Osteoporosis in women after 50 years

Osteoporosis is a disease that is accompanied by destructive processes. Bones become brittle, minerals are washed out, and cartilage becomes thinner. As a result, the risk of fractures increases. Large bones, such as the femoral neck, are most often affected. It is very important not to ignore the first signs of the disease and consult a doctor in time. Only properly selected therapy will help stop further progression of the disease and reduce the rate of development of pathological processes. You can undergo comprehensive treatment for osteoporosis in Moscow at ArthroMedCenter.

What is osteoporosis

During the development of osteoporosis, there is a loss of bone density in the human skeleton. As a result, it becomes too fragile and there is a risk of fractures.

People who have this pathological process are often at risk of breaking one or more groups of bones due to minor injuries, for example, falling even from a small height. This is a very common diagnosis among older people. It is diagnosed more often in men. In women, it often appears during the postmenstrual period, when dramatic hormonal changes occur in the body.

This disease is insidious due to its slow and inconspicuous development. Symptoms begin to appear at the stage of irreversible changes in bone structures. Bone mass decreases significantly, bone density and strength decrease. They become brittle and break easily. The decrease in bone mass occurs gradually. These degenerative processes begin around the age of 35. Over time they progress. In people over 50 years of age, these processes are clearly expressed.

Osteoporosis is a chronic progressive systemic disease. Accompanied by a decrease in bone mass density. The microarchitecture of bone structures is also disrupted, bone strength decreases, and the risk of fractures increases. According to studies, after 60 years, every third woman is diagnosed with osteoporosis. After 70 years, almost every woman has this disease.

The main role in the mechanism of development of the disease is played by the inconsistency of the processes of mineralization of young bone tissue and destruction of old tissue. The body cannot form the required number of these structures within a certain period of time, and the destruction of old tissues occurs actively. Therefore, it is very important to prevent pathological processes.

Types and forms of the disease

Depending on the nature of the lesion, the following types of osteoporosis in older people are distinguished:

Postmenopausal
. Occurs in women after menopause, aged 45-55 years. If menopause occurs earlier, patients need to undergo regular densitometry, which can detect changes in the early stages and prevent complications.
Senile
. Associated with natural aging of the body. Most often it begins at the age of 70; in men it can occur earlier, after 60 years. The disease in this case is associated with a decrease in calcium levels, impaired absorption of vitamin D and other important microelements.

Osteoporosis varies not only in type, but also in form, each of which has its own characteristics.

Primary form. It is observed in 85% and occurs as an independent disease.

Secondary. Develops against the background of hormonal disorders, liver and kidney diseases.

Local. Often observed in rheumatic diseases. Around the inflamed joint, the bones begin to gradually deteriorate.

Widespread (diffuse). A typical form for elderly patients, when all bones are affected, with varying degrees of severity.

Cortical and trabecular. There is a simultaneous destruction of the bone substance of a dense and loose structure.

Active form. Observed at the stage of disease progression.

Inactive. Characteristic of the remission stage.

Depending on the clinical picture, the doctor prescribes treatment. If you strictly follow all the instructions, you can slow down the development of the disease and stop its destructive effect.

Causes of osteoporosis in older women

There are certain predisposing factors under which osteoporosis may develop:

Scientists have proven that women who are representatives of the white or Asian race, have short stature, and a thin build are at risk of developing the disease. Also in women, this pathology develops during menopause, since all metabolic processes in the body slow down and cardinal hormonal changes occur.
Age category. The older a person gets, the higher the risk of destructive processes occurring in his body. In women during menopause, the production of estrogen in the body decreases, and the synthesis of this hormone gradually stops. As a result, there is a risk of fractures and bone deformation.
Hormonal disorders. For example, if androgen production decreases in men, and estrogen production is disrupted in women.
Dysfunctions in the menstrual cycle, algodismenorrhea, frequent delays of menstruation.
Long-term use of certain medications. For example, anticonvulsants, glucocorticosteroids, under the influence of which calcium is washed out of bone structures.
The presence of bad habits - smoking, alcohol abuse.
Physical inactivity, sedentary lifestyle, lack of physical activity.
Tumor-like processes in bone tissue, weak muscles.

