Osteoporosis – causes, treatment

Proven content

It works secretly and deceitfully. Suddenly it turns out that she has stolen a few centimeters from you. How to avoid osteoporosis?

It does not come on for a very long time. But he attacks more and more often. Experts estimate that in the European Union, someone breaks their bones every half a minute due to osteoporosis. In Poland, 2,5 million women and nearly half a million men are ill, and in the future this disease will affect every fourth female and every fifth male. Younger and younger people are getting sick! So you can see that the problem is serious – osteoporosis has even been recognized as a disease of civilization. It is said that she is a silent bone thief. Most people are surprised to hear the diagnosis, because osteoporosis develops without symptoms, without pain. The first sign is a fracture of: the vertebrae of the spine, hip bone, wrist. In addition, bones break like sticks under any pressure when carrying out simple everyday activities. The worst thing is that after such a fracture it is difficult to regain full fitness and the patient often requires constant care. It is worth getting to know the enemy of our skeleton, thanks to which it will be easier to defeat him.

New every twelve years

Osteoporosis is a bone metabolic disease. Throughout your life, bones try to adapt their shape and structure to the changing loads and functions of the body. Old ones are constantly being removed and new, usually slightly different, tissues are formed there.

This process involves bone cells: osteoblasts – building (bone) cells that are responsible for the construction of new bone, osteocytes – mature bone cells and osteoclasts – the so-called food (osteoclast) cells that dissolve and remove old bone tissue.

In childhood and adolescence, osteoblasts are more active, which is why bones grow. Between the ages of 20 and 35, the processes of dissolution and reconstruction proceed more or less at the same rate, therefore bone mass hardly changes. Later in life, the number of osteoclasts increases and the destruction process begins to dominate (we lose about 1% of mass annually). The bones become weaker.

In adults, 8% of them undergo reconstruction within a year. skeleton. So you can assume that every 12 years each piece of your bones is renewed.

With age, bones become more porous and brittle. The process is very slow at first, but then escalates. That is why the health of bones in old age depends on how they were formed in the early years of life. The higher the ceiling from which the bones begin to lose, the later the so-called bone loss will be exceeded. fracture threshold.

Women are more likely to develop osteoporosis

Both men and women suffer from osteoporosis. However, women in the perimenopausal age are more exposed, especially those who started the menopause before the age of 45. This phenomenon is associated with a decrease in the production of sex hormones supporting bone building processes and a deterioration in calcium absorption, which leads to faster bone loss. For this reason, hormone replacement therapy protects against osteoporosis. Therapy may be indicated in women who are entering the menopause, who have low bone mass and who are at increased risk of developing osteoporosis (e.g. small body builder, taking steroids). Women with menopause too early, i.e. before 45 years of age, should decide on HRT. Of course, the therapy is selected individually to the health condition and needs of the woman. Only then will it benefit.

Osteoporosis is more likely to threaten lean, flabby people whose muscles are too weak to sufficiently protect the skeleton. When muscles are strong, they better protect weak bones from breaking.

Disease development is also fostered by smoking, alcohol and coffee abuse, a sedentary lifestyle, a diet low in calcium and vitamin D. Cigarette smoke contains cadmium which destroys bones. Additionally, smokers tend to go through the menopause earlier and are therefore more likely to suffer from the disease. In turn, caffeine hinders the absorption of calcium.

You should also remember that some drugs can cause osteoporosis – they help with one condition, but they “steal bones”. Doctors usually report side effects of therapy. Among the drugs that have a bad effect on bone mass, there are, among others, chemotherapy drugs, antiepileptic drugs, heparin, lithium, certain contraceptives, proton pump inhibitors (drugs for acid reflux), SSRI antidepressants, steroids (glucocorticoids), thyroid hormones, etc.

The disease also happens to children. Fortunately, it is rare and is associated primarily with dietary mistakes (eating fast food and drinking cola from an early age) and a lack of physical activity.

Milk and walk are important in the prevention of osteoporosis

It is believed that eating the right amount of dairy products, providing the body with enough vitamin D, and an active lifestyle will help prevent osteoporosis. It turns out, however, that it is not that simple. Calcium, vitamin D and physical activity protect bones, but if we are genetically predisposed to osteoporosis, they will not protect us from the disease. On the other hand, if we did not drink milk, did not replenish vitamin D, did not move, etc., the course of the disease would be worse. That is why it is worth ensuring that the bones do not run out of anything.

The condition of the skeleton is primarily influenced by calcium. This element is involved in the formation and mineralization of bone tissue, which is why it is so important that the diet includes milk (but not pasteurized!) And its products (yellow cheese, real yogurt). They are the source of the most easily absorbed calcium (it is absorbed in 80%, from other products only in 12-30%). Such perfect digestibility is guaranteed by the correct proportion of calcium and phosphorus (1: 1). If we do not provide the body with calcium with food, it will start to take this element from the bones, weakening them. 3 glasses of milk a day are enough to reduce the risk of osteoporosis, and even completely avoid it.

