Systemic osteoporosis symptoms and treatment. Causes, symptoms and treatment of systemic osteoporosis. Which doctor treats osteoporosis

The spine is an important part of the human musculoskeletal system. It not only supports our back in the correct position, but also concentrates on itself a lot of ligaments, muscles and nerve fibers. In addition, the spinal column is another step in protecting the human spinal cord.

A disease such as systemic osteoporosis can reduce bone density and lead to serious consequences for the body. Let's consider how dangerous such an ailment is, how to correctly diagnose it and start treating it in a timely manner.

What is systemic osteoporosis

Systemic osteoporosis of the spine makes your bone thinner - very small pores appear in it, which gradually become more and more wide. Accordingly, this leads to the fact that the vertebrae become less durable.

Since there are large loads on the spinal column, even from the wrong lifting of a small weight, you can earn a compression fracture. Moreover, the risk of separation of fragments that can severely injure both the spinal cord and the tissues that surround it is potentially increased. This will require serious and long-term treatment.

Causes of the disease

No one is immune from the appearance of symptoms of systemic osteoporosis. Representatives of the Caucasian race in general, according to statistics, are more prone to the occurrence of such an ailment.

There are several risk factors that can potentially increase the risk of the onset of the disease:

• Elderly age. It begins to gradually wash away calcium from the bones, and without the right diet and medication, the risk is very high.
• Allergy to milk protein. A person in this position is deprived of one of the main sources of calcium and bone-strengthening vitamins.
• Female. According to statistics, bone density disorders are three times more common in women than in men.
• Problems with the menstrual cycle. In this case, a woman begins to lack estrogen, which directly affects how the bones “feel” themselves.
• Wrong way of life. Smokers, people who consume too much alcohol, salty or sweet foods are susceptible to such diseases.

Types of systemic osteoporosis

It is important not only to understand what systemic osteoporosis of the spine is, but also to determine its type. There are primary and secondary types of such a disease, differing both in symptoms and in the causes that lead to their occurrence.

Primary

The main risk factor for the occurrence of such a disease is the large age of the patient. Often appears in the fairer sex during the onset of menopause. The disease develops on its own due to hormonal disruptions, gradual leaching of nutrients, lack of movement.

Secondary

This form of the disease often acts as an addition to other diseases and is provoked by them. Often there is a thinning of the bone against the background of malfunctions in the thyroid gland or diabetes. Some medications can also cause the patient's condition to worsen. The problem can occur against the background of injuries, as well as scleroderma.

Forms of the disease

In addition to the types described above, there are several forms of the disease. This:

• Local. Often occurs after a person has received an injury, for example, after a fracture. Numerous burns, toxic effects, and much more can also provoke such problems. In this case, the bone is affected at the site of injury.
• Regional. In this case, the coverage of a certain area appears unevenly. The entire skeleton is not affected, but several joints and bones are affected. Systemic uneven osteoporosis is quite difficult to diagnose.
• Periarticular. Another metabolic species that affects the tissue of the bone located near the joint. In addition, there is a risk of tissue problems. Often occurs, for example, on the hands and feet.
• diffuse. It will be characterized by a gradual thinning of the bones under the influence of an unhealthy lifestyle, loss of vitamins and minerals by the skeleton. Often because of this, a hump appears, a stoop occurs, a fracture occurs.

signs

It is important not only to understand what it is, systemic osteoporosis, but also how to recognize it at an early stage. The symptoms of the disease are as follows:

• Severe discomfort in the place where the osteopathic damage is concentrated.
• A person feels that their muscles have weakened or tightened too much to compensate for the decrease in the bearing capacity of the bones.
• The appearance of pain. It can be concentrated both in a specific area and resonate in nearby tissues.
• Severe change in posture. The person either leans to the side or becomes stooped and cannot move normally.
• Often there are injuries of various nature, including fractures and cracks.
• Human growth is getting smaller. This is due to the fact that compression fractures occur in the spine, and therefore, the height of the vertebrae becomes smaller.

How to Diagnose

Before starting the treatment of systemic osteoporosis, it is necessary to correctly determine the location of such bone damage. It can even be seen on an X-ray - it shows that the bones have become porous and the amount of substance in them has decreased. In addition, the doctor collects an anamnesis and looks at what complaints and test results you had.

