WHAT IS OSTEOPOROSIS?
It is the most common metabolic bone disease. There is a loss of bone strength and an increased risk of fracture. Reduced bone mass and changes in microarchitecture, comes to break bones. These fractures appear and with a little physical effort. At osteoporosis, bone porosity exists. Bone is living tissue. They have the decomposition process and the process of construction (remodeling). During life, they replaced by new. In one’s own body, there are ” osteoclasts ”. Their tasks are to cut obsolete bone tissue. And ‘osteoclasts,’ ‘who are rebuilding the old with the new tissue. There is a balance between these two factors.
Can we prevent and treat osteoporosis?
The best time to build healthy and strong bones is during childhood and adolescence. But, is significant and food with enough calcium, vitamin D3, and protein. It should avoid smoking cigarettes, taking large quantities of alcoholic beverages, and seating indoors. All these healthy habits are not enough. It is necessary for optimal body mass and increased activity. Osteoporosis is a disease that originates in childhood. So, to prevent her development, we need to bring more calcium and vitamin D3.
Guidelines for forming healthy bones and prevention;
- As much as possible to enter the milk and milk products, fruits and vegetables
- Avoid the consumption of junk food and carbonated drinks. They interfere with the absorption of calcium in the body
- Daily physical activity
- Do not consume too much alcohol or coffee
- No smoke
- Bodyweight- skinny people have a higher risk for the development of osteoporosis
Risk factors for osteoporosis:
- Higher age
- Family predisposition
- Lack of movement
- Too low body weight
- Insufficient supply of calcium and vitamin D
- Vitamin K deficiency
- Drinking large amounts of alcohol
- Consuming large amounts of coffee (more than 4 cups a day)
- Taking of large quantities of salt (more than 5 milligrams per day)
- A particular disease such as rapid thyroid, diabetes
- Certain medications such as sleeping pills, antidepressants, glucocorticoids
These particular risk factors of osteoporosis are important for healthy and strong bones. Osteoporosis is a disease that originates in childhood and presentation in the elderly. So, to prevent her development, we need to bring more calcium and vitamin D3.
For the sake of rapid expansion, at the global level, osteoporosis is the silent epidemic. Extended lifespan is the reason for the increase in illnesses. But there are other reasons. Such as; due to the use of drugs affecting bone mass and the modern way of life.
Bone fracture is a common complication of osteoporosis. The fall is often the cause of the bone fracture. Often the reasons for the emergence of the invoice. Reduced mobility and muscle distorted patients.
At the global level, the risk of osteoporotic fracture is 30-40%. Most occur within the female population. Every other woman at the age of 50 years, has a fracture associated with osteoporosis. The most common are vertebral fractures. They are difficult to diagnose. Hip fractures are the second most frequent. And the third most common is the distal forearm. All fractures associated with comorbidity, a hip fracture with mortality.
The greatest risk factor for the occurrence of osteoporosis, in women, is menopause.
The etiology and pathogenesis
Collagen is the basis of bone (that is a protein that forms a soft mesh). And calcium phosphate, (that is a mineral that strengthens and reinforces the bone structure). These two things make the bone elastic and firm. 99% of the calcium from our body is in bones, only 1% as in the blood.
Bones are the active organ of the human body. There is a process of building and breakdown (Osteoblastic and osteoblastic activity). Osteoblastic activity is stronger in his youth and childhood. Then the bones grow and become firm. At that time, formed the density of bone mass. When growth is complete, the performance period takes 10 to 20 years. After 35 or 40 years of age, begins natural bone loss. Old bone cannot be fast enough to replace it with a new one. Bone loss is a result of the natural aging process.
The protective role of bone has sex hormones (Estrogen, testosterone). With women, the loss of estrogen and the occurrence of menopause comes to a loss of bone mass. In men, bone loss is slower and smaller.
There are two types of osteoporosis, primary and secondary.
Includes idiopathic osteoporosis, is a rare disease, which manifests itself in two forms;
Juvenile-in early childhood or late adolescence becomes visible, accompanied by breaking bones.
Gravidity-appears, but rarely, during pregnancy. Manifested with vertebral fractures, pain in the spine, loss of height.
Postmenopausal-occurs during menopause. Such as declining hormone estrogen. So, the bones become more susceptible to osteoporosis. During the first years of menopause, annual losses by up to 3% of bone mass.
Senile-involution-identified in the 75-year life. Characterized by the fracture of the spine, neck, femur, and distal forearm. At an advanced stage, has a reduced height of the hull.
These two types of osteoporosis, cause most fractures in women over 50 years.
