Why are women older than 50 years prone to fractures? It happens that after an injury the doctor informs the patient about the fragility of the bone, prescribing calcium preparations. Many women do not even realize that the cause of postmenopausal osteoporosis (PMO).
The article will learn in detail about what kind of pathology and how it can be prevented.
Effect of sex hormones on the musculoskeletal system
Among all forms of osteoporosis, the frequency of postmenopausal is 85%. According to statistics, every fourth woman over 50 years old has one (or more) serious change in history.
It is believed that age-related hormonal changes and "off" the ovaries (cessation of menstruation) leads to a deficiency of estrogen. According to numerous studies, for twenty years after menopause, developing osteoporosis provokes a decrease in the mass of trabecular (wrists, tarsi) by 50% and cortical (it consists of 80% of the skeleton) tissue - by 30%. The bones of the vertebrae are especially vulnerable. With their looseness, senile kyphosis occurs, which is often combined with the "widow's hump."
Interesting to know! The widow's hump (below the photo) is the accumulation of fat in the projection of the seventh cervical vertebra. Pathology received its so interesting name in the Middle Ages, famous for its crusades, feudalism and the Hundred Years War. As a rule, women "aged" no longer had husbands, because they often died very early, before they were fifty years old.
The risk of fracture mainly depends on the initial bone mass. If a woman in her 30s had low bone mass, then postmenopausal thinning would greatly exceed the chances of getting a surgical injury. So, even with a slight fall or spontaneously, you can “earn” a severe fracture of the femur.
To learn more about the effects of female sex hormones on bone structure, see the video in this article.
Doctors give disappointing statistics according to osteoporosis. Bone loss is ranked fourth in the world in severe pathologies, yielding to respiratory and cardiovascular diseases, oncology.
The basis of prevention of MIP, and, therefore, fractures, is to preserve the density of bone tissue. Table 1 for your attention “How to prevent osteoporosis postmenopausal? Recommendations.
Before you begin to stay under direct rays, consult a specialist. After all, there are such diseases, such as hypertension, post-stroke conditions, etc., in which sunbathing is strictly prohibited.
It is also worthwhile to carry out secondary prevention of MIP: correction of estrogen-deficient conditions caused by amenorrhea, artificial or surgical menopause, chemotherapy. However, you need to think about preventing falls - use a cane or a wheelchair.
It is also not advisable to go out in wet or wet weather, in ice, to wear shoes with rubberized anti-slip soles. Listen to the recommendations of the doctor about wearing special protectors and corsets.
Diagnosis of osteoporosis
To date, osteoporosis is not a problem. It is enough to visit the therapist and take the necessary directions.
Apparatus bone examination methods for diagnosing osteoporosis menopausal:
- Densitometry. This is a painless and safe procedure, which is carried out relatively quickly - from 10 to 30 minutes, and in the study of peripheral departments it is enough and a few minutes. The principle of operation of the equipment is based on an exclusive geometrical scanning, which allows a highly accurate assessment of the state of the bone tissue by a fan-shaped beam.
The patient can remain in the clothes, if it is sufficiently free and there are no metal elements on it. Experts recommend that all women over 45 years old undergo densitometry once every 24 months to study the dynamics of skeleton density. The average cost of diagnostics in Moscow ranges from 1,200 to 2,000 rubles.
- Radiodiagnosis. This research method is considered insufficiently informative and reveals osteoporosis only in the case when bone loss is 40 percent or more. But it is worth noting the positive aspects of radiodiagnosis, in particular, it is its low cost, accessibility and speed of image acquisition.
- A study using CT and MRI. The basis of the work of computed tomography (CT) is also R-irradiation, but it is more accurate in comparison with radiography. The results of the study will help to find out the condition of not only the bone tissue, but also the cartilage, ligaments and muscles. With the help of magnetic resonance imaging (MRI), you can get a three-dimensional image of the investigated area due to outgoing radio signals produced by the oscillation of hydrogen atoms in a magnetic field.
There are also laboratory methods for testing blood and urine, which are assigned to evaluate the phosphorus-calcium metabolism in the body.
Table No2. Laboratory methods for the diagnosis of software:
Dpid - 4-21 mmol / l
Modern methods of treatment of osteoporosis
The main goal to be achieved is to reduce the frequency of fractures (up to the lack thereof) and to prevent further progression of the disease.
In order for the patient to select the most appropriate therapy, she may need to consult the following specialists:
- endocrinologist - in violation of the thyroid, parathyroid gland, the presence of diabetes mellitus or Ishenko-Cushing syndrome in history,
- an oncologist - if there are suspicions of a metastatic lesion of the skeleton,
- with numerous and frequent fractures - consultation of an orthopedist,
- geneticist - if the patient has a genetic predisposition to osteoporosis or there are already such diseases as osteogenesis imperfecta, desmogenesis, Marfan syndrome,
- Gastroenterologist - in case of chronic liver disease (primary biliary cirrhosis), digestion disorder, transportation and absorption of nutrients (malabsorption), after removal (resection) of a part of the stomach,
- nephrologist - if present in the history (or were detected during the diagnosis of osteoporosis) renal dysfunction (chronic renal failure, glucose-phosphate-amine diabetes, renal tubular acidosis),
- gynecologist - when detecting estrogen-deficient conditions,
- Hematologist is recommended to undergo the passage in cases of suspected presence of a disease of the blood-forming organs (generalized plasmacytoma, “sea anemia”, fat cell leukemia),
- rheumatologist consultation, if osteoporosis is accompanied by rheumatoid arthritis, Liebman-Sachs disease and Bechterew's disease.
Sometimes a woman is recommended to consult a psychologist, a narcologist, if she is addicted to tobacco, alcohol or drugs, and also if she is suspected of having anorexia nervosa.
Fully getting rid of osteoporosis is not possible, so the patient should learn to live with this ailment and with the help of therapy to halt the further development of the pathology.
