More money is spent on the treatment of osteoporosis than on the treatment of heart attacks and strokes, and after a hip fracture (the most formidable complication of osteoporosis) 36% of patients die, 11% remain permanently bedridden.
How to prevent the development of this disease? Tells Corresponding Member of the Russian Academy of Sciences, Professor, Director of the National Medical Research Center of Endocrinology of the Ministry of Health of Russia Natalya Mokrysheva.
Lydia Yudina, “AiF”: Natalia Georgievna, heart attacks and strokes are diseases that are on everyone’s lips. Only a few people know about osteoporosis. How common is it?
Natalia Mokrysheva: Osteoporosis – a systemic disease in which, due to the loss of calcium, there is a violation of the density and changes in the structure of bone tissue – every third woman in menopause and every fourth man over 50 years old. Women are more susceptible to osteoporosis, since the state of the bone depends on the level of the main female hormone – estrogen. After menopause, estrogen levels drop sharply and women lose up to 3-5% of bone mass per year.
This is an asymptomatic process that many are unaware of until the first fracture, which can occur with minor trauma. Often, the first manifestation of the disease is the most formidable consequence of osteoporosis – a hip fracture.
Indeed, less is known about osteoporosis than other diseases. Although the sooner a predisposition to it is revealed, the more opportunities to prevent it. Fractures without trauma are the “red flag” for starting the examination of a patient for osteoporosis.
Cattle are not a sentence
– It is believed that thinness is a direct path to osteoporosis. Does excess weight protect against disease?
It is not weight deficiency that leads to osteoporosis, but the conditions associated with it. For example, a lack of trace elements, primarily calcium and vitamin D. However, excess weight does not protect against disease! What’s more, type 2 diabetes, which is more common in obese patients, negatively affects bone density. Also, obese people are more likely to have vitamin D deficiency, which aggravates the development of osteoporosis.
Seriously increases the risk of disease, heredity (the presence of a hip fracture in parents was included by WHO as one of the risk factors for osteoporosis in a special risk calculator – FRAX), age, chronic diseases of the gastrointestinal tract (in which the absorption of nutrients is impaired), chronic renal failure, endocrine disorders. Such people need to constantly monitor the state of bone tissue.
– Which method is considered the most reliable?
– Today, for these purposes, densitometry is mainly used (X-ray is considered the most accurate), which measures the amount of mineral in the bone and allows you to calculate the density of bone tissue in various parts of the skeleton. This calculation is compared with the average, which is considered to be sufficient density. Such devices are now in most medical institutions in all regions of Russia, and each person has the opportunity to undergo this study. Once a year, those who belong to the risk group should pass it, every two years – all the rest.
Eat and run
– What do doctors recommend for people with a predisposition to osteoporosis?
– The easiest way to prevent complications is with an active lifestyle – physical activity (which provides blood supply to the periosteum – the sheath of the bone) and proper nutrition. The diet should contain a sufficient amount of protein foods high in calcium and foods containing vitamin D (fish, seafood, egg yolks). It is known that a person gains peak bone mass at the age of 20-25. Therefore, to achieve maximum bone density, such foods should be consumed from childhood. The daily rate of calcium (a building material for bones) is 1–1.5 thousand mg per day. The need for vitamin D depends on many factors and is calculated individually.
– And if osteoporosis has already developed, is it too late to eat fish?
– It’s never too late to eat right. Bone is a constantly renewing tissue. Therefore, all treatment regimens for osteoporosis still include recommendations for proper nutrition and exercise.
As for the direct treatment of osteoporosis, today there are two main groups of anti-osteoporotic drugs (bisphosphonates and a monoclonal antibody drug, denosumab). Their mechanism of action is different, but both reduce the intensity of bone destruction, due to which the cells of the bone tissue (osteoblasts) have time to synthesize new bone tissue. Due to this, the bone density increases. A fundamentally different approach to therapy has also been developed – anabolic, which stimulates bone formation.
Also, most patients with osteoporosis, in addition to the main therapy, are prescribed calcium and vitamin D preparations – calcium is a “building material” for increasing bone density, and vitamin D helps it to be absorbed in the intestines and get into the bones.
To each his own
– Once upon a time, all women were prescribed calcium supplements for preventive purposes. Then they were abandoned due to dangerous side effects. Does osteoporosis treatment have the same side effect?
– They did not refuse calcium preparations. They ceased to be appointed thoughtlessly. It used to be thought that most women have a calcium deficiency. However, studies have shown that hypercalcemia (high levels of calcium in the blood) is also common, and taking calcium supplements against this background can lead to dangerous consequences, in particular to the formation of kidney stones.
However, for those women who need calcium, calcium is still prescribed – under medical supervision and in combination with vitamin D.
As for anti-osteoporotic drugs, any treatment carries with it certain risks. For example, for patients with gastroenterological problems, we prescribe intravenous or subcutaneous drugs. Also, the attending physician, when prescribing therapy, must take into account the patient’s renal function.
– How will osteoporosis be treated in the future?
– Our goal is primarily to prevent osteoporosis. This can be done by screening the general population, checking blood calcium levels regularly, and taking action as soon as an abnormality is detected. Work on the creation of new, better drugs for the treatment of osteoporosis is ongoing. But it is easy and relatively inexpensive to control the incidence of osteoporosis only through prevention.
To date, no “miraculous pill” has been developed to prevent a hip fracture. But promptly started treatment can significantly improve the condition of bone tissue and reduce the risks of this fracture to the level of risks of a healthy person.
The main way to combat osteoporosis in the future should be its prediction, detection at the earliest stages and preventively prescribed treatment. We pin great hopes on artificial intelligence technologies – computer programs that allow us to make high-precision predictions based on Big Data analysis.
There are contraindications. Be sure to consult your doctor