Osteoporosis Treatment

Osteoporosis is a condition that manifests itself by a decrease in bone density, an increase in their fragility and an increase in the likelihood of fractures.

Fractures most often affect the bones of the spine, wrists and hip neck, although other areas, such as, for example, the bones of the arms or pelvis, can also be damaged.

According to the Russian Association for Osteoporosis, 14 million people (10% of the country's population) suffer from this disease in our country, and clinically pronounced fractures occur in 9 million people. And although osteoporosis is usually associated with changes occurring in women after menopause, but the disease can also affect men, young women and children.

Often we do not notice signs of osteoporosis until a fracture occurs, which usually occurs after a slight fall. The most common injuries in patients with osteoporosis are fractures of the wrist bones, hip neck or spine bones (vertebrae).

If your doctor suspects you have osteoporosis or there is a high risk of developing this disease, you may be referred for a bone density check. Therapy for osteoporosis is aimed at treating and preventing fractures, and also consists in prescribing medications that strengthen bone tissue.

Usefull Information About Osteoporosis Treatment

Osteoporosis develops slowly, over several years. It is likely that you will not feel any symptoms of the disease until a slight fall or other sharp impact provokes a fracture.

Healthy bones must withstand the load that occurs when falling from a height of their own growth, and if the bone is damaged under such conditions, it means that the fracture is osteoporotic in nature. The most common injuries in people with osteoporosis:

  • wrist fractures;
  • hip neck fractures;
  • fractures of the bones of the spine (vertebrae).

In osteoporosis, a simple cough or sneeze can lead to a rib fracture or partial destruction of one of the vertebrae. In the elderly, fractures can have the most serious consequences. Their severity depends on the localization of the injury and can cause long-term disability. For example, a hip fracture can permanently deprive a person of the ability to fully move.

One of the most noticeable signs of osteoporosis is the characteristic forward tilt of the body (stoop), which develops in the elderly. This is due to damage to the bones of the spine, as a result of which the ability to withstand the weight of one's own body is impaired.

Osteoporosis usually does not cause pain until a bone fracture occurs. Not mandatory, but the most common cause of chronic pain in osteoporosis are fractures of the bones of the spine.

In childhood, bones grow and recover very quickly, but with age this process slows down. Bone growth stops in the period from 16 to 18 years, but the increase in their density continues up to 30 years. Starting around the age of 35, bone tissue gradually loses its density. These are normal age-related changes, however, in some people they can lead to the development of osteoporosis and an increased risk of fractures.

Other factors that increase the likelihood of developing osteoporosis include:

  • diseases of the hormonal glands, for example, increased activity of the thyroid gland (hyperthyroidism);
  • the presence of the disease in the next of kin;
  • long-term use of medications that affect bone strength or hormone levels, such as prednisone;
  • malabsorption (malabsorption of nutrients in the small intestine);
  • alcohol abuse and smoking.

The structure of the femoral bone, some people are more at risk of developing the disease, some are less. The disease is more common in the elderly, but it can also occur in youth.

Women have a higher risk of developing osteoporosis than men. This is due to the fact that changes in hormone levels in women can affect bone density. The female hormone estrogen is essential for maintaining bone health. After menopause, the level of estrogen in the body drops, which can lead to a rapid decrease in bone density. Women are at even greater risk of developing osteoporosis if:

  • there is an early menopause (under the age of 45);
  • a hysterectomy (operation to remove the uterus) was performed, especially if the ovaries were also removed, at the age of 45;
  • there is no menstruation for a long time (more than six months) as a result of excessive enthusiasm for fitness or diet.

The causes of osteoporosis in most men are not known. However, there is a relationship between the level of the male hormone testosterone and bone health. A man's body continues to produce this hormone in old age, but with a drop in testosterone levels, the risk of osteoporosis increases.

Known causes of osteoporosis in men include:

  • the use of certain medications, such as, for example, oral glucocorticoids;
  • alcohol abuse;
  • hypogonadism is a condition caused by abnormally low testosterone levels.

Many hormones in the body can affect the processes of bone renewal in both sexes. If you have endocrine gland diseases, the risk of developing osteoporosis is increased. Osteoporosis can be caused by hormonal abnormalities such as:

  • hyperthyroidism (increased activity of the thyroid gland);
  • diseases of the adrenal glands, for example, Cushing's syndrome;
  • reduction of the amount of sex hormones (estrogen or testosterone);
  • violation of the pituitary gland;
  • hyperparathyroidism (hyperactivity of the parathyroid glands).

