Osteoporosis in a pill. Diagnosis and treatment
WHAT IS OSTEOPOROSIS?
Osteoporosis is a disease of the bones in which they become thinner. Bones become brittle and break easily. We call it the silent thief of bones, because it does not cause any pain for a long time and often the first symptom is a fracture. In people over 50 Osteoporosis affects 30% of women and 8% of men. The lifetime risk of a fracture in a 50-year-old woman is as much as 40%! After the first fracture, the risk of another fracture increases 2-10 times. In women, the main cause of osteoporosis is menopause, which causes a sudden drop in estrogen levels. Osteoporosis can also occur in the course of other diseases, such as: diabetes, hyperparathyroidism, thyroid, adrenal cortex. Osteoporosis may be the result of long-term use of certain drugs, such as: glucocorticoids, immunosuppressants, antiepileptic drugs, drugs that reduce blood clotting. The occurrence of the disease is influenced by: age, genetic conditions, low calcium intake (milk, dairy products).
FRACTURES IN OSTEOPOROSIS
Fractures are the result of untreated osteoporosis. The most common fractures are: spine, radius (wrist fracture), femoral neck. The approximate number of people with osteoporotic fractures in Poland in 2010 was 2.800.000.
Fractures of the spine
They occur in every fourth woman over 50 and in every second woman over 85 years of age. These fractures are usually asymptomatic (70%). A history of fracture may indicate a decrease in height. With a lowering of 4.0 cm, the probability of fracture is very high. A fracture of the spine causes deepening of the kyphosis of the thoracic spine - the so-called. "widow's hump". Pain may occur after fractures. The resulting deformations of the figure lead to a decrease in the respiratory capacity of the lungs, deterioration of the efficiency of the circulatory and respiratory system and a tendency to constipation. Spinal fractures are stable, do not threaten with neurological complications and always heal. As a rule, they are treated conservatively. If pain cannot be controlled with analgesics, vertebroplasty (cementation) may be considered after a few months.
Fractures of the radius
They occur as a result of a fall. They are most often treated with immobilization in a plaster cast. After applying the cast, keep the limb elevated and move the fingers as much as possible. If the pain, bruising or numbness of the fingers worsens at home, you should immediately report to the facility where the plaster cast was applied. It is worth taking vit. C in a dose of at least 1000 mg. per day . 40% of patients experience complications such as: abnormal union, pain syndromes, including complex regional pain syndrome (Sudeck disease).
Fractures of the femoral neck
They are among the most dangerous fractures. As a result of complications, every 5th woman and every 4th man dies within a year. Of those who survive, 50% become disabled. Fractures of the femoral neck are usually treated surgically, regardless of the patient's age. Bone fusion is most often performed, and sometimes an endoprosthesis is implanted. After a fracture of the femoral neck, the risk of fracture on the other side increases as much as 6 times! The risk of hip fracture is higher than breast, uterine and ovarian cancer combined, and the risk of death from hip fracture is higher than breast cancer.
DIAGNOSIS OF OSTEOPOROSIS
Decreased bone mineral density is one of the strongest fracture risk factors. According to WHO recommendations, bone mineral density testing (densitometry) should be performed at the femoral neck or spine using the DXA method. Densitometric measurements in other sections of the skeleton do not allow for diagnosis or control of treatment results. The program of the device compares the measurements of a given patient with the results in the control group and on this basis calculates the so-called the T index, which shows how much bone mineral density has decreased in a given patient compared to healthy people aged 35.
According to the WHO, the value of the T index to -1 is considered normal, -1 to -2,4 is a precursor to osteoporosis, and at -2,5 or less, osteoporosis is diagnosed. A normal densitometric test result does not exclude the risk of fracture, as most fractures occur in the group of patients with undiagnosed osteoporosis, as much as 75% (similar to a normal ECG, it does not exclude the risk of myocardial infarction).
Decreased bone mineral density (BMD) found by DXA requires differential diagnosis to determine whether osteoporosis is due to menopause or is due to other conditions. For this purpose, we perform blood and urine tests. In the blood test, we mark: ESR, morphology, level of calcium, phosphorus, alkaline phosphatase, creatinine, vit. D and others depending on indications. We determine the level of calcium, phosphorus and creatinine in XNUMX-hour urine, regardless of the general examination.
AM I AT RISK OF BREAKING?
The correct result of the densitometric test does not mean that we are not at risk of fracture. Currently, it can be accurately determined without leaving home and without performing any specialized tests. Just go to www.kcm.pl and click on the link FRAX-PL Calculator (a handheld calculator can also be used). The FRAX calculator, developed by the WHO, allows you to calculate the risk of fracture based on a completed questionnaire containing questions about the factors that affect the risk of fracture. This risk can also be calculated by providing the results of the densitometry test. Questions for the FRAX calculator include, among others: information about: history of fracture, fracture in parents, smoking, alcohol abuse, steroid use, rheumatoid arthritis and secondary osteoporosis. The program calculates the 10-year risk of major fracture and hip fracture. If the risk of fracture of the main (spine, femoral neck, humerus) is more than 5%, you should contact your doctor in order to implement appropriate procedures.
