An estrogen drug for the treatment of postmenopausal osteoporosis. Postmenopausal osteoporosis: calcium supplements in modern prevention and treatment strategies

Postmenopausal osteoporosis is a skeletal disease manifested by increased bone fragility and a tendency to fractures against the background of age-related decline in ovarian function.
A decrease in skeletal mass and bone strength begins already at 35-40 years of age. After the cessation of menstruation (monthly uterine bleeding associated with the physiological rejection of the endometrium - the inner layer of the uterine mucosa), this process accelerates significantly, which is associated with insufficient formation of estrogens - female sex hormones.
With the development of severe postmenopausal osteoporosis, fractures of the vertebrae, forearm and neck bones are most typical femur.

Symptoms of postmenopausal osteoporosis

For a long time, osteoporosis occurs without clinical manifestations. It is only after significant bone loss that the following symptoms occur:

• back pain (in the lumbar and sacral area), aggravated by walking, turning the body, lifting heavy objects;
• feeling of heaviness in the spine between the shoulder blades, fatigue;
• pain in the pelvic bones (girdle of the lower extremities), in the bones of the legs;
• compression fractures of the vertebrae (the height of the vertebral body decreases), fractures of the radius (the bone between the wrist and the elbow joint), ankles (tibia bones), hip bones, occurring after a slight load or a slight fall or for no reason at all;
• poor posture, curvature of the spine, decreased height (sometimes by several centimeters per year).

Reasons

Causes of postmenopausal osteoporosis:

• decrease in the amount of estrogens (female sex hormones), which regulate the processes of restoration and renewal of bone tissue, are involved in the metabolism of calcium (a mineral necessary for bone strength);
• poor nutrition (lack of dairy products, vegetables, herbs, legumes, fish in the diet, excess fat, easily digestible carbohydrates, salt, etc.);
• decreased physical activity.

Risk factors for postmenopausal osteoporosis:

• age over 65 years;
• Caucasian race;
• hereditary predisposition (osteoporosis or frequent fractures in relatives);
• long-term use of glucocorticoids (medicines - adrenal hormones and their analogues);
• forced immobility (for example, after a cerebrovascular accident - stroke), prolonged bed rest for various diseases;
• low body weight;
• early onset of menopause (last menstruation (monthly uterine bleeding associated with physiological rejection of the endometrium - the inner layer of the uterine mucosa) before the age of 45 years);
• previous gynecological diseases (infertility, removed ovaries, scanty or absent menstruation, etc.);
• smoking;
• Excessive caffeine consumption (coffee, strong tea, cola, etc.)
• alcohol abuse.

Diagnostics

• Analysis of the medical history and complaints (presence of pain in the spine and bones, “accidental” fractures, long-term use of any medications, dietary habits, etc.).
• Analysis of hereditary history (whether relatives suffered from similar diseases, frequent fractures, etc.).
• Analysis of gynecological history (past gynecological diseases, surgeries, number of pregnancies, abortions, etc.).
• Analysis of menstrual function (at what age did the first menstruation begin (monthly uterine bleeding associated with the physiological rejection of the endometrium - the inner layer of the uterine mucosa), what is the duration and regularity of the cycle, how long ago menstruation stopped, etc.).
• Dual-energy X-ray absorptiometry (DXA) - x-ray method studies of the density of various parts of the skeleton (most often the spine, forearm bones and femur), which has high accuracy and allows diagnosing osteoporosis in early stages(with still minor bone loss).
• Biochemical blood test (determination of blood concentrations of calcium, phosphorus, sodium, potassium, chlorine, protein, creatinine, urea, alkaline phosphatase, etc.).
• Analysis of 24-hour urine for calcium concentration.
• Determination of biochemical parameters (markers) of bone damage. The analysis, on the one hand, shows the amount of bone breakdown products, and on the other, the amino acids and enzymes involved in its construction. Depending on the ratio of these markers, we can conclude that the processes of bone breakdown (resorption) predominate over its restoration in osteoporosis.

Treatment of postmenopausal osteoporosis

• Diet enriched with dairy products, seafood, legumes.
• Therapeutic exercise.
• Wearing corsets or special braces that reduce the risk of fractures.
• Taking calcium and vitamin D supplements.
• Hormone replacement therapy with sex hormone analogues (estrogens, as well as their combinations with other hormones).
• Taking medications that slow down bone destruction (bisphosphonates, calcitonins, etc.).
• Taking drugs that enhance bone formation (fluorides, anabolic steroids, analogues of parathyroid hormones, androgens, etc.).

Complications and consequences

• Constant bone pain.
• Bone fractures due to heavy lifting, slight falls, bruises, awkward movement, that is, with minimal trauma or no apparent reason at all.
• Curvature of the spine.
• Reduced growth – “trampling”, sometimes up to 4 cm per year.
• Decreased quality of life.

Prevention of postmenopausal osteoporosis

• Rational nutrition, enriching the diet with foods containing calcium (dairy products, canned fish, nuts, seafood, vegetables, leafy greens).
• Active lifestyle physical culture, regular exercises in accordance with age standards.
• Additional intake of calcium and vitamin D during special periods of life (in childhood, during pregnancy and lactation, during postmenopause (lack of menstruation (monthly uterine bleeding associated with physiological rejection of the endometrium - the inner layer of the uterine mucosa) against the background of age-related decline ovarian function)).
• Quitting bad habits (smoking, alcohol).
• Moderate caffeine consumption (coffee, tea, chocolate, cola, energy drinks).
• Dosed exposure to the sun.
• Timely and complete treatment of gynecological diseases, as well as conditions associated with deficiency or imbalance of hormones in the body.
• Regular visits (2 times a year).

