Osteoporosis : causes, symptoms , diagnosis, treatment , complications
Endocrinology / / May 21, 2016
What is osteoporosis?
Types and osteoporosis causes
Risk factors for osteoporosis
osteoporosis risk factors in children and adolescents
symptoms of osteoporosis
Treatment of osteoporosis
Prevention of falls and fractures in osteoporosis
Medicinal products for the treatment of osteoporosis
complications of osteoporosis
What is osteoporosis?
human skeleton consists of groups of bones which protect the body and help it to move.Osteoporosis is a progressive skeletal disease in which bones become thin, weak, brittle and prone to fractures.Osteoporosis literally means "porous bones".Thinning of bones caused by a loss of bone density.Bone mineral density contribute to the calcium and other minerals that help to strengthen and protect the bone.
Bones are made up of living tissue that is constantly absorbed and re-formed.The balance between formation and brittle (resorption) bones is controlled by
bone resorption occurs at a higher rate than their formation, which means that the bones become less dense, and the person is at high risk of developing osteoporosis.
In a healthy adult human process of formation and resorption of bone - almost perfect bound system in which one phase is balanced by the other.But with age or under certain conditions, the system goes down, and then the two processes begin to flow out of sync, not together.In the end, the destruction of bone ahead of their capacity.
in women after menopause estrogen levels dramatically drop.In particular, it is associated with rapid resorption and loss of bone density, thus the higher the risk of subsequent development of osteoporosis and fractures.
Types and causes of osteoporosis
Primary osteoporosis . Primary osteoporosis is the most common type of osteoporosis.As a rule, it is associated with age and postmenopausal so - a decrease in estrogen levels, or is associated with calcium deficiency and vitamin D.
- Women and estrogen. woman is experiencing a rapid decline in bone density after menopause, when the ovaries stop producing estrogen.Estrogen is of several forms:
- strong form of estrogen - estradiol;
- other important, but less powerful types of estrogen - estrone and estriol.
The ovaries produce most of the estrogens in the body, but estrogens may also be formed in other tissues - such as the adrenal glands, fat, skin, and muscle.After menopause, a number of estrogen produced in the adrenal glands continue in the circumferential and fat in the body.Despite the fact that the adrenal glands and the ovaries stop producing estrogen directly, they continue to be the source of the male hormone testosterone, which is converted to estradiol.
Estrogens may have a different influence on bone density, including the slowing bone breakdown (resorption).
- Men and androgens to estrogens. In men, the most important of androgen (male hormone) is testosterone, which is produced in the testicles.Other androgens produced by the adrenal glands.Androgens are converted to estrogens in various parts of the human body, including bone.
Studies show that a decrease in testosterone and estrogen levels in older men may contribute to loss of bone mass because both hormones are important for bone strength in men.
- Vitamin D and parathyroid hormone imbalance. low levels of vitamin D, and high levels of parathyroid hormone (parathormone, PTH) associated with bone loss (osteoporosis) in women after menopause (climacteric) or before it.
Vitamin D is a vitamin with hormone-like properties (functions).It is necessary for calcium absorption and normal bone growth.Low levels of Vitamin D can cause disruption of calcium absorption, which in turn causes an increase in PTH.Parathyroid hormone is produced parathyroid glands.These four small glands located on the surface of the thyroid gland.They are the most important regulators of calcium levels in the blood.When the calcium level is low, the glands secrete more PTH, which then increases the level of calcium in the blood.Persistent high levels of PTH stimulated bone loss.
Secondary osteoporosis. Secondary osteoporosis is caused by other conditions - such as hormonal imbalance, illness or medication.
Causes of secondary osteoporosis
Secondary osteoporosis often develops due to taking certain medications or other medical conditions.
- Medicines. Drugs that can lead to osteoporosis:
- Oral corticosteroids (also known as glucocorticoid or steroid) can reduce bone mass.Inhaled steroids can also cause bone loss when taken in high doses for long periods of time.
- Loop diuretics - such as furosemide (Lasix) excretion increase (isolation, removal of the end products of metabolism of the organism - egestas interfering maintain normal conditions in the body) of calcium in the kidneys, which can lead to a thinning of the bones.Thiazide diuretics, on the other hand, to protect against bone loss, but the protective effect is terminated after use.
