Bone density decreases with age, as a result of hormonal imbalance and impaired calcium metabolism. If the fragility of the skeleton increases, fractures become more frequent, then treatment of osteoporosis with the help of medications is necessary. You should pay attention to the diet, use medicines containing bisphosphonates, calcium and vitamin D.
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What is osteoporosis?
This is a common metabolic disease that leads to the loss of mineral salts and a decrease in bone density. The main reason is the imbalance between the creation of the extracellular matrix and the destruction of old structures. Bones become brittle, unstable to mechanical damage.
The main participants in bone tissue processes are osteoblasts, osteocytes, and osteoclasts. The cells of the first type synthesize the intercellular substance, are responsible for its mineralization. The bone matrix is a strong structure due to the content of mineral salts and organic components, mainly collagen. The main inorganic substance of bone is calcium hydroxide phosphate. In addition, the skeleton is a repository of sodium, magnesium and potassium ions.
Osteocytes are present in the matrix, but almost do not participate in the synthesis of substances. Osteoclasts are needed for the destruction, resorption of old bone tissue (resorption). During the first third of life, the processes of creation and destruction of bone substance are balanced.Until about 35 years, bone mass increases, after - decreases by 1% per year. In old age, destruction prevails over the creation of substances.
Healthy elderly people lose 6 times less bone tissue, compared with peers who are sick with osteoporosis.
The disease is characterized by the appearance of "holes" in the bones - gaps that are not filled with solid matter. Density decreases and bone fragility increases. Osteoporosis in the elderly occurs more often due to a decrease in metabolic rate in the body.
Causes of occurrence
The accumulation and destruction of bone matter is regulated by hormones. Calcitonin blocks the activity of osteoclasts, therefore, resorption is reduced. The hormone of the parathyroid glands starts the work of osteoclasts, the bone substance is destroyed. Calcium is released from the bones and enters the bloodstream. This process is very important in reducing plasma calcium levels.
Estrogens and testosterone stimulate the activity of osteoblasts, regulate calcium binding. The risk of developing osteoporosis in women after the onset of menopause is higher, as there is a deficiency of estrogen. The disease occurs in every third lady over 50 years old. For comparison: every fifth man in old age is ill with osteoporosis.
The normal regulation of bone function is impaired in case of deficiency:
- hormones (estrogen, androgen, calcitonin);
- vitamin D;
- glucocorticoids.
With a lack of these substances, calcium-phosphorus metabolism changes - the basis for the creation of the matrix. Osteoporosis occurs with an increase in the formation of cortisol, thyroid hormones. Malignant tumors, a decrease in the absorption of vitamin D and calcium, and an inflammatory process in the intestine can lead to this disease.
One of the causes of osteoporosis is considered physical inactivity. If a person leads a sedentary lifestyle, bedridden, then the metabolism in the bones is reduced. A similar effect is exerted by a lack of calcium and “building materials” to create hormones in anorexia. After treatment, bone density often remains low, not restored.
The risk of developing osteoporosis in women is higher with the late onset of the menstrual period, early menopause, and removal of the ovaries. With osteoporosis in men, a decrease in bone density is observed with a low level of testosterone. There are other risk factors: old age, cases of osteoporosis in relatives, foods low in calcium.
Alcoholism, smoking, insufficient insolation (for the formation of vitamin D3) can contribute to the development of osteoporosis. Salt in food, phosphoric acid in cola, high-fat foods interfere with calcium absorption.
Degrees of development and classification of the disease
To determine the stage of development of osteoporosis (the degree of the disease), an indicator of bone mineral density is used.
- Grade 0, osteopenia. Loss of bone mass is poorly expressed.
- The first degree of osteoporosis is characterized by a further loss of minerals, but there are no "holes" yet.
- The second degree is manifested by a decrease in the mineral density of bones. 1-3 fractures occur without an accident.
- The third degree leads to a further decrease in bone density. The mineral content is low. Multiple fractures of the vertebrae and other bones.
In the classification of osteoporosis, the primary and secondary form are distinguished. Primary disease accounts for up to 85% of all cases. Varieties: postmenopausal, senile (senile), juvenile (youthful), idiopathic osteoporosis. The latter is not caused by any known factors, conditions.
The main causes of secondary osteoporosis:
- therapy with glucocorticoids (GCS), immunosuppressants, thyroid hormones;
- endocrine diseases (thyrotoxicosis, hyperparathyroidism);
- chronic obstructive pulmonary disease;
- genetically determined disorders;
- nutritional deficiency;
- rheumatic diseases;
- malabsorption.