The development of the disease can also be provoked by a low amount of calcium and vitamin D in food, various eating disorders, for example, anorexia, bulimia. The listed provoking circumstances can be divided into two types:

unmodifiable - they cannot be influenced or changed in any way. These are heredity and age-related changes;
modifiable - they can be corrected. This is leading a certain lifestyle, drinking alcohol, smoking, unhealthy diet, taking medications.

Women are at particular risk for developing the disease during menopause. This phenomenon is called postmenopausal osteoporosis. Already from the age of 50, women experience bone thinning and demineralization. Calcium replenishment processes occur slowly. This is due to a gradual decrease in the production of hormones in the ovaries. When they cease their function, bone mass is lost by 3% already during the first year of menopause. Thereafter, bone density is lost every year by approximately 2% per year.

A characteristic feature of osteoporosis after menopause in women is the formation of kyphosis, the so-called widow's hump. As a result, a woman’s height decreases, and various deformities of the spinal column are formed. The risk of fracture of the wrist, femoral neck, and spine increases. Making such a diagnosis in the early stages is problematic, since degenerative processes develop slowly and there are no pronounced symptoms.

Diagnostics: possibilities of modern medicine

Symptoms of osteoporosis in women over 55 years of age are similar to those of other diseases, so spinal x-rays are often used for accurate diagnosis. Images from different angles make it possible to detect pathological processes such as changes in the shape of the vertebrae, thinning of bone tissue, and thickening of the upper partitions. But the most effective way to recognize the disease is densitometry - a modern method for studying the mineral composition of bone tissue. Densitometry helps to identify abnormalities in tissue structure and see the full picture of decreased bone density.

Popular auxiliary diagnostic methods: urine and blood tests, biochemistry, endocrinological tests. For all patients, the question of whether osteoporosis can be cured in older people and which methods are most effective is very important. Experts agree that, unfortunately, it is impossible to completely get rid of the disease, but it is possible to achieve stable remission and maintain the body in a stable state.

Women after menopause must undergo densitometry every two to three years. Osteoporosis is much easier to prevent than to treat.

Signs of osteoporosis in women after 50 years

The main insidiousness of this pathology is that it can be asymptomatic for a long time. In most cases, such a diagnosis is made only after a fracture of one or more bones has already occurred. You can suspect the development of osteoporosis based on the following signs:

increased fatigue that does not go away even after rest;
the nail plates begin to delaminate and become fragile;
periodically there are attacks of convulsions in the lower extremities;
development of periodontal disease;
pain in the lumbar region, in large joints;
the appearance of excess plaque on the surface of tooth enamel;
early graying of hair;
attacks of arrhythmia, tachycardia, rapid heartbeat;
curvature of the spinal column;
frequent fractures of large and small bones;
decreased growth;
quick satiation with food;
the appearance of attacks of heartburn, pain in the chest;
the stomach protrudes forward;
painful sensations in the spine, hip joints.

The clinical picture in women and men is almost the same. However, women have a higher risk of developing pathological processes in the musculoskeletal system.

Consequences and complications

The most common consequence of osteoporosis in older women and men is frequent fractures. In most cases, injuries are uncomplicated and, if the doctor’s recommendations are followed, result in a complete recovery. However, fractures often lead to constant pain, the development of bone deformities, limitation of motor activity, the need for constant care, and psychological problems.

The most dangerous complication is considered to be a hip fracture, requiring hospitalization and constant care. Only 40% of patients recover completely after such an injury and return to normal life.

Constant pain, immobility, changes in the usual routine - all this leads to disruption of the psycho-emotional mood in patients and the development of depression. In addition, patients often experience anger, aggression, and constant fear of falling. All this negatively affects the speed of recovery and can lead to even more serious complications. This is why it is so important to provide the patient with good, comprehensive care and moral support.

Modern diagnostic methods

With early diagnosis, you can prevent the development of dangerous health consequences of osteoporosis. Diagnostic measures include:

laboratory blood test;
laboratory urine test;
study of biochemical blood parameters;
determination of the level of thyroid-stimulating hormone;
study of the amount of vitamin D;
undergoing densitometry;
radiography;
ultrasonography;
if necessary, the doctor may prescribe a computer or magnetic resonance imaging scan.