Increased risk of osteoporosis

Other causes that presumably increase the risk of osteoporosis and bone fractures include:

  • cases of osteoporosis in the family and close relatives;
  • femoral neck fractures in the family history;
  • low body mass index (BMI) — less than 19;
  • long-term use of high doses of corticosteroid drugs (widely used to treat diseases such as arthritis and asthma), which can affect bone strength;
  • alcohol abuse and smoking;
  • rheumatoid arthritis;
  • malabsorption (problems with the absorption of nutrients in the small intestine), which can be caused by celiac disease (impaired intestinal absorption due to gluten intolerance) or Crohn's disease (inflammation of the intestine);
  • some drugs used in the treatment of breast or prostate cancer that affect hormone levels;
  • prolonged periods of inactivity, for example, prolonged bed rest.

To detect osteoporosis, there is a specific study of bone density — densitometry. A simple X-ray examination is not a reliable method of diagnosing osteoporosis, although it helps well in detecting fractures.

DERA scanning (dual-energy X-ray absorptiometry) — this type of densitometry will help diagnose osteoporosis. The procedure lasts only about 15 minutes and is completely painless. With the help of DARE, you can measure bone mineral density and compare it with normal indicators for healthy young people, as well as representatives of your age and gender.

The difference between your testimony and the testimony of a healthy person is calculated according to a special formula, it is commonly called the "T-indicator":

  • above 1 is the norm;
  • between 1 and 2.5 — osteopenia (bone density is below average, but not low enough to call this condition osteoporosis);
  • below 2.5 - osteoporosis.

If you have been diagnosed with low bone mineral density, this does not always mean that you are at risk of fractures. Talk to your doctor about the factors that provoke the development of osteoporosis and bone fractures. It will help you take the right steps to improve the health of the bone apparatus.

Bone density scans can help diagnose osteoporosis, but the result of densitometry is not the only factor determining the risk of a fracture. The attending physician will take into account your age, gender, and any prior injuries before deciding whether you need to be treated for osteoporosis.

Therapy for osteoporosis is aimed at the treatment and prevention of fractures, as well as the use of drugs that strengthen bone tissue.

If you suffer from fractures after falls, you have been diagnosed with osteoporosis, or there are risk factors for the development of this disease, then to choose the optimal method of treatment or prevention of osteoporosis, you should consult your doctor.Something to remember for the elderly, their relatives or guardians caring for patients with osteoporosis.

Although the risks of falling increase with age, but still you should not consider them inevitable. There are a number of measures that can be taken to prevent or minimize the consequences of falls.

Stay active and healthy (for example, through exercise and a healthy diet). This will help to remain independent and reduce the risk of falls.

If you lose your balance and often fall, consult a doctor to identify possible causes. This may be due to visual impairment, medication, muscle weakness and disorders in the vestibular apparatus. Any abnormalities must be identified and treated.

In the treatment of osteoporosis, it is not necessary to take medications. However, you should take care to maintain sufficient levels of calcium and vitamin D in the body. Your doctor may advise you to change your diet or take dietary supplements.

There are recommendations about who should use medications in the treatment of osteoporosis. Among the determining factors:

  • age;
  • the result of the study of bone mineral density;
  • the risk of fractures.

Medications for the treatment of osteoporosis

There are a number of different drugs for the treatment of osteoporosis. Your doctor will determine the treatment method that is optimal for your case.

Biphosphonates slow down the work of cells that destroy bone tissue (osteoclasts). This maintains bone density and reduces the risk of fractures. There are several different bisphosphonates, including alendronate, ethidronate, ibandronate, risedronate, and zoledronic acid. They are presented in the form of tablets or injections.

The main side effects associated with taking biophosphants include irritation of the esophageal mucosa, difficulty swallowing, stomach pain, but not everyone experiences these unpleasant sensations. Osteonecrosis (necrosis of the bone area) of the jaw is a rare side effect associated with the use of biphosphonates (usually when using intravenously high doses for the treatment of cancer, not osteoporosis). Cells in the bones of the jaw die, and this can lead to problems with subsequent treatment. If you have ever had problems with your teeth, then before you start treatment with biphosphonates, you may need to undergo an examination. If you have any questions related to treatment, contact your doctor.

Strontium ranelate affects both the cells that destroy bone tissue and the cells that renew it (osteoblasts). The drug can be used as an alternative to biphosphonates, if contraindications are found to them, Strontium ranelate is taken in the form of a powder dissolved in water.

