Osteopenia and osteoporosis
Bone is an extremely dynamic tissue that is continuously exposed to remodeling processes throughout life, depending on the different circumstances. It is made of a solid mineral part (mainly calcium and phosphate), incorporated and connected by an organic matrix, which is mostly collagen.
In bones, we find two types of cells that play an important role: osteoblasts (they produce and secrete organic matrix) and osteoclasts (they play a role in bone breakdown). Their function is influenced by hormones (vitamin D, parathyroid hormone and calcitonin), as well as some cytokines (IL-1, IL-6, TNF-α).
The most common chronic, metabolic bone diseases
Osteopenia and osteoporosis are the most common chronic, progressive and multifactorial bone diseases. They are characterized by a decrease in the amount and density of bone tissue along with a disruption of the bone architecture with an increased risk of fractures, especially in the area of the spine, hips and wrists.
Both clinical entities represent diseases of the elderly population, predominantly feemales and are a significant cause of chronic bone pain syndrome, disability and immobility. The loss of bone mass begins already between the ages of 20 and 30 and factors such as the individual's genetic structure, early menopause, lack of physical activity, a diet with low calcium and vitamin D content, the use of certain drugs (corticosteroids, drugs to reduce gastric acidity), smoking, alcoholism and restrictive diets, often significantly contribute to the early onset of these disorders.
Factors that change bone metabolism
It is considered that the share of the prevalence of osteopenia after the age of 50 is around 30 - 35%, while the prevalence of osteoporosis is around 6%. There are numerous etiological factors that change bone metabolism, the most important of which are a lack of the hormone estrogen (postmenopausal osteoporosis), a decrease in osteoblast activity in older age (senile osteoporosis), the use of drugs (corticosteroids, diuretics), increased thyroid function (hyperthyroidism), increased function of the parathyroid glands (hyperparathyroidism), pituitary diseases, reduced ovarian function, anorexia nervosa, deficient nutrition, vitamin D deficiency, chronic liver failure, chronic alcoholism, chronic kidney disease, rheumatoid arthritis, malignant diseases, etc.
- Postmenopausal osteoporosis (type I) is caused by a lack of the hormone estrogen in feemales and the hormone testosterone in males, occurs most often after the age of 60 and approximately 5 times more often in women. Low levels of estrogen and testosterone increase the activity of cytokines, which encourage osteoclasts to break down the bone.
- Senile osteoporosis (type II) occurs in older age (usually after the age of 60) and occurs as a result of a physiological decrease in the function of osteoblasts. People suffering from senile osteoporosis often have associated postmenopausal osteoporosis
Patients complain of pain in the bones, especially in the lower back, which arise as a result of fractures invisible to the eye, often without any reason. Fractures of the femur, forearm and spine occur very often, sometimes due to minimal trauma or pressure. The reduced height of the affected person with the development of spinal deformity (hunched posture), limitation of motion range in the joints, and muscle tension and soreness is striking.
Diagnostics and treatment
The diagnostic procedure consists of a specialist examination, laboratory and hormonal tests, measurement of bone density (densitometry) and other tests according to indications and complications. Osteoporosis is treated with increased intake of calcium and vitamin D, increased physical activity and special medication.