The most important factors in the development of secondary osteoporosis are hormonal disorders and treatment of corticosteroids. Common causes are immune and rheumatic diseases. An additional risk is associated with weight loss diets.
Symptoms and signs of the disease
Every second patient at first does not feel anything, since osteoporosis at first is asymptomatic. Further destruction of the bones leads to typical fractures (forearms, vertebrae, ankles, femoral neck). Even minor bumps, falls, lifting weights are traumatic.
Possible symptoms of osteoporosis, except for increased fractures:
- aching pains in the lower parts of the spine, between the shoulder blades, in the hip and ankle joints after walking, staying in the same position for more than 30 minutes;
- asthenovegetative syndrome (headaches, dyspepsia, decreased appetite);
- change in posture ("the position of the supplicant", "widow's hump");
- a decrease in the growth of a sick person (by 20 cm);
- premature aging.
Change in posture, the appearance of a widow's hump, a decrease in growth occurs when the shape and flattening of the vertebrae change. At the same time, skin folds may appear on the side of the chest and lower abdomen.
Indirect signs of osteoporosis:
- night cramps in the feet, calf muscles;
- fragility and stratification of nails,
- early graying;
- sleep disturbances;
- periodontal disease;
- dyspnea.
Osteoporosis is most often hidden. Tides, heavy sweating can be its harbingers in women. It is important to pay attention to the appearance and combination of the main symptoms and indirect signs.
Which doctor will I contact, diagnosis
Comprehensive treatment of the disease requires the participation of several doctors in the diagnosis and therapy. First, they turn to an osteopath and an orthopedic traumatologist, if there are no such specialists, then to a local therapist.
The doctor prescribes x-ray of the spine and densitometry (determination of bone density). It will take a blood test for thyroid hormones, identification of calcium and phosphorus levels. Women need to visit a gynecologist. After obtaining the results of all studies, the patient is prescribed a course of therapy.
Treatment of osteoporosis in women and men
The prescription of drugs, the choice of treatment methods is the prerogative of the doctor. The specialist can determine the amount of necessary care for the patient at each stage of the disease. Zero and first degree require one treatment tactic, loss of a large mass of bone substance - another. The most commonly used medicines: bisphosphonates, hormones, calcium, vitamin D.
The most effective drugs
Bone resorption inhibitors act on a process that normally normally occurs with the participation of osteoclasts. Imbalance leads to the fact that more bone is destroyed than synthesized. In pharmacology, there is a group of drugs that restore disturbed balance. They are included in the group of cartilage and bone tissue metabolism correctors.
Diphosphonates or bisphosphonates for the treatment of osteoporosis prevent bone loss due to excessive resorption. The name "bisphosphonates" is also used. These are the same organophosphorus compounds, only the writing of the multiplying prefix is different, indicating the number of substituted hydroxyl groups in phosphonic acid.
The drugs are used to treat osteoporosis and other pathologies in which there is a decrease in density and an increase in bone fragility.
The active substances of bisphosphonates are acids: alendronic, zoledronic, ibandronic, clodronic. These drugs reduce the rate of bone destruction and increase their strength. As a result, after taking bisphosphonates, the skeleton is strengthened, the risk of fractures is reduced.
Drugs containing alendronic acid are prescribed for osteoporosis in postmenopausal women, for men in old age, with a hereditary predisposition to bone diseases. Alendronate, Ostalon, Fosamax, Tevanat, Forosa, Binosto - complete analogues in terms of active substance and release form. The first two drugs are cheaper than other bisphosphonates. The cost of tablets is from 300 to 550 rubles. The price of packing Foroz (4 pcs.) - 600, Tevanata (12 pcs.) - from 1700 to 2300 rubles.
Trade names for zolendronic acid preparations:
- Aklast;
- Blaster;
- Resorba
- Zometa;
- Solerix;
- Veroclast;
- Zoledrex.
Medicines are available in the form of concentrates or lyophilisates, from which solutions for infusion are prepared. The prices in pharmacies for one bottle of Aklast reach up to 19 thousand rubles. The cost of the drug produced in Russia by Rezorb is about 6 thousand rubles.
Ibandronic acid is a third generation bisphosphonate. The drug suppresses the activity of osteoclasts, as a result, bone resorption is reduced. The commercial name of the drug is Bonviva. They are produced in the form of tablets and a solution for drip injection into a vein. The drug is dispensed in pharmacies at a price of 1100 (1 tablet), from 4700 (1 syringe tube).
