Focal osteoporosis. Osteoporosis: what is it, causes of occurrence. Medical treatment of osteoporosis of the bones

Osteoporosis is a restructuring of the bone structure, accompanied by a decrease in the number of bone beams per unit of bone volume. On radiographs, osteoporosis is manifested by increased transparency of the bone pattern, rarefaction of the bone structure and thinning of the cortical layer with a normal shape and size of the bone. Osteoporosis can be limited to a piece of bone (local), capture several bones (regional), all the bones of a limb (common), or the entire skeletal system (systemic). Osteoporosis develops in old age, as well as as a result of fractures and inflammation. bone tissue, with osteodystrophy (see) and other diseases.

Osteoporosis (from the Greek. osteon - bone and poros - time) - rarefaction of the structure of bone tissue.

X-ray examination is the only objective means lifetime definition osteoporosis. On the basis of the x-ray picture, it is possible to resolve the issue of the presence or absence of osteoporosis, to establish its localization and extent of spread, to study its nature, form and phase. Osteoporosis begins simultaneously with the underlying disease causing it, but it is detected radiographically only after a certain period. IN clinical setting this is about the second week after the onset of an acute inflammatory process or after an injury. Radiographically determined osteoporosis is already a significantly pronounced pathological shift in the structure of bone tissue. Detection of osteoporosis is possible only after a significant loss of bone substance (about 20%), and with dynamic observation, a loss or gain of bone substance within 10% is necessary in order for a series of technically flawless radiographs to reveal a distinct gradation of the shadow radiographic picture. Osteoporosis differs from true bone atrophy in that the bones affected by osteoporosis retain normal shapes and sizes, and osteoporosis is primarily a deep neurotrophic quality pathological process in bone tissue.

Osteoporosis can be expressed in two forms: spotted, or piebald, and uniform. general radiographic symptom for both types of osteoporosis is the increased transparency of the bone pattern. If spotted osteoporosis is characterized by multiple, more or less densely located small foci of enlightenment against the background of all bone structural pattern(Fig. 1), then with uniform osteoporosis, the pattern of enlightenment of the pattern has a diffuse homogeneous character. With pronounced osteoporosis, the bone can become so permeable to x-rays and peculiarly vitreous that its shadow does not differ in intensity from the shadow of the surrounding soft tissues, and the bone stands out only due to the thin line of the cortical layer surrounding it. There is no fundamental difference between patchy and uniform osteoporosis; patchy osteoporosis is more often an expression of an early pathological process and then usually turns into uniform. In other words, patchy osteoporosis is more often a phase of osteoporosis than a specific form.

Rice. 1. Spotted (or piebald) osteoporosis of the head humerus with polyarthritis.
Rice. 2. Osteoporosis in tuberculous arthritis of the left wrist joint (J); 2 - normal bone structure.

Osteoporosis can be local, regional, widespread and systemic. Local osteoporosis is limited to the area where the main pathological process is localized. Regional osteoporosis occupies an entire anatomical region, for example, a certain joint with a tuberculous lesion (Fig. 2). Widespread osteoporosis involves the skeleton of an entire limb, such as gunshot injury nerve or extensive burns. Standing apart is systemic osteoporosis, which affects all the bones of the skeleton. Like any systemic lesion, generalized systemic osteoporosis is always caused by common cause lying outside skeletal system. Its physiological prototype is senile osteoporosis. Systemic osteoporosis can be of alimentary, toxic, elimination, endocrine and hormonal, neurotrophic origin.

pathological anatomy. In osteoporosis, resorption processes predominate over osteogenesis processes. Osteoporosis is characterized by enlargement of the Haversian canals, thinning of the compact laminae (Fig. 3), as a result of which they resemble a spongy substance in structure (spongiosis of the compact lamina). In the spongy substance, the bone beams are thinned, their number is reduced (Fig. 4).

Rice. 3. Spongiation of the cortical layer.
Rice. 4. Osteoporosis of the vertebrae.

Osteoporosis occurs due to a decrease in bone mass, which may be associated with its increased resorption at normal rates of bone apposition. It is also possible to develop osteoporosis as a result of a decrease in the rate of apposition with normal resorption.

With the rapid development of osteoporosis (for example, with acute atrophy of Zudek), bone resorption proceeds in the axillary type, at a slow pace - in the type of smooth or lacunar. Both the mineral and organic parts of the bone substance disappear simultaneously. The presence in some cases of osteoporosis (rickets, osteomalacia) on the surface of bone structures of osteoid tissue is not associated with decalcification of the bone during its resorption, but with a violation of the formation of bone substance during these pathological processes.