• Authors

  1. Gynecology: National Guide / Ed. V. I. Kulakova, G. M. Savelyeva, I. B. Manukhina. - “GOETAR-Media”, 2009.
  2. Gynecology. Textbook for universities / Ed. acad. RAMS, prof. G. M. Savelyeva, prof. V. G. Breusenko. - “GOETAR-Media”, 2007.
  3. Practical gynecology: A guide for doctors / V.K. Likhachev. - Medical Information Agency LLC, 2007.
  4. Gynecology. Textbook for students medical universities/ V. I. Kulakov, V. N. Serov, A. S. Gasparov. - "Medical Information Agency LLC", 2005.
  5. New concept in the treatment of postmenopausal osteoporosis (literature review) / S. V. Yureneva. - “Attending Physician” magazine, No. 05, 2010.
  6. Postmenopausal osteoporosis / N.V. Toroptsova, O.A. Nikitinskaya. - “Attending Physician” magazine, No. 03, 2009.
  7. Postmenopausal osteoporosis. Treatment and prevention of postmenopausal osteoporosis /S. V. Yureneva. - Consilium Medicum Volume 06/N 9, 2004.

Why are women over 50 prone to fractures? It happens that after an injury, the doctor informs the patient about the fragility of the bone, prescribing calcium supplements. Many women do not even realize that postmenopausal osteoporosis (PMO) is to blame.

In the article we will learn in detail about what kind of pathology this is and how it can be prevented.

Among all forms of osteoporosis, the incidence of postmenopausal osteoporosis is 85%. According to statistics, every fourth woman over 50 years of age has a history of one (or more) serious fracture.

It is believed that age-related hormonal changes and the “turning off” of the ovaries (cessation of menstruation) leads to estrogen deficiency. According to numerous studies, within twenty years after the onset of menopause, developing osteoporosis provokes a decrease in the mass of trabecular (wrist, tarsus) tissue by 50% and cortical (80% of the skeleton consists of it) tissue by 30%. The bones of the vertebrae are especially vulnerable. When they become loose, senile kyphosis occurs, which is often combined with a “dower’s hump.”

Interesting to know! widow's hump(below photo) is an accumulation of fat in the projection of the seventh cervical vertebra. Pathology received its interesting name back in the Middle Ages, famous for the Crusades, feudalism and the Hundred Years' War. As a rule, “older” women no longer had husbands, because they often died very early, before reaching fifty years of age.

The risk of fracture mainly depends on the initial mass of the bone. If a woman had low bone mass at age 30, postmenopausal thinning will significantly exceed the chances of surgical trauma. So, even with a slight fall or spontaneously, you can “earn” a heavy one.

To find out detailed information about the influence of female sex hormones on bone structure, watch the video in this article.

Preventive measures

Doctors cite disappointing statistics regarding osteoporosis. Bone loss is the fourth most severe pathology in the world, behind respiratory and cardiovascular diseases, oncology.

The basis for preventing PMO, and therefore fractures, is to maintain bone density. For your attention, table No. 1 “How to prevent postmenopausal osteoporosis? Recommendations".

Preventive measures	Brief description
Healthy eating	Nutrition for osteochondrosis involves eating foods rich in calcium (in particular, sesame seeds, Dutch cheese, parsley, cottage cheese, milk). You should also avoid mono-diets, for example, “sitting” exclusively on rice, buckwheat, etc. It is also worth removing salty and fatty foods and carbonated drinks from your diet.
Sufficient activity and sports	It has been proven that muscle inactivity leads to bone demeneralization. In this regard, doctors recommend a daily half-hour walk, which is a good way to strengthen the skeleton. You can also perform strength training, flexibility and resistance exercises under the supervision of a specialist.
Maintaining a normal weight	Obesity negatively affects musculoskeletal system, in particular, on bones, joints and ligaments. If at the same time the patient has osteoporosis, then the risk of getting a fracture increases significantly.
For gastrointestinal diseases - daily intake of calcium and vitamin D	As a rule, a person receives calcium and vitamin D in full through food. But for some diseases (for example, malabsorption), the doctor prescribes these substances additionally, in tablets. Also, during pregnancy, to protect your own bone tissue, you should not give up a synthetic vitamin-mineral complex.
Leading a healthy lifestyle	Women who smoke and drink alcohol produce less estrogen, which means that menopause will occur earlier. Tobacco also contributes to a decrease in bone mass, which can lead to the development of a fracture in the future. In addition, it is worth pointing out that bone fusion in women who smoke occurs more slowly than in those who healthy image life.
Staying in the sun	Sunbathing is the simplest and most enjoyable measure to prevent PMO. The sun is a source of vitamin D, which is so necessary for the body, in particular for bone tissue. Before you start exposure to direct rays, consult a specialist. After all, there are diseases, for example, hypertension, post-stroke conditions, etc., in which sunbathing is strictly prohibited.

It is also worth carrying out secondary prevention of PMO: correction of estrogen deficiency conditions caused by amenorrhea, artificial or surgical menopause, and chemotherapy. At the same time, it is necessary to think about preventing falls - using a cane or wheelchair.

It is also not advisable to go outside in wet or damp weather, or in icy conditions; wear shoes with rubberized anti-slip soles. Listen to your doctor's recommendations regarding wearing special protectors and corsets.

Diagnosis of osteoporosis

Today, identifying osteoporosis is not a problem. To do this, just visit a therapist and take the necessary referrals.

Hardware methods for studying bone tissue to diagnose menopausal osteoporosis:

1. Densitometry. This is a painless and safe procedure that is carried out relatively quickly - from 10 to 30 minutes, and when studying peripheral parts, a few minutes are enough. The principle of operation of the equipment is based on exclusive geometric scanning, which allows high-precision assessment of the condition of bone tissue using a fan-shaped beam.

The patient can remain in clothing if it is loose enough and there are no metal elements on it. Experts recommend that all women over 45 years of age undergo densitometry once every 24 months to study the dynamics of skeletal density. Average price diagnostics in Moscow ranges from 1200 to 2000 rubles.