Diagnosis of osteoporosis

Currently, diagnosing osteoporosis does not present significant difficulties. We only need to remember that traditional radiography is not able to assess the degree of development of osteoporosis, so other methods are used for diagnosis. Radiography allows one to only suspect the presence of osteoporosis based on a characteristic change in bone density on X-ray images, however, to plan treatment and assess the dynamics of changes in bone density, it is necessary to have quantitative information about the condition of the bone - i.e. it is necessary to be able to express bone density digitally.

Quantitative assessment of bone density is central to the diagnosis of osteoporosis. For this study, a special term was invented - “densitometry”,

those. density measurement. It is often written differently – “osteodensitometry”, emphasizing that bone density is measured.

Densitometry can be of three main types:

X-ray densitometry (synonyms: DEXA, dual-energy X-ray computer densitometry);
computed tomographic densitometry;
ultrasonic densitometry.

With X-ray densitometry

X-rays of bones are taken at standard points (usually there are three standard points: femoral neck, lumbar spine, radius). After receiving the X-ray image, a special computer program calculates the bone density in the area of interest to the doctor and compares it with indicators characteristic of a healthy person of the same age (this is called the Z-index) or for a healthy person aged 40 years (this indicator is called the T-index ).

Diagnosis of osteoporosis

is carried out according to the deviation of the T-index from normal values:

from 0 to -1 – normal bone density;
from -1 to -2.5 – osteopenia (loss of bone tissue);
less than -2.5 – osteoporosis.

With computed tomographic densitometry

Computed tomography is performed on a multislice tomograph, followed by calculation of bone density and comparison with the reference one. As a result, the density of 1 cubic centimeter of bone tissue in the study area is calculated, and the T- and Z-indices are calculated. The advantage of computed tomographic densitometry is its high accuracy and the ability to calculate bone tissue density regardless of the patient’s weight, the presence of adhesions, and metal structures, which can make it difficult to obtain results with conventional X-ray densitometry. The disadvantage of densitometry on a tomograph is the increased radiation exposure to the patient’s body.

Ultrasound densitometry

carried out by measuring the speed of passage of an ultrasonic wave through bone tissue. It has been proven that a decrease in bone density makes it looser and does not allow the bone to quickly conduct sound waves. The lower the bone density, the slower the sound wave travels along the surface of the bone. The ultrasound densitometer is equipped with special sensors for measuring the speed of ultrasound along the surface of the bones, and the built-in software of the device allows you to calculate bone density with the determination of T- and Z-indexes.

Ultrasound densitometry uses superficially located bones to determine density - the phalanges of the fingers, the radius on the forearm, the anterior surface of the tibia, the fifth metatarsal bone on the foot. The indicators calculated using ultrasound densitometry (T- and Z-indices) can be compared with similar indicators obtained from X-ray densitometry (that is, if osteoporosis was detected during X-ray densitometry, then ultrasound densitometry will reveal the same changes). At the same time, if the patient underwent X-ray densitometry during the first study, which revealed osteoporosis, and then treatment for osteoporosis was prescribed, then the second study should be carried out using the same assessment method, that is, also X-ray densitometry - only in this case will it be most reliable evaluate the effectiveness of treatment. Of course, the same rule applies to ultrasound densitometry - if treatment is carried out based on the results of the initial ultrasound examination, then monitoring of the treatment results should be carried out using ultrasound densitometry.

Diagnosis of osteoporosis using ultrasound densitometry has a number of advantages - ultrasound densitometry is not accompanied by radiation and can be carried out in a convenient environment for the patient for a fairly short time. The safety of the study is so high that ultrasound densitometry can be performed on both children and pregnant women.

In short, densitometry allows you to completely solve the problem of diagnosing osteoporosis, while any densitometry method is cheap, painless, and accurate.