The strength of the bone in osteoporosis decreases, as a result of which fractures and deformations of the bones, especially the vertebral bodies, easily occur. In the latter, as a result of a fracture of the cartilaginous and bone endplates, a part of the nucleus pulposus can be displaced into the spongy substance with the formation of Schmorl's hernia. Neck fractures are especially common. femur, compression fractures vertebral bodies. The occurrence of microfractures in spongy bones with the subsequent formation of microcorns is also characteristic.

Osteoporosis can be local and general. Local osteoporosis occurs in chronic osteomyelitis, bone tumors, after X-ray irradiation for therapeutic purposes (for example, in the pelvic bones after X-ray therapy for uterine cancer), etc. The occurrence of osteoporosis is associated with circulatory disorders and bone tissue trophism accompanying the underlying disease. General osteoporosis develops with general metabolic disorders - osteodystrophy, starvation, beriberi (A, C), some endocrine diseases, prolonged bed rest, especially in old age, etc.

It should be emphasized that in osteoporosis, not only bone atrophy occurs, but also its significant restructuring in accordance with changing functional and morphological conditions. This explains, for example, the thickening of some systems of beams of the spongy substance of the vertebral bodies, the neck of the femur, which bear the maximum mechanical load in conditions of osteoporosis. See also bone tissue.

Osteoporosis is a rarefaction of bone tissue due to reduced formation of the bone base by osteoblasts. In hyperparathyroidism, osteoporosis is diffuse and is usually accompanied by increased level calcium and reduced level phosphorus in plasma (serum) blood.

Osteoporosis is observed in Itsenko-Cushing's disease, acromegaly, thyrotoxicosis, diabetes mellitus, climacteric syndrome. Normally develops in old age. Osteoporosis also occurs as a result of malnutrition, beriberi C, long-term treatment glycocorticoids, etc. In these forms of osteoporosis, the level of calcium and phosphorus in the blood serum is normal, as well as the activity of alkaline phosphatase. In osteoporosis from inactivity, serum calcium levels are elevated.

Osteoporosis is one of the most common diseases affecting the bones. It has a non-infectious nature and is characterized by a decrease in bone density and strength, as well as a latent course on early stages of its development. Spotted osteoporosis is one of the forms this disease characterized by focal lesions of bone tissue.

The disease provokes the destruction of bone tissue, resulting in an increased risk of bone fracture

There are two main types of osteoporosis: generalized (the entire skeletal system is affected) and local (the fragility of any one bone increases). Local osteoporosis is divided, in turn, into patchy and uniform. These forms of the disease differ in the prevalence of the pathological process:

1. Uniform local osteoporosis affects the entire bone as a whole, causing a uniform rarefaction of its structure. This process occurs gradually, the disease is constantly progressing. This form of the disease is also called diffuse.
2. Spotted, or focal, osteoporosis captures separate, chaotically placed, sections of the bone. The x-ray shows round or oval foci of bone tissue with low density. The affected segments may have a different size, shape and shape. With patchy osteoporosis, the size of the bone is preserved, but its structure becomes porous in some places, which leads to excessive fragility.

Focal osteoporosis, if left untreated, most often becomes uniform, thus being its precursor.

Most often, osteoporosis affects women. Every third representative of the fair sex suffers from this disease. In some cases, the disease manifests itself at a relatively young age.

Causes of Spotted Osteoporosis

The focal form of the disease refers to secondary pathologies, that is, it occurs against the background of any other ailments or malfunctions in the body. Among the most common causes occurrence are as follows:

1. Post-traumatic osteoporosis. Develops as a result of trauma.
2. Postoperative. The disease manifests itself as a result of the surgical intervention.
3. Idiopathic. If the specific causes of the disease are not identified, then we are talking about this particular form.

In addition, the following factors can become indirect provocateurs of the development of the disease:

1. Genetic. If a person belongs to the Caucasoid or Mongoloid race and one of his close relatives suffered from osteoporosis, then with a high degree of probability he may develop this disease. People with low weight are also at risk.
2. Hormonal. Often the disease affects women during menopause. Focal osteoporosis can also manifest itself against the background of hormonal disruptions, and with infertility.
3. Endocrinological. The disease can be caused by pathologies such as diabetes, a syndrome of hypocorticism, in which the adrenal glands secrete too much a large number of hormones.
4. Reception of some medicines. These are glucocorticoids anticonvulsants, anticoagulants, antibiotics, cytostatics.
5. Rheumatoid arthritis, Libman-Sachs disease, chronic insufficiency circulation.