Important! Instructions to the drug should not be viewed as a call for self-therapy!
Postmenopausal osteoporosis treatment is most often carried out according to the following scheme:
- Biophosphonates. The drugs will stop the destruction of the skeleton, thereby contributing to the formation of new bone tissue. Biophosphonates are absolutely safe for the human body and have virtually no side effects. According to studies, taking medications reduces the incidence of fractures by 50%.
- Calcium preparations. The best known to all of us is calcium gluconate. It is prescribed to all patients suffering from bone fragility. Calcium preparations are “not friendly” with biophosphonates, therefore the interval between doses should be at least four hours.
- Vitamin D. Vitamin D preparations stimulate the work of osteoblasts (these are the cells necessary for “building” bone) and improve the mineralization of solid connective tissue. Therefore, it is considered that this group of medicines is involved in the healing process of fractures, the formation of micromozols, which is a necessary condition for increasing the strength of the skeleton.
- Correctors metabolism of bone and cartilage tissue. One of the common drugs belonging to this pharmacological group is Miacalcic. Medication treatment will help fill the deficiency of calcitonin. The drug inhibits the production of parathyroid hormone, also contributes to the regulation of calcium metabolism and bone tissue metabolism. If, however, a fracture occurs, the medication Miacalcic in this case will have an analgesic effect.
Sometimes doctors prescribe hormone replacement therapy. Treatment, as a rule, is prescribed to women aged 45-50 years in postmenopause. Older hormones are not prescribed because of the high risk of serious side effects, such as venous thrombosis or breast cancer.
Lemon and chicken eggs
Squeeze the juice of ten lemons and pour six eggs on it. It is advisable to use enameled utensils (pan) for this, cover the “mixture” and put it in a cool place. Wait until the eggs (along with the shell) completely dissolve (it will take about a week).
In the resulting thick mass add 300 grams of honey and a glass of brandy. To mix everything. "Homemade drug" is stored in the refrigerator, take a teaspoon once a day before meals.
Osteoporosis can also be treated with eggshells. It is advisable to use an egg homemade chicken, which went "by the will." Wash the shell thoroughly, dry, chop with a rolling pin.
Take the powder every morning before breakfast, the volume - at the tip of a knife. Treatment is carried out for a month, then a break for three months and, if necessary, you can restart therapy.
The dish is cooked very quickly, simply, it is also low-cost. To do this, you need to take two medium-sized onions, wash them with husks (then remove and wash them again), chop them finely and fry them on the skirt until golden brown.
Pour a liter of water in a saucepan, throw the fried onions and husks, cook for fifteen minutes. Let it stand for several hours. Husk to get the rest - divided into three equal portions.
Each portion to use in one day (preferably at one time). Total - three days. Continue the procedure to continue. The course of treatment is one month.
As we found out, menopausal osteoporosis is not a harmless disease. Early diagnosis, prevention and compliance with all medical prescriptions will allow in the future to avoid both small fractures and severe, for example, a fracture of a vertebra or hip joint.
Symptoms of the disease
Postmenopausal osteoporosis most often manifests itself in the form of:
- vertebral compression fractures,
- cracks and fractures in the forearm,
- bone destruction of the femur.
For a long time, postmenopausal osteoporosis develops in a latent form, without showing any symptoms.
But at a certain point, when the bulk of the bone tissue is lost, characteristic signs appear:
- When walking, there is pain in the lower back, which may increase with weight lifting or when bending.
- Stiffness in the area of the shoulder blades and spinal column.
- Marked reduction in height, stoop, spinal deformity.
Causes of Postmenopausal Osteoporosis
Often provoking factors that lead to the development of this disease, most women are the same. The main one is the insufficient amount of estrogen produced, the main function of which is the regeneration of bone tissue and participation in the complete metabolism. A huge role is played by an unbalanced diet, more precisely, the lack of vegetables, dairy and legumes, as well as excessive consumption of vegetable fats. A sedentary lifestyle significantly aggravates the situation. Women are at risk:
- at the age of over 55,
- long time hormonal drugs,
- with genetic predisposition,
- in which the menstrual cycle ended up to 42 years,
- previously undergoing gynecological pathology (absence of menstruation, infertility, surgery on the uterus or removal of the ovaries, etc.),
- bad habits.
Therapeutic and preventive measures
Prevention of postmenopausal osteoporosis should begin at the age of forty, but better before. Meals should be complete, it is necessary to include low-fat varieties of cheese, cottage cheese, milk, kefir. Useful fish of marine origin, spinach, fresh fruits and vegetables, peas, beans, lentils. Canned fish from salmon, saury, sardines should be used together with pits. It is desirable to minimize the use of coffee, as it reduces the absorption of calcium.
A woman’s body should be supplied with the necessary amount of vitamin D, which is formed when sunlight hits the skin. It also enters the body with certain foods: eggs, fried fish, cereals, etc.
The important component is an active lifestyle. For the prevention of osteoporosis have a beneficial effect: sports, morning exercises, walking and jogging, dancing. Make it a rule for the following years: not a day without exercise. Women who are accustomed to a passive lifestyle, have every chance of getting postmenopausal osteoporosis.
Treatment by folk methods
Treatment and prevention of osteoporosis folk remedies are completely aimed at restoring the balance of hormones in the body, the most popular of which are herbal extracts.
For the preparation of therapeutic drugs are needed:
- fragrant woodruff
Take all the ingredients in equal parts and fill with 0.5 liters of hot water. Allow the drug to infuse for two hours. Take ½ cup throughout the day. This remedy will cure and prevent menopausal osteoporosis.