Clodronic acid reduces pain caused by bone damage, increases bone mass during the first year of therapy. The trade names for the drugs are Bonefos and Klobir. Method of release - capsules and concentrate used for the preparation of an infusion solution. The cost of Bonefos capsules (100 pcs.) - from 8 to 10 thousand rubles, 5 ml ampoules - 5400 rubles, Klobir capsules (100 pcs.) - 7500 rubles,
For preparations containing the same active substance in identical dosages, the indications and contraindications are practically the same.
Denosumab is part of drugs that affect bone mineralization. The trade name is Prolia. The drug is prescribed for postmenopausal women, people of both sexes with symptoms of drug osteoporosis. The active substance inactivates the creation and existence of osteoclasts in bone tissue. The result of treatment is a decrease in bone resorption. Apply one dose of Prolia once every six months. The cost of 1 ml of the drug, ready for administration, is an average of 15 thousand rubles. Injections can be done independently (in the thigh).
Calcitonin in the composition of Vepren and Myakaltsik is an analogue of the hormone that regulates the metabolism and accumulation of calcium in bone tissue. Combined products contain two or more drugs. For example, the Tevabon kit contains tablets and capsules with alendronic acid and alfacalcidol, a regulator of phosphorus-calcium metabolism.
Along with treatment with bone resorption inhibitors, calcium and vitamin D preparations are necessary. There are a large number of vitamin preparations and dietary supplements for the prevention and treatment of osteoporosis. This means Menopause Ladis formula, Aquadetrim, Calcium-D3 Nycomed, Calcemin Advance.
Folk remedies
Herbs, roots and fruits of plants contain vitamins, phytohormones, flavonoids, mineral compounds, which are important for maintaining the density and strength of bone tissue. Hormones, similar in structure to estrogens, are part of the rhizome of wild yam (dioscorea). This is a grassy liana native to the forests of the Khabarovsk Territory. In pharmacies, you can buy dioscorea root in bags and ready-made preparations that contain phytoestrogens of wild yam, for example, dietary supplements Menopause, Laura, Chi-Klim.
Men are recommended to take infusion of calamus or celery rhizomes for the treatment and prevention of osteoporosis. Infusions of red clover, sage are more suitable for women. To everyone who is not allergic to bee products, honey is very useful.
Prepared from 2 tbsp. l sweet "amber", 50 ml of cahors, 5 eggs, 5 lemons balm for oral administration. It is necessary to mix the contents of the eggs with honey, chop the shell and pour in the juice squeezed from the lemons. Insist 5 days, then combine the mixture, dilute with Cahors.Balm take 1-2 tbsp. l in a day.
Nutrition rules
Women and men with a predisposition or an increased risk of osteoporosis should include more foods rich in calcium, magnesium, vitamins D, C, K. In childhood and adolescence, such a diet is very useful, as it helps to prevent bone diseases.
Processed foods may not be a complete source of vitamins.
Therefore, it is necessary to eat raw vegetables and fruits, freshly squeezed juices. Vitamin D3 is produced in the skin under the influence of sunlight and comes with food (sea fish and fish oil, eggs, avocados and other products). Cheese, natural yogurt, milk, mushrooms, carrots, hazelnuts, almonds, cabbage, fennel are rich in calcium.
You can drink mineral water without gas. Therapeutic, with a high content of macronutrient, is prescribed by a doctor. Mineral water is suitable for daily use.
Possible complications
Osteoporosis is not cured. Early diagnosis and supportive care will help prevent the progression of the disease. Otherwise, bone loss will continue, leading to increased pain and frequent fractures.
Disease prevention
Intestinal malabsorption often causes a shortage of bioactive substances in the body. Such a “foundation” for the development of osteoporosis can be created in childhood, at a young age. With a decrease in the absorption of calcium and vitamin D, gastrointestinal diseases should be treated, several higher doses of drugs that contain these components should be taken. In other cases, the intake of vitamin D and calcium in the body should correspond to age norms.
“Killers” of bones are called alcohol, cola and caffeine, which help to wash out calcium from bones. These products are excluded.
Useful for the prevention of sports. Exercise can be performed indoors and outdoors. The best choice is cycling, swimming in open water, dancing, Nordic walking. Strength exercises with inclinations, weight lifting are contraindicated. With weighting, one can carefully sit down, bending the knees, and get up.
Feasible physical activity, sunbathing, proper nutrition are the three “whales” that make up the basis for preventing bone destruction.