Provoke the development of rheumatoid arthritis in many ways can and lifestyle. We are talking about insufficient physical activity, smoking and alcohol abuse, vitamin D deficiency caused by living in a cold climate. Persons with an asthenic body type are also subject to the development of patchy osteoporosis.

Symptoms and stages of the disease

Symptoms of pathology make themselves felt only at advanced stages of development

main danger this disease is its imperceptible development for a long time. Most patients do not even suspect that they are sick, turning to a specialist even when the disease is at an advanced stage.

Spotted osteoporosis is treatable conservative methods in the first and second stages of their development. However, during this period, the disease cannot be recognized even on x-rays. Therefore, even an accidental detection of a disease on early stages its development is almost completely excluded.

There are 4 stages of patchy osteoporosis:

1. At the first stage, the disease does not have any symptoms. There are minor changes in the bone structure that cannot be detected modern methods research.
2. In the second stage, mild discomfort may occur. X-ray often does not show changes in bone structure. Usually, when osteoporosis is suspected, more accurate methods are used, in particular, densitometry.
3. In the third stage, the patient develops significant pain, which hinders his movements. It can be present not only in the process of movement, but also at rest. Osteoporosis in the third stage is fixed on the x-ray.
4. The fourth stage is associated with disability. The patient has visual changes in the bone structure: a violation of posture, a decrease in growth. The pain can become unbearable.

The main symptoms of patchy osteoporosis of the bones are:

• aching pain in the bones;
• fragility of nails;
• high degree of fatigue;
• convulsions at night.
• slouch.

Complications of the disease

If untreated, the consequences of osteoporosis are:

• frequent fractures that grow together extremely poorly (for example, a fracture of the femoral neck);
• external defects, as evidenced by numerous photos of patchy osteoporosis;
• problems with movement up to the complete loss of ability to work.

If patchy osteoporosis is suspected, a full examination and take tests

To make an accurate diagnosis, the specialist relies on the following factors:

• the presence of risk factors in the patient's history;
• general inspection data;
• the presence of bone pain.

If, following the results of the examination of the patient, the doctor suspects osteoporosis, he prescribes additional laboratory and instrumental studies. These include:

• densitometry;
• radiography;
• CT scan;
• biochemical blood and urine tests;

If the patient complains of pain in a certain area, then the examination should be primarily focused on the study of the painful area. For example, radiography of the hip or wrist joints, spine is performed.

Features of treatment

The course of treatment for spotted osteoporosis is determined by a traumatologist. Depending on the degree of damage to the bone tissue, the patient is prescribed individual therapy. This treatment has several goals:

1. If the development of osteoporosis is a consequence of the progression of another disease, then it should be treated first of all.
2. Bone Enrichment essential vitamins and calcium to prevent their increased fragility.
3. If necessary, the affected joints are replaced.

Comprehensive treatment includes the following areas:

1. Medical therapy. It is the basis for the treatment of spotted osteoporosis of the bones of the foot, however, it does not always have the expected effectiveness. Taking medications is usually aimed at eliminating the underlying cause of the disease and replenishing calcium stores in the body.
2. exercise therapy. Ligament and tendon training, as well as exercises that give growth, can prevent bone fragility. muscle mass. A properly composed set of exercises creates optimal conditions for curing the disease.
3. Massage procedures. Only a professional should perform massage for osteoporosis, since improper exposure can cause damage to brittle bones. With the right course of massage, it is possible to achieve high results.
4. Folk remedies. IN folk medicine widely known recipes based on onion peel and egg shells, contributing to the enrichment of the body with calcium. It should be understood that such methods will not be enough to cure such a serious illness, but they can improve the results of treatment with official medicine.
5. Diet. Patients with spotted osteoporosis should avoid fried, peppery, fatty, salty foods. It is advisable to refrain from drinking alcohol, smoking. An individual diet is determined by the attending physician.
6. Joint replacement. This is an extreme measure, which is used only when conservative methods have not yielded tangible results.

Forecast

Timely treatment gives a chance for a successful recovery

Since patchy osteoporosis does not completely capture the bone tissue, but only destroys its individual sections, the prognosis is favorable with the right approach to treatment. It is very important to start therapy as early as possible.

Focal - one of the forms of this serious illness. The second name of the pathology is spotted osteoporosis. And if, with a uniform form, almost all large and small joints are affected, then the described form has its own peculiarity. Only certain areas of the bone are affected.