Eggshell is the best source of calcium. A common remedy that is recommended for osteoporosis is ground eggshell mixed with lemon juice. It is necessary to remove the inner film from the egg. Next, sterilize it and grind in a blender. The resulting powder is mixed with lemon juice in a 1: 1 ratio and infused for a week, after which take tsp in the morning. The course of treatment is a month, after it is necessary to take a break, then the treatment can be continued. You can also take egg powder mixed with honey. Baked in the oven shell (100 g) must be mixed with lime or buckwheat honey (50 g) and add propolis (100 g). The resulting product must be taken 2 tablespoons three times a day.
Citric acid promotes the absorption of calcium in the body. The following recipe also includes eggshells and lemon juice. For the preparation of a remedy, it is necessary to squeeze the juice of 10 lemons into a small container and immerse 6 raw eggs in it, after washing well. Cover the resulting product with a lid and leave it for a while until the shells are completely dissolved in lemon juice. About a week later, add 300 g of honey or 150 g of brandy to the container and mix thoroughly. The resulting tool must be taken every day for dessert spoon. Store the tool should be in a dark cool place.
Clover tincture. To treat osteoporosis, add 100 g of clover inflorescences to half a liter of vodka and let it brew well for 14 days. Take 1 teaspoon before meals. The course of treatment is a month, after which you need to take a break for 10 days. Further treatment can be continued.
Onion soup. Two small onions (unpeeled) must be finely chopped and fry in sunflower oil. Fry the onion in water and boil for 15 minutes, let it stand. Next you need to remove all the husks from the pan and use the soup for three days.
Causes of Osteoporosis in Women
Osteoporosis is understood to mean a pathological condition characterizing a decrease in density and subsequent destruction, i.e. destruction of bone tissue. Signs of this disease affect almost 80% of women over 50, i.e. postmenopausal period. Bone tissue is characterized by constant dynamic equilibrium, during which the process of mineralization occurs. It 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 the regeneration of bones. It also regulates mineralization. During menopause, its amount significantly decreases, which leads to osteoporosis. The disease is characterized by leaching of calcium and phosphorus, which are contained in bones. Because of this, their density and strength are reduced. In women, bone destruction occurs throughout the body, i.e. osteoporosis is present in their postmenopausal diffuse form.In addition to age, the causes or risk factors for this disease include:
- unbalanced diet with a lack of dairy products, legumes, greens, vegetables, fish,
- sedentary lifestyle,
- insufficient body weight
- abuse of caffeine, alcohol or cigarettes,
- gynecological problems, which include remote ovaries, infertility, lack of menstruation,
- long-term glucocorticoid treatment, i.e. drugs with hormones of the adrenal cortex,
- endocrine system pathologies,
Signs of osteoporosis in women
The peculiarity of postmenopausal osteoporosis is that in the early stages it practically does not bother a woman. Only after washing out a large amount of calcium with phosphorus, the bones become brittle. Then the woman begins to show signs and symptoms indicating osteoporosis of the postmenopausal period:
- decrease in height by 1-1.5 cm or more, curvature of the spine,
- fractures due to minimal effects on the bone, such as normal walking, a weak stroke or an awkward movement,
- cramps in the lower limbs at night,
- aching pains affecting the knee and elbow joints, especially when the weather changes,
- nail exfoliation,
- lumbar spine pain,
- 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 during osteoporosis in the postmenopausal period the amount of calcium decreases, does not give grounds to diagnose the disease with the help of a blood test, because in this substance it remains normal. Modern medicine in these conditions has other methods for confirming such a diagnosis. It is called bone densitometry. This is an ultrasound method that allows you to identify 15-20% loss of bone tissue. Traditional radiography for the diagnosis of postmenopausal osteoporosis is used less frequently.
In addition to these methods, analyzes of the menstrual function, urine, gynecological history are conducted. Based on all studies, postmenopausal osteoporosis is confirmed. The following measures help to cure the disease:
- Diet. The diet must include foods high in calcium. This is seafood, milk, legumes.
- Replacement therapy. These include hormonal drugs for osteoporosis with menopause, based on estrogen and its combinations with other hormones.
- Medication that slows down the process of bone tissue destruction. Among them are calcitonins and bisphosphonates.
- Physiotherapy. Performing special exercises helps to increase bone density and reduce the processes of its destruction.
Causes of osteoporosis during and after menopause
The essence of the pathology is that in women after 40-45 years, under the influence of hormone deficiency, the body loses the ability to absorb calcium.
In addition to the lack of this essential building element for the renewal of bone tissue, a woman has a metabolic disorder, protein digestion and other trace elements in the menopausal period. Without hormone control, osteoblasts that destroy bone tissue are activated.
Over time, the destruction of bone mass far exceeds its synthesis, the disease progresses. After 10-15 years from the beginning of menopause, postmenopausal osteoporosis becomes severe.
The woman's posture is disturbed, growth is reduced, the spine is bent. Compression fractures of the vertebrae, fractures of the bones of the forearm, lower leg, and thigh occur even after a slight fall, little physical exertion, or for no reason. Fracture treatment lasts a very long time, and can put a woman to bed for a long time.
Excessive consumption of fat and carbohydrates, carrying excess weight, deficiency in food calcium and vitamin D, which helps the absorption of this mineral.
When direct relatives in the female line during menopause, too, suffered from bone fragility.
Diseases of the endocrine system.
Violating the regulation of mineral metabolism.
Rheumatoid arthritis in history.
It creates a load on the articular tissue, violates the absorption of calcium and other trace elements.
Alcohol and nicotine.
Accelerate the destruction of the bones of the skeleton, prevent the absorption of calcium through the intestinal wall.
Violate the synthesis of bone tissue, calcium absorption.
More often than others, a Caucasian woman of a fragile physique with one or several risk factors is subject to the disease.
How to treat osteoporosis?