Methods of treatment

In many ways, the success of treatment will be influenced by the cause of the development of this type of disease. There are several ways:

• Diet. A person is prescribed a nutrition program with plenty of calcium and magnesium.
• Reception of vitamin complexes. Vitamins D and K enter the body with them. They provide better absorption of calcium and magnesium.
• Physiotherapy. It is aimed at relieving pain and strengthening the muscular frame of your body. Massage and electrotherapy are often used.
• Surgical treatment is indicated only in extreme cases, with severe fragmentation of the vertebrae.

Prevention of systemic osteoporosis

So that you are not so worried about the symptoms and treatment of systemic osteoporosis, you should take care of its proper prevention. To reduce the risk of disease, try to lead a proper lifestyle, walk more in the fresh air, do not forget about foods rich in magnesium and calcium, as well as dietary supplements. Stopping smoking and regular exercise will provide a significant improvement in the condition.

Systemic osteoporosis

a disease belonging to the group of metabolic osteopathies. In the development of the disease, the leading role is assigned to the violation of the mechanisms of modeling and remodeling of bone tissue. O. s. can be both the result of exposure to adverse environmental factors and genetic defects. The latter is confirmed by cases of systemic osteoporosis, which are observed in several members of the same family. Active mutagenic factors are ionizing radiation, some chemical compounds, viruses. Risk factors for systemic osteoporosis may include early menopause, adrenal hyperfunction, hyperthyroidism, hypogonadism, excess phosphorus intake, starvation (insufficient calcium intake), long-term use of drugs such as heparin, barbiturates, alcohol, smoking, excessive coffee consumption, physical inactivity and etc. In some cases, the disease develops during pregnancy and lactation, as well as in the pathology of the gastrointestinal tract. More often, several risk factors act simultaneously, so the disease is considered polyetiological multifactorial.

clinical picture. O.'s manifestations with. varied. One of its most persistent symptoms is pain in the lumbar region, sacrum, and hip joints. Patients usually note a feeling of heaviness between the shoulder blades, general muscle weakness and gait disturbance. In some forms, the first manifestation of the disease may be pain and deformity of the ankle joints or the appearance of swelling and pain in the area of ​​the feet with its gradual spread to the large joints of the lower and small upper extremities. Subsequently, pain in the pelvic bones, ribs, which increases with physical exertion, joins. Further progression of the process is accompanied by a persistent pain syndrome, which does not disappear at rest and often forces one to take analgesics for a long time. Sometimes the first manifestation of O. with. there is a pathological fracture of the bones of the lower third of the forearm. None of the symptoms are pathognomonic and can be seen in many other metabolic osteopathies, multiple myeloma.

The course of the disease is often slow, but progressive. Spontaneous regression has been described only in some patients with a transient form of systemic osteoporosis (for example, in young men with idiopathic juvenile osteoporosis, in women during pregnancy or during lactation). With the progression of the disease, the violation of bone mineralization increases every year, which is accompanied by a decrease in its mechanical strength. As a result, pathological fractures, secondary deformities are noted, which often lead to disability.

Diagnosis. The most important role in O.'s diagnosis with. X-ray examination is assigned, in which a decrease in bone shadow density (osteopenia), increased vertical striation of the vertebral bodies, sclerosis of the subchondral plates, numerous depressed fractures in the central sections of the subchondral plates, fractures of the vertebral bodies (Fig. 1), pelvic bones, femoral necks, other bones of the skeleton. Thinning of the cortical layer of long tubular bones, restructuring processes similar to Looser's zones in the necks of the femurs (Fig. 2) and pelvic bones are also characteristic. In some cases, granular foci of enlightenment are observed in long tubular bones, as well as in the bones of the skull and hands.

