Osteoporosis in the elderly

Osteoporosis in the elderly is a disease of the skeleton, manifested by a decrease in bone mass and microstructural damage to bone tissue, leading to increased fragility of the bone and, as a result, an increased risk of fracture.

In osteoporosis, two main processes of bone metabolism are distinguished, each of which leads to a decrease in bone mass:

• a high degree of bone resorption is not compensated by normal or increased bone formation;
• The process of resorption is at a normal level, but the level of bone formation decreases.

Osteoporosis can be primary: juvenile, idiopathic in young adults, postmenopausal (type 1) and senile (type 2); or secondary - with thyrotoxicosis, Illness and Cushing syndrome, hypogonadism, hyperparathyroidism, type 1 diabetes mellitus, hypopituitarism, liver diseases, chronic renal failure, malabsorption syndrome, rheumatoid arthritis, sarcoidosis, malignant tumors, immobilization, treatment with certain medications (corticosteroids , barbiturates, heparin, anticonvulsants, immunosuppressants, aluminum-containing antacids).

Older and older people have both primary and secondary causes of osteoporosis. The total loss of compact substance by the age of 70 reaches 19% in men and 32% in women. The loss of a spongy substance after 25 years, regardless of sex, is, on average, 1% per year and to 70 years, up to 40%.

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What causes osteoporosis in the elderly?

Predisposing factors of osteoporosis are:

• Gender and composition: in men, because of the large amount of testosterone, the bone is initially thicker and stronger; in women, the processes of bone resorption are more active, especially during the menopause (in 50% - up to 1-2% per year) or after removal of the ovaries (they slow down at the birth of children - every birth reduces the risk of fractures by 9%); tall and thin people are more susceptible to osteoporosis than people of dense physique and short stature.
• Inactive, lifestyle: prolonged immobilization leads to osteoporosis, as well as being in zero gravity.
• Vitamin D deficiency: It is involved in the regulation of calcium absorption in the intestines and the mechanism of bone tissue formation (vitality is synthesized in the body under the influence of sunlight or comes in ready form with oil, fish oil, eggs, liver and milk).
• Alcohol and smoking: alcohol, regardless of sex, leads to a decrease in bone mass; Smoking in a greater degree affects the speed of osteoporosis in women.
• Heredity: There is a certain influence of genetic and family factors on bone density (for example, osteoporosis is rare in representatives of the Negroid race), and the contribution of hereditary factors to the variability of this indicator is up to 80%.
• Nutritional factors: the bone consists mainly of calcium and phosphorus, which are deposited in a protein matrix called the osteoid, and the balance of calcium depends on the intake of dietary calcium, the absorption of calcium in the intestine, and the degree of excretion in the urine, and then the feces.

How does osteoporosis manifest in the elderly?

Most susceptible to osteoporosis is the proximal humerus, the distal radius, the spine, the femoral neck, the large spit, the leg cramps.

Osteoporosis in the elderly is called a "silent" epidemic, as it often occurs in a low-symptom pattern and is detected already in the presence of bone fractures. However, the majority of patients have complaints about back pain (between the shoulder blades or in the lumbosacral region), increasing after exercise, prolonged stay in one position (standing or sitting). These pains are facilitated or disappear after resting lying, which is required by patients repeatedly throughout the day. In the anamnesis there may be indications of episodes of acute pain in the back, which were regarded as lumbosacral radiculitis due to osteochondrosis and deforming spondylosis. Indirect signs of the disease include senile stoop (hump), nocturnal leg cramps, fatigue, paradontosis, brittle nails and premature graying. And although the presence of these symptoms is not 100% confirmation of the diagnosis, it still allows you to determine the range of studies needed to refine it.

How to recognize osteoporosis in the elderly?

Traditional X-ray examination allows to determine the decrease in bone density from the level of 25-30%. Nevertheless, radiographs of the thoracic vertebrae are important, the reduction in their density often begins earlier than in other parts of the spinal column.

Bone densitometry, which measures the level of X-ray absorption by bone substance, allows estimating bone density as the basis of its strength. However, osteoporosis in the elderly is a disease of the protein matrix of the bone, and the content of minerals changes again and, in addition, this technique is not entirely accurate due to the measurement of only the projection mineral density (it depends significantly on the thickness of the bone) and bone tissue heterogeneity (increases with age the fat content in the bone marrow, which decreases the absorption coefficient).

The technique of dual-energy x-ray absorptiometry is recognized as the "gold standard" in the diagnosis of osteoporosis, as it has a number of beneficial properties: the ability to examine the axial skeleton, good sensitivity and specificity, high accuracy and low reproducibility error, low radiation dose (less than 0.03 meV), relative cheapness and speed of research.

Computed tomography (volumetric spiral CT) makes it possible to investigate the trabecular structure of both the spine and the femur, although it remains an expensive method with a high radiation load. With the same success can be used magnetic resonance imaging.

Quantitative ultrasound (ultrasonic densitometry) provides information not only about the mineral content, but also about other properties of bone that determine its "quality" (strength). With this method, you can examine the heel, tibia, phalanges of the fingers and other surface-located bones.

How is osteoporosis treated in the elderly?

Treatment of osteoporosis is a complex problem. Since the disease has a multicomponent pathogenesis and a heterogeneous nature. The goals of treatment of osteoporosis are:

• slowing or stopping the loss of bone mass, its increase is desirable on the background of treatment;
• preventing the development of bone fractures;
• normalization of bone metabolism;
• reduction or disappearance of pain syndrome, improvement of the general condition of the patient;

Expansion of motor activity, maximum possible restoration of work capacity and improvement of the quality of life of the patient. Systematic treatment of osteoporosis includes:

1. application of a diet balanced in calcium and phosphorus salts, protein: dairy products, small fish with bones, sardines, sprats, vegetables (especially green ones), sesame, almonds, peanuts, pumpkin and sunflower seeds, dried apricots, figs;
2. pain relievers in the period of exacerbation (non-steroidal anti-inflammatory drugs, analgesics);
3. use of muscle relaxants; dosed physical exercises and exercise therapy;
4. wearing corsets;
5. massage 3-6 months after the beginning of pharmacotherapy.

All means of pathogenetic treatment of osteoporosis can be divided into three groups:

• preparations with the predominant inhibition of bone resorption: natural estrogens (estragen-gestagenic preparations), calcitonins (myacalcic, sibacalcine calcitrine), bio-phosphonates (etidronate, alendronate, and reso- dronate);
• preparations stimulating bone formation: fluoride salts (sodium fluoride, monoflurophosphates), parathyroid hormone fragments, somatotropic hormone, anabolic steroids; preparations with a multifaceted effect on both processes of bone remodeling: vitamin D1 and vitamin D3, active metabolites of vitamin D3, alfacalcidone, calcitriol, osteogenone.

How can osteoporosis be prevented in the elderly?

Prevention of osteoporosis should be aimed at the timely detection and elimination of risk factors for the disease, diagnosis and adequate treatment in the early stages of the disease (before the onset of fractures).

The following measures are proactive:

• weight loss with a chain of reducing the load on the spine and joints;
• painstaking daily medical gymnastics directed precisely to the affected section of the skeleton;
• refusal to lift weights (weight more than 2-3 kg);
• compliance with the diet (refusal of concentrated broths, canned food, smoked products, coffee, chocolate;
• use of various combined food additives, vitamin preparations. Important in preventing the consequences of severe osteoporosis is the implementation of a set of social and individual measures to prevent injuries in elderly and senile people.