Osteoporosis – a skeleton disease with change of structure of bones. The mass of bones gradually decreases, they become less strong and more fragile. The disease proceeds malosimptomno and often comes to light only after a fracture of a beam bone, a neck of a hip or bodies of vertebras. Not only detection of osteoporosis, but also definition of its reason is important. The comprehensive investigation of the patient including a X-ray analysis, densitometry, KT, a research of metabolism of a bone tissue and a hormonal background is for this purpose conducted. Treatment is carried out in a complex by calcium medicines, a calcitonin, vitamin D, biophosphonates and hormonal medicines.
Osteoporosis (Latin of osteon a bone + is time for poros, an opening) – a skeleton disease with change of structure of bones. The mass of bones gradually decreases, they become less strong and more fragile. The disease proceeds malosimptomno and often comes to light only after a fracture of a beam bone, a neck of a hip or bodies of vertebras. According to WHO data, osteoporosis is a noninfectious disease, the fourth on prevalence, after heart troubles and vessels, oncological diseases and diabetes. The disease affects mainly elderly people and women in a postmenopause. The probability of development of osteoporosis increases with age. Allocate two forms of osteoporosis: primary and secondary.
Osteoporosis – a polyfactorial disease. Involutional (primary) osteoporosis, as a rule, develops at patients 50 years are aged more senior. Risk factors of development of primary osteoporosis are:
- the family anamnesis (instructions on the changes resulting from a small trauma at elderly family members);
- advanced and senile age;
- asthenic constitution, decrease in body weight;
- small growth;
- the late beginning of periods (at the age of 15 years is also more senior);
- early approach of a menopause (aged up to 50 years);
- violations of a menstrual cycle;
- large number of pregnancy and childbirth;
- long feeding by a breast.
As the condition of a bone tissue depends on production of estrogen, osteoporosis frequency sharply increases after approach of a menopause. Women at the age of 50-55 years suffer from changes owing to osteoporosis 4-7 times more often than men. By 70 years changes arise at every second woman. According to modern traumatology the risk of developing of fractures increases in proportion to decrease in density of a bone tissue. At decrease in density of bones by 10% the frequency of changes increases by 2-3 times. Osteoporosis first of all affects bones with prevalence of spongy substance (vertebras, forearm bones in a luchezapyastny joint) therefore a typical complication of a disease are fractures of bodies of vertebras and a beam bone in the typical place.
Secondary osteoporosis is caused by endocrine violations and a way of life of the patient. Risk factors of development of secondary osteoporosis:
- endocrine violations (decrease in function of ovaries, diabetes, increase in production of hormones of bark of adrenal glands and thyroid gland);
- violations of food (unbalanced diets, nevrogenny anorexia, the increased contents in food of proteins and fats, deficiency of calcium);
- abuse of nicotine, alcohol and coffee;
- long reception (more than a month) of kortikosteroidny medicines, antikonvulsant and heparin;
- chronic renal failure;
- violation of absorption of calcium in intestines;
- genetic predisposition;
- low-mobility, insufficient physical activities;
- long bed rest (at injuries, operations, chronic diseases).
Often osteoporosis remains unnoticed for a long time. Pains of area of a backbone (chest and lumbar department) become the only signs of development of a disease. At osteoporosis growth of the patient gradually decreases, his bearing changes, the backbone becomes less mobile.
The most significant display of osteoporosis are changes (usually – bodies of vertebras or a beam bone). Special danger is constituted by fractures of a neck of a hip which in 20-25% of cases become a cause of death of patients during the first half of the year after a trauma, and in 40-45% lead to approach of heavy disability.
Diagnosis of osteoporosis is made on the basis of complaints of the patient, studying of the clinical record, results of survey of the traumatologist and measurement of mineral density of bone tissues. For determination of density of bones use one-photon it (is not always informative) also two-photon densitometry, ultrasonic densitometry and quantitative KT of a backbone. Radiological methods of a research allow to reveal authentically symptoms of osteoporosis only at considerable loss of mass of bone tissues (more than 30%).
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
The main goal at treatment of osteoporosis – to achieve reduction of losses of a bone tissue with simultaneous activization of process of its restoration. Complex treatment of osteoporosis includes hormonal therapy (estrogen, androgens, gestagena), vitamin D, bifosfonata, a calcitonin.
Hormonal medicines at osteoporosis select depending on a sex, age and risk factors. At the choice of medicines for women the phase a klimakteriya, existence of a uterus and desire of the woman to have menstrualnopodobny reactions in the post-menstrual period is considered.
Hormonal therapy is contraindicated at the accompanying serious illness of a liver and kidneys, tromboemboliya, sharp thrombophlebitises, uterine bleedings, tumors of female genitals and severe forms of diabetes. In the course of hormonal treatment of osteoporosis it is necessary to control arterial pressure and to carry out onkotsitologichesky researches. Once a year mammography and ultrasonography of a small pelvis is carried out.
The calcitonin to treatment of osteoporosis is applied in the presence of contraindications to performing hormonal therapy. Medicine slows down losses of a bone tissue, promotes increase in receipt in a bone of phosphorus and calcium, has the anesthetizing effect, improves processes of an union of bones at changes. Bifosfata reduce a resorption of a bone tissue. Vitamin D stimulates absorption of phosphorus and calcium, intensifies processes of formation of a bone tissue.
Prevention of osteoporosis has to begin since young years and proceed all life. Special attention to preventive actions should be paid in the puberty period (formation of bones) and the post-menopausal period.
Increase in durability of a bone tissue and reduction of its resorption are promoted by good nutrition (the balanced structure of food, sufficient receipt in a calcium organism), regular physical activity. It is necessary to limit consumption of alcohol, coffee and nicotine. At advanced age it is necessary to reveal in due time risk factors of development of osteoporosis, if necessary to accept vitamin D and calcic additives. Perhaps preventive purpose of hormonal medicines.
Women in peri-and a postmenopause are recommended to increase consumption of dairy products rich with calcium. At an allergy and food intolerance of milk the need for calcium can be filled with the tableted medicines in combination with vitamin D. On reaching 50 years it is regularly necessary to undergo preventive inspections for identification of risks of development of osteoporosis and need of replaceable hormonal treatment.