Causes

The disease is not independent, but develops against the background of other diseases. Most of the time it's trauma. surgical intervention, for example, osteosynthesis, or even an idiopathic variant, in which even after the most thorough research, the cause cannot be identified.

But this is far from full list causes that can cause this disease of the skeletal system. Other provoking factors include:

1. genetic predisposition.
2. Lack of physical activity.
3. Hormonal disruptions.
4. Climax.
5. Infertility.
6. Diabetes.
7. Taking glucocorticoids.
8. Treatment with cytostatics.

Each case has its own cause, and it is very important to detect it as early as possible and start treating the disease from the first appearances.

Symptoms

For a long time, focal osteoporosis of the wrist joint, as well as other bones, does not manifest itself in any way. Initially, complaints such as barely noticeable bone pains appear, especially at night, which are attributed to fatigue. Cramps at night are also attributed to fatigue or an uncomfortable posture during sleep.

The fragility of the nail plates appears, which is considered the result of a lack of vitamins. And, finally, increased fatigue and a desire to spend most of the day on the bed.

In the absence of any treatment, when these symptoms appear, as well as when self-medicating or not going to the doctor, the symptoms become different, which indicates the active progression of the disease.

The pain syndrome in this pathology is poorly expressed. This is due to the fact that there are no nerve endings in the bones and when they are destroyed, irritation, infringement or inflammation of the nervous tissue does not occur. That is, the body is simply not able to give a signal with the help of pain.

First of all, bone fractures occur, moreover, without visible reasons. There are problems with independent movement, as well as noticeable external defects not only in the joints, but also in the bones. If the patient goes to the doctor at this stage, then it will be quite difficult to get rid of the disease, especially since it is chronic and affects several bones at once.

Classification

At the first stage, there are no symptoms and manifestations. The patient does not know that he is ill.

In the second stage, barely noticeable pains of an unclear location appear, which can be in the back, then in the legs, and then in the arms. If the diagnosis is made at this stage and treatment begins, the prognosis may be favorable.

In the third stage, the cervical hump begins to appear. This is due to a decrease in the height of the vertebrae, as they acquire a flattened shape.

In the fourth stage, the bones look almost transparent, as they no longer have bone mass. Fracture can happen even under the weight of its own weight.

Diagnostics

Diagnosing the disease is easy. This can be done using x-rays, which will show what exactly is happening in the bone tissue and how badly it is affected. In addition, there are mandatory tests blood and urine with special tests. And in order to understand how much bone density suffers, it is recommended to undergo densitometry.

At initial stage disease may require CT or MRI. But even after all the tests, it is not always possible to accurately determine the cause of osteoporosis of this type, which means that it will be impossible to get rid of it.

Treatment

Diffuse focal osteoporosis is best treated in the first or second stage. The treatment is complex, with the use of drugs of various groups. First of all, vitamin D and calcium preparations are prescribed, which help to assimilate each other.

It is also mandatory to use drugs that help prevent bone resorption - for example, alendronic acid, ibandronic acid, strontium ranelate.

With the development of complications, an operation is performed. But surgical intervention with the help of osteosynthesis of a fracture in osteoporosis is very risky, therefore it is carried out only in exceptional cases.

Treatment is carried out strictly individually and it all depends on general condition patient and his symptoms. The prognosis is most often unfavorable.

By the way, you may also be interested in the following FREE materials:

• Free books: "TOP 7 Bad Morning Exercises You Should Avoid" | "6 Rules for Effective and Safe Stretching"
• Restoration of knee and hip joints with arthrosis- free video recording of the webinar, which was conducted by the doctor of exercise therapy and sports medicine - Alexandra Bonina
• Free Low Back Pain Treatment Lessons from a Certified Physical Therapist. This physician developed unique system restoration of all parts of the spine and helped already over 2000 clients With various problems back and neck!
• Want to know how to treat pinching sciatic nerve? Then carefully watch the video on this link.
• 10 Essential Nutrition Components for a Healthy Spine- in this report you will find out what should be daily diet so that you and your spine are always in a healthy body and spirit. Very useful information!
• Do you have osteochondrosis? Then we recommend to study effective methods treatment of lumbar, cervical and thoracic osteochondrosis without medication.

Osteoporosis is a disease in which the leaching of calcium and other minerals from the bone tissue prevails over their accumulation, which causes its irreversible modification. The bones become brittle, and in the structure of their tissues there is a “restructuring”, which consists in reducing the number of plates that form it.

Voids and pores are formed, the size of which is sometimes comparable to the size of holes in hard cheeses.