1. X-ray diagnostics. This research method is considered insufficiently informative and detects osteoporosis only when bone loss is 40 percent or more. But it is worth noting the positive aspects of X-ray diagnostics, in particular, its low cost, accessibility and speed of image acquisition.
2. Examination using CT and MRI. Computed tomography (CT) also relies on R-irradiation, but it is more accurate than radiography. The results of the study will help to find out the condition of not only bone tissue, but also cartilage, ligaments and muscles. Using a magnetic resonance imaging (MRI) scanner, you can obtain a three-dimensional image of the area under study thanks to outgoing radio signals generated by the vibration of hydrogen atoms in a magnetic field.

There are also laboratory methods for testing blood and urine, which are prescribed to assess phosphorus-calcium metabolism in the body.

Table No2. Laboratory methods PMO diagnostics:

Analysis name	Description	Norms for women in menopause
Total calcium indicator	Calcium is the main element involved in the synthesis of bone tissue. A decrease in its concentration in the future may provoke a fracture. On initial stage osteoporosis, the calcium level will no longer correspond to the norm, therefore, with the help of this analysis, early diagnosis of bone disease is also carried out.	2.2-2.65 mmol/l
Inorganic phosphorus	85% of phosphorus in the form of salts is contained in bone tissue. Since two microelements - phosphorus and calcium (more precisely, their metabolic processes) are closely related to each other in the body, this analysis is most often prescribed with a general calcium indicator.	0.85-1.45 µmol/l
Osteocalcin (OK)	It is a non-collagenous protein of bone tissue, making up 25% of the matrix. The OC level completely depends on the amount of calcium and calcitonin.	5.4-59.1 ng/ml
Pathormon	This is a hormone produced by the parathyroid glands and takes part in calcium-phosphorus metabolism.	0.7-5.6 pmol/l
Structural components of type 1 collagen (pyridine bonds) pyridinoline and deoxypyridinoline (Pid and Dpid)	Pyridine bonds are specific components of mature collagen, present only in the strong type connective tissue(bones, cartilage, dentin). To conduct the study, it is recommended to collect the second morning portion of urine (from 8-9 am). Using the analysis, it is possible to monitor the activity of resorptive processes in bone tissue, as well as evaluate the effectiveness of therapy.	Pid – 22-89 mmol/l Dpid – 4-21 mmol/l

Modern methods of treating osteoporosis

The main goal that must be achieved is to reduce the incidence of fractures (even to the point of no fractures) and prevent further progression of the disease.

In order for the patient to choose the most appropriate therapy, she may need to consult the following specialists:

• endocrinologist – in case of dysfunction of the thyroid, parathyroid glands, the presence diabetes mellitus or a history of Ishenko-Cushing syndrome;
• oncologist - if there is a suspicion of metastatic lesions of the skeleton;
• in case of numerous and frequent fractures, consult an orthopedist;
• geneticist – if the patient has a genetic predisposition to osteoporosis or already has diseases such as osteogenesis imperfecta, desmogenesis, Marfan syndrome;
• gastroenterologist - at chronic disease liver (primary biliary cirrhosis), digestion, transportation and absorption disorders nutrients(malabsorption), after removal (resection) of part of the stomach;
• nephrologist - if there is a history (or were identified during the diagnosis of osteoporosis) of impaired renal function (chronic renal failure, glucose-phosphate-amine diabetes, renal tubular acidosis);
• gynecologist - if estrogen deficiency conditions are detected;
• a consultation with a hematologist is recommended in cases of suspected presence of a disease of the hematopoietic organs (generalized plasmacytoma, “marine anemia”, mast cell leukemia);
• consultation with a rheumatologist if osteoporosis is accompanied by rheumatoid arthritis, Liebmann-Sachs disease and ankylosing spondylitis.

Drug treatment

It is not possible to completely get rid of osteoporosis, so the patient should learn to live with this disease and stop it with the help of therapy. further development pathology.

Important! The instructions for the drug should not be considered as a call for self-therapy!

In postmenopause, it is most often carried out according to the following scheme:

1. Biosphosphonates. The drugs will stop the destruction of the skeleton, thereby promoting the formation of new bone tissue. Biosphosphonates are absolutely safe for the human body and have virtually no side effects. According to studies, taking the drugs reduces the incidence of fractures by 50%.
2. Calcium preparations. The one we all know best is calcium gluconate. It is prescribed to all patients suffering from bone fragility. Calcium preparations are not friendly with biosphosphonates, so the interval between doses should be at least four hours.
3. Vitamin D. Vitamin D preparations stimulate the work of osteoblasts (these are cells necessary for the “building” of bone) and improve the mineralization of hard connective tissue. Therefore, it is generally accepted that this group of medications is involved in the healing process of fractures and the formation of microcalluses, which is a necessary condition to increase skeletal strength.
4. Correctors of bone and cartilage tissue metabolism. One of the common drugs belonging to this pharmacological group is Miacalcic. Treatment with medication will help compensate for the deficiency of calcitonin. The drug inhibits the production of parathyroid hormone and also helps regulate calcium metabolism and bone metabolism. If a fracture does occur, then the medication Miacalcic taken in this case will have an analgesic effect.

Sometimes doctors prescribe hormone replacement therapy. Treatment is usually prescribed to postmenopausal women 45-50 years old. At older ages, hormones are not prescribed high risk the development of serious side effects such as venous thrombosis or breast cancer.

Traditional methods of treatment

Attention! Before describing traditional methods from osteoporosis, it should be pointed out that using them alone as treatment will never save you from the “fragile” problem. This type of therapy is recommended to be used in parallel with medications, after consulting with your doctor in advance!

Lemon and chicken eggs

Squeeze the juice from ten lemons and pour it over six eggs. It is advisable to use enamel dishes (saucepans) for this, cover the “mixture” with a lid and place in a cool place. Wait until the eggs (along with the shell) are completely dissolved (about a week will pass).

Add 300 grams of honey and a glass of cognac to the resulting thick mass. Mix everything. The “homemade preparation” is stored in the refrigerator, take a teaspoon once a day before meals.

You can also treat osteoporosis using eggshells. It is advisable to use an egg from a domestic chicken that has walked “at will.” Wash the shells thoroughly, dry, and crush with a rolling pin.