They occur as a result of other diseases such as;
Endocrine diseases. – Such as Hyperparathyroidism, hyperthyroidism, hypogonadism, amenorrhea any cause, hypopituitarism, and diabetes.
Chronic inflammatory diseases (rheumatoid arthritis, ankylosing spondylitis) and hematological diseases (many myelomas, lymphoproliferative disease, mastocytosis).
Iatrogenic (glucocorticoids, heparin, anticonvulsants, methotrexate, thyroid hormone with overdosing, antacids containing Al, cytostatics)
Hereditary (osteogenesis imperfect) – This is a rare disease. Characteristics of disorders are; brittleness of bones, many pathological fractures, scoliosis, and deafness. All disorders associated with irregularities in the formation of the bone matrix. Fractures in the long bones are characteristic of this disease.
Osteoporosis caused by immobilization-important for maintaining bone mass is a physical activity and weight load. Thus losing bone mass, at age. In severe trauma and strict immobilization, occurs rapid and progressive osteoporosis. The reason is an imbalance between bone resorption and the sudden formation of new.
Affect bone mass comes from endocrine disorders-various hormones. We must subtract the negative effect of hypercortisolism and hypogonadism.
Corticosteroids and osteoporosis in patients who have expressed endogenous Cushing’s syndrome. They are the much more pronounced loss of spongy bone. The spine and ribs are the biggest faults that occur in the area. Corticosteroids cause degradation of bone and preventing the creation of new ones.
Thyrotoxicosis and osteoporosis in this disease appear strong bone remodeling. Resorption of bone is stronger than the creation of a new.
Hypogonadism in men-This is a well-known factor in the appearance of osteoporosis. In this type of osteoporosis, there is a loss of trabecular and cortical bone.
Anorexia and osteoporosis- bone mineral density is low and the occurrence of fractures.
Diagnosis of osteoporosis-how to identify and detect osteoporosis?
Osteoporosis is a disease that has no clear symptoms and long stays unrecognizable. Insidious pain in the spine, various bone fractures, weight, height. These are all indications that point to osteoporosis. But the first look will always be ignored. To detect osteoporosis and to determine, there are several methods and ways to do this. We will mention some of them.
One of those is radiology. With radiology, we will get imaging for bone loss or bone fracture. In a case of a reduction of weight, when there is acute back pain. Using a radiological review will determine osteoporosis.
Densitometry is a standard procedure and has more kinds.
Here are a few of them;
DXA is a method that uses x-rays to indulge through the bone. With this method, we will measure the density of minerals in the bones. That is the area of the lumbar spine, femoral neck (hip), and the lower third of the radius bone. Thus recommended densitometry for individual risk assessment of fracture.
Quantitative ultrasound-custom peripheral bone mineral density. Used for epidemiological studies. This method is less accurate, but it is cheap and fast.
CT-These are devices that are good, precise, expensive, and with an increased radiation dose.
Routine laboratory analysis is not of importance for diagnosis. Using this analysis can detect abnormalities. That may show the etiology of secondary osteoporosis.
There were biochemical markers of bone metabolism-measuring enzyme osteoclast and osteoblast activities. Also analysis of the components of bone matrix released into the bloodstream and urine. Can estimate the rate of bone formation and resorption.
Treatment of osteoporosis
The goal of osteoporosis treatment is to slow bone turnover. Stabilize and increase bone density and improve the quality of the bone. Primary treatment means removing risk factors. This means that the behavior of the organism enough calcium and vitamin D3. That entails healthy feeding and regular physical activity. Also and physical therapy and rehabilitation.
Prevention of osteoporosis includes the application of hormone replacement therapy. Using this therapy yields optimal performance. In a short period due to a side effect.
Medications for the treatment of postmenopausal are;
- Drugs that inhibit bone resorption (antiresorptive)
- Drugs that stimulate bone-building (anabolic)
Antiresorptive pharmacological prevention and therapy consist of estrogen. Selective estrogen receptor modulators, bisphosphonates, and calcitonin. Models for osteoporosis, such administration are oral (through the mouth) daily, weekly, monthly. So, has an intravenous administration by injection once every three months. All these modes of treatment cause continuous bone formation.
- Osteoporosis prevention should begin at an early age.
- A goal of preventing osteoporosis is to prevent bone loss.
- The prevention of osteoporosis;
- non-pharmacological means (physical therapy with kinesitherapy) and pharmacological therapy (antiresorptive medicaments).
- More therapies including calcium and vitamin D3
- Osteoporosis is a progressive systemic metabolic disease, characterized by a loss of bone mass.