Frequent fractures in osteoporosis

Loose bone tissue is easily destroyed. Fractures cannot be avoided, and they happen not only during winter walks on slippery ice or autumn slush. Sometimes, to break an arm, it is enough to lift a heavy bag, and tripping over a rug in the hallway is enough to earn a “bedridden” fracture of the femoral neck. Such metamorphoses are caused by a violation of phosphorus-calcium metabolism in the body. Where does calcium “leave” and why does osteoporosis occur, what are its symptoms and how successful is the treatment?

Prerequisites for the development of osteoporosis largely take into account its classification. Let's consider the most common of them.

Let's start with a topographic classification, in which two forms of the disease are distinguished - local and generalized.

With local form the bone substance of a particular bone loses its density due to fractures, displacements, bruises, burns, toxic effects, etc.

Depletion of bone tissue can take the form of round or oval foci of various sizes (spotted osteoporosis).

If the bone is evenly depleted, they speak of uniform local osteoporosis.

Osteoporosis hip joint can lead to severe fractures

Local rarefaction of the bone tissue structure often occurs in the bones that form large joints. A typical case and a common cause of severe, "immobilizing" fractures in the elderly is osteoporosis of the hip joint, in which the disease affects the neck of the femur.

There are also regional osteoporosis, covering an anatomical region consisting of several bones, more often a joint. This form of the disease threatens not only bone fractures.

Osteoporosis of the joints develops, in which the fragility of the surfaces of the articular bones is combined with degenerative processes in the cartilage tissue.

The most commonly affected are the hip and knee joints.

If the pathological process affects and soft tissues joint, talking about periarticular osteoporosis. Periarticular osteoporosis of the hands is a frequent consequence of a decrease in bone density and a violation of their structure, manifested by pain in the joint and its crunching at the time of movement.

Leads to severe consequences diffuse osteoporosis of the spine, in which there is a reduced density of tissue in its vertebrae.

Diffuse osteoporosis of the spine threatens to fracture the spinal column

In addition to stoop, gain lumbar curve and the formation of a hump, this type of disease threatens with severe fractures of the spinal column.

Systemic osteoporosis affects all the bones of the skeleton.

Osteoporosis in children and adults

Also distinguished:

Gender injustice

Although osteoporosis of the bones is diagnosed in almost 100% of men who have crossed the 75-year mark, women still remain the first contenders for “bone porosity”.
Causes of osteoporosis in women:

• Disharmony of hormones caused by menopause. The metabolism of calcium ions is carried out mainly in the constantly renewing bone tissue. It goes on continuously metabolic processes. Special cells - osteoblasts - synthesize bone substance, while others - osteoclasts - "resorb" it. Responsibility for the balance in this system is the sex hormones - estrogens and progesterone in women, androgens - in men. Menopause accompanied by sharp decline the production of sex hormones, disrupts the exchange of "building material";
• Poor diet. A diet based on carbohydrates and refined foods, soda and coffee threatens with a deficiency of calcium, phosphorus and magnesium, proteins and unsaturated fatty acids, vitamin D, which does not at all contribute to strengthening bones;
• A dangerous "couple" - alcohol and nicotine, if they are not separated for a long time, lead to a loss of 25% of bone mass;
• Ovarian dysfunction or removal.

See the video for more details:

The beginning of the disease is very easy to miss - its first symptoms are very blurred.
In the early stages, signs of impaired salt metabolism will help to suspect osteoporosis:

• pain in the bones and neck;
• increased fatigue and low performance;
• tearfulness or apathy;
• sleep disturbance, feeling of fear;
• night cramps;
• periodontitis and excess plaque;
• delamination of the nail plate and early gray hair;
• gastrointestinal dysfunction and the onset of diabetes mellitus;
• tachycardia;
• allergy.

Progressive osteoporosis is irreversible, and its symptoms worsen in women. With a decrease in bone mass, painful sensations appear.

Pain in osteoporosis is aching in nature, often localized in the lower back and sacrum, pelvic bones, ankle and hip joints.

Squatting on tiptoe, pressure from above on outstretched arms, accompanied by pain in the spine. Often there is a "painful" sensation between the shoulder blades. Bone fractures are on the rise. A further decrease in bone density in some women causes a decrease in height, sometimes significant, up to 10-15 cm.
With similar symptoms, the disease declares itself to the representatives of the opposite sex.
In women who have not reached the menopausal period, the depletion of bone tissue can be the result of significant weight loss. So, rigid unbalanced diets, poor in calcium and minerals, in addition to reflecting a slender body in the mirror, can provoke osteoporosis. knee joint, the first manifestations of which - prolonged aching pain in the knee after physical exertion - eventually result in a severe degree of bone demineralization, fraught with joint deformity.
For more information on the symptoms of osteoporosis, see the video:

It has been established that blond women with very fair skin are at risk of getting “porosity” of bones more than, for example, dark-skinned representatives of the Negroid race.