Densitometry should be performed on all women aged 65 years

– following this simple rule could significantly reduce the incidence of fractures among older women. At the same time, densitometry is absolutely indicated for other groups of patients, including young patients. Among the indications for densitometry, the following should be noted:

early onset of menopause;
hormonal disorders in women, accompanied by estrogen deficiency, with the development of amenorrhea (absence of menstruation);
low body weight (including due to a disease such as anorexia nervosa);
presence of blood relatives suffering from osteoporosis;
the presence of primary hyperparathyroidism (parathyroid adenoma);
the presence of secondary hyperparathyroidism due to chronic renal failure;
thyrotoxicosis (due to diseases such as diffuse toxic goiter, polynodose toxic goiter, toxic thyroid adenoma);
decreased testosterone levels in men;
long-term immobilization for fractures or other injuries;
Itsenko-Cushing syndrome and disease;
long-term use of glucocorticoids;
the presence of rheumatic diseases (spondyloarthritis, rheumatoid arthritis), which are often combined with the development of osteoporosis.

It is important to understand that osteoporosis significantly complicates the treatment of joint diseases. Osteoporosis of the joints reduces the strength of the bones that articulate at the joint. Nowadays, endoprosthetics of hip and knee joints for arthrosis has become widespread. In this case, instead of a joint, the patient is fitted with a metal endoprosthesis, which is attached to the bones that form the joint. The stability of the resulting structure directly depends on the strength of the bones that bear the load of the endoprosthesis. The presence of osteoporosis of the joint creates preconditions for instability of the endoprosthesis, bone fractures in the area where the endoprosthesis is attached, and the development of severe complications. Therefore, diagnostics aimed at identifying osteoporosis is mandatory for all patients planning to undergo endoprosthetics.

Laboratory tests are of auxiliary importance in the diagnosis of osteoporosis. There are a number of markers (they are also called “osteoporosis tests”

), allowing to assess the severity of osteoporosis and the dynamics of its progression (osteocalcin, bone fraction of alkaline phosphatase, B-crosslaps, pyridinoline, etc.), however, their diagnostic significance is lower than the significance of densitometry.

When examining a patient with a suspected disorder of bone tissue density, important laboratory indicators are also mandatory:

ionized calcium, parathyroid hormone, 25-hydroxyvitamin D;
TSH, T4 St. (thyroid hormones);
for women – sex hormones (estradiol, testosterone, etc.);
for men – the level of free testosterone in the blood.

Treatment of osteoporosis in older women

It is very important to start treating the disease as early as possible. This will prevent the development of various complications and disabilities.

Diet

Proper nutrition is of no small importance in the treatment of osteoporosis. A therapeutic diet requires adherence to the following rules:

the menu should contain food containing a large amount of calcium;
refuse or minimize the amount of salty foods and alcoholic beverages;
consume fermented milk products in large quantities;
include foods that contain a lot of phosphorus, potassium, magnesium.

Exercise therapy and gymnastics

Correctly designed therapeutic exercises play a very important role in the recovery of patients after a fracture. Rehabilitation therapy must also include massage and physical therapy.

Therapeutic gymnastics involves resistance and stretching exercises - expander, horizontal bar. To evenly distribute the load on the spine, it is recommended to wear orthoses or corsets.

Medications

For therapy, doctors prescribe regulators of phosphorus-calcium metabolism. Such drugs include:

Calcytocinins. These are substances similar to the hormones produced by the thyroid gland. These hormones slow down the thinning of bone structures, activate bone formation, and have a pronounced analgesic effect. Such drugs include Ossteover, Vepren.
Biosphosphonates. With their help, the processes of bone loss are inhibited. These drugs help in the remineralization process. These include Bonefox, Etidronate.
Recombinant human hormones that stimulate bone production. For example, Forsteo.
Fluoride preparations, which improve stimulation of the formation of bone structures.

If there are severe symptoms of the disease, a treatment regimen similar to the treatment of arthrosis and arthritis is drawn up:

non-steroidal anti-inflammatory drugs;
painkillers;
muscle relaxants;
glucocorticosteroids;
pain blockades;
chondroprotectors.

Thanks to the listed medications, new bone mass is formed and bone destruction and thinning are prevented.

Physiotherapy

The main methods of physiotherapy are:

diadynamic currents;
UHF;
interference currents;
electrical stimulation;
ultrasound;
magnetic therapy;
balneology;
ozokerite.

ArthroMedCenter uses the following effective procedures for the treatment of osteoporosis:

Hivamat therapy. This procedure improves blood circulation and activates recovery processes.
Electrophoresis. Thanks to the procedure, medicinal substances act more effectively on the damaged area of bone tissue.
SMT therapy. The procedure improves blood circulation and initiates regeneration processes in bone tissue. The overall tone of the body increases, metabolic processes occur faster.

