Osteoporosis
Summary/Definition
The term “osteoporosis” describes a condition in which bone tissue becomes thin and loses its density. It is a metabolic disease characterized by a decrease in bone mineral density, making bones brittle and susceptible to fractures. Approximately 90% of human bone mass is formed during puberty, but after the age of 35, a gradual decline in bone mass begins. However, after the onset of menopause, usually around the age of 50, there is a dramatic decline in bone density. The greatest loss of bone density usually occurs within 3 to 5 years after the menopause.
Causes of osteoporosis include impaired calcium absorption, vitamin D deficiency, menopause, medication side effects, physical inactivity and hereditary predisposition. Osteoporosis can result from impaired calcium absorption, for example after stomach resection, chronic inflammatory bowel disease, Itsenko-Cushing’s disease or anorexia nervosa. Vitamin D deficiency causes calcium deficiency in the body due to inadequate calcium absorption. A decrease in the levels of estrogen after menopause, which helps maintain bone density, and the use of certain medications, such as anticoagulants, anticonvulsants, thyroid hormones or corticosteroids, can also contribute to osteoporosis. There are two main types of osteoporosis. Secondary osteoporosis is associated with other diseases such as diabetes, endocrine disorders such as hyperparathyroidism, gastrointestinal disorders and others.
Symptoms
Due to the nature of the bone structure, there are usually no obvious symptoms in the early stages of osteoporosis. However, as the bones weaken, the spine can become kyphotic, or compressed, resulting in reduced height. In severe cases, the spine may not be able to support the weight of the body, causing the front of the spine to deform even when there is no injury. In addition, as bone health deteriorates, the risk of fractures increases, and in more severe cases fractures can even occur during everyday activities such as bending over or coughing. Fractures of the wrist, spine or femur are common.
Diagnostics
To diagnose osteoporosis, it is also important to assess the risk of fractures using special scales. The following tests are used to prescribe treatment for osteoporosis: densitometry (bone density measurement), radiography of suspected fracture sites, measurement of serum vitamin D concentrations, and biochemical tests for bone markers. In clinical practice, dual-energy x-ray absorptiometry is the most commonly used method of measuring bone density. Quantitative computed tomography (QCT) and ultrasound are also used.
Treatment and course of the disease
Treatment for osteoporosis includes medication, physical rehabilitation (physiotherapy) and diet. The medications used in pharmacological therapy can be divided into two categories: those that inhibit bone resorption and anabolic agents that stimulate bone synthesis. The use of medications that inhibit the activity of osteoclasts (cells that break down bone tissue) promotes bone strengthening. Female sex hormones, selective estrogen receptor modulators (SERMs), bisphosphonates, denosumab and other medications also help to strengthen bone. Medications that stimulate the synthesis of bone tissue activate the work of osteoblasts, which leads to an increase in bone mass. Preparations containing parathyroid hormone, romosozumab, etc. are used. Physical rehabilitation includes exercises such as walking, jumping rope and swimming, and the diet includes foods rich in calcium and vitamin D. Prevention of osteoporosis is essential and includes regular exercise and a healthy diet.
