Postmenopausal osteoporosis. How to treat postmenopausal osteoporosis? Postmenopausal osteoporosis symptoms

Pathological destruction of bone tissue caused by systemic metabolic disorders due to hypoestrogenism. In half of the cases, it proceeds hidden and is diagnosed after the onset of a fracture. It can manifest itself as pain in the sacrum, lower back, interscapular region, pelvic bones, forearm and lower leg, curvature of the spine, and a decrease in growth. It is diagnosed using densitometry, determining the level of calcium, phosphorus, bone resorption markers, calcitonin, and parathyroid hormone. Hormonal agents, osteoresorption inhibitors, osteosynthesis stimulators, calcium and vitamin D preparations are used for treatment.

General information

Primary postmenopausal osteoporosis is the most common variant of osteoporotic disease, accounting for more than 85% in the structure of this metabolic disease. musculoskeletal system. According to WHO, a densitometrically confirmed decrease in bone mineral density and a violation of their microarchitectonics is observed in 30-33% of women over 50 years old. In Russia, the frequency of forearm fractures typical of osteoporosis is more than 560 cases per 100,000 postmenopausal patients, osteoporotic hip fractures - more than 120 per 100,000. The social significance of the pathology is determined by its impact on disability and mortality in older women.

Causes

A decrease in bone mass and a violation of the microarchitectonics of bones during postmenopause is associated with involutive processes occurring in the female body and age-related changes in lifestyle. Specialists in the field of gynecology have studied in detail the causes of the disorder and predisposing factors. Osteoporosis in older women is caused by:

• Decreased estrogen levels. Female sex hormones are involved in the metabolism of calcium - an important structural component of bones, which ensures their strength, renewal and restoration of bone tissue. Hypoestrogenism develops with insufficiency or extinction of ovarian function, drug suppression of estrogen secretion, surgical removal of an organ in patients with tumors, endometriosis, ectopic pregnancy.
• Irrational nutrition. Calcium deficiency occurs with limited consumption of dairy products, fish, dietary meats, legumes, herbs, vegetables, fruits against the background of an excess of easily digestible carbohydrates, fats, coffee, strong tea. Such a diet is characterized by a low content of calcium, substances that promote the absorption of the mineral by the body, and an increased concentration of inhibitors of its absorption in the intestine.
• Low physical activity. With age, a woman's mobility decreases. The situation is aggravated by a decrease in the time of natural insolation