The main side effects associated with taking strontium ranelate are nausea and diarrhea. Extremely rarely, patients may experience severe allergic reactions. If you find a skin rash while taking strontium renelate, stop taking the drug and consult your doctor immediately.

Selective estrogen receptor modulators (SMERS) are a group of drugs that have the same effect on bones as the hormone estrogen. They help maintain bone density and reduce the risk of fractures, especially in the bones of the spine. The only form of SMER suitable for the treatment of osteoporosis is raloxifene. Raloxifene is taken daily in the form of tablets. Side effects associated with taking raloxifene include hot flashes, leg cramps and an increased risk of blood clots.

Parathyroid hormone (parathyroid hormone) is naturally produced in the body. It regulates the amount of calcium in the bone tissue. Parathyroid hormone (human recombinant parathyroid hormone or teriparatide) is used to stimulate osteoblasts - cells that create new bone tissue. Parathyroid hormone is prescribed in the form of injections. While other drugs can only slow down the rate of bone thinning, PTH is able to increase bone density. However, it is used only in a small number of patients with very low bone density, and only if other treatments do not work. Common side effects from PTH include nausea and vomiting. Parathyroid hormone treatment should be carried out only by appointment of a specialist.

Calcium and vitamin D can be beneficial for older men and women and help reduce the risk of hip fractures. A sufficient amount of calcium in an overall well-balanced diet is an important factor for maintaining bone health. It is necessary to strive for the use of at least 700 mg of calcium daily. This is equivalent to a little more than 0.5 liters of milk. If you are not getting enough calcium with food, consult with your doctor about taking dietary supplements.

In order to ensure a positive effect on bone tissue, prevent the occurrence of fractures and successfully treat osteoporosis, it is necessary to take the correct doses of calcium (1.2 g per day) and vitamin D (20 mcg). Such dosages are present only in a small number of prescription drugs from individual manufacturers. Therefore, any drugs sold in a pharmacy without a prescription may not contain the necessary doses of calcium, and vitamin D may not be present in them at all.

Hormone replacement therapy (HRT) is used in women going through menopause and helps them control the symptoms characteristic of this period. But, in addition, HRT is also indicated to maintain bone density and reduce the risk of fractures. Nevertheless, HRT is not recommended to be used specifically for the treatment of osteoporosis and is currently practically not used for this purpose. This is due to the fact that when using HRT, the likelihood of developing breast cancer, endometrial cancer and ovarian cancer increases, and the risk of strokes also increases, thus overriding the positive effects of osteoporosis treatment. Discuss the benefits and risks of HRT with your doctor.

Calcitonin is a hormone produced by the thyroid gland. It suppresses the work of osteoclasts - cells that destroy bone tissue, and thereby increases bone density. Calcitonin or salkatonin is taken as a nasal spray or daily injections. Side effects include nausea, vomiting and diarrhea.

Testosterone treatment in men is useful if osteoporosis is caused by insufficient production of male sex hormones (hypogonadism).

Although your genes determine the potential growth and strength of the skeleton, lifestyle factors such as a healthy diet and exercise can have an impact on the health of your bones.

Types of therapeutic load for osteoporosis

Regular exercise is necessary. Every adult should devote at least 150 minutes (2 hours and 30 minutes) to moderate aerobic exercise (cycling or brisk walking) during the week. Exercises with the load of your own body weight on your legs and weight training are especially important for increasing bone density and helping to prevent osteoporosis.

If you have been diagnosed with osteoporosis, it is worth consulting with your doctor before supplementing your exercises with any new elements — this will help make sure they are safe for you.

Exercises with the load of your own body weight on your legs — when performing these exercises, your feet and legs support your own body weight. Active exercises, such as running, jumping rope, dancing, aerobics and even jumping on the spot, will help strengthen muscles, ligaments and joints. When performing exercises, use shoes that will provide good ankle support, for example, training or walking sneakers

Exercises with the load of your own body weight on your legs will be useful for people over 60 years old. It can be brisk walking, fitness classes or a game of tennis. Swimming and cycling are not exercises with a load of body weight on the legs.

Exercises with weights — when performing exercises with weights, the strength of the muscles is used, while, thanks to the work of the tendons that pull the bones, the bone itself is strengthened. Exercises include push-ups, weight lifting, or gym sessions. If you have started studying recently or have not visited the gym for a long time, you will probably need an introductory lesson. During it, you will be taught how to use simulators, and the technique of performing exercises will be recommended. If you do not know how to use any sports equipment or how to perform an exercise, contact the gym instructor for help.