At some forms O. of page. X-ray features are possible. Thus, in the steroid form of the disease, in contrast to the postmenopausal one, the deformity of the vertebral bodies in the fish type is more common (Fig. 3). Wedge-shaped deformity of the vertebral bodies in patients with postmenopausal form occurs without visible trauma, and with O. s. in young and middle-aged people, such a deformation of the vertebral bodies can be detected after lifting weights or falling from a height of their height. Numerous compression fractures of the vertebral bodies, which were previously described as hormonal spondylopathy or osteoporotic spondylopathy, are more appropriately referred to as platyspondylia, given that such an x-ray picture can be observed not only in various forms of O. s., but also in other diseases and metabolic osteopathies. As a rule, there is no connection between such a deformation of the vertebral bodies and endocrine disorders. Fractures of the necks of the femur are more common in patients with senile form O. s., and pelvic fractures - in young and middle-aged people. None of the radiological symptoms is pathognomonic, because similar changes can be noted in osteomalacia, osteoporotic form of myeloma, etc. In this regard, radiological changes, like clinical ones, should be considered only in conjunction with other data.

The results of laboratory tests are of great importance for establishing the diagnosis. With O. s. hypocalcemia, an increase in the level of phosphorus in the blood while maintaining its normal excretion and tubular reabsorption, a decrease or increase in the activity of alkaline phosphatase, transient hypercalciuria, increased urinary excretion of hydroxyproline are possible. In cases where hypocalcemia is combined with an increased release of hydroxyproline and a slight increase in the level of alkaline phosphatase, it is necessary to carry out a differential diagnosis with osteomalacia (Osteomalacia).

Often, invasive and non-invasive methods for determining bone mass are used in the diagnosis of the disease. Non-invasive methods include X-ray densitometry, X-ray morphometry, gamma-photon absorptiometry. X-ray morphometric and X-ray densitometric methods are quite simple, take little time, but they allow you to determine mainly the mass of the cortical part of the bone and measure only in the area of ​​​​the phalanges or II metacarpal bone, which are affected in O. with. not in the first place. The spine and femoral neck are considered the most vulnerable parts of the skeleton in systemic osteoporosis, so data on the state of these parts of the skeleton are of the greatest value. They can be obtained by two-photon absorptiometry and computed tomography.

An invasive method for assessing bone mass is histomorphometry of the material obtained from a biopsy of the iliac wing. It allows to obtain a quantitative characteristic of such parameters of bone tissue as cancellous bone volume, trabecular width, cortical plate width and porosity.

In all cases when there are difficulties in O.'s diagnosis with. according to the clinical and radiological picture and biochemical data, the patient should be referred to a specialized orthopedic hospital.

Treatment. The use of calcium preparations alone does not stop the progression of the pathological process and does not increase bone mass. The use of anabolic hormones contributes to an increase mainly in muscle mass. Data regarding the therapeutic effect of estrogens are contradictory. Their use, undoubtedly, is pathogenetically justified at O. of page which developed against the background of the Hypogonadism at women. Calcitonin has a pronounced analgesic effect, but does not stop the progression of the process. In addition, long-term use of calcitonin can lead to secondary hyperparathyroidism and increased bone resorption.

Wide application for O.'s treatment of page. found fluorine preparations, tk. their introduction as a result of the substitution of hydroxyl ions in hydroxyapatite leads to an increase in bone volume, improves the structure of the crystal lattice. But the matrix newly formed under the influence of fluorides is poorly mineralized, therefore, treatment with fluoride preparations (ossin, correberon, tridine) must be combined with the appointment of active vitamin D metabolites and calcium preparations. Long-term fluoride treatment, at least 2 1/2 years. The daily dose of calcium gluconate is 1.5 g. Due to the fact that fluorine forms insoluble compounds with calcium, the intake of fluorine and calcium cannot be combined in time, and the interval between their intake should be several hours. With fluorine preparations, it is also impossible to simultaneously take dairy products, cereals cooked in milk. In cases where hypocalcemia is observed in systemic osteoporosis, treatment should be supplemented with the intake of oxydevit (an active metabolite of vitamin D), which improves calcium absorption in the intestine.