Traditional methods of treatment

The most effective folk remedies in treating the disease are:

dill infusion;
infusion, decoction or oil of golden mustache;
onion peel decoction;
alcohol infusion from comfrey rhizome;
dandelion decoction;
mumiyo;
blue clay;
grated eggshells with lemon juice;
decoction of burdock rhizome;
horsetail infusion;
centaury decoction;
Chernobyl, sleep-grass, woodruff - collection for decoction;
jujube, moss, speedwell, horsetail, aster - collection for infusion;
field grass, calamus, fragrant woodruff, celery - collection;
sage, alfalfa, horehound, red clover, fenugreek - herbal collection.

TREATMENT AND PREVENTION OF OSTEOPOROSIS: DRUGS OF CHOICE (Part II)

Preferanskaya Nina Germanovna

Associate Professor, Department of Pharmacology, Faculty of Pharmacy, First Moscow State Medical University named after. THEM. Sechenova, Ph.D.

Ibandronic acid

150 mg (as sodium ibandronate monohydrate 168.80 mg) is the active ingredient of the drugs
Bondronat
and
Bonviva
. Approximately 40–50% of the drug circulating in the blood penetrates well into bone tissue and accumulates in it. The half-life varies from 10 to 72 hours. The specific effect of Ibandronate on bone tissue is based on its affinity for hydroxyapatite, which forms the mineral basis of the bone matrix. Ibandronic acid reduces bone resorption but has no direct effect on bone formation. In postmenopausal women, it reduces the rate of bone destruction to reproductive age levels, which leads to a progressive increase in bone mass. This is confirmed by a decrease in the level of biochemical markers of bone resorption both in blood plasma and in urine, an increase in tissue mineral density and a decrease in the incidence of fractures.

The drug (tb. 2.5 mg, tb., coating volume 150 mg, syringe tube contains solution for intravenous administration 3 mg) is very convenient for long-term use, because to achieve a therapeutic effect, take only 1 tablet orally once a month (preferably on the same day of each month), 60 minutes before the first meal of the day, liquid (except water) or other drugs and nutritional supplements. The tablets should not be chewed or sucked due to possible ulceration of the upper gastrointestinal tract. Treatment of postmenopausal osteoporosis for 3 years with Bonviva helped reduce the risk of developing vertebral fractures by 62%. The drug has an extremely convenient, prolonged form of action; it is enough to take 1 TB. once a month or give one injection every three months.

Etidronic acid
(Xidifon)
is an inhibitor of osteoclastic bone resorption, prevents the release of Ca2+ from bones, pathological calcification of soft tissues, crystal formation, growth and aggregation of calcium oxalate and calcium phosphate crystals in the urine. By maintaining Ca2+ in a dissolved state, it reduces the possibility of the formation of insoluble Ca2+ compounds with oxalates, mucopolysaccharides and phosphates, thereby preventing relapses of stone formation. In interstitial nephritis, it has a moderate anti-inflammatory effect. Like other complexons, it accelerates the removal of heavy metals - Pb, Sn, antimony, strontium, Mg, silicon, without disturbing the balance of microelements.

Used internally in the form of a 2% solution, which is prepared by adding 9 parts of distilled or boiled water (50 ml + 450 ml of water, respectively) to 1 part of a concentrated 20% solution, 30 minutes before meals. The initial course of treatment is 14 days. Adults and children over 10 years old - 1 tbsp. (0.3 g) 2-3 times a day. Children aged 3–10 years - 1 des.l. (0.2 g) 2-3 times a day, up to 3 years - 1 tsp. (0.01 g/kg) 2–3 times a day.

If we take into account the list of side effects that occur during bisphosphonate therapy for osteoporosis, then we can say with confidence that treatment should be carried out under the strict supervision of a doctor with strict adherence to the prescribed dosage and under mandatory laboratory control. Before and after administration of the drug, constant monitoring of the concentrations of calcium and magnesium, phosphorus, potassium and creatinine in the blood serum, a detailed complete blood count, and hematocrit are required.

Some drugs in this group are taken mainly for hypercalcemia caused by malignant tumors or lytic tumors in the bones.