- Hormonal contraceptives, which are used without estrogen progestin (e.g., Depo-Provera) may lead to loss of bone density.For this reason, Depo-Provera injections should not be used more than 2 years.
- Anticonvulsants (anti-seizure) drugs increase the risk of bone loss (as, indeed, and epilepsy).
- Proton pump inhibitors (PPIs) used for the treatment of gastroesophageal reflux disease (GERD), may increase the risk of bone loss and risk of fractures when administered in high doses for longer than one year.These drugs include omeprazole (Prilosec), lansoprazole (Prevasid) and esomeprazole (Nexium).Other drugs that increase the risk of bone loss include blood-thinning drug heparin and hormonal drugs that suppress estrogen (such as gonadotropin-releasing hormone agonists and aromatase inhibitors).
- Diseases. Osteoporosis may be secondary to other diseases, including alcoholism, diabetes, thyroid imbalances, chronic diseases of the liver or kidney disease, Crohn's disease, celiac disease (gluten enteropathy), scurvy, rheumatoid arthritis, leukemia, cirrhosis of the liver, gastro-intestinal diseases, a deficiency of vitamin D, lymphoma, hyperparathyroidism, anorexia, premature menopause, and rare genetic disorders - such as Marfan and Ehlers-Danlos syndrome.
Risk factors for osteoporosis
Major risk factors for osteoporosis:
- Paul. 70% of people with osteoporosis - are women.Men in childhood and youth are starting with higher bone mineral density with age and lose calcium more slowly than women, and that is why they have the risk of developing the disease later.However, older men also at risk for osteoporosis.
- Age. with age in humans increases the risk of osteoporosis.Aging causes the bones to become thin and weak.Osteoporosis is most common in postmenopausal women, and low bone density is characteristic for all women over the age of 65 years.
- Race. While adults in all ethnic groups are predisposed to osteoporosis, Caucasian and Asian men and women are at relatively greater risk.
- Build. Osteoporosis is more common in people who have a small, thin body and a thin bone structure.A small weight is a risk factor for the development of osteoporosis.
- Family history. People whose parents had fractures due to osteoporosis are at increased risk of developing this disease.
- deficiency of hormones in women. estrogen deficiency is one of the major risk factors for osteoporosis in women.
Lack of estrogen associated with: menopause ; surgical removal of the ovaries.
- deficiency of hormones in men. Low testosterone levels also increase the risk of osteoporosis.Some medical conditions (hypogonadism - a lack of secretion of androgens) and treatment (eg androgen deprivation for prostate cancer - a recognized treatment strategy for patients with prostate cancer at high risk of disease progression) can cause testosterone deficiency.
- Lack of weight. Anorexia nervosa (an eating disorder) or extremely low body weight can affect the production of estrogen by the body.
- Nutritional factors. Diet plays an important role in preventing and acceleration in both men and women losing bone mass.Disadvantages of absorbable calcium and adequate vitamin D are risk factors for osteoporosis.Other dietary factors may also be harmful to some people.
- Exercises. Lack of physical activity and sedentary lifestyle increases the risk of osteoporosis.Conversely, excessive exercise, which are professional athletes can reduce estrogen levels, which also results in the loss of bone mass.Eating disorder - anorexia nervosa - may provide the same effect.
- Smoking. Smoking can affect the absorption of calcium and estrogen levels.
- Alcohol. Excessive consumption of alcohol can increase the risk of bone loss.
- Lack of sunlight. Vitamin D gets energy through the skin to ultraviolet rays in sunlight.Vitamin D is essential for calcium absorption in the stomach and gastrointestinal tract and is an essential addition to calcium in maintaining strong bones.With a lack of sunlight, this effect will not be fully utilized.
osteoporosis risk factors in children and adolescents
maximum bone density, which is achieved through the years, is one of the main factors that will continue whether a person develop osteoporosis.There are people (usually women) who have never developed an adequate peak bone mass early in life, and because they have a higher risk of developing osteoporosis in the future.Children with dangerously low peak bone mass - is:
- were born prematurely;
- anorexia nervosa;
- born with delayed puberty or abnormal absence of menstruation from their mothers.