Since the symptoms of the disease at the beginning of menopause are often erased, when visiting a doctor, a woman undergoes an instrumental and laboratory examination, which includes:
- Ultrasonic densitometry - determination of bone structure,
- Dual-energy X-ray absorptiometry - X-ray examination of the density of the spine, bones of the thigh and forearm at an early stage of the disease,
- Blood chemistry,
- Urinalysis to determine the concentration of calcium,
- Determination of markers of bone damage to determine the ratio of the processes of disintegration of the processes of bone repair.
It is advisable to give up bad habits, to find time for feasible physical activity in daily mode. The main link in the treatment of the disease - drugs that slow down the destruction of bone mass.
Medicines for osteoporosis treatment:
- Biophosphonates - first-line drugs (Zoledronate, Nerindronate, Rizendronate, Ibandronate) to reduce the risk of osteoporosis and fractures,
- Stimulants of bone formation - anabolic steroids, fluorides, androgens,
- Hormone replacement therapy (HRT) - estrogen, progestogen, combination with androgens and progestogens.
The treatment is carried out for a long time, it may take 10 years or more. Dosage and treatment regimen is determined by the doctor. The disease has the ICD code 10, where it is defined as M80.0 (Osteoporosis in menopause with a pathological fracture).
How to prevent osteoporosis with menopause?
Systematic prevention of osteoporosis with menopause will avoid fractures, help maintain bone density. Prevention of bone destruction is best to start from 30-35 years old, but much more can be done at a later date to improve the quality of life.
- Filling your menu with foods rich in calcium, maintaining weight at an optimal level,
- Creating a muscular frame, moderate exercise, promoting the absorption of calcium and metabolism,
- Refusal of bad habits, destructive efforts to prevent disease,
- Intake of calcium (at least 1000 mg per day), vitamin D (400 IU per day),
- Minimizing the use of drinks containing caffeine (coffee, cola, tea, energy),
- Timely treatment of gynecological pathologies associated with hormonal imbalances during menopause.
For mild compensation of estrogen deficiency, you can use phytoestrogen-based drugs, medicinal fees (Klimaksan, Klimadinon, Chi-Klim). If the diagnosis has shown that the disease has already affected the structure of the bones, secondary prophylaxis is carried out. It includes medication:
- Synthetic hormones (Divin, Estriol, Proginova, Klimonorm, Premarin),
- Preparations for the restoration of bone tissue,
- Vitamin-mineral complexes with calcium (Calcium D3 Nycomed, Natekal, Kaltsinova),
- Calcium-containing drugs (Bonviva, Akvadetrim, Osteogenon).
To avoid the effects of osteoporosis, women need to take care of this long before the onset of menopause. A healthy lifestyle, HRT, taking special means to preserve and restore bone tissue will help avoid complications.
Symptoms of postmenopausal osteoporosis
In almost half of women, the disease is asymptomatic and is detected only after a fracture caused by a minor injury. In other cases, the symptoms progresses gradually. As the bone mass is lost, the patient begins to feel pain in the lumbosacral region, aggravated during the lifting of heavy objects, turns, and walking. Subsequently, there is a feeling of heaviness in the interscapular space, pain in the pelvic ring, long tubular bones of the tibia. To get rid of pain and discomfort, during the day you need extra rest in the prone position.
The increase in the intensity of painful sensations leads to the fact that over time they disturb the patient, even at rest. Usually a violation of posture and spinal curvature is accompanied by kyphosis. Often, women of postmenopausal age with osteoporosis complain of weakness, rapid fatigue during exercise. Compression fractures of the lower thoracic and upper lumbar vertebrae, with a decrease in their height, spontaneous or ankle fractures, forearm bones, and hip neck fractures that occur with minor loads, become the extreme forms of pathology. A characteristic sign is a decrease in height by several centimeters per year.
The most serious consequence of postmenopausal osteoporosis is disability due to spinal curvature and frequent fractures of the extremities, aggravated by constant pain in the bones. It is difficult for the patient to move not only over long distances, but also around the house, take care of herself, perform simple household activities. A significant deterioration in the quality of life can provoke emotional disorders - anxiety, tearfulness, hypochondria, a tendency to depressive response. In some women with osteoporosis, there is prolonged insomnia.
Treatment of postmenopausal osteoporosis
The main goal of therapy is to prevent possible fractures by improving bone mineralization and architectonics, while simultaneously improving the quality of life of patients. For this purpose, a comprehensive anti-osteoporotic therapy is used, aimed at various links of the pathogenesis of the disease. The standard treatment regimen for osteoporosis caused by postmenopausal changes in a woman’s body includes the following groups of drugs:
- Bone Resorption Inhibitors. Estrogens, their combinations with progestins or androgens prevent the premature destruction of bones and are recommended while maintaining menopausal manifestations in the early years of postmenopausal women. If there are contraindications or patient’s refusal to take sex hormones, they can be replaced by phytoestrogens, selective estrogen modulators or estrogen receptors. In addition to hormone replacement therapy, calcitonin, bisphosphonates, and strontium preparations have the effect of slowing resorption.
- Bone formation stimulants. Strengthening osteogenesis contributes to the appointment of parathyroid hormone, anabolic steroids, androgens, somatotropin, fluoride. Accelerated bone remodeling with the use of these drugs is achieved by activating osteoblasts, enhancing anabolic processes, and stimulating hydroxylation. It should be borne in mind that in postmenopausal disorders, the use of such drugs is limited by a number of contraindications and possible complications.
- Multiple Action Tools. The mineralization and architectonics of bone tissue improves when calcium supplements are taken, especially in combination with vitamin D, which makes it possible to classify such drugs as basic. The osseino-hydroxylate complex and flavone compounds, which, with a minimal probability of complications, effectively inhibit the function of osteoclasts responsible for resorption and demineralization, stimulating osteoblast osteopoiesis, also have a diverse effect on the processes of osteogenesis and bone destruction.
Effective treatment of osteoporosis in women of postmenopausal age is impossible without correction of lifestyle and diet. Elderly patients are recommended moderate exercise with the exception of falls, weight lifting, sudden movements. Calcium-rich foods such as milk, cottage cheese, hard cheese, legumes, fish, and other seafood should be added to the diet, avoiding the abuse of coffee and alcohol.