Clodronic acid (Bonefos, Klobir).

The active substance is disodium clodronate. Release forms: capsules of 0.4 g and solution in ampoules (1 ml of solution contains 0.06 g of disodium clodronate) of 5 ml. Clodronic acid prevents osteolysis and osteolysis-induced hypercalcemia. It forms complex compounds with bone hydroxyapatite, changing the crystal structure, and thereby preventing the destruction of calcium phosphate crystals. The drug reduces pain in patients with bone metastases, delays the progression of the latter, and prevents the development of new metastases. It is used for maintenance therapy in patients with malignant tumors. When using oral forms of the drug, take 2 caps. 2 times a day. 1 amp is administered intravenously. the drug by drip for at least 2 hours daily. The duration of treatment should not exceed 10 days, regardless of the form of the drug used.

Pamidronic acid ( Aredia, Pamidronate medac, Pomegara)

inhibits bone resorption carried out by osteoclasts. Interacts with bone tissue hydroxyapatite crystals and inhibits their dissolution. Prevents the entry of osteoclast precursors into bone tissue and inhibits their transformation into mature osteoclasts. It counteracts osteolysis induced by malignant tumors, reduces the severity of hypercalcemia in cancer patients and the clinical manifestations caused by it.

In combination with standard antitumor therapy, it slows down the progression of bone metastases, stabilizes existing changes, and promotes the development of osteosclerosis in these areas. It is administered only intravenously, slowly, using a pre-prepared infusion solution.

GROUP OF CALCITONINS

Calcitonin —

parathyroid hormone antagonist, regulating calcium-phosphorus homeostasis.
The hormone calcitonin is produced by the C cells of the thyroid follicles; its incretion increases with an increase in calcium in the blood plasma. Unlike parathyroid hormone, calcitonin reduces the concentration of calcium in the blood plasma. Calcitonin increases the concentration of cAMP, inhibits the transport of calcium ions through the osteoclast membrane, reduces the activity of alkaline phosphatase and the rate of bone metabolism, reduces bone resorption, and promotes the transition of Ca2+ and phosphates from the blood to bone tissue. Stimulates specific osteoclast receptors and reduces their activity. All these effects prevent further development and progression of osteoporosis. The drug has been approved for the treatment of osteoporosis and hypercalcemia of various origins. Calcitonin is produced from several types of animal samples; there are also synthetic analogues. The therapeutic value of this drug lies in its ability to suppress bone decalcification. Calcitonin has been shown to prevent bone loss in postmenopausal women. In women with established osteoporosis, calcitonin has been shown to increase bone density and strength only in the spine. Calcitonin is not as effective at increasing bone density and bone strength as estrogens and other antiresorption agents. In addition, it is not as effective in reducing the risk of vertebral fracture, and it has not been shown to be effective in reducing the risk of hip fracture. When treating women with established osteoporosis, it is not the drug of choice. Calcitonin is the drug of second choice after bisphosphonates; it has
a pronounced analgesic effect, which is realized through the central nervous system.
For bone pain, 200–400 IU/day is prescribed daily for several days. Calcitonin is produced (Kalsinar, Salkatonin, Sibacalcin), Porcine Calcitonin, Human Calcitonin
in amp. 1 ml containing 50ME or 100ME; in fl. 2 ml containing 100ME or 400ME (for drip infusions); in vial/aerosol containing 14 single doses of 50 IU or 100 IU. Prescribed in a small dose into a vein (intravenously, intravenously), under the skin (subcutaneously, subcutaneously), into a muscle (intramuscular, intramuscular). The duration of the hypocalcemic effect of a single dose is 6–10 hours.

Common side effects of both the injectable and nasal spray are nausea and hot flashes. Injectable calcitonin may cause localized skin redness at the injection site, skin rash, and flushing. Being a polypeptide (consists of 32 amino acid residues), the drug is capable of causing the induction of antibodies in the body.

Salmon calcitonin is produced under the trademark "Miacalcic"

, intranasal spray 1 ml/200 IU and solution for injection. 1 ml/100 IU. It must be remembered that long-term use of this drug increases the risk of developing cancer. For long-term therapy, human calcitonin can be used, because it causes less allergic reactions. When carrying out long-term therapy, the initial daily dose is reduced and/or the intervals between administrations are increased.

