry are most often used. In radiographic studies, the most commonly used are radiography of the spine in two projections, a survey image of the pelvis with the femoral bones, and an image of the skull and hand in frontal and lateral projections.
Laboratory methods – determination of calcium, phosphorus, alkaline phosphatase in the blood, calcium, deoxypyridinoline and hydroxyproline in the urine.
Treatment of osteoporosis
Treatment of secondary osteoporosis depends on the cause that caused it, however, in all its forms, as well as in the treatment of primary osteoporosis, calcium supplements, vitamin D and its metabolites, calcitonin, bisphonates, as well as physical therapy, which can slow down bone loss and prevent development of pathological fractures.