Osteopenia is a pathological condition in which there is a decrease in bone density that does not reach the degree of osteoporosis. As a rule, it is asymptomatic. Accompanied by a slight increase in the likelihood of fractures. It is diagnosed accidentally during radiography or densitometry for other reasons or as part of a preventive examination. Treatment includes correction of nutrition and lifestyle, therapy of provoking diseases, the appointment of vitamin D, calcium preparations, hormones, anabolics, anti-catabolic drugs. Sometimes physical therapy is indicated.
Osteopenia is the “depletion” of bone tissue as a result of a decrease in bone mass and density, an intermediate state between the physiological norm and osteoporosis. It is widespread, occurs mainly in middle-aged and elderly people. Women suffer more often than men. Timely treatment of osteopenia helps prevent the development of osteoporosis, reduce the likelihood of pathological fractures.
Thinning and reduction of bone strength is a natural involution process. It develops due to the predominance of bone tissue destruction over its remodeling. On average, the peak of bone density occurs at 20 years. Up to 35-40 years, the condition of the skeleton remains stable. Subsequently, bone mass gradually decreases at a rate of 0.3-0.5% per year.
After the cessation of menstruation in women, losses accelerate to 2-5% annually. Throughout their lives, the fairer sex lose 50% of the trabecular and 35% of the cortical bone tissue. In men, these indicators are, respectively, 20-30% and 15-20%. In some cases, osteopenia is not associated with bone loss, but with an initially low bone density. The following factors contribute to the occurrence of this condition:
- Genetic features. The first place in the prevalence of the violation is occupied by Caucasians, the second by persons of Asian nationalities, the third by representatives of the Negroid race. Pathology is more often detected in people whose close relatives suffer from osteopenia or osteoporosis.
- Changes in estrogen levels in women. It has the greatest clinical significance among the endocrine causes of the disorder. The probability of osteopenia increases with late menarche, prolonged absence of menstruation in reproductive age, infertility, early onset of menopause.
- Other hormonal causes. A decrease in the amount of testosterone in older men has a certain significance. In people of both sexes, the risk of developing osteopenia increases in the presence of such endocrine diseases as thyrotoxicosis, hyperparathyroidism, endogenous hypercorticism, hypogonadism, hypopituitarism, type 1 diabetes mellitus, polyglandular endocrine insufficiency.
- Lifestyle. The number of provoking circumstances includes smoking, alcohol abuse, excessive addiction to caffeinated beverages. The disease is more often diagnosed in people who lead a sedentary lifestyle or, conversely, suffer from constant excessive physical exertion.
- Features of nutrition. Unfavorable factors are considered insufficient nutrition, adherence to strict diets, intolerance to dairy products, forcing people to abandon the most popular foods rich in calcium. Osteopenia occurs when eating an excessive amount of meat, a lack of vitamin D in the diet.
- Taking some medications. The long-term use of thyroid hormones, glucocorticoids, cytostatics, diuretics, anticonvulsants, anticoagulants, antacid preparations containing aluminum has a negative effect on the condition of bones.
- Somatic diseases. Predisposing rheumatic pathologies include SLE, rheumatoid arthritis, ankylosing spondylitis. Malabsorption, the condition after resection of the stomach and intestines, gastric operations in obese patients are considered dangerous lesions of the digestive organs. Potentiating renal diseases are CRF, Fanconi syndrome, tubular acidosis. Osteopenia is often detected in patients with leukemia, lymphoma, thalassemia, myeloma.
- Other pathological conditions. The risk group includes people who have experienced prolonged immobilization due to injury; patients after organ transplantation; people who have received a large dose of ionizing radiation; alcoholics; patients with anorexia nervosa.
Two variants of bone metabolism disorders can lead to osteopenia. The first is accelerated resorption, which is not compensated by normal or accelerated bone formation. The second is normal bone resorption with a decrease in the rate of bone formation. The most common menopausal osteopenia is explained by the increased release of fluoride by osteoblasts with a decrease in the amount of estrogens. This trace element stimulates the activity of osteoclasts, which leads to increased bone destruction.
In addition, after menopause, calcitonin secretion decreases, and bones become more sensitive to the action of parathyroid hormones. In women, the absorption of calcium from the intestine worsens, against which a secondary deficiency of vitamin D develops. As people of both sexes age, the importance of a negative calcium balance increases.
The formation of osteopenia in rheumatic pathologies is explained by a decrease in mobility, treatment with glucocorticoids and anticoagulants, synthesis of cytokines in synovial membranes. In diseases of the gastrointestinal tract, pathology occurs due to malabsorption. In kidney diseases, bone strength decreases against the background of hypocalcemia and hyperphosphatemia, stimulating increased production of parathyroid hormone and the development of secondary hyperparathyroidism.
As a rule, pathology is asymptomatic. Bone pain and spinal deformities characteristic of osteoporosis are absent due to a less significant decrease in bone strength. Changes are detected either during a routine preventive examination, or when a fracture occurs. As in the case of osteoporosis, osteopenia most often damages the vertebral bodies, the distal parts of the forearm, the femoral neck.
Clinical manifestations correspond to a normal fracture, in people of the older age group, the symptoms may be somewhat smoothed out. Injuries to the femoral neck and the beam in a typical place are accompanied not only by pain syndrome, but also by a violation of the functions of the segment, so patients, as a rule, immediately turn to doctors. Spinal fractures sometimes remain unrecognized.
Pathology increases the likelihood of fractures. Among women of the European race who are more prone to osteopenia, violation of the integrity of bones is more common than among other groups of the population less prone to the development of this condition. Half of the fairer sex suffers at least one fracture during their lifetime. The consequence is a long-term disability, the need for surgical interventions, limitation of the functions of the damaged segment in the long term.