In addition to calcium, bones are affected by:

* Vitamin D – increases the absorption of calcium and stimulates the formation of osteogenic cells. Its lack causes the bones to weaken – they cannot regenerate, they become brittle. This vitamin can be found in fish, butter and egg yolks. It is also formed in the skin under the influence of sunlight (10 minutes of walking a day is enough. Note! UV filters block the production of vitamin D).

* Magnesium – is involved in the process of calcium absorption. Magnesium absorption is increased in the presence of vitamin B6 (found in bananas, liver, tuna and grain products).

* Vitamin K – affects the activity of a protein (osteocalcin) that binds calcium in the bones. It determines the bone density. Vitamins K and D mutually reinforce each other’s effects. Vitamin K is found in broccoli, spinach, fermented dairy products, egg yolks.

* Vitamin C – is necessary for the proper synthesis of collagen, which is the main organic component of bones. This vitamin is found in black currants, parsley, kiwi, citrus.

In order to prevent osteoporosis, you should not forget about physical activity, especially walking. They stimulate the formation of bone mass. When walking, the bones are affected by gravity and the muscle tone changes. Together, these two components inhibit bone loss. Movement increases the tolerance of bone tissues to exercise, and protects the joints from damage. It is best to walk at least half an hour a day with a brisk step and waving your arms. When we are just starting training, let us march intensively for a quarter of an hour, gradually extending this time. Nordic walking is worth recommending, because during this march we support the body movement with rhythmic pushing off with poles. The march stimulates 90 percent to work. muscles, but cycling and swimming are also beneficial. Dancing is also a great exercise. In this case, however, it is not only about inhibiting the development of the disease, but also about good motor coordination. Thanks to it, it is easier to avoid tripping and therefore falling and breaking.

Training must be adapted to age and health. People with osteoporosis should avoid jumping, jerking movements, bending, and lifting weights. Isometric exercises are recommended for everyone. In patients, they are necessary because they strengthen the muscles, which become a kind of corset supporting weak bones, rather than being strenuous.

System for catching patients with osteoporosis

Often, the first and only symptom of osteoporosis is serious fracture for little reason. The disease is very advanced then. A signal that your bones are becoming brittle can also be back and spine pains, especially when you sit down and stand up, or if you sit or stand for a long time. Many people ignore these ailments, believing that it is the result of overstrain, sitting in an uncomfortable position or a reaction to a change in weather. As the disease becomes more advanced, acute pain accompanies almost all daily activities. It is worthwhile to perform bone density tests prophylactically. They have to be done even when we are fine and we are at risk. The test is free if we have a referral from a GP.

The bone mineral density (BMD) method detects disease when it is asymptomatic, and the risk of fractures and the risk of osteoporosis. The FRAX method is helpful in qualifying for osteoporosis testing. Thanks to it, it is possible to assess the risk of fracture of the main bones (spine, hip, forearm and upper arm) in the next 10 years. It consists in entering into a special calculator (available on websites, e.g. www.shef.ac.uk/FRAX) the data of the person, such as: age, gender, country of origin, weight, addictions (smoking, alcohol), family inclinations. for osteoporosis, etc. This method is recommended by the World Health Organization.

Treatment of osteoporosis is possible

The goal of therapy is to prevent fractures. Medicines stop bone destruction and stimulate the formation of bone tissue.

* Bisphosphonates are the group of the oldest (known for over 30 years) and most commonly used drugs. They inhibit bone degradation, i.e. have an anti-resorptive effect, reduce the risk of vertebral fractures by about 40-60 percent. However, they are sometimes poorly tolerated by patients. Drugs are taken orally once a week or once a month. They are also given intravenously quarterly or annually.

* Denosumab, a human monoclonal antibody, is the newest biological drug. Affects the system regulating bone remodeling. It is administered subcutaneously once every 6 months. It reduces the risk of vertebral fractures by 68 percent and the risk of hip fractures by 40 percent.

* Calcitonin is rarely used today. It has a positive effect on the vertebrae, has an analgesic effect. Does not prevent non-vertebral fractures.

* Parathyroid hormone promotes bone regeneration, is effective in severe osteoporosis, it is administered subcutaneously every day. However, it cannot be taken for more than 18 months.

* Strontium ranelate inhibits bone resorption and stimulates bone formation.

* Raloxifene is a drug from the SERM group (Selective Estrogen Receptor Modulators). It reduces the risk of vertebral fractures but does not affect the risk of other osteoporotic fractures.

Tekst: Anna Bugno

Consultation: Tomasz Blicharski, MD, PhD, orthopedist, Lublin Diagnostic Center