Take the powder every morning before breakfast, the amount is on the tip of a knife. Treatment is carried out for a month, then take a break for three months and, if necessary, you can start therapy again.

Onion soup

The dish is prepared very quickly, simply, and is also inexpensive. To do this, you need to take two medium-sized onions, wash them with the husks (then remove them and wash them again), chop them finely and fry them on high speed until golden brown.

Pour a liter of water into a saucepan, throw in the fried onions and peels, and cook for fifteen minutes. Let it brew for several hours. Remove the husks and divide the rest into three equal portions.

Consume each serving in one day (preferably in one dose). Total - three days. Then continue the procedure. The course of treatment is one month.

As we found out, menopausal osteoporosis is not such a harmless disease. Early diagnosis, prevention and compliance with all medical prescriptions will allow you to avoid both minor and severe fractures in the future, for example, a fracture of the vertebra or hip joint.

Content

As women age, ovarian function gradually begins to decline. In this regard, the level of the sex hormone estrogen in the body decreases. Against the background of this process, a disease called osteoporosis develops. It is characterized by increased bone fragility. You will learn more about the causes, symptoms and treatment of this disease below.

Causes of osteoporosis in women

Osteoporosis is understood as a pathological condition characterized by a decrease in density and subsequent destruction, i.e. destruction of bone tissue. The signs of this disease affect almost 80% of women over 50 years of age, i.e. those in the postmenopausal period. Bone tissue is characterized by a constant dynamic equilibrium, during which the process of mineralization occurs. It itself consists of spongy and cortical substances. Postmenopausal osteoporosis is characterized by damage to the first of them.

In women, the hormone estrogen is responsible for bone regeneration. It also regulates mineralization. During menopause, its amount decreases significantly, which leads to osteoporosis. The disease is characterized by the leaching of calcium and phosphorus, which are contained in the bones. Because of this, their density and strength decreases. In women, bone destruction occurs throughout the body, i.e. osteoporosis is presented in postmenopausal women diffuse form. In addition to age, causes or risk factors for this disease include:

• unbalanced diet with a lack of dairy products, legumes, herbs, vegetables, fish;
• sedentary lifestyle;
• underweight;
• abuse of caffeine, alcohol or cigarettes;
• gynecological problems, which include removed ovaries, infertility, lack of menstruation;
• long-term treatment with glucocorticoids, i.e. drugs with adrenal hormones;
• pathologies of the endocrine system;
• heredity.

Signs of osteoporosis in women

The peculiarity of postmenopausal osteoporosis is that in the first stages it practically does not bother the woman. Only after washing large quantity calcium and phosphorus make bones brittle. Then the woman begins to show signs and symptoms indicating postmenopausal osteoporosis:

• decrease in height by 1-1.5 cm or more, curvature of the spine;
• Fractures due to minimal impacts on the bone, such as normal walking, a slight blow, or awkward movement;
• convulsions in lower limbs at night;
• aching pain affecting the knees and elbow joints, especially when the weather changes;
• peeling of nails;
• pain in the lumbar spine;
• constant fatigue;
• reduced performance;
• stiffness of the spine in the area of ​​the shoulder blades.

How to treat osteoporosis in women

Even the fact that with osteoporosis in the postmenopausal period the amount of calcium decreases does not provide grounds for diagnosing the disease using a blood test, because this substance remains normal in it. Modern medicine in these conditions, has other methods for confirming such a diagnosis. It's called bone densitometry. This is an ultrasound method that can detect 15-20% bone loss. Traditional radiography is used less frequently for diagnosing postmenopausal osteoporosis.

In addition to these methods, analyzes of menstrual function, urine, and gynecological history are performed. Based on all studies, postmenopausal osteoporosis is confirmed. The following measures help cure the disease:

1. Diet. The diet must include foods high in calcium. These are seafood, milk, legumes.
2. Replacement therapy. This includes hormonal drugs for osteoporosis during menopause, based on estrogen and its combinations with other hormones.
3. Taking medications that slow down the process of bone destruction. Among them are calcitonins and bisphosphonates.
4. Therapeutic exercise. Performing special exercises helps increase bone density and reduce the processes of its destruction.

Drugs

Drug treatment of osteoporosis that develops during the postmenopausal period is carried out using several types of drugs. Below is 1 from each group of drugs:

1. Miacalcic. Belongs to the group of calcitonins. Available in the form of a nasal spray or solution. For the treatment of postmenopausal osteoporosis, 200 IU of the drug must be administered intranasally daily.
2. Alendronate. A medicine from the group of bisphosphonates. Presented in tablets. Take 1 piece per week, and do it in the morning on an empty stomach, after which they remain in an upright position for about half an hour.
3. Ephista. This medicine is a representative of drugs with estrogen. It is recommended to take 60 mg daily. Treatment is determined by the doctor and is characterized by duration.

Folk remedies

Arsenal effective methods There are also treatments in folk medicine. Such methods should only be used in agreement with the doctor and only in combination with basic therapy, diet and exercise. From especially effective recipes the following can be distinguished:

1. Comfrey compresses. Take some dry leaves the specified plant, mix it with dimexide in a ratio of 1:2, then leave for 12 hours. Soak a bandage or gauze in the resulting product and apply to sore spots twice a day.
2. Eggshell with lemon juice. Mix the indicated ingredients in a 2:1 ratio. Take 1 tbsp. l. every day.
3. Mumiyo. Take the specified substance approximately the size of a match head, then pour a glass of water. In 20 min. Before meals, take the entire remedy, repeating three times a day. The duration of treatment is 20 days.

Prevention of osteoporosis in women

Any doctor will confirm that preventing a decrease in bone density is easier than restoring it. For this reason, it is worth following a few simple rules regarding lifestyle. This includes dietary food with lots of calcium. Its principles are as follows:

• 5 meals daily;
• break between meals no more than 3.5 hours;
• combining meat not with cereals, but with vegetables;
• daily consumption of fermented milk products;
• excluding alcohol and coffee.

