Bone osteoporosis: causes, symptoms, examinations for diffuse bone osteoporosis, treatment in Moscow

Diffuse osteoporosis is a bone disease that results from an imbalance between the formation and destruction of bone tissue. This pathology is detected mainly in elderly people, but the disease also occurs in young people. A feature of diffuse osteoporosis is the formation of pathological foci in many bones. Diagnosis of the disease at the Yusupov Hospital is carried out using the latest equipment from the world's leading manufacturers. Rheumatologists provide complex therapy for diffuse osteoporosis.

The term "osteoporosis of bones" is incorrect because the word osteoporosis already contains the root "osteo", which means "bone". The disease has a systemic progressive nature, the main symptom of which is a decrease in density and disruption of the structure of bone tissue. The main danger with osteoporosis is the occurrence of bone fractures due to minor loads. Fractures lead to immobilization of the patient.

Severe cases of the disease are discussed by doctors and candidates of medical sciences, doctors of the highest category at a meeting of the Expert Council, and collectively develop tactics for managing the patient. Rehabilitation specialists prepare an individual rehabilitation therapy plan for each patient. Specialists at the rehabilitation clinic provide the latest physiotherapeutic procedures, massages, and conduct physical therapy classes. An integrated approach to the treatment of diffuse osteoporosis allows you to stabilize the patient’s condition and improve the quality of life.

Causes and mechanisms of development of diffuse osteoporosis

Postmenopausal osteoporosis develops in women after 60 years of age. The disease is associated with low production of female sex hormones after menopause. The aging of the human body is accompanied by a breakdown in the structure of bone tissue. In old age, bone tissue density decreases, pathological foci appear in various bones, and senile osteoporosis develops. In patients who take glucocorticoids for a long time, the structure of bone tissue is disrupted. In this case, glucocorticoid osteoporosis develops.

The following diseases can cause secondary diffuse osteoporosis:

Diabetes;
Chronic kidney disease with the development of renal failure;
Primary hyperparathyroidism (benign neoplasm of the parathyroid gland;
Chronic obstructive pulmonary disease.

Diffuse osteoporosis develops in the presence of prolonged deficiency of calcium and vitamin D in the human body. This happens when there is little calcium and vitamin D in food. The disease occurs in patients suffering from diseases of the digestive system, which are accompanied by impaired absorption of nutrients. Risk factors that increase the likelihood of developing diffuse osteoporosis include female gender, genetic predisposition to the disease, age, low mobility, insufficient or excess body weight, and fragile physique.

Two opposing processes constantly occur in the human body - the formation and destruction of bone tissue. Bone is a complex network of interconnected and intersecting bone beams. The direction of their movement and strength make it possible to counteract the mechanical loads that act on the bone. The nature of loads changes throughout a person's life. Inert tissue is forced to adapt to new conditions and remain stable. The process of bone remodeling is constantly occurring - bone beams are destroyed in one place and formed in another.

Special cells – osteoclasts – are responsible for the destruction of bone tissue. The formation of new bone beams is carried out by osteoblasts. They form a bone matrix into which calcium salts are deposited, ensuring the strength of the bone of the constructed structure. When the processes of bone tissue destruction intensify in combination with a weakening of the processes of bone formation, osteoporosis develops. If not enough calcium salts enter the bones, they become soft and cease to perform supporting and frame functions.

More about body weight

Excess weight is the cause of many age-related diseases, since obesity leads to persistent metabolic disorders. However, osteoporosis is an exception to the generally accepted pattern. The lower the body mass index, the higher the risk of changes in bone structure and fractures. This phenomenon has a completely logical justification. In obese people with a large layer of adipose tissue, female hormones (estrogens) are more actively produced, which are involved in the synthesis of osteoblasts and thus protect bones and joints from pathological changes. The fat layer puts pressure on the skeleton, promoting compaction of bone tissue, and in the event of an accidental fall, the fat acts as a shock-absorbing cushion.

However, this state of affairs should in no case serve as an incentive to gain extra pounds. Obesity provokes diabetes, hypertension, diseases of the vascular system and many other pathologies that are difficult to treat. Without completely getting rid of the main problem, you will acquire a lot of other ailments.