Treatment of various forms of systemic osteoporosis with only active vitamin D metabolites is based on evidence of calcium malabsorption in the intestine. There is evidence that the appointment of oksidevit for 1 year in patients with the postmenopausal form of the disease, with osteoporosis in young and middle-aged people, as well as with osteoporosis that has developed against the background of diabetes mellitus, stabilizes the x-ray picture, eliminates pain (already after 2 -5 months after the start of treatment), stops the loss of spongy bone, maintains the thickness of the trabeculae and the width of the cortical bone plate. In some patients, during treatment with oxydevit, a significant increase in the width of the trabeculae and cortical plate is noted, which indicates the effect of the drug on the processes of modeling and remodeling. In each case, an individual selection of the dose of the drug and the duration of the course of treatment is necessary. Just as in the treatment with fluoride preparations, biochemical control is necessary at least once every 6 months. Mandatory components of O.'s treatment with. are exercise therapy, massage. With muscle weakness, hydrokinesitherapy is recommended. The therapeutic motor regimen is determined individually, health paths, close tourism or walks are prescribed. The complex of therapeutic measures includes orthotics. Corsets are prescribed according to indications.

Violation of the processes of remodeling and modeling in patients with O. s. excludes the possibility of surgical treatment of fractures of the femoral neck or other fractures without prior and subsequent conservative treatment.

Bibliography: Kon R.M. and Roth K.S. Early diagnosis of metabolic diseases, trans. from English, p. 350, 398, M., 1986; Violation of calcium metabolism, ed. D. Heath and S.J. Marx, trans. from English, M., 1985.

- a chronic progressive disease of the skeleton, which is manifested by a decrease in bone density, which reduces bone strength and several times increases the risk of fracture. It may be a separate disease or syndrome that can manifest itself in other pathologies.

To date, 35% of all women and 20% of men who have suffered fractures have had previously undiagnosed osteoporosis. And most often such people get a fracture of the femoral neck. A feature of systemic osteoporosis is that it can occur due to a variety of factors, among which the following are in the first place:

1. The presence of osteoporosis in relatives.
2. Advanced age.
3. Female.
4. Weight less than 60 kg.
5. Fragile physique.
6. Dairy intolerance.
7. Hormonal disorders.
8. periods of amenorrhea.
9. Infertility.
10. Smoking.
11. Alcoholism.

In addition, one of the development factors can be long-term use of certain types of drugs - anticoagulants, cytostatics, tetracycline antibiotics.

Clinical picture

Symptoms of systemic osteoporosis remain undetected for a long time. Receiving certain injuries, the patient does not even suspect that he has this insidious disease. Most often, you need to see a doctor for pain in the back, which does not go away for a long time and is not removed by taking painkillers. Fractures of the vertebral bodies and their arches almost always resolve without the development of symptoms. However, a person begins to develop and increases cervical lordosis, which leads to the so-called widow's hump.

Such attacks cannot be compared with trauma in the past, since fractures of the spine often happen by themselves. The pain lasts for about a week, after which it subsides, and the person returns to his normal life. Over time, it becomes increasingly difficult to sit and get up from a sitting position. The course of the disease itself is not predictable, and the interval between vertebral fractures can range from several months to several years.

Other signs of pathology include:

1. Growth decline.
2. Increased tone of the back muscles.
3. Pain on palpation of the spine.
4. Slouch.
5. Increased lumbar lordosis.
6. Shortening of the spinal column.
7. Increased skin folds on the sides of the body.

Pain syndrome is quite rare, but such a serious complication as a fracture of the femoral neck is very common. For women, multiple fractures of the ribs are also typical, especially in the postmenopausal period.

Today, there are two types of this pathology - slow and fast osteoporosis. In the first case, at the very beginning of the disease, there is practically no pain, but in the future they begin to manifest themselves very often. In the second case, there is an acute onset, which resembles the clinical picture of lumbago, which is associated with a compression fracture of the vertebral body. This can happen with awkward movement or heavy lifting.

Diagnostics

Diagnostics includes several types. Firstly, it is an objective examination, history taking, measurement of height and weighing. Secondly, these are methods such as CT or MRI, and, if necessary, x-rays. Thirdly, biochemical blood tests. And finally, the study of a biopsy of bone tissue.

It is impossible to identify the onset of the disease on an x-ray. This can only be done using CT or MRI. Of great importance is the study of bone tissue in dynamics.