Along with nutrition, to prevent osteoporosis, it is worth introducing daily physical activity in the form of walking along the stairs or just in the park. This also includes dancing, muscle stretching exercises, gymnastics on the horizontal bar and swimming. Physical activity It will also help maintain normal weight, which is also necessary for the prevention of osteoporosis. Walking will provide adequate sun exposure, which is another factor in preventing osteoporosis.

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Osteoporosis is a systemic skeletal disease characterized by a decrease in bone mass, disruption of bone microarchitecture with a subsequent increase in bone fragility and an increased risk of fractures. Bone loss occurs gradually and is often diagnosed only after fractures. As women live longer, their risk of developing osteoporosis and fractures increases.

In adult individuals, the mineral composition of bone tissue is determined by the influence of several factors: heredity, motor activity, dietary habits and hormonal status. A few years after reaching the peak of bone tissue mass, by the age of 30-35, its loss begins, which is a universal phenomenon of human biology, occurring regardless of gender, race, profession, habitual activity, characteristics economic development, geographical area of ​​residence and historical era. The average bone loss in a woman is approximately 1% per year relative to the level of peak bone mass during reproductive age. This process accelerates within the first five years after menopause.

Primary or involutional osteoporosis is systemic lesion elderly street skeletons (50 years and older).

Primary

Primary osteoporosis develops pathogenetically in two clinical variants:

• postmenopausal;
• senile or senile

Risk factors for primary osteoporosis are often hereditary and also associated with family and/or personal history:

• old age;
• graceful, short women with a fragile physique and fair skin, especially from among the residents of Northern Europe and Asia;
• indications of fractures in the family history;
• later menarche (after 15 years);
• early menopause (before 50 years);
• oligo- or amenorrhea during reproductive age;
• anovulation and infertility;
• more than 3 pregnancies and births during reproductive age;
• long-term lactation (more than 6 months)

Secondary

Secondary osteoporosis is a multifactorial disease in which the following factors play a role:

• endocrine (hyperthyroidism, hypoparathyroidism, hypercortisolism, diabetes, hypogonadism);
• malnutrition and calcium deficiency in the diet;
• excessive intake of alcohol, nicotine, coffee (more than 5 cups per day);
• long-term use (over 4 weeks) of corticosteroids, heparin, anticonvulsants;
• genetic factors: incomplete osteogenesis, low peak bone mass;
• other factors: chronic renal failure, decreased absorption of calcium in the intestine, prolonged immobilization, physical inactivity.

The incidence of primary osteoporosis in developed countries is 25-40%, with a predominance of this disease among white women. By age 70, 40% of white women have a history of at least one osteoporotic fracture. Among black African women, the incidence of osteoporosis is 11-12%. Among Moscow residents, osteoporosis of the lumbar vertebrae in the population of women 50 years and older was detected in 23.6%. The frequency of bone fractures in women in the age group 50-54 years increases 4-7 times compared to men of the same age and continues to increase in older age groups. Among women who have suffered bone fractures, osteoporosis is found in 70% of cases.

The processes of formation and resorption constantly occur in bone tissue. In the processes of its formation, osteoblasts play a leading role, and osteoclasts play a leading role in resorption (Fig. 14). During the period of reaching peak bone tissue mass, formation processes prevail over resorption processes. Loss of bone mass in menopause is accompanied primarily by bone damage with a predominance of spongy substance (vertebral bodies, distal parts of the forearm bones, etc. (Fig. 15).

Senile osteoporosis develops after 70 years of age and is characterized by predominant damage to long bones with an increase in femoral neck fractures. At the same rate of bone loss, the severity of its deficiency in older women primarily depends on the magnitude of its peak mass. Deficiency of sex hormones in menopause can have both direct and indirect effects on the condition of bone tissue.

Pathogenesis

The pathogenesis of osteoporosis in estrogen deficiency conditions is characterized by:

• increased sensitivity to parathyroid hormone due to an increase in the content of parathyroid hormone receptors in bone tissue and increased resorption;
• a decrease in the level of calcitonin, which stimulates the synthesis of calcitriol in the kidneys and, accordingly, a decrease in calcium absorption;
• increased Ca excretion in urine;
• decreased absorption of Ca in the intestine;
• decreased hydroxylation of vitamin D in the kidneys;
• insufficient supply of calcium to bone tissue

The direct effect of exo- and endogenous sex hormones (estradiol, progesterone and testosterone) on bone tissue occurs through their binding to specific receptors on osteoblasts. Thus, spongy bone tissue is a kind of target organ for sex hormones.

The processes of bone tissue formation and resorption are also associated with the influence of a number of local factors that can have an inhibitory and stimulating effect on osteoblasts and osteoclasts. Thus, proliferation, differentiation and general activity of osteoblasts (collagen synthesis, bone matrix formation) are stimulated by transforming growth factor, insulin-like growth factors (somatomedins), α-microglobulin, osteopectin and other factors. Stimulation of proliferation, differentiation and resorptive activity of osteoclasts is carried out by prostaglandins E2, interleukins-1 and -6, vasoactive intestinal peptide, interferon, tumor necrosis factor, lymphotoxins, macrophage colonizing factor, etc. Age-related loss of part of the spongy layer disrupts the structure of the bone and contributes to the occurrence of fractures.

The generally accepted hypothesis about the mechanism of development of osteoporosis is based on the idea of ​​the protective effect of estrogens in relation to bone tissue. A decrease in the level of estrogenic influences of various etiologies makes bone tissue more sensitive to the absorbable influence of parathyroid hormone and/or vitamin D3. The protective effect of estrogen is realized through calcitonin, the secretion of which is stimulated by estrogen. In this regard, in postmenopause the need for Ca increases, to maintain the balance of which it is necessary to replenish the daily requirement in the amount of 500 to 1500 mg. According to changes in bone density, a 10% reduction in bone density increases the risk of fractures. spinal column and the proximal part of the femur increases 2-3 times.