Physical exercise and proper nutrition during the first three decades of life (when you reach peak bone mass), are excellent protection from osteoporosis and other health problems.
osteoporosis Osteoporosis is usually quite early symptoms.Unfortunately, a broken wrist or hip is often the first sign of osteoporosis.In this case, these fractures can occur even after relatively minor injuries - such as slopes, lifts, jumping or falling from a standing position.
compression fractures (occur at the same time bending and compression of the spinal column, leading to greatly increased pressure on the front of the spine structure - to the body of the vertebrae and discs, serious damage to the spine, trauma, at which the body compress vertebrae usually in human fallon the feet, buttocks and forced a sharp bending of the body during athletic training) may occur in the vertebrae of the spine as a result of weakened bones.
Early compression fractures of the spine may go unnoticed for a long time, but after the loss of a large percentage of calcium, the vertebrae in the spine begin to break down, gradually causing a stooped posture (kyphosis, or "hump widow").Although it is usually painless, patients may lose a few centimeters in height.
- Study of bone density. Because that osteoporosis may have a variety of symptoms, testing is important.Testing on bone density is recommended for:
- all women aged 65 years and older;
- women younger than 65 years with one or more risk factors for osteoporosis;
- all men over 70 years;
- men aged from 50 to 70 years with one or more risk factors for osteoporosis.
In addition to age, the main risk factors for osteoporosis:
- a small weight or low body mass index;
- long term use of tobacco;
- excessive use of alcohol;
- the presence of the parents who have had a fracture caused by osteoporosis.
Other risk factors that may indicate the need for testing of bone mineral density - the following:
- long-term use of such drugs associated with low bone mass or bone loss, as corticosteroids, some anticonvulsants, Depo-Provera, thyroid hormones oraromatase inhibitors;
- the history of the treatment of prostate cancer and breast cancer;
- history of diseases such as diabetes, thyroid imbalance, estrogen or testosterone deficiencies, early menopause, anorexia nervosa, rheumatoid arthritis;
- a significant loss of body weight.
To measure bone density using certain tests, including central DXA (dual-energy X-ray absorptiometry), central DXA (central ray osteodensitometry), screening tests and predict fracture risk.Osteoporosis is diagnosed when bone density has decreased to such an extent that it can lead to so-called fracture threshold.
- Laboratory tests. In some cases, your doctor may recommend the patient to do a blood test to measure levels of vitamin D. The standard test measures 25-hydroxyvitamin D, which is also called a 25 (OH) D.Depending on the results, your doctor may recommend that the patient take vitamin D.
- Age-related changes in the bones, muscles, joints, spine
- Back pain and lower back
Treatment of osteoporosis
- Changing lifestyles . Healthy living, including adequate intake of calcium and the body of vitamin D, essential for the prevention of osteoporosis and support treatment.
- Calcium and vitamin D. As we have said, a combination of calcium and vitamin D may reduce the risk of osteoporosis.Certain types of foods may interfere with calcium absorption.These include foods high in oxalate (such as spinach and beet greens), peas, pinto beans, navy beans, wheat bran.Diets high in animal protein, sodium or caffeine can also interfere with the absorption of calcium.
Food sources of vitamin D include:
- fatty fish (salmon, mackerel, tuna);
- egg yolks;
- beef liver;
- orange juice;
- soy milk or cereal.
daily requirement of vitamin D
Recommended norms of daily intake of vitamin D:
- Kids and Teens: 5 mg
- Men and women up to 50 years: 5 mg
- Men and women from 51 to 70 years: 10mg
- Men and women from 71 the year: 15 mg
- Pregnant and lactating women: 5 mg.
daily rate of calcium
- Children under 6 months of 210 mg.
- Children from 6 to 12 months 270 mg.
- Children from 1 to 3 years 500 mg.
- Children from 4 to 8 years, 800 mg.
- Children from 9 to 13 years, 1300 mg.
- Teenagers from 14 to 18 years, 1300 mg.
- adults 19 to 50 years in 1000 mg.