Detection of the violation is the responsibility of orthopedic doctors. It is impossible to diagnose osteopenia based on the results of an external examination or the presence of certain sensations. The only way to detect pathology in a timely manner are special studies shown to the following population groups:
- Women over 55 years old, men over 70 years old. In the presence of risk factors for the development of osteopenia, the age from which preventive examinations are indicated is reduced to 50 and 65 years, respectively.
- Patients with fractures of any localization, if the severity of the injury does not correspond to the strength of the traumatic impact.
- People with signs of decreased bone density according to radiography performed in connection with any other pathologies.
- Patients receiving treatment with steroid hormones, anticonvulsants.
In addition, the examination is prescribed to smokers with low body weight, patients with anorexia nervosa, after organ transplantation, with back pain of unclear etiology, chronic diseases of the endocrine glands, gastrointestinal tract and kidneys associated with an increased likelihood of developing osteopenia. The referral is issued by the attending physician of the appropriate profile (endocrinologist, gastroenterologist, nephrologist).
Radiography is not informative enough, since only a significant decrease in bone density is visualized on the images. The most accurate method for determining osteopenia is double energy X-ray absorptiometry, which is considered the international “gold standard”. The diagnosis is made with a decrease in bone mineral density by 1-2.5 SD compared to the norm. A decrease of more than 2.5 SD indicates the presence of osteoporosis.
If this method is unavailable or inappropriate, quantitative computed tomography (CT), quantitative ultrasound densitometry, and bone peripheral densitometry are performed. The advantages of CT are the possibility of obtaining a three–dimensional image, greater measurement accuracy, the disadvantage is a higher radiation dose.
Ultrasound technique allows you to assess the risk of fractures by detecting areas of reduced peripheral bone density. The advantage of the method is the absence of radiation exposure, the disadvantage is the impossibility of a reliable diagnosis. Additional examinations are necessary for the final verification of osteopenia. Peripheral densitometry is available and is used as a screening technique. It is associated with obtaining a small dose of radiation exposure, but it is inferior to double absorptiometry in terms of information content.
Patients with this diagnosis are shown long-term complex therapy, which includes lifestyle changes, elimination of risk factors, treatment of provoking diseases. The purpose of therapeutic measures is to prevent further bone loss, stimulate bone restoration, prevent the transition of osteopenia to osteoporosis, and prevent complications.
Bone health largely depends on behavioral stereotypes. The following recommendations help to slow down the development of osteopenia:
- Correction of the power regime. Strict diets are contraindicated. Patients are advised to include in the diet a sufficient amount of dairy, legumes, green vegetables, fish, and other foods containing a lot of calcium. To improve the absorption of calcium, the diet should be balanced, containing all the necessary vitamins and trace elements.
- Correction of physical activity. The level of load is selected taking into account age and general health. The best option for all categories of patients is walking. Cycling, yoga, swimming, and exercise equipment classes may be recommended. To preserve the strength of bone tissue, it is important that physical activity is regular, sufficient, but not excessive and not traumatic.
- Giving up bad habits. Reducing the amount of coffee, alcoholic beverages in combination with quitting smoking helps prevent excessive excretion of calcium in the urine, increase the level of bone remodeling.
The program of therapy of provoking diseases is compiled depending on the nature of the pathology. The decision on the need for drug treatment of osteopenia is made individually, taking into account the presence of risk factors, assessing the likelihood of osteoporosis. It is possible to use the following tools:
- Calcium and vitamin D. Calcium is usually used in women after 45, men after 55 years. When women reach 55 and men reach 71, the dose is increased. To improve absorption, the drug is taken fractional 2-3 times a day. Vitamin D, if indicated, is prescribed at any age, the highest dose is required for women over 71 years old.
- Hormones. Due to the link between osteopenia and menopause, estrogens are most often used in clinical practice. The type and dose of the drug is determined taking into account the stage of menopause, the presence of diseases of the reproductive system. Less often, patients with osteopenia require androgen therapy.
- Anabolics. Funds based on parathyroid hormone directly affect osteoblasts, stimulating the active formation of bone tissue. In addition, drugs of this group indirectly increase the absorption of calcium in the intestine, the reabsorption of trace elements in the kidneys.
- Anti-catabolic medications. They include calcitonin preparations, bisphosphonates, which slow down the resorption of bone tissue, contribute to the preservation of normal bone architectonics.
General UFO therapy is used to stimulate the production of vitamin D in the skin. Provides natural regulation of the level of this compound, unlike dosage forms does not provoke hypervitaminosis. Especially important in winter. First of all, it is shown to residents of the north who suffer from a lack of natural ultraviolet radiation.
Patients with chronic diseases that limit normal physical activity are prescribed special exercise therapy complexes. For fractures, laser therapy, magnetotherapy, medicinal electrophoresis with calcium, fluorine and phosphorus are used, restorative measures (massage, physical therapy) are carried out.
With timely initiation of therapy, the prognosis is favorable. Patients with osteopenia remain physically active for a long time, retain their ability to work. Adequate therapeutic measures help to prevent the occurrence of osteoporosis, the development of pathological fractures. In the absence of correction, the violation is aggravated.
The optimal time to start the prevention of osteopenia is a young age at which the maximum increase in bone strength is possible. Proper nutrition, a sufficient level of physical activity, refusal to drink coffee, nicotine, alcohol are recommended. Women in preclimacteria and climacteria need to increase the amount of calcium-containing foods in the diet, regularly undergo preventive examinations, and receive hormone replacement therapy according to indications.
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