Symptoms of diffuse osteoporosis

Diffuse osteoporosis occurs secretly, without obvious signs of the disease. Very often, the first symptom of the disease is a fracture that occurs with minor stress. Doctors begin to conduct an examination and find out that the cause of the loss of bone integrity is osteoporosis.

There are symptoms that allow you to suspect the disease at an earlier stage, before fractures appear. Patients are often concerned about changes in posture, decreased height, stooping, and accelerated tooth decay. One of the main signs that suggest the development of osteoporosis is bone pain. At first it appears when the weather changes, then it is constantly present. Patients complain of pain in the spine, forearm, hands, and thighs. Often the pain intensifies with mechanical stress or prolonged exposure to an uncomfortable position. With a sharp decrease in the height of the vertebrae, the pain is localized in the back and lumbar region. When there is a deficiency of calcium in the blood, muscle cramps appear.

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Complications of diffuse osteoporosis

The most dangerous complication of osteoporosis is fractures. With the diffuse nature of the disease, they can occur in the vertebrae, femoral neck, and shoulder. Osteoporosis of the spine leads to the development of compression fractures even when exposed to minor loads (landing after a jump or falling from one’s own height). A fracture of the spine or femoral neck leads to immobility of the patient, the development of bedsores, congestive pneumonia, infectious complications, and thrombosis. Early surgical treatment can reduce mortality from hip fractures, but it cannot be performed in many elderly patients due to the presence of severe concomitant diseases. For osteoporosis of the spine, operations are not performed at all. Therefore, the only effective treatment for diffuse osteoporosis is early diagnosis and combined conservative therapy. This is the only way to avoid the development of fractures.

Hormonal imbalances

Osteoporosis has a direct connection with hormonal levels, so the disease is often included in the list of endocrine pathologies. Factors that provoke fragility of guests due to hormonal imbalances include:

thyroid hormone therapy for thyroid disease;
ovarian dysfunction, leading to decreased production of sex hormones;
chemotherapy for certain cancers

Osteoporosis often develops in patients with hyperfunction of the adrenal glands. Problems with the functioning of the gastrointestinal tract

The bulk of nutrients are absorbed in the intestines. If this process is disrupted for any reason, a deficiency of vitamins, minerals and other components vital for the body occurs. Digestive disorders provoke the development of many chronic diseases that negatively affect the condition of bone tissue.

How to treat bone osteoporosis

Diffuse osteoporosis is a complex multifactorial problem. Endocrine, age-related, and behavioral factors are to blame for the development of the disease. At the Yusupov Hospital, doctors from several specialties (rheumatologist, endocrinologist, cardiologist, neurologist) take part in the treatment of patients suffering from diffuse osteoporosis.

The main goals in the treatment of osteoporosis are increasing bone mass, preventing the development of fractures, completely eliminating or reducing pain, and providing patients with an optimal motor regimen. Endocrinologists treat the main diseases that cause diffuse osteoporosis (thyrotoxicosis, hypothyroidism, hypogonadism, Cushing's disease and syndrome). To build bone mass, rheumatologists carry out therapy with calcium supplements, vitamin D, and medications from the bisphosphonate group - Fosamax, Forosa, Fosavance, Zometa.

Calcium and vitamin D and calcium are aimed at increasing bone formation by increasing the supply of calcium to the patient's body. Bisphosphonates inhibit bone resorption (bone breakdown). The main effect of bisphosphonates is to block the work of osteoclasts - cells that are responsible for the destruction of bone tissue. Patients take drugs from this group for a long time, for ten years. Alendronate sodium (Fosamax, Forosa) is taken once a week, other drugs can be taken once a month or once every few months. Bisphosphonates for osteoporosis have a high efficacy and safety profile. With proper treatment, bone density increases by 5-10% per year, which greatly reduces the risk of developing fractures.

The diet for diffuse osteoporosis is aimed at ensuring that the body receives sufficient amounts of vitamin D and calcium, which are necessary for the formation of new bone tissue. The richest foods in calcium are dairy products, cabbage (including broccoli), fish, and various nuts. The main source of vitamin D in the body is fish or fish oil. Significant amounts of vitamin D are produced in the skin when exposed to sunlight. Diet for diffuse osteoporosis is only one of the elements of treatment of the disease. To eliminate long-term chronic deficiency of vitamin D in the body, doctors prescribe them in the form of tablets.