Prognosis and prevention
Although postmenopausal osteoporosis is a progressive disease, regular supportive treatment and a healthy lifestyle can significantly reduce the likelihood of fractures. For prophylactic purposes, postmenopausal women are recommended to take calcium supplements containing vitamin D, dosed out insolations, diet correction, sufficient physical activity taking into account age norms, smoking cessation, limited consumption of products containing caffeine (coffee, tea, chocolate, cola, energy drinks) . If signs of osteoporosis are detected, corsets and hip protectors can be an effective protection against the loads that provoke fractures.
Characteristic of the disease
The onset of loss of bone density in humans is observed after 35 years. The process is more prone to the female half of humanity. Currently, osteoporosis is close to an epidemic, it is more common than cardiovascular and oncological diseases. Already 50% of women entering menopause suffer osteoporosis.
The lion's share of damage in osteoporosis occurs in the neck of the femur. In connection with the aging of the population, experts predict an increase in hip fracture from 500 thousand to a million cases per year.
Regardless of the reasons, the main thing in the pathogenesis is a violation of mineral metabolism and vitamin D deficiency. Not the least role is played by the lack of such trace elements as boron, magnesium, fluorine, silicon, manganese. As well as a lack of vitamin A, E and K, ascorbic acid.
The likelihood of osteoporosis depends on many factors. They are conventionally divided into two groups — factors that cannot be prevented, and those that can be influenced and changed. The first are:
- the woman’s white race
- predisposition to osteoporosis embedded in the genes
- age category,
- late onset of menstruation and early menopause,
- frequent violations of the menstrual cycle in history,
- lack of ovulation, ovarian removal, infertility.
It is impossible to affect these factors, but the risk of osteoporosis can be reduced by eliminating the second risk group.
- In time to treat acute and chronic diseases that can further lead to osteoporosis.
- Adhere to a healthy, balanced diet.
- Monitor the physical condition, feasible load, strengthen the muscles.
- Avoid bad habits (alcohol, smoking).
- Use medicinal complexes to replenish the body with vitamins and mineral salts.
- Enough time to give walks.
The main task is actions aimed at preserving the density of bone tissue, preventing its destruction, and preventing fractures. The treatment consists of non-pharmacological care, the use of drug complexes and other drugs.
Hormonal replacement therapy has a good effect on the state of the bone tissue. The drugs prevent the development of osteoporosis during menopause and in the postmenopausal period. Usually drugs contain estrogen or a complex of progesterone and estrogen. This means for oral use or patches.
Treatment consists of three groups of drugs - drugs that affect the metabolism, inhibit the process of bone destruction, and the drug that stimulates bone formation. Means acting on the metabolism contain calcium, flavonoids and vitamin D, a protein that inhibits osteoclasts and stimulates osteoblasts.
Preparations that stop bone resorption are represented by bisphosphonates, selective modulators, non-sex hormones. These funds are aimed at reducing the destruction of bones, reduce bone loss, improve structure.
To stimulate bone formation include agents containing parathyroid hormone. In old age with osteoporosis, somatotropic hormone and fluorine salts are prescribed. Because of the pronounced contraindications, these tools are used in limited quantities.
Diet and load
Those women diagnosed with osteoporosis also need non-pharmacological assistance. It consists, above all, of the correct diet, correction of the way of life. Shown a balanced diet, rich in seafood and dairy products.
It should increase the intake of foods containing calcium. As for vitamin D, the body can synthesize it under the influence of sunlight in the skin, or get it with products in the winter.
To strengthen the muscular corset requires regular feasible exercise. Walking is useful, it can somewhat suspend the disastrous course of bone destruction.
Unconventional healing offers a warming compress from chamomile infused with vodka for bone pain. Dry raw materials, 150 grams of dried flowers, insist in 500 ml of vodka for three days. In the same way prepare the tincture of walnut (leaves).
For ingestion brew 200 grams of green raw materials, taken equally parsley and dill, half liters of hot (70 °) water, kept in the form of heat for 3 hours, use 100 ml three times a day. Herbal therapy is used as an adjunct to medications and after consulting a doctor.
How to prevent illness
Prevention of diseases of the skeletal system should be present throughout the life of a woman. It consists in the implementation of simple and accessible measures that will minimize the loss of calcium by the body, preventing the destruction of bones.
Prevention of osteoporosis in menopause will prevent disability, maintain a decent quality of life for a long time. Since the symptoms are mild and can be taken for signs of other diseases, it is important to diagnose osteoporosis on time and take preventive measures:
- physical activity,
- good rest,
- control of calcium and vitamin D levels
- rejection of bad habits.
Active prevention of osteoporosis is carried out with the same medicines as for the treatment of the disease.
With the onset of menopause, I was very worried about the question of the future, my mother had osteoporosis and I saw how she was tormented. We began to discuss this topic with the gynecologist, she said that osteoporosis due to estrogen deficiency occurs, and normal calcium metabolism is disturbed. And she wrote me Estrozhel gel and Utrozhestan capsules. So I have 2 years on the preparations. I put Estrozhel on the abdominal or lower back area and insert 100 mg Utrozhestan capsules daily. I began to drink vitamins Famvital (2 red capsules in the morning and 1 silver capsule in the evening) to improve the metabolic processes. While I feel good. The only negative, of course, the price of all these drugs per month is not small, but I would spend more on the treatment of osteoporosis anyway. It is better to spend on health than on illness.
During climax, I was also prescribed Estrogel and additionally Utrozhestan capsules so that there would be no problems with memory and sleep. Of course, this is an extra hassle, smear in the morning, do not forget to take the capsule, but I am ready to endure everything, this prolongs my youth))).