Conservative therapy

Treatment of systemic osteoporosis begins with the right one. Its main task is to establish a sufficient intake of calcium and vitamin D in the body. It is recommended to give up coffee, bad habits, and salty foods. Calcium should be predominantly consumed in the form of dairy products, but remember that the best ratio for calcium absorption is 1 gram of fat for every 10 mg of calcium.

Drug treatment includes taking several groups of drugs at once. Firstly, these are drugs that affect the metabolism of bone tissue. These are calcium preparations and vitamin D, osteochin, osseino-hydroxyapatite complex. Secondly, agents that inhibit the destruction of bone tissue are estrogens for postmenopausal women, calcitonin, and strontium preparations. Drugs that stimulate the formation of bone tissue - teriparatide, fluorine salts, growth hormone.

Disability in systemic osteoporosis most often occurs on the background of incorrect or absent treatment. Therefore, all women and men over 50 must visit a doctor and do all the necessary tests for early detection of pathology.

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Systemic osteoporosis is a pathological process of reduced bone mineralization, in which the strength and density of bone tissue decreases.

Systemic osteoporosis is also called diffuse osteoporosis because the process simultaneously affects all the bones of the skeleton.

There are several reasons for the development of the disease:

1. Decreased motor activity, lack of proteins and calcium, vitamin C, impaired absorption of calcium in the intestine.
2. Long-term use of glucocorticoids,
3. Osteoporosis due to pathology of endocrine proteins. This also includes hypogonadism. Due to thyrotoxicosis, an excessive increase in thyroid function, systemic osteoporosis can also occur. Diabetes and hyperparathyroidism (hyperactivity of the parathyroid glands), hypothyroidism, hypercortisolism (excessive secretion of hormones by the adrenal cortex) are recognized as factors influencing the onset of the disease.
4. Gastrointestinal disorders, such as ulcers, surgery to remove any part of the stomach, cirrhosis of the liver, impaired enzyme activity, alcohol abuse.

Separately, it is worth mentioning the consequences of drug treatment - long-term use of heparin or anticonvulsants can lead to the development of the disease.

In addition, the influence is exerted by:

• genetic defects,
• Adolescence or juvenile factor associated with rapid growth,
• Senile or senile osteoporosis (develops in people older than 70 years). It is characterized by a decrease in motor capabilities, insufficient intake of proteins and calcium, deterioration of calcium absorption in the gastrointestinal tract,
• Bone marrow disorders such as myeloma, lymphoma, or leukemia

A prolonged decrease in the load on the skeleton also leads to the development of the disease.

This can be when being in conditions of weightlessness or with paralysis, which are characterized by the inability to move the limbs or one of them.

Idiopathic osteoporosis. Such a diagnosis is made when the cause remains unclear.

Depending on the causes that caused osteoporosis, the symptoms may be different. This is due to the fact that complaints from other diseases that are not related to osteoporosis may come to the fore.

In most cases, you first have to eliminate the cause that has become the provocateur of osteoporosis, and only then make up for the deficiency of minerals in the bone tissue. Periarticular osteoporosis affects large joints, such as the shoulder, knee, or elbow. The disease affects the cartilage near the bone, reducing its elasticity.

It should be especially noted that bone osteoporosis is not a mandatory component of aging. Normally, bone density decreases, but the mechanical strength is sufficient to withstand physical stress.

Many clinical studies indicate that long-term use of calcium supplements, as well as active vitamin D metabolites (more than a year), leads to:

• slowing down the process of calcium leaching from the bone,
• stabilization of the x-ray picture,
• elimination of pain in the bones, which is caused by microfractures.

Thus, calcium and vitamin D3 preparations must be prescribed for the prophylactic purposes of osteoporosis or in the early stages of its development.

Bisphosphonates are increasingly used in osteoporosis. These are special synthetic substitutes for inorganic pyrophosphate, which is involved in the regulation of cellular calcium metabolism.

Long-term use of bisphosphonates in the development of osteoporosis, in most cases, increases bone density and thickness, causing a significant increase in cancellous bone.

Bisphosphonates are prescribed along with calcium and vitamin D3 supplements. The dosage of bisphosphonates and the duration of such treatment is selected on a strictly individual basis.