Degrees of manifestation

In order to assess the intensity of bone tissue damage, radiographic diagnostics are required. However, the standard technique can only help when bone density decreases by 25%. Signs of a diffuse process are:

large spots of enlightenment in the bone pattern;
dilated bone marrow canal;
the cortical layer (closer to the periosteum) is thinned, with areas of fiber disintegration, and has an accentuated edge;
The transparency of bone tissue is increased.

Spotted and uniform

Initially, against the background of the usual or slightly reduced number of bone trabeculae, clearings appear in the form of an oval or polygon. Their outlines are blurred, and in the cortical layer the inner part is loose, the fibers do not fit tightly to each other. In some cases, the cortical zone takes on the characteristics of spongy tissue.

If bone destruction occurs evenly (most often with hyperparathyroidism), then from the very beginning there are no focal clearings, but there is increased transparency along the entire length of the bone. The partitions are thin, do not block X-ray radiation, and are then impossible to detect.

Bone tissue appears glassy because the spongy layer is replaced by fat cells and does not differ in appearance from the layers surrounding the bones. The cortical part is thin, contrasts against the background of diffuse clearing and appears drawn. Its inner surface is layered.

Moderate and pronounced

At the initial stage, bone mottling is most often detected; it is most pronounced in the spongy substance of the limbs and vertebrae. The latter gradually lose transverse partitions while maintaining longitudinal ones. The height of the bodies is moderately reduced in the anterior part, there are no traces of previous fractures.

Severe osteoporosis is manifested by uniform transparency of the bones, the disappearance of the spongy substance of the vertebrae (frame symptom). The central part disappears in them, biconcave forms appear, compression fractures and posterior wedge-shaped deformity are detected. These characteristics reflect advanced changes and a high risk of low-traumatic bone injuries.

Prevention of diffuse osteoporosis

Prevention of bone density disorders is aimed at eliminating risk factors for osteoporosis. To ensure adequate intake of calcium and vitamin D from food, you should eat foods rich in calcium. You should reduce your consumption of alcohol, drinks and foods that contain caffeine.

Long-term use of vitamin D and calcium supplements for prophylactic purposes can reduce the risk of developing osteoporosis. Taking moderate doses of calcium with vitamin D for 3-4 years improves bone density and does not lead to side effects. It is enough to take 500 mg of calcium carbonate with 200 IU of vitamin D twice a day. To prevent osteoporosis, doctors prescribe Calcemin Advance, also 1 tablet twice a day, or calcium D3 Nycomed, 1 tablet 2 times a day. Vitamin D and calcium supplements are safe even in the presence of urolithiasis. Rheumatologists decide on preventive therapy after consulting an endocrinologist.

The next factor that helps prevent the development of diffuse osteoporosis is physical activity. Rehabilitation specialists at the Yusupov Hospital create an individual set of gymnastic exercises for each patient, which can increase the load on the bone and stimulate its strengthening. After patients have mastered these exercises under the guidance of a senior exercise therapy instructor in a rehabilitation clinic, they can practice independently at home.

For women during menopause, endocrinologists provide hormone replacement therapy to prevent diffuse osteoporosis. Hormonal drugs allow you to “imitate” normal ovarian function for a long time and reduce the risks associated with the extinction of natural hormonal function. If osteoporosis is suspected, thyroid function should be monitored. To do this, it is enough to perform an ultrasound examination and determine the level of thyroid-stimulating hormone and antibodies to thyroid peroxidase in the blood. When patients come to the Yusupov Hospital, doctors monitor the level of ionized calcium. In order to undergo treatment and examination if you have risk factors for developing diffuse osteoporosis, call the contact center.

Secondary form

Secondary osteoporosis, which occurs in 15% of cases out of the total number of diagnoses, is a consequence of one or more serious diseases or long-term therapy using a certain number of medications. In medicine, there are several types of pathological conditions leading to the development of the disease:

genetic disorders;
dysfunction of the gonads;
disorders of the endocrine system;
deficiency or excess of vitamins, microelements;
eating disorders;
diseases of the blood organs;
other violations.

Treatment is aimed at eliminating the underlying disease that causes osteoporosis.