They write everything correctly, if drugs are prescribed on time, then it is very affecting the condition of the bones. I have been taking hormones for 7 years, Estrogel smears and drinks Utrozhestan - and there are no problems with osteoporosis yet. Here and an active lifestyle affects, but the completion of hormones is necessary. I recommend to anyone with a menopause on the way.
Persuaded mom to Estrozhel from osteoporosis. She is pleased, she said, correctly did what she had convinced. Better hormones than fear to go out of the house.
Major risk groups
Subjected to the disease more often:
- women with premature (35-38 years old) or with early (39–43 years) menopause,
- patients who are diagnosed with infertility or oligomenorrhea at child-bearing age,
- many women giving birth, lactating for a long time (more than 2 years),
- genetic predisposition plays an important role
- the presence of chronic diseases (diabetes, kidney disease, liver disease, low or overweight),
- bad habits,
- lowest bone mineralization
Causes leading to illness
The main reason for the development of the disease, in which there is a maximum loss of bone tissue, is a deficiency of hormones. The onset of menopause and leads to the progression of resorption (destruction) of bone mass.
The essence of the pathology is that in women in the period of menopause (after 40-45 years) the level of female sex hormones, estrogen, decreases sharply. Under the influence of hormone deficiency, the body loses the ability to absorb calcium, protein and other trace elements. Against this background, there is an activation of osteoblasts, which destroy bone tissue, and this leads to irreversible consequences.
In the development and course of the disease, an important role is played by these factors: the amount of a woman’s bone mass before menopause, the speed at which bone material is lost. Experts subdivide bone loss in women in the postmenopausal period into 3 phases:
- Rapid loss - observed in the first 5 years of postmenopause. During this period, the annual loss of spinal bone mass is 3%.
- Slow - the beginning of the phase occurs at about 55 years. The loss is about 0.5–1% per year (depending on the area of the skeleton).
- Normal loss - the loss of bone matter is constantly stable, 1–2% per year.
Manifestations and symptoms
For a sufficiently long period from the onset of menopause, osteoporosis proceeds without any obvious clinical manifestations, therefore, already ill people do not seek medical help. Only when the body already has a significant loss of bone mass, the onset of the following symptoms begins:
- pain in the back, which have a tendency to increase when turning the torso, when walking fast, when lifting a little heaviness, after a long stay on my legs, pain in the lumbosacral region is especially pronounced,
- rapid general weakness, fatigue,
- feeling of stiffness, heaviness and aching pain between the shoulder blades,
- crouching back, protruding abdomen and difficulty breathing after exercise,
- increased pain in the spine and pelvic bones as the disease progresses,
- fractures of the vertebral bodies, distal radial and femoral bones,
- gradual flattening and deformation of the anterior walls of the vertebrae,
- weakening of the muscular system of the back, which leads to the formation of a characteristic posture (stoop, kyphosis),
- gradual decrease in growth
- violation of the functions of internal organs.
Drug treatment of postmenopausal osteoporosis
The primary importance and main task of a specialist is the right choice of an effective treatment regimen. The method of treatment of the disease depends entirely on the individual tolerance and sensitivity of the organism to the drug, risk factors, the effectiveness of the drugs and the occurrence of side effects.
Modern doctors treat postmenopausal osteoporosis according to individually developed techniques. These developments include a combination of anti-osteoporotic drugs and non-pharmacological methods.
- biophosphonates (Etidronat, Clodronat, Tiludronat, Aledronat, Risedronat) - drugs have a pronounced effect on reducing resorption and remodeling (destruction) of osteoclast bones, reducing the risk of fracture by 40-50%,
- Anabolic steroids (Tibolon) maximize bone mineral density,
- recombinant human parathyroid hormones (Teriparatide, HPTH 1-34) the use of drugs leads to an optimal increase in the level of bone tissue mineralization of the lumbar spine, used in the treatment of very serious forms of the disease,
- vitamin preparations (calcium preparations, vitamin D) - the agents used in combination reduce the risk of fractures.
Anti-resorptive therapy is especially popular with specialists. The technique consists in the following: use of female sex hormones, antiestrogens, taking calcitonin drugs, bisphosphonates, bone tissue formation stimulants.
A priority role in the selection of a group of drugs or a combination of drugs plays a goal - the result of the treatment. The maximum reduction in the risk of fractures of the spine and extremities - treating doctors prefer drugs of the bisphosphonate group.
The goal of treatment is to minimize the risk of spinal fractures — selective modulators, bisphosphonates, and vitamins. Severe forms of the disease are treated with parathyroid hormones, vitamin preparations. The treatment process is long from 2 to 5–8 years, requiring special exposure from patients, revision of their lifestyle.
Postmenopausal disease prevention includes:
- Full nutrition.
- Preventive measures to prevent bone loss in case of early menopause.
- Regular intake of drugs that contain vitamin D, and drugs containing calcium.
- Physical activity.
- Healthy way of life.
It must be remembered: if postmenopause has contributed to the disease, it is necessary to consult a specialist. Be sure to include in the diet vitamin D and calcium. It is necessary to avoid all sorts of negative effects on bone metabolism. It is recommended to monitor your movements, to carry out preventive measures of diseases of the endocrine and digestive systems. If necessary, wear a hip or corset protector.
The causes of the disease
According to the latest global classification review of diseases, the ICD – 10 code of this ailment is M81.0, which means “Postmenopausal osteoporosis”. In terms of the frequency of diagnosis, osteoporosis is second only to heart, lung and oncology diseases. They suffer from at least one third of the world's population over the age of fifty years.
The occurrence of the disease can be provoked by such factors:
- Reducing the production of female sex hormones, through which there is an update and restoration of bone tissue. Female hormones are responsible for retaining the calcium needed to give bones sufficient strength.
- Maintaining a sedentary lifestyle. Because of this, metabolism deteriorates, bone density decreases as a reaction to the absence of physical exertion. A similar result is observed in patients who have been bedridden for a long time.