√ The antiparathyroid drug Cinacalcet
(Mimpara)
is not used for osteoporosis, but is used for hypercalcemia and secondary hyperparathyroidism.

OTHER MEANS

Denosumab (Prolia, Exjiva)

- corrector of bone and cartilage tissue metabolism. A new drug for the treatment of osteoporosis is a human monoclonal antibody (TNFSF11), which has high affinity and specificity for the receptor activator of nuclear factor kappa B ligand and prevents the activation of the only receptor RANKL (Receptor activator of nuclear factor kappa-B ligand), located on the surface of osteoclasts and their predecessors. The RANK ligand is a protein present in the body in membrane-bound and soluble forms. Plays an important role in bone metabolism and activates osteoclasts. RANKL is a major mediator of a metabolic pathway required for the formation, function and survival of osteoclasts, the only cell type responsible for bone resorption. Increased osteoclast activity induced by RANKL is a major cause of bone destruction in bone metastases from solid tumors and multiple myeloma.

Prevention of RANKL/RANK interaction inhibits osteoclast formation, activation, and survival. The recommended dose of the drug is one subcutaneous injection of 120 mg every 4 weeks in the thigh, shoulder or abdominal area. During the course of treatment, it is recommended to additionally take calcium supplements in a dose of at least 500 mg and vitamin D 400 IU.

Disease prevention

To prevent the development of early osteoporosis, it is recommended to follow the following preventive measures:

Adhere to the principles of proper nutrition. Include a large number of foods in your diet that contain calcium, phosphorus, and magnesium. As prescribed by the doctor, take medications that contain calcium and vitamin D. Be sure to increase the concentration of these substances during pregnancy, menopause, and breastfeeding.
Include physical and sports activities and therapeutic exercises in your daily regimen.
Stop smoking and drinking alcohol. Minimize stress and the amount of fast food.
Be very careful when taking medications for a long time, under the influence of which calcium is washed out of the body. If it is not possible to refuse to take them, you need to monitor calcium and magnesium levels in the body.

It is important to consult a doctor promptly when the first suspicious symptoms appear. You should not ignore signs that may indicate the development of destructive processes in the musculoskeletal system.

Mechanism of development of osteoporosis

In bone tissue, two mutually opposite processes constantly coexist - osteogenesis (formation of bone tissue) and resorption (destruction) of bone tissue. Bone is a living structure that provides important support and organization functions to the human body. The human bone is a complex network of interconnected and intersecting bone beams, the direction of movement and strength of which make it possible to counteract the mechanical loads acting on the bone as a whole (the weight of the bone and muscles, the weight of internal organs and external loads, loads due to body position or acting on external acceleration, etc.). The nature of loads changes throughout a person’s life - body weight changes, height often changes with age, the nature of activity changes - all this forces the bone to adapt to new conditions and remain resistant to the forces acting on it. Bone beams are destroyed in one place and formed in another - this process is called bone remodeling and occurs constantly.

Special cells, osteoclasts, are responsible for the destruction of bone tissue during remodeling, which, like bulldozers, “bite” into bone tissue and destroy it. The formation of new bone beams is carried out by “mason” cells, osteoblasts, which form new bone tissue - the bone matrix, into which calcium salts are deposited, ensuring the strength of the constructed structure.

Increased bone resorption processes combined with weakened bone formation processes are the main cause of the development of osteoporosis. Osteoporosis occurs when old bone tissue is destroyed and new bone tissue is formed in insufficient quantities. Also, the reason for its appearance may be insufficient intake of calcium salts into the bones - in this case, the bone becomes soft and ceases to perform frame and supporting functions.

It should be remembered that the causes of osteoporosis are always directed against the formation of new bone, or “help” the destruction of bone tissue - both of which ultimately lead to fractures.

