Osteoporosis in adults

What is osteoporosis

“Osteoporosis is a skeletal disease in which bone mineral density decreases, causing bones to become brittle,” says Kira Zotkina, rheumatologist, member of the Russian Association for Osteoporosis. – In osteoporosis, fractures can occur with minor trauma or even without trauma – pathological fractures.

And with age, by the way, the risk of getting such a diagnosis increases. According to our expert, one in three women and one in five men over 50 suffer from osteoporosis.

What you need to know about osteoporosis

Degrees of osteoporosis in adults

“There are no stages of osteoporosis as such,” says Dr. Zotkina. – As a rule, a condition called osteopenia and severe osteoporosis are distinguished separately.

Osteopenia

It’s kind of an alarm. Roughly speaking, the initial stage of the development of the disease.

– Osteopenia is a decrease in bone density, which we can see on densitometry (a method for diagnosing bone density – author’s note). Most often, osteopenia does not require prescribing drugs for the treatment of osteoporosis, with the exception of adequate intake of vitamin D and calcium from food or in the form of supplements, says Kira Zotkina.

Severe osteoporosis

Here we are talking about the running state.

“This is the name of osteoporosis with a history of a pathological fracture: vertebrae, femur, or multiple fractures, regardless of the degree of decrease in bone mineral density according to densitometry,” our expert notes. – In patients who have undergone osteoporotic fractures, the quality of life decreases, which is only partially restored after an average of 1-2 years, depending on the location of the fracture. Given the projected increase in life expectancy in Russia, there will be an increase in the incidence of pathological fractures in the coming years.

Symptoms of osteoporosis in adults

In the medical literature and on various websites, you can often find the concept of “silent epidemic of the 21st century.” Why is it called osteoporosis? Are the symptoms not clear enough?

“The meanness of this disease is that a person does not feel when the bones become brittle,” explains Dr. Zotkina. “Osteoporosis itself does not cause pain. Pain occurs as a result of a fracture. And often osteoporosis is detected only when fractures have already occurred.

However, it is clear that not every fracture indicates this disease.

The most typical for osteoporosis, according to our expert, are fractures of the femoral neck, bones of the forearm, shoulder, ribs, as well as compression fractures of the vertebral bodies (when, in fact, the vertebrae “flatten”). But fractures of small bones, for example, fingers, as a rule, are traumatic, and not osteoporotic.

Causes of osteoporosis in adults

Experts can name a number of reasons that, together or individually, can provoke the development of the disease.

Starting from genetic predisposition and gender, ending with lifestyle and even the use of certain medications.

The risk factors include:

• age over 65 years;
• belonging to the female sex;
• postmenopause;
• early – up to 45 years – menopause (including surgical);
• previous pathological fractures;
• heredity (for example, a hip fracture in a close relative);
• prolonged immobilization (immobility) – more than 2 months;
• taking glucocorticoids (methipred, prednisolone) for more than 3 months;
• the presence of certain diseases;
• smoking, alcohol abuse;
• low body weight.

“Primary osteoporosis develops as an independent disease, it occupies 95% in the structure of osteoporosis in postmenopausal women (postmenopausal osteoporosis) and 80% in the structure of osteoporosis in men over 50,” says rheumatologist Zotkina. – Secondary osteoporosis develops as a result of various diseases or medications. That is, there is a specific cause leading to osteoporosis. In the structure of the disease, secondary osteoporosis occupies 5% in women and 20% in men.

Treatment of osteoporosis in adults

“The treatment of osteoporosis at home includes, first of all, sufficient intake of calcium and vitamin D,” says the rheumatologist. – The prophylactic dose of vitamin D is 800-2000 IU per day (1 drop of liquid vitamin D contains 500 IU). Vitamin D can be taken in the form of tablets, drops, capsules – there is no difference.