- Irrational food. Often, women in large quantities consume semi-finished and canned goods, in which there are practically no substances necessary for the body, vitamins, minerals and proteins.
- Poorly thought-out diet that caused weight loss. From this pressure on the musculoskeletal system weakens, as a result, the bone tissue becomes thinner, becomes fragile and fragile.
- Genetic predisposition. As a result of medical observations, it was established that osteoporosis is inherited. They may suffer several generations of female relatives.
- Long-term treatment of kidney disease, accompanied by the admission of glucocorticoids. These drugs displace and suppress the activity of female sex hormones.
- Premature menopause. After this event, the gradual rejection of the endometrium begins - a layer of cells forming the inner layer of the uterine mucosa.
- Abuse of smoking, alcohol, strong coffee and tea. These drinks have a negative impact on metabolic processes in bone tissue.
- Fractures that have happened before. The consequences can appear several decades after the injury. Osteoporosis is one of the complications of fractures.
- The birth of 3 or more children, a long period of lactation. During the processes of pregnancy and lactation, phosphorus and calcium are actively removed from the woman’s body.
The risk group includes athletes, elderly ladies and women of the Caucasians.
Diagnosis of postmenopausal osteoporosis
Since the primary symptoms of osteoporosis are characteristic of many diseases of the musculoskeletal system, a comprehensive diagnosis is needed to make an accurate diagnosis. Without this, it is impossible to prescribe an effective course of treatment.
Examination of the patient is carried out in the clinic with the following methods:
- Initial examination by a specialist. With the help of a number of leading questions, the doctor finds out the possible cause of the disease, its symptoms and duration. A physical examination reveals the degree of pathology of the musculoskeletal system visually.
- Conducting bone densitometry. This method allows to determine the bone mineral density. According to the obtained indicators, the presence and extent of the disease is found out.
- Ultrasonic densitometry. This is an effective way to diagnose osteoporosis, based on the readings of the device, which are quite accurate.
- Blood test for calcium and calcitonin. The results give an idea about the amount of beneficial substances that are washed out of the bone tissue.
- A urinalysis, the results of which determine the percentage of hydroxyproline, type I collagen and serum osteocalcin.
Radiography helps to get a picture of the disease only in cases where the loss of bone mass is more than a third of the original.
In addition to identifying osteoporosis itself, the patient is scheduled to undergo a differential diagnosis. It is necessary in order to determine the causes of the disease and factors that may interfere with its effective treatment. After going through consultations with specialized specialists, a woman is prescribed a course of medicines, recommendations are given on diet and exercise therapy.
What is postmenopausal osteoporosis?
Postmenopausal osteoporosis - It is a chronically progressive systemic, metabolic disease of the skeleton due to a decrease in the content of minerals in human bone tissue, against the background of the age-related extinction of ovarian function.
This defeat is very insidious, as outwardly practically does not manifest in any way. Only in the later stages a woman can be bothered by pain in the joints, back, until everything develops into frequent fractures.
In the first 5 years after menopause, the bone system loses almost a third of the mineral components, and with the increase in the general age of the population, the problem of menopausal osteoporosis is becoming increasingly urgent.
The main causes of the disease is considered to be:
- Reducing female estrogen hormones. One of the functions of the hormone estrogen is to participate in the regulation of mineral metabolism, including calcium metabolism, which is the main element of the human musculoskeletal system. After extinction of the reproductive function, the level of estrogen in the body decreases, and hence the level of the main component of the skeletal system decreases. As a result, it becomes porous, soft, ceases to withstand the load. This is called menopausal osteoporosis..
- Poor nutrition. Another factor whose importance is often underestimated. Experts note that the majority of people suffering from this pathology follow an extremely inadequate diet. Such people, as a rule, consume insufficient quantities of dairy products, meat, greens, beans, vegetables. In addition, they do not compensate for this deficiency, which inevitably leads to calcium deficiency in the body.
- Low mobility. With age, the motor activity of most people, including women, decreases markedly. The reasons can be many: severe somatic diseases, obesity, consequences of injuries and emergency conditions in the past. All this also leads to a decrease in time spent on the street, which entails a decrease in the production of vitamin D in the body, which is a necessary component for the successful absorption of calcium and maintaining bone density.
What factors predispose to the appearance of postmenopausal osteoporosis?
At risk groups include persons:
- over 65 years old
- who had early menopause,
- smoking abusers
- abusing alcoholic beverages,
- having hormonal disorders, especially disorders of thyroid hormones, adrenal glands, pituitary,
- having a genetic predisposition.
Detailed mechanism for the onset of menopausal osteoporosis
In the bone tissue of a healthy person, there are constant remodeling processes, that is, restructuring. The cells continuously re-form and resorb the bone. This balance is supported by a number of hormones that are closely related to each other.
After the completion of the period of functioning of the reproductive function of a woman, the ovaries cease to perform their tasks, including not producing sex hormones, in particular estrogen. The synthesis of estrogen is associated with the synthesis of calcitonin, which, in turn, reduces the level of parathyroid hormone.
Parathyroid hormone increases the content of calcium ions in the blood due to increased absorption in the intestine, due to the resorption of bone tissue and reduce its excretion in the urine.
As mentioned above, malnutrition and lack of physical activity provide a shortage of calcium in the body. Therefore, the only result will be permanent destruction of the bone.
Additional causes will be a deficiency of vitamin D, which is directly involved in the absorption of calcium, insufficient intestinal function due to the inevitable aging processes, which causes insufficient absorption of calcium from food, low mobility, disrupting adequate blood supply to the bones.
What symptoms indicate postmenopausal osteoporosis?
Unfortunately, due to asymptomatic, menopausal osteoporosis cannot be diagnosed independently. As a rule, such a diagnosis is made in a hospital after a woman goes there with a spontaneous fracture.