What are the complications of disability?

Poorly healed fractures and skeletal deformities associated with osteoporosis with a high degree of bone demineralization often render the patient unable to work and may even be bedridden.

The question is brewing - do they give disability in osteoporosis?

The decision of the special commission depends on the severity of the complications:

• Obtaining a disability of the 3rd group is likely with significant kyphoscoliosis, aggravated by a strong pain syndrome;
• Fracture of the femur or other bone, complicated by the development of the so-called "false joint" - a reason for establishing group 2 disability. The likelihood of getting it increases in the presence of cardiovascular or respiratory failure;
• Disability of the 1st group is established in the critical course of life-threatening and bedridden osteoporosis.

Osteoporosis threatens disability

Sick, come on!

The best way to determine how much bone mass has decreased is densitometry, which allows you to express in numbers the dynamics of changes in bone density.

Such quantification will show that the patient has osteopenia or osteoporosis, the difference between them in terms of the level of reduction mineral density bones.

Among the auxiliary methods for diagnosing osteoporosis are radiography, the study of the levels of such markers of osteoporosis as osteocalcin, bone fraction of alkaline phosphatase, etc., biopsy and differential diagnosis.

Instead of a conclusion

The human skeleton is comparable to an architectural structure, the stability of which depends on the strength of its building blocks - the bones. But just as water wears away the strongest foundation, the disease destroys the bones from the inside, turning their strong homogeneous tissue into a fragile structure with gaping voids. Therefore, it is necessary to lay the “foundation” and strengthen the bones without waiting for fractures, starting from the moment of intensive growth, during pregnancy and lactation. How? Compensate for calcium deficiency, which is always accompanied by imperfections in the diet, with products containing mineral salts and vitamin D.

But do not forget at the same time that the body does not make “reserves” for the future, and therefore, taking the right portion of calcium from the tablet, it will hasten to get rid of the excess, removing them through the kidneys. Therefore, the presence of calcium, minerals and vitamin D in the diet is the most important point in the prevention and treatment of osteoporosis. And in order for the body to be able to use them “for their intended purpose” during menopause, women during this period often need replacement therapy estrogen, combined with the intake of calcium, vitamin D and bisphosphonates - drugs aimed at suppressing bone decay. Fluorine preparations are also effective.

Prevention of osteoporosis will help to avoid the disease

In some cases, the doctor prescribes the wearing of supporting corsets - you should not neglect such a recommendation, but it is better to take care of strengthening your own muscle corset. Therefore, do not neglect physical activity. However, in old age exercise stress should not only be dosed, but also “correct” - incorrect exercises can lead to fractures, so the character sports load should be discussed with the doctor and deal with the exercise therapy instructor.

We should not forget about the intrapersonal "underlying reason" of the disease. After all, the psychosomatics of osteoporosis, or its psychological reasons often indicates that a person has a feeling of lack of some kind of support. Therefore, follow the recommendations of the attending physicians - an endocrinologist and a rheumatologist, eat rationally, eradicate bad habits and be sure: you can protect yourself, because life can sometimes support in the most unexpected way! Be healthy!

Types of osteoporosis are classified depending on the prevalence of destructive changes in the body, the intensity of these processes, the type of tissue that has undergone demineralization and etiology. The variety of types of the disease depends on the causes that caused the imbalance of resorption and bone formation.

Systematization and classification of pathology

Osteoporosis of bones does not have a single classification. The classification of osteoporosis proposed at the end of the 20th century at a meeting of the Russian Association for Osteoporosis is considered the most convenient. According to the approved system, osteoporosis is divided into:

1. Primary, which is divided into 2 types. I is postmenopausal and type II is senile.
2. Secondary.

Like any tissue of the human body, bone has periods of restructuring. In order for the structure to function normally, old cells must be destroyed and new ones formed. Normally, these processes are balanced and should take place at the same speed. However, throughout a person's life, these processes occur with varying intensity.

resorption various kinds bone tissue occurs at different rates. It has been found that over the course of a woman's life, more than 30–40% of compact (cortical) bone and 50% of spongy (trabecular) bone are lost. In men, this process is twice as slow.