Therapeutic nutrition for osteoporosis

A healthy and balanced diet is recommended to everyone without exception. It will help prevent the development of a number of diseases, including heart disease, diabetes, many forms of cancer, as well as osteoporosis.

Foods with a high calcium content

Calcium is essential for maintaining bone strength. The recommended daily intake of calcium is at least 700 mg. This is equivalent to 0.6 liters of milk. Calcium can be obtained from a number of foods, for example, green leafy vegetables, dried fruits, tofu and yogurt.

Vitamin D is important for bone and dental health because it helps the body absorb calcium. Vitamin D is found in eggs, milk and oily fish. Most of the vitamin D is produced in the skin under the influence of sunlight.

Foods high in vitamin D

A short stay in the sun without sunscreen (10 minutes twice a day) throughout the summer should help to stock up on the amount of vitamin D, which is enough for the whole year.

Some people may be deficient in vitamin D. These include those who are forced to stay indoors all the time, often get sick, eat unbalanced, avoid sunlight on the skin due to the need to wear special closed clothes, and women who are pregnant or breastfeeding. If you are deficient in vitamin D, you can take it in the form of dietary supplements.

The recommended dose for adults is 10 micrograms per day. Children's doses: 7 mcg per day for children under the age of six months, and 8.5 mcg - from six months to three years. For more information, consult your doctor.

Get sunlight!

Sunlight (from May to September) triggers the production of vitamin D, which helps the body absorb calcium. This process helps strengthen teeth and bones, which, in turn, reduces the risk of osteoporosis.

Other factors of your lifestyle will help prevent the development of osteoporosis:

  • quitting smoking - smoking is associated with an increased risk of osteoporosis;
  • restriction of alcohol consumption - men are not recommended to consume more than 1-2 servings of alcohol per day (75-90 g in terms of vodka), women — more than 1 (45 g in terms of vodka).

Having osteoporosis does not necessarily mean suffering from fractures. There are a number of measures that will help reduce the risk of falls and fractures.

Some changes in the environment of your home will help reduce the likelihood of falling and, as a result, the formation of cracks or fractures of bones. Check the house for objects that you can trip over, for example, wires lying on the floor. Make sure that the carpets and carpeting are safe, and put rubber mats near the sink and in the bathroom, which will help not to slip.

Check your eyesight and hearing regularly. Some older people may have to wear special protection on their hips to cushion the fall. Your doctor can also give you useful tips related to your lifestyle.

Regular exercise and a healthy diet are recommended to everyone without exception, not just patients with osteoporosis. They will help prevent many diseases, including heart disease and many forms of cancer. Try to stick to a balanced diet, which includes those food groups that will provide your body with all the necessary substances. Regular exercise will help increase bone strength, relieve stress and reduce fatigue.

Some people find it useful to talk to other patients suffering from osteoporosis. This can be done in special support groups or in Internet chats.

Recovery from a fracture usually takes six to eight weeks. The presence of osteoporosis does not affect the recovery time. The duration of this period depends on the type of fracture. Some of them heal easily, while others may require additional procedures.

If you have a compound fracture of the wrist or hip neck, surgery may be required to properly fit the bone. Sometimes it is necessary to perform prosthetics of the femoral neck, and some patients may lose mobility as a result of weakening of the bone structure.

Osteoporosis can cause a decrease in growth as a result of damage to the spinal column. This means that the spine is no longer able to support your body weight, and can lead to a slouching posture. This can be very painful and, moreover, can lead to the appearance of chronic (long-term) pain. Your doctor will help you in case of such a complication.

During treatment, you may need the help of a physiotherapist to recover as fully as possible after a fracture.

How to cope with the pain of osteoporosis?

Pain is unique for each individual. There are several different ways to deal with pain:

  • taking medications;
  • heat treatment, for example, warming baths or hot compresses;
  • cold treatment, for example, cold compresses. It is also possible to treat with the help of CHANCE (percutaneous electrical stimulation), which acts with an electric current on the nerve endings and reduces the feeling of pain;
  • the usual relaxation techniques, massage or hypnosis.

To manage pain, you can use several techniques at the same time (for example, medication, warm compresses and relaxing techniques).

If you have osteoporosis, you will be able to continue working. It is very important to stay physically active and live a full life. This will help you maintain bone health and protect you from unnecessary thoughts about the potential problems that the disease can cause. However, if your job involves a risk of falls or fractures, consult with your employer and doctor about how best to reduce the risk of an accident or injury that can lead to fractures.

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