Primary features that are usually ignored - back pain, back, pelvis, legs, jointswhich appears after physical exertion and passes after rest, fatigue, night leg muscle cramps. Over time, these symptoms bother the woman more and more.
Also can guard curvature of the spine in the form of a "hump", a decrease in growth of several centimeters per year, a decrease in body weight without changing volumes and proportions.
Untimely recourse to a specialist leads to spontaneous fractures of the femoral neck, forearm, lower leg, and thoracic spine. All this together can lead to severe disability of a person and impairment of his mental health.
How to diagnose?
After collecting anamnesis and identifying risk factors for menopausal osteoporosis, the specialist prescribes studies designed to assess the state of the bone tissue and also to detect signs of its destruction in blood tests.
The most common methods are:
- Densitometry. It is carried out with the help of an apparatus whose action is based on X-rays. He estimates bone density. The same study is available using ultrasound diagnostics, as well as using computed tomography. Skeleton areas most susceptible to osteoporosis: spine, hip joint, pelvic bones, humerus, radius, hands, feet.
- Blood chemistry. Here pay attention to the amount of calcium, phosphorus, alkaline phosphatase, osteocalcin, which are direct evidence of bone destruction. In some cases, an additional analysis of urine for calcium content.
- Blood test for hormone levels. First of all, they determine the level of thyrocalcitonin and parathyrin, thyroid hormones, which are responsible for the balance of calcium in the body. Additional research on the content of sex hormones allows you to make a definitive diagnosis of menopausal osteoporosis.
What drugs are used for treatment?
Modern methods of treatment of postmenopausal osteoporosis are aimed at eliminating the links of the pathological process. Drugs increase bone mineralization, suspend resorption and prevent the occurrence of complications.
- Bone formation stimulants. This group includes hormonal and steroid drugs, minerals. They affect the hormonal regulation of bone destruction and stimulate cells to form new tissue.
- Drugs with multiple effects. These, in the first place, include calcium supplements in combination with vitamin D. This combination contributes to adequate absorption of the mineral, which allows the body to successfully use it to build new bone tissue. Flavone compounds and osseino-hydroxylate complexes inhibit the destruction of the skeleton, inhibiting the activity of the cells responsible for it.
- Drugs that prevent bone resorption mechanisms. In addition to hormonal drugs, this group includes bisphosphonates. It also includes hormonal agents: estrogens and progestins, calcitonin.
Bisphosphonates as the main link in the treatment of menopausal osteoporosis
Simply put, the mechanism of bisphosphonate preparations is to suppress the functions of osteoblasts, the cells that destroy bone tissue. That is, they affect the final link of osteoporosis.
These medicines are used for a long time, since the middle of the twentieth century. Since then, many new products have been invented, which can be divided into three generations.
The use of bisphosphonates has become possible in the treatment of oncological diseases, as they are able to prevent tumor metastasis.
All drugs, which are based on bisphosphonates, can be divided into two large groups:
Due to the molecular structure, they have features in the mechanism of action, which determines their field of application in the treatment of menopausal osteoporosis.
Preparations of bisphosphonates, belonging to this group, contain a number of active substances that determine their properties, pharmacodynamics and pharmacokinetics:
- Alendronate Sodium is the basis for second-generation drugs. This is a specific regulator of bone tissue metabolism, which has a non-hormonal nature. Therefore, preparations of bisphosphonates with this active ingredient may be used in both men and women.
- Ibandronic acid (INN) or ibandronate sodium is the basis of a number of third-generation drugs. It is shown to women who have entered the complicated menopausal phase, for the prevention of osteoporosis, as well as in the case of pathologically high levels of calcium ions to the blood. Men are not recommended to use bisphosphonates from this group.
- Zoledronic acid. Its unique property is molecular affinity with the structure of bone tissue, which causes the selective effect of these drugs. Studies have helped to find that preparations of bisphosphonates containing zoledronic acid also have an antitumor effect.
Representatives of this group belong to the first generation. But do not think that these are outdated and ineffective drugs. The use of non-nitrogen containing bisphosphonates is still widespread in the treatment of menopausal osteoporosis.
- Sodium tiludronate. It is widely used in the treatment of patients with deforming osteodystrophy and Paget's disease. It slows down the destruction of bone tissue, contributes to the accumulation of calcium and phosphate in it, increasing the percentage of mineral substances.
- Sodium Etidronate. Appointed with Paget's disease, osteoporosis, increased calcium ions in the blood.
- Clodronate. It affects the final parts of menopausal osteoporosis: it inhibits bone resorption process and prevents calcium from leaching from it. This compound can be incorporated into the structure of the skeleton, changing its chemical composition, strengthening the bonds between the molecules.
Rules for taking bisphosphonates
These medicinal substances belong to potent groups, and therefore their purpose, dose and regimen should be strictly controlled by a doctor. In order for the chosen therapy to be as effective as possible and not cause side effects, it is necessary to adhere to the following rules for the use of bisphosphonates:
- take the drug should be on an empty stomach, half an hour before breakfast,
- drink plenty of pills with clean water
- do not take a horizontal position for an hour,
- preparations containing calcium in combination with vitamin D should be consumed 2-3 hours after the use of bisphosphonates.
Ways to prevent menopausal osteoporosis
No matter how trite it may sound, it is much easier and cheaper to prevent the development of a pathological condition than to treat it. The main conditions for reducing the risk of osteoporosis:
- Maintain a healthy lifestyle. Quitting smoking and alcohol will in many respects contribute to the continued preservation of the functions of all organ systems.
- The optimal mode of physical activity. Hypodynamia causes the development of degenerative processes in the musculoskeletal system, including bone tissue.
- Balanced diet. Every day the body should receive all the necessary minerals and trace elements with food. Diets built to reduce the proportion of fat consumed can also contribute to the development of osteoporosis in a more mature age.
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