Types of primary pathology

The primary type is systemic and accounts for 88–94% of the total number of all isolated forms of pathology. Depending on the age at which the reverse process of bone tissue mineralization is noted, it is divided into:

1. Genetically determined or hereditary, in which the pathology occurs in representatives of the same family and is inherited.
2. Juvenile, the causes of which are unknown. Pathology affects adolescents in puberty.
3. Involutive, arising from the destructive processes of aging of the body. This group is divided into postmenopausal, which occurs in women after 50 years of age and is the result of hormonal imbalance and senile (or senile), which causes the natural aging processes of the whole organism. It manifests itself at the age of 70 years and older. In men, pathology can be observed earlier, after 50 years. This type of bone mineralization disorder is called presenile.
4. Idiopathic. This is a pathological process that develops in women before menopause, and in men over the age of 25 years. The etiology of this early destruction of skeletal tissues is unknown.
5. Scientists believe that the main cause of occurrence is hereditary predisposition. The natural aging process of the body is inherent in all people, but not everyone develops osteoporosis.

hereditary type of disease

As a result of identifying the causes of the pathology, it was found that in more than 80% of cases, systemic osteoporosis was genetically determined. Conducting mass studies is complicated by the fact that pathology is diagnosed in adulthood, the bulk of the patient's relatives with a suspected hereditary type are no longer available for research.

However, when examining identical twins with osteoporosis, it was found that the pathology was caused by a mutation of more than 30 genes that are responsible for various processes of bone tissue mineralization. Genes that are part of the osteoporosis gene network have been identified and are responsible for:

• calcium homeostasis;
• hormone balance;
• regulation of the formation and resorption of bone forming elements;
• for the synthesis of proteins that make up the structure of skeletal tissue;
• lipoprotein metabolism.

It has been established, for example, that the association of the gene responsible for the synthesis of collagen and the vitamin D receptor has great importance in bone mineralization. Mutation of one of the genes leads to pathology.

Research to identify genetic markers of osteoporosis is of great clinical significance. They play an important role in the development of methods for early detection of a positive or negative reaction to therapeutic methods treatment and the creation of new generations of drugs for the disease.

Juvenile or adolescent form

Prior to 2000, osteoporosis was considered an inherent problem age group humanity. Attempts to identify juvenile forms of pathology were made more than a quarter of a century ago, but due to imperfection diagnostic methods the clinical significance of the identified cases of osteoporosis in adolescence was too low for the juvenile form of the pathology to be studied.

Only with the introduction of densitometry, it was found that in 30% of children school age there is a deficiency of bone mass (BM). A high incidence of juvenile osteochondrosis was also established in the group of adolescents with varying degrees development of scoliosis. The juvenile type is divided into:

• idiopathic osteoporosis not associated with systemic pathologies;
• secondary, developed under the influence of external and internal factors.

The onset of the disease is associated with a decrease in bone metabolism or with an accelerated resorption process. Both ways of pathology formation can be both genetically determined and acquired. The increased number of adolescents with skeletal disorders and the risk of developing osteoporosis at a young age is associated primarily with exposure to pathogenic factors with a genetic predisposition to the disease. These factors include:

• low physical activity;
• early smoking, alcohol, drug use;
• passion for diets and nutritional habits;
• excessive physical activity.

Intensified propaganda of the cult of the body among young people leads to high loads on the insufficiently strong skeleton during exercise on weight machines. Increasingly, steroid osteoporosis occurs among teenagers trying to quickly build muscle mass.

In girls, the emergence of the juvenile type is associated with a decrease in body weight, which is not only characteristic of the period of feminization of the physique, but also in the passion for diets. The peak risk of bone fractures in girls is between 11 and 12 years of age. An imbalance between growth and accumulation of CM leads to increased bone fragility in boys aged 13–14 years.

Insufficient dietary intake of calcium and other micronutrients leads to an increased risk of osteoporosis, especially in girls. In puberty, the danger is regional osteoporosis, which results in fractures of the bones of the extremities.

Decreased mineral density of CM by 1 standard deviation increases the risk of developing juvenile osteoporosis by 3 times.

Idiopathic osteoporosis can be compensated the right way life and nutrition.

Type I pathology

This type of pathology develops against the background of an imbalance of sex hormones in the postmenopausal period. Regardless of gender, a violation of the synthesis of sex hormones leads to increased bone loss at any age. During menopause, osteoporosis is caused by several mechanisms that are not fully understood, which are accompanied by an increase in osteoclast activity and an imbalance in resorption/formation processes.

Involutive osteoporosis progresses in the first 5-6 years after menopause, leading to a loss of 5-10% of bone minerals per year. The lack of estrogen activity, characteristic of the postmenopausal period, leads to an increase in the sensitivity of the skeletal bones to the action of parathyroid hormone on tissues. This hormone stimulates the leaching of calcium from the bones.

Estrogen deficiency affects the production of certain types of interleukins, which contribute to the activation of osteoclasts. It has been found that postmenopausal women are particularly sensitive to certain types of medications. So, for example, glucocorticoid osteoporosis develops in 30-40% of patients against the background of long-term use of anti-inflammatory drugs. This is due to the mechanism of action of drugs.

An important factor in the development of pathology is that GC receptors are realized on osteoblasts and osteoclasts and belong to the superfamily, which includes receptors of other steroid hormones. Steroid osteoporosis causes a cascade of pathogenetic effects due to the action of glucocorticoids:

• decreased absorption of calcium in the intestine;
• the mineral is lost in the urine as a result of impaired renal reabsorption;
• the occurrence of secondary hyperparathyroidism;
• decreased activity and ability to differentiate osteoblasts;
• inhibition of the synthesis of sex hormones.

The action of glucocorticoids increases the risk of a senile type of disease. Treatment of common inflammatory processes prostate in older patients, this group of drugs increases the risk of developing osteoporosis by 3-4 times.

Osteoporosis type II

The formation of senile osteoporosis is based on a decrease in the activity of osteoblasts and their inability to restore bone tissue. As a result, remodeling processes begin to prevail over the formation process, which leads to increased bone porosity. Additional factors affecting the occurrence and progression of type II pathology are:

• decreased physical activity;
• age-related loss of muscle mass;
• increased activity of the parathyroid glands;
• drop in the active form of vitamin D.

Today, systemic osteoporosis occurs in 200 million of the world's population. Every year this figure increases by 1-2%, which is associated with the aging of the population of economically developed countries. The most common consequence of the degenerative processes of aging of the body is epiphyseal osteoporosis and its complication - a fracture of the femoral neck. As a result of such an injury, 20–30% of patients die, and 60–80% have persistent disability.

Secondary disease type

Secondary develops against the background of systemic diseases and under the influence of various external factors. The level of bone mineral density is affected by Negative influence pathologies of the following systems:

• endocrine;
• collagenoses;
• digestive;
• kidneys;
• blood.

In addition to systemic pathologies, some conditions increase the risk of development:

• alcoholism (alcoholic type of illness);
• anorexia nervosa;
• consequences of operations on the reproductive organs;
• prolonged immobilization;
• organ transplant;
• taking certain medications (corticosteroids, antidepressants, tetracycline antibiotics, hormones, antispasmodics, diuretics);
• hormonal disorders.

The secondary view (as opposed to the system view) has various forms manifestations and localization.

Classification by process localization

Depending on the localization of the destructive process in the skeleton, osteoporosis is divided into:

• uniform;
• focal.

If, with uniform distribution, demineralization captures all the bones of the skeleton, then focal osteoporosis is characterized by damage to one type of bone tissue or a certain part of the skeleton. If the systemic or uniform form is more common in the primary form of pathology, then focal osteoporosis is caused by systemic diseases and external damaging factors. Limited lesions are more characteristic of the secondary form of the disease.

Local osteoporosis develops against the background of local damage caused by trauma, inflammation of the bone tissue and periosteum, degenerative and destructive processes (metastases, tumors).

Post-traumatic osteoporosis causes prolonged immobilization. Reflex dystrophy, which occurs when bones are fractured and prolonged immobilization in plaster, is accompanied by autonomic disorders, which lead to a decrease in blood circulation and nutrition, hormonal dysfunction, tissue atrophy. Spotted osteoporosis is an x-ray symptom of reflex dystrophy.

Depending on the location of the lesion along the bone vector, periarticular osteoporosis is distinguished, which may occur due to joint trauma or a destructive disease (arthritis). Epiphyseal osteoporosis, which affects the joints of the upper and lower extremities, spine.

Complications are fractures that are difficult to treat due to impaired bone tissue restoration. The most common manifestation of age-related destructive processes in the support system is epiphyseal osteoporosis of the femoral neck. The risk of fracture of the hands also increases with the age of the patient.

Osteoporosis is called a silent epidemic of the XX-XXI centuries. In terms of the number of patients, it ranks 4th in the list of socially significant diseases. Therefore, scientists attach such great importance to the study of pathology, the improvement of methods for early diagnosis of the disease and the creation of new drugs for more effective treatment. Therefore, the classification of this pathology is important.