The decrease in the density of the spongy substance of the vertebrae in early postmenopause is directly related to the initial volume of bone tissue: the higher the density of the latter, the greater the magnitude of the absolute loss. The loss of bone tissue is especially great in early postmenopause, when the mass of the spongy substance of the vertebral processes decreases by 5% per year, and the cortical layer - by 1.5%.

In the development of age-related AP, parathyroid hormone plays the role of a mediator. Changes in mineral homeostasis and bone tissue deficiency develop against the background of decreased function of the parathyroid glands, endocrine kidney function and other manifestations of age-related involution.

Clinical picture

Osteoporosis develops gradually and can go undetected for a long time. The manifestation of its characteristic symptoms reaches a maximum after approximately 10-15 years (Fig. 16).

The main clinical symptoms are pain in the bones, especially often in the bones of the lumbar or thoracic spine, which can transform into a picture of radiculitis. There is a slow decrease in height with corresponding changes in posture, progressive limitation of motor activity of the spine, and loss of body weight.

Patients are often treated for a long time without sufficient effect for “radiculitis”, erroneously diagnosed multiple myeloma, metastases of a malignant tumor, and multiple spinal injuries.

Fractures are the late and most striking manifestation of osteoporosis. Fractures often occur at home when falling from a height. The most common fractures are the radius and vertebrae. Particularly tragic are hip fractures, mortality in which is observed in 20-25% of cases during the first six months, and severe disability occurs in 40-45% of cases.

Diagnosis of osteoporosis

1. Study of anamnesis
2. Determination of body weight and height
3. Determination of bone mineral density

Single-photon densitometers Typically used to measure bone mineral density in the hand, distal forearm, or lower leg. Equipment of this class is easy to use, mobile, small in size and light in weight, and does not require a separate room or lengthy operator training. The duration of one study (without data analysis) is 5-10 minutes. Single-photon densitometers can be used for screening studies.

However, it should be taken into account that mineral density indicators of the distal parts of the bone skeleton in a significant number of peri- and postmenopausal women may differ little from the norm and do not always reflect age-related metabolic changes.

Two-photon X-ray densitometry is based on the use of a modification of two-photon radionuclide densitometers. The latest models make it possible to examine any bone and the entire skeleton in two or more projections. Examination time has been significantly reduced by enlarging the detectors. The duration of the study is 1-15 minutes, depending on the immediate task and model of the device.

Quantitative computed tomography. The main disadvantages of this method are associated with the difficulties that arise when studying small bones due to the so-called “partial volume effect” and with the relatively large total radiation dose during long-term dynamic observations.

Ultrasound densitometry. It has advantages when examining postmenopausal women, since against the background of estrogen deficiency, trabecular bones are primarily affected. The object of study is usually the heel bone.

X-ray diagnostics- informative for loss of bone tissue mass over 30%.

To assess the activity of the processes of bone formation and resorption, as well as to dynamically assess the effectiveness of the treatment, they resort to determining biochemical markers.

Prevention

Preserving bone mass is an easier task than restoring it. In this regard, the prevention of osteoporosis, which should be carried out throughout a woman’s life, is of particular importance. In this case, serious attention should be paid to the formation of peak bone mass and the creation of a skeleton with maximum strength by the period of puberty and the prevention of postmenopausal and age-related deficiencies in the mineral composition of bone tissue.

Since the genetic determinants of bone tissue are predetermined, the main attention should be paid to environmental factors, the period of bone growth in adolescence, pregnancy, lactation and perimenopause.

• nutritious diet with adequate intake of calcium-containing foods;
• physical activity, “ability to fall”;
• elimination of bad habits (smoking, coffee, alcohol);
• maintaining regular menstrual cycle in reproductive age;
• active advertising of preference for dairy drinks over carbonated ones;
• timely identification of risk groups;
• prescription of vitamin D and calcium supplements, incl. and in women over 70 years of age;
• prevention of a progressive decrease in peri- and postmenopausal bone loss is also achieved through the administration of sex hormones

It is generally accepted that a postmenopausal woman should receive 1200-1500 mg of calcium per day, which is preferably compensated for by a nutritious diet. The most natural source of calcium is dairy products. In cases of enzyme deficiency, milk allergy or blood lipid problems, calcium tablets may be used. Vitamin D stimulates the absorption of calcium in the intestines, reduces the activity of parathyroid hormone and increases the activity of bone formation processes.

Treatment

Due to the fact that the pathogenesis of postmenopausal osteoporosis is quite complex and ambiguous, the treatment of this contingent of patients aims to block the processes of bone tissue resorption and, at the same time, activate the processes of bone formation.

The following are used to treat osteoporosis:

1. Sex hormone preparations:
   • estrogens + gestagens, in the form of mono-, two- and three-phase preparations;
   • estrogens + androgens
2. Calcitonin
3. Bisphosphonates
4. Vitamin D

I. The mechanism of the protective effect of estrogens on bone tissue:

• activation of calcitonin synthesis;
• blockade of parathyroid hormone activity by reducing its synthesis or reducing the sensitivity of osteoclasts;
• decreased sensitivity of bone tissue to the absorbable effect of vitamin D 3 metabolites;
• activation of the processes of hydroxylation of vitamin D 3 in the kidneys and its conversion into the active form 1,25-dihydroxycholecalciferol;
• increased absorption of calcium in the intestine;
• reduction of the catabolic effect of thyroxine due to increased synthesis of thyroglobulin

Optimal doses of estrogen for the prevention and treatment of osteoporosis:

• estradiol valerate 2 mg per day;
• conjugated estrogens - 0.625 mg

The protective effect of gestagens on bone tissue manifests itself as a direct effect through specific receptors on osteoblasts and indirectly by blocking glucocorticoid receptors and reducing their inhibitory effect on bone tissue.