The daily intake of calcium is 1000-1200 mg, and it is easier to get it from food. A sufficient daily intake of calcium is considered to be the presence in the daily diet of at least three servings of dairy products. One serving is, for example, 30 g of cheese, 100 g of cottage cheese, 150 g of yogurt, 200 ml of milk.

Yes, of course, vitamin D can also be obtained without resorting to pharmacology for help. This vitamin is produced in the skin when exposed to the sun, and it can also be obtained from food, for example, fatty fish are rich in vitamin D. But, alas, not everyone has such products in their daily diet. And the sun spoils not everyone all year round – the inhabitants of the northern latitudes especially lack sunlight.

– Therefore, everyone is advised to take vitamin D prophylactically. And not only in winter, but also in summer. But do not overdo it: long-term use of large doses of vitamin D (more than 4000 IU per day) is not recommended, primarily because of the risk of kidney stones, emphasizes Kira Zotkina. – Calcium, by the way, can also be obtained from supplements – especially important if a person does not like dairy products or cannot tolerate them. But the additional intake of magnesium and vitamin K in osteoporosis is not required.

But unfortunately, calcium alone with vitamin D cannot increase bone density. Therefore, drugs are also prescribed for the treatment of osteoporosis at home. More on that below.

Diagnostics

In the case of osteoporosis, the laboratory method, alas, does not work. Osteoporosis cannot be detected by blood and urine tests. Maybe an x-ray?

— A densitometer measures bone density in the lumbar spine, femoral neck, and sometimes the bone density of the forearm (the area between the hand and elbow) is measured. These points can be used to judge whether a person has osteoporosis, says Kira Zotkina.

Don’t be afraid of the unknown term. The examination is painless and takes only 15-20 minutes.

Modern treatments

“If osteoporosis is detected, medications should be used,” says our expert. – Medicines for osteoporosis can be divided into those that inhibit the destruction of bone tissue (bisphosphonates and denosumab) and those that stimulate bone formation (in Russia – teriparatide). The optimal drug is selected by the attending physician, depending on the severity of osteoporosis and the presence of concomitant diseases.

The drugs are available in different forms:

• tablets (alendronic acid, ibandronic acid) to be taken once a week or once a month;
• drugs for intravenous administration (zoledronic acid, ibanronic acid) – once a year or every 3 months;
• subcutaneous injections (denosumab, teriparaid).

“Osteoporosis cannot be cured quickly. The treatment of osteoporosis is long, but still not endless, says Kira Zotkina. – Usually a minimum of 3-5 years of taking the above drugs is required, and once a year – observation by a doctor. More often than once a year, densitometry is not necessary, but not because it is harmful (in fact, it is not harmful, the radiation dose during densitometry is very small), but because the processes in the bones are very slow and earlier than in a year treatment, we just won’t see anything.

Prevention of osteoporosis in adults at home

In order not to have problems with your own skeleton at a respectable age, you need to pay attention to the prevention of osteoporosis from childhood. Yes, yes, because it is at this age that a set of bone mass occurs.

– It is necessary to provide the child with good nutrition, including dairy products, vitamin D, – the rheumatologist recommends. Physical activity also plays a big role in the prevention of osteoporosis. Bones need exercise to maintain density. Moderate strength training (Nordic walking, Pilates, swimming) is needed to strengthen the muscular corset, improve coordination in elderly patients with osteoporosis. Patients with fractures of the vertebral bodies should avoid sharp bending of the body forward and sideways, lifting heavy weights, as well as performing exercises that exert a force on the vertebrae (for example, running, jumping).

Separately, it is worth mentioning the prevention of fractures – especially in the elderly.

– Since most fractures are caused by falls, it is necessary to create a safe environment at home: remove carpets and wires from the floor that can be tripped over, create good lighting, use convenient handrails / holders in bathrooms. In winter, be sure to wear comfortable non-slip shoes, and do not be shy about using a cane when walking, says Kira Zotkina.

Popular questions and answers

We discussed this disease with our expert Kira Zotkina.