Prevention of osteoporosis

Treatment of osteoporosis is a rather difficult and lengthy process.
It requires patience and willpower from the patient. For this reason, rheumatologists at the Yusupov Hospital recommend that all women who have crossed the age of forty begin to prevent osteoporosis. Many people, as soon as they suspect osteoporosis, begin to eat cottage cheese and dairy products, and take calcium supplements to prevent further bone destruction. Taking complex vitamin-mineral complexes that contain calcium is useless for osteoporosis. Bone tissue consists not only of calcium, but of 12 minerals, protein, fat and collagen. Calcium has some role in the prevention of osteoporosis, but consuming large amounts of calcium-rich foods cannot prevent the development of the disease. To prevent osteoporosis, doctors prescribe 1200 mg of calcium per day in combination with 400-800 IU of vitamin D. Bones contain a structural protein - collagen. With age, the body produces much less of it. Bones remain strong and flexible as long as they have enough collagen.

The most important factor in preventing osteoporosis is proper nutrition. The diet should be balanced. It should definitely include meat, fruits, vegetables, herbs, all types of nuts, whole grains, legumes and dairy products. One of the main methods of preventing osteoporosis is physical activity. Following the increase in muscle activity, blood flow improves, and the bones of the skeleton receive a sufficient amount of nutrients. Rehabilitation specialists at the Yusupov Hospital develop an individual complex of therapeutic exercises for each patient.

Doctors recommend stopping smoking, drinking alcohol, and consuming products containing caffeine. People who lead a healthy lifestyle and exercise regularly have a strong musculoskeletal system. They are not bothered by pain in the muscles and joints until old age.

Therapeutic exercise, gymnastics

Exercise therapy is a mandatory element of the rehabilitation of patients diagnosed with osteoporosis.
Regular exercise can reduce the risk of developing fractures. Developed muscle tissue stimulates the strengthening of bone tissue. This protects it from increased fragility. As a result, exercise therapy helps not only strengthen bones, but also increase their density. Women over 50 years of age are recommended to regularly perform exercises for both therapeutic and preventive purposes. The degree of load is determined individually. The patient’s age, severity of osteoporosis, and the presence or absence of concomitant diseases are taken into account.

Nutrition, diet

Treatment and prevention of osteoporosis is not complete without adherence to dietary nutrition. To do this, you need to consume a sufficient amount of foods rich in vitamin D and calcium. These include:

cheese;
dairy products;
fish;
nuts;
eggs;
greenery;
cabbage.

Fatty, spicy, smoked foods should be excluded from your daily diet. A diet combined with an active lifestyle will improve health and reduce the risk of exacerbation of pathology.

Symptoms and treatment of osteoporosis of the hip joint

Osteoporosis of the hip joint is predominantly asymptomatic.
Doctors make the initial diagnosis during an examination of a patient with a hip fracture. Patients who undergo hip replacement surgery after a femoral neck fracture are faced with the problem of instability of the endoprosthesis. Stress remodeling is a reaction of bone tissue to an implant. It is manifested by increased destruction and formation of bone tissue, which is considered as a process of adaptation to new conditions. A change in the intensity of remodeling promotes an increase in bone mass to create close contact with the implant; on the other hand, it causes the development of aseptic instability and limits the viability of the implant.

Elderly patients with femoral neck fractures who have been diagnosed with osteoporosis by X-ray or densitometry are considered to be at high risk for endoprosthetic instability. At the Yusupov Hospital they are given therapeutic measures to prevent the progression of osteoporosis.

If you have signs of osteoporosis, call the contact center of the Yusupov Hospital and make an appointment with a rheumatologist. Adequate therapy for decreased bone mineral density is an effective method for preventing osteoporosis, bone fractures and disability.

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Risk factors for drug-induced osteoporosis

Many patients with drug-induced AP have so-called risk factors that increase the likelihood of bone loss and fractures. Factors for the development of AP include low calcium intake, alcohol consumption (>2 drinks per day), smoking and lack of physical activity, as well as older age, female gender, history of falls and/or fractures, reduced body weight or body mass index, postmenopausal status, family history of fractures [3,12,13]. Some of these risk factors are included in the WHO Fracture Risk Assessment Tool (FRAX) [17].

It is known that some diseases (chronic liver or kidney disease, chronic obstructive pulmonary disease, depression, diabetes mellitus types 1 and 2, thyrotoxicosis, hypogonadism, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, organ transplantation, vitamin D deficiency), as well as drugs used in their treatment have an adverse effect on bone tissue [3,12,13]. However, it is often difficult to separate the effect of drugs on bone remodeling from the effect of the disease itself.