Contraindications to replacement therapy hormone therapy for osteoporosis:

• tumors of the uterus, ovaries and mammary glands;
• uterine bleeding of unknown origin;
• acute thrombophlebitis;
• acute thromboembolic disease;
• thromboembolic disorders associated with estrogen use;
• renal and liver failure;
• severe forms of diabetes mellitus

During replacement therapy, monitoring is required every three months. blood pressure, oncocytological examination, genital ultrasound and mammography once a year, regular participation of patients in mini-lectures and group discussions on the benefits and safety of hormone therapy.

Postmenopausal hormone therapy remains the treatment of choice for the prevention and treatment of postmenopausal osteoporosis.

Hormone replacement therapy has a positive effect on bone mass. A placebo-controlled study showed that after three years of continuous treatment, the mineral composition of the forearm bones was 9% higher than that of women in the placebo group (Fig. 17).

In order to prevent osteoporosis, prescribing hormonal drugs indicated for a period of time within 5-8 years of postmenopause. When carrying out replacement therapy, not only does bone loss stop, but also the mineral density of bone tissue increases both in the spine and, importantly, in the femoral neck.

II. Calcitonin(CT) is prescribed in cases of verified osteoporosis in the presence of contraindications to the use of sex hormones or if the patient has a negative attitude towards them.

The main biological effect of CT:

• inhibits bone resorption by inhibiting the activity and reducing the number of osteoclasts;
• has a pronounced analyzing effect for bone pain through interaction with P-endorphins;
• promotes the reparative formation of bones during fractures, blocking the breakdown of collagen;
• increases the supply of calcium and phosphorus to the bone

The formation of CT in the body can be stimulated by the administration of testosterone, estrogens, gestagens and combined estrogen-progestogen drugs.

In clinical practice, synthetic CT is widely used, which is 20-40 times more active than natural one (Table 4).

Table 4. DOSAGE OF MIACALCIC FOR OSTEOPOROSIS
Chronic It's a dull pain in the lumbar region (initial osteoporosis)	Acute episodes of pain due to vertebral fractures	Maintenance therapy (to increase bone density)
For 3 weeks, 50 IU subcutaneously or intramuscularly every other day or intranasally 50 IU 2 times a day. Repeated course depending on the effectiveness of the treatment	100 IU/day SC or IM daily for 1 week, then 50 IU daily or every other day for 2-3 weeks (depending on patient response) or 50 IU SC or IM 10 days, then intranasally 50 IU 2 times for 2 weeks	For 3 months, 50 IU subcutaneously or intramuscularly every other day or intranasally 2 times a day

Patients should receive 600-1200 mg of calcium daily in addition to taking CT. Adverse reactions are observed in 10-30% of cases (nausea, dizziness, polyuria, chills, hot flashes).

III. Bisphosphonates(xidifon) - active analogues of pyrophosphate, which blocks bone resorption processes and is prescribed at a dose of 5-7 mg/kg body weight for 14 days, one course of treatment every 3 months. According to biochemical and densitometric studies, the cessation of bone resorption is determined. In high doses, bisphosphonates can block bone mineralization (!).

IV. Vitamin D 3. Biological effect it is:

• stimulation of calcium and phosphorus absorption in the intestines;
• simultaneous impact on the processes of resorption and formation of bone tissue through blockade of parathyroid hormone secretion;
• increasing the concentration of calcium and phosphorus in the matrix and stimulating its maturation;
• influence on growth factors, which helps increase bone strength

The dose of vitamin D 3 is adjusted during the first two weeks under the control of serum calcium levels. Subsequently, monitoring of calcium balance is necessary every 2-3 months. Vitamin D supplementation is recommended for life as it may serve in an efficient way prevention of senile osteoporosis.

Activation of bone formation processes can be achieved by administering sodium fluoride, anabolic steroids and active forms vitamin D. Sodium fluoride at a dose of 75 mg with the addition of calcium has a long-lasting anabolic effect on bone tissue. Anabolic steroids may be used for severe osteoporosis in the elderly, however, side effects(hirsutism, decreased voice timbre, increased atherogenic lipid fractions, etc.) limit their intake for a long time.

Despite the variety of methods for the prevention and treatment of postmenopausal osteoporosis, the most reasonable method of intervention for the purpose of prevention and pathogenetically based treatment is the use of sex hormones.

A serious argument in favor of prescribing hormonal replacement treatment to women of any age for the purpose of preventing and treating hormone deficiency conditions is evidence of a 50% reduction in the risk of fractures of the forearm and femoral neck after treatment carried out during the first 5-7 years since menopause.

Due to the important medical and social significance of the problem of postmenopausal osteoporosis and significant material costs associated with the treatment and rehabilitation of patients with osteoporosis and bone fractures in modern society, screening examinations to identify risk groups.

• Carrying out the first screening at the age of 50 allows us to distinguish three degrees of risk, justify the need for hormonal effects and clarify the time of re-screening;
• Screening at age 70 makes it possible to more accurately predict a woman's risk level by age 80

During menopause, there is a high probability of postmenopausal osteoporosis. The cause of this disease is the loss of estrogen in the body, which in turn causes a decrease in bone density throughout the body.
But a woman can avoid this disease if she takes care of her health in advance and supports her body. To do this, you need to know basic preventive measures, as well as the symptoms of osteoporosis for timely treatment.

Causes of the disease

A decrease in ovarian activity is accompanied by a decrease in the concentration of estrogen in the blood. Soon, metabolic processes are disrupted in bone tissue, where a decrease in the volume of mineral elements is noted. As a result, bones become more fragile due to disturbances in the absorption of calcium by the body, and recovery processes are very slow.

Osteoporosis is diagnosed during menopause, but already at this time practically nothing can be done about the disease. Therefore, it is worth paying attention to your health from the very initial phase of menopause. Although some women suffer from this disease earlier than others.

