OSTEOPOROSIS

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OSPOINT.org

Osteoporosis is a disease with massive incidence, which is remarkably growing in the last decades. On the basis of performed studies, it is possible to assume that osteoporosis represents a threat to every third white female and every sixth white male aged over 50. Osteoporosis is a chronic systemic disease of the skeleton, characterised with bone mass loss and disorder of bone tissue micro architecture, which consequently leads to higher bone fragility and fracture tendency.

Imbalance begins between bone proliferation and bone mass loss, and it leads to fractures formation without previous injury or after inadequately minor injury. It is unnaturally enhanced process of bone tissue loss.
Osteoporosis is a disease, which significantly deteriorates life quality, is a frequent cause of invalidity, and can also result in death. Osteoporosis without fractures mostly does not cause any troubles to patients. Osteoporosis should always be considered, and it is necessary to avoid the first fracture. Consequences of osteoporosis include fractures of forearm, femur neck fractures and vertebral fractures. In years 1973–1993, growth of femur neck fractures in the Czech Republic was 2.4 fold. 20–30% of patients, who suffer from this fracture, die within one year; 30–40% are permanently dependent on other person’s help. More women die on consequences of femur neck fracture than on cancer of ovaries, uteral neck, and uterus, altogether. Statistics show that, considering only the Czech Republic, one person suffers a femur neck fracture every 30 seconds and 10 persons die due to consequences of osteoporotic fracture every day.
Process of diagnostics and therapy of osteoporosis runs optimally in so-called osteocentres, i.e. places specialized in diagnostics and therapy of skeleton diseases. It is always necessary to find out all risk factors of osteoporosis, densitometry examinations must be carried out, and secondary causes of osteoporosis must be excluded.

What are the risk factors of formation of osteoporosis: about 60% of the maximum bone mass is genetically conditioned; other impacts represent hormonal factors and lifestyle factors. Risk factors of osteoporosis include: incidence of osteoporosis in the family, menopause, higher risk in early menopause, higher risk in women without previous delivery, late onset of sexual maturity, long periods without menstruation in adulthood, slim figure, low body weight, smoking, lack of exercise and physical activity, low intake of calcium and vitamin D in diet, food intake disorders, digestive tract diseases and some other diseases, especially endocrinological ones, excessive intake of alcohol and coffee, use of some drugs, e.g. corticoids.

In general, osteoporosis can affect anyone, regardless of age and gender. Most serious threat relates to women during the period after menopause, when osteoporosis is formed due to lack of sexual hormones.

Osteoporosis is often called a silent thief of bones and a patient is surprised by sudden fracture without significant traumatic mechanism. In the beginning, osteoporosis can be demonstrated by indeterminate backache, later there can be a slight sensitivity of some vertebral thorns, and usually also reflexive spasm of paravertebral muscles. First symptom, however, is usually a sudden sharp pain in the area of thoracic spine and lumbar spine, occuring during usual activity or in rest, caused by compressive vertebral fracture.

Osteoporosis diagnose cannot be identified only on the basis of simple clinical examination or on the basis of x-ray images. These findings can only evoke suspicion on osteoporosis. It is the same with ultrasound devices, which are used in examination of heel bone, or x-ray devices used in examination of forearm; they can only lead to indications of risk patients.

Diagnosis must be identified by bone density measurement, made by so-called densitometer (DEXA). Densitometry determines bone density; it represents a special examination, which is exact, painless, and non-invasive. Examination takes about 30 minutes with minimum radiation burden, which roughly corresponds to a flight by plane. This method also monitors impact of the therapy on the bone and thus evaluates its effect. Interval of check-ups is always individual; control examination is mostly carried out after one or two years of therapy.

Aim of osteoporosis therapy is restitution of thinned bone tissue. Drugs used for osteoporosis therapy have different mechanisms of action, but the aim is the same: to prevent from osteoporotic fractures. At present we can choose from several drugs, which favourably affect bone mass loss. They are estrogens, bisphosphonates, estrogen receptors selective modulators, and calcitonin.