Prevention of osteoporosis starts in the fetal period. The baby builds its skeleton from calcium, which it gets from the mother's blood. Therefore, the mother must take care of the supply of calcium (milk, preserves) and vitamin D in the diet. Up to 18 years of age mineralization of the skeleton takes place and we achieve the so-called peak bone mass. From the age of 35 bone loss may begin, which accelerates during menopause and reaches 45-1% per year. So it is very important to build a high peak bone mass so that gradual loss does not lead to such weakness that a fracture occurs. The supply of calcium, vit. D and physical stress on the bones, i.e. an active, sporty lifestyle. One of the possibilities is Nordic Walking (walking with sticks) because it engages 3% of muscles.
The goal of osteoporosis treatment is to avoid fractures and improve your quality of life. The treatment consists of:
- Supplementing calcium and vit. d
- Drugs active in osteoporosis.
- Fall prevention.
- Healthy lifestyle.
Supplementing calcium and vit. d
In the inhabitants of Poland, as well as throughout Europe, calcium and vitamin deficiencies are common. D. The daily requirement for calcium is 800-1200 mg. We can provide them with an appropriate diet, remembering that 1000 mg of calcium is found in 1 liter of milk or 4 slices of cheese. Vit. D is essential for calcium absorption, we call it "the key to the calcium pantry" and the dose needed is 800-2000 IU (International Units) per day. Vit. D is produced in the skin under the influence of sunlight. In practice, supplementation with Vit. D applies to all periods of life, starting from pregnancy. Adults should take a prophylactic dose in autumn and winter, and people over 60 years of age. throughout the year.
Active drugs in osteoporosis
Today, we have many drugs with high anti-fracture efficacy. These drugs are available by prescription only. Currently, we use: bisphosphonates, denosumab, strontium, PTH, SERM.
Bisphosphonia are currently most commonly used in the treatment of osteoporosis. They reduce the risk of spine fracture by approx. 60% and hip fracture by approx. 40% (alendronate, risedronate). Drugs for use once a week, once a month and intravenous drugs for use once every 3 months are currently available in pharmacies (ibandronate) or once a year (zoledronate). Since oral bisphosphonates are difficult to absorb, they must be taken on an empty stomach with a glass of water (preferably boiled). After taking, do not eat and lie down for at least 30 minutes (the possibility of irritation of the esophagus). Note that ibandronate is not effective in preventing hip fractures.
Denosumab is a human antibody that blocks the activity of bone-destroying cells. It is administered subcutaneously once every six months. Denosumab reduces the risk of fractures: the spine by 68% and the hip by 40%. It does not pose a risk of side effects on the gastrointestinal tract, which is of particular importance in the elderly taking many other drugs. In contrast to bisphosphonates, it is effective in preventing hip fractures also in people without a previous fracture. It can also be administered to patients with renal failure.
romosozumab is an antibody administered subcutaneously once a month. It is currently the most effective drug in osteoporosis, because it not only reduces bone resorption, like previous drugs, but above all causes its formation. Bone strength after treatment with romosozumab is 1 times higher than with bisphonate treatment. Reduces the risk of spine fractures 2,5%, other 60% (currently unavailable in Poland).
Teriparatide i Abalparatide are derivatives of parathyroid hormone. Daily subcutaneous administration affects bone formation and significantly reduces the risk of fractures (currently unavailable in Poland).
Hormone Replacement Therapy it is not currently a drug used to prevent fractures, although it does. It is used to treat menopausal complications, such as hot flashes. This therapy has many beneficial effects, but it can have side effects. Treatment requires close monitoring by a gynecologist.
Risk of falls
Falling is the cause of 90-100% of radius and hip fractures. Everyone is at risk of falling, and with age they become more frequent and more dangerous. After the age of 60, about 40% of healthy people fall once a year, and after the age of 80, 50%. Every 20th fall ends in a fracture. Falls are one of the leading causes of disability and the fifth leading cause of death in people over 75 years of age.
Falls are due to health and environmental reasons. Check if you are at risk of falling at home. The most common reasons are: poor lighting, obstacles on the floor, slippery floors, lack of a rug, lack of a handle in the bathroom. Watch out for slippery surfaces, uneven sidewalks, snow and ice outside your home.
Health causes of a fall: visual impairment, muscle weakness, dizziness, gait disturbances, degenerative changes in the joints, taking many medications, including: tranquilizers, sleeping pills, antidepressants.
Always keep your hands free for a soft landing in the event of a fall. Take a shoulder bag or backpack when shopping. Wear appropriate footwear, especially in winter (it is worth buying anti-slip overlays for shoes). If you feel "insecure" take a cane.