The causes of the disease may be:

• Poor nutrition. If the diet lacks foods with calcium and vitamin D, then metabolic disorders in bone tissue can occur at any age. Calcium and vitamin D are interconnected, because the vitamin ensures normal tissue absorption of calcium.
• Weight problems. Every extra kilos negatively affects bones. Overweight creates additional pressure on human bones, which primarily affects the joints and spine.
• Digestive problems. If the intestines are not able to stably absorb useful elements, then bone tissue does not receive enough calcium, on which the strength of bone tissue directly depends.
• Rheumatoid arthritis. Affects the health of human joints, problems with which create additional stress on the bones due to a lack of necessary substances.
• . The thyroid gland is an important regulator of mineral metabolism in the human body. Therefore, malfunctions of the thyroid gland reduce the strength of a woman’s skeleton.
• Heredity. If the older generation of women in the family had problems with bones, then prevention of osteoporosis during menopause is extremely necessary.
• Bad habits. Accelerated bone destruction occurs due to problematic absorption of calcium.
• Taking glucocorticoids. They negatively affect the restoration processes in the bones and block the absorption of minerals.

Diagnosis of the disease

Modern medicine offers the optimal and most informative method for timely diagnosis of osteoporosis. During X-ray densitometry, bone mass can be determined to determine the body's susceptibility to the disease or to determine the stage of development of osteoporosis.

In addition, the doctor may recommend an ultrasound and computed tomography. It is worth noting that blood and urine tests are a mandatory element of diagnosis.

The results of the examination will help to find out the condition of the bone tissue of the body, but in order to accurately determine how to avoid osteoporosis during menopause, it is necessary to find out the problems of the body that can cause bone disease.

Symptoms of osteoporosis in women during and after menopause

It is difficult to independently identify the stage when treatment for osteoporosis during menopause is necessary. Because the disease develops unnoticed, and its symptoms often merge with the woman’s constant sensations, which are usually attributed to overwork.

Primary signs of osteoporosis:

1. Almost imperceptible tension in the spine and limbs, which can be accompanied by short-term pain, even in a state of complete rest.
2. Fatigue and inability to maintain the same level of activity.
3. The occurrence of discomfort when staying in one position for a long time.

Postmenopausal osteoporosis worsens over time, causing other unpleasant and painful sensations:

• permanent painful sensations in the spine
• the occurrence of curvature of the spine or hump,
• minor injuries lead to very serious injuries,
• the bones heal slowly (sometimes surgery is necessary).

If a woman notices any of the listed signs, she should urgently consult a doctor and undergo an examination. You need to worry about the timely prevention of osteoporosis during menopause: taking medications and vitamin complexes, an improved lifestyle and a balanced diet.

Find out what other years there are by following the link.

Why is it important to organize disease prevention in advance?

With proper prevention of osteoporosis during menopause, a woman organizes reliable support for the body to maintain normal motor activity. If at a young age you eliminate cigarettes, alcohol, coffee, organize healthy eating, then the likelihood of osteoporosis during menopause is significantly reduced.

It is worth remembering that it is almost impossible to cure osteoporosis. The complex of drugs and therapy only slow down the destruction of bone tissue that has already begun. Therefore, a woman needs to visit a gynecologist or endocrinologist at least once every six months, and also undergo appropriate examinations.

Primary methods for preventing osteoporosis

Preventive measures are extremely necessary, starting from the age of 35, but even at a younger age, a woman can follow the following recommendations:

1. We reduce the amount of protein and provide required supply and absorption of calcium by bone tissue. In this matter, it is necessary to give up coffee and organize a balanced diet.
2. We maintain optimal muscle tone. There is no need to engage in dangerous sports. The best option– aerobics several times a week and slow running. As a result, the muscle frame will reliably support the bones and will also help calcium to be better absorbed.
3. We completely give up cigarettes and alcohol. Bad habits practically reduce to zero all a woman’s actions aimed at maintaining healthy bone tissue.
4. We take medications with calcium and vitamin D, but only after consulting a doctor.

Secondary prevention

At this stage, the woman already needs more serious preventive measures. In addition to maintaining strong bone structure, it is worth taking care to slow down the weakening of bones.

Hormones, phytoestrogens, biosphosphonates, and vitamin sets with calcium will help cope with this problem. Any medicine should be taken only after consulting a doctor, because some medicines They simply may not be suitable, so they will only harm the female body.

Treatment of postmenopausal osteoporosis

Unfortunately, it is almost impossible to cure this disease. The success of any measures will depend on the stage at which the bone disease was detected. But time plays an important role in the fight against osteoporosis. The sooner you start taking medications for osteoporosis during menopause and maintain a healthy lifestyle, the greater the chance of stopping or at least slowing down the loss of minerals by the body.

Medicines

Drugs that slow down the thinning of bone tissue are considered effective:

• Fosamax,
• Calcitonin
• Trontium ranelate.

These are the ones medicines have the least negative consequences even with long-term use. Stronger drugs include:

• Bisphosphonates (Fosamax, Boniva, Actonel, Reclast or Zometa);
• Forteo (for severe osteoporosis);
• Denosumab (injections);

An innovative direction in the treatment of osteoporosis during menopause is a group of selective estrogen receptor modulators (tamoxifen, raloxifene).

It is important to remember that any drug for the treatment of osteoporosis is prescribed by a doctor. Self-medication is not allowed!

Traditional medicine in the fight against bone depletion

It is very remarkable that traditional medicine play an important role both during the prevention and treatment of the disease. show themselves well herbal infusions based on:

• Chernobyl;
• cucumbers;
• sleep-herbs;
• wormwood;
• fragrant woodruff;
• dandelion root;
• rapeseed;
• touch-me-not herbs;
• field yarutki;
• thyme;
• St. John's wort.

Herbs that can help fight osteoporosis are found in abundance. Follow the link to get complete information about it.

But not all of nature's gifts are suitable for preventing osteoporosis. There are some foods that are undesirable to eat. This includes plants that contain oxalic acid (blocks calcium absorption). Contained in rhubarb, sorrel, tomatoes.

You need to remember that osteoporosis is easier to prevent than to later deal with the consequences of thinning the body’s bone tissue .