Is osteoporosis a disease?
– No, this is not a disease, this is a condition in which a person’s bone tissue becomes fragile. Calcium is washed out of the body, bones become brittle and prone to fracture as a result. Osteoporosis exists or will exist in all inhabitants of the Earth, and according to statistics, it is the cause of death of 25% of the population. But mostly, it still affects women. For them, it happens earlier and stronger after the onset of menopause and worsens over the years.
– Why is low weight a more frequent indicator for the development of osteoporosis and not vice versa? After all, is the burden on the skeleton greater with excess weight?
“It’s not about weight, it’s about bone thickness. There are people with thinner bones, and there are people with “big bones” like the famous actress Nonna Mordyukova. You can visually determine the thickness of the bones by the “Soloviev index” – this is the circumference of the wrist. If the wrist is more than 14 cm, the bones are large. For a person with thin-boned osteoporosis, the losses will be more significant.
Why do people lose bone tissue with age?
– This happens for various reasons. For example, with vitamin D deficiency. This vitamin is a minibus that transports calcium from the stomach to the bones for a person. There is no vitamin D – no matter how much calcium you eat, it will stay in your stomach. Therefore, vitamin D deficiency is a big problem, especially for those living in Russia, where the sun is scarce.
– How can a person know that he does not have enough bone tissue?
– The first bell is usually a shard. There are three places where fractures can be understood even without additional research where osteoporosis develops. This is a fracture of the radius on the arm, a fracture of the vertebrae and a fracture of the femoral neck.
Do men with osteoporosis have fractures in the same places?
– Yes. Let’s say they happen after 10-15 years. But men can destroy their natural protection by smoking, vitamin D deficiency, taking diuretics. Long-term use of diuretics, as in men and women, contributes to the leaching of bone tissue.
“Fracture is such a thing that it’s hard not to feel it.” And a broken vertebra sounds awful. However, do people keep walking with them?
– The vertebrae gradually break. These are microfractures, so you can’t feel them. However, it can be seen – growth is shrinking. I had a patient who sneezed once and broke all four of his vertebrae at once.
And didn’t he feel?
“Of course I did. Fracture of the four vertebrae led to a marked pain syndrome and surgical treatment because that is one thing when the situation is slowly changing, and it is completely different when there are four vertebrae at the same time.
But in general microfractures can be seen with a decrease in height and gradual bending of the trunk: the classic grandmother with a stick facing down is just one picture of osteoporosis, the result of numerous microfractures of the vertebrae that accompany it. decades. However, these fractures are not fatal, just like breaking the wrist bone. But a fracture of the femoral neck is already very worrying, as it leads to immobility. Inactivity in old age leads to a sharp decompensation, weakness. In other words, if a patient is 75 years old, for whatever reason, let’s say for a month, it is not possible to get up later.
– How do these broken vertebrae look on X-ray or MRI?
– A normal vertebral disc. Since the center of gravity is in the front, the pressure force due to the head goes to the front of the disc. When broken from the front, it creates a wedge with a larger area at the rear. Therefore, the patient gradually begins to lean forward. For this reason, a triangular vertebra, sometimes called a “fish” vertebra, can be seen on an X-ray.
– Can a person be standing upright, his torso does not have any inclination, but he already has “fish” vertebrae?
– Yes, maybe.
– It seems that after 55 years you always need to monitor your growth?
– Yes. And if it has decreased, you should go to the doctor. You also need to go to him in two more cases: if you are a woman and you are over 55, and also if you have broken your radius. To clarify the diagnosis, the doctor will prescribe you a bone densitometry – a study of bone density. Three minutes – you went into the machine, it took a picture and you left.
Is it possible to prevent the development of osteoporosis or does it happen to everyone?
– Everyone who lived before him. You can only slow down its development.
Why so? Stomach, relatively speaking, three “trucks” of calcium can pass through the “customs”. Let’s say there is enough vitamin D and all three “trucks” will be delivered to the bones. With age, purification will reach five “trucks”. Therefore, there will be a negative balance.
Is it possible to “close” this negative balance with some drugs?
— Yes, there are first-line drugs, mostly zoledronic acid drugs. They “close” the balance: three trucks were brought, three trucks were taken away. These drugs are very easy to use. You can put a dropper a year, inject it under the skin every six months, there are pills that can be taken once a week. There are different forms, they are quite simple and have almost no side effects.
But if the patient caught himself late and his “whole tank was stolen”, it is pointless to take drugs from this line. You will of course stop “stealing” this calcium, but the stores are already empty.
– So what to do in this situation?
– In this case, a bone anabolic is prescribed, in my opinion, now there is only one for sale – Forsteo. It is injected into the stomach every day for four months and allows you to build bone tissue. The list of drugs that can help ends here.
– And why not start taking zoledronic acid, let’s say from the age of 50, so everything will be fine later?
– This can be started if you have a good personal doctor who checks you regularly. However, the cost of one injection is 20 thousand rubles, two – 40 thousand per year. Quite expensive. Tablets for the year will come out about 40-50 thousand. You should take one tablet per week. Getting vitamin D is easier and cheaper. Women need to understand that if they do not take vitamin D for several years, but still menstruate, the body already receives less calcium.
“On the contrary, isn’t it possible to eat too much calcium?” Often the same women are afraid of calcifications, for example, located on the chest …
– NO. This has nothing to do with calcium intake. Indeed, calcifications are found in the chest, they are located in the vessels, where they are a part of cholesterol plaques. But these are completely different processes that are in no way connected with bone tissue. So if you eat too much calcium, there will be no calcium in the veins. It comes from a completely different disease called atherosclerosis.
— What is spine kyphoplasty and in what situations is it performed?
Kyphoplasty is a procedure in which a doctor takes a needle and pours bone cement into a broken vertebra. Bone cement straightens the vertebrae. This is a way to return a broken vertebra to its previous size. Unfortunately, kyphoplasty does not add density to other bones. A bonded vertebra becomes much denser than the vertebra above and below, so it acts like a hammer striking the anvil. Since osteoporosis is a systemic disease, the top and bottom of the vertebrae are hollow. All bones become brittle, calcium is washed out from everywhere.
So is this a bad practice?
– Since the technique is also expensive, you need to think seriously in each case here. We had a patient with severe osteoporosis whose entire vertebra was on the verge of breaking. We tried to save the situation with kyphoplasty. But when we filled some vertebrae, others became unusable. As a result, we poured him 13 vertebrae in three steps. Caused? We poured the first, and the rest broke – this is called creeping fracture. It is important to understand that one vertebra costs about 150 thousand rubles.
– They say that a good effect in protecting the spine in osteoporosis is given by mechanical support of the spine – that is, orthoses, orthopedic corsets. When should they be worn?
“You need to understand that this is not a method of treatment, but just a crutch – a way to alleviate the patient’s condition. This really reduces the pain syndrome, but the vertebrae do not get stronger from it. Therefore, it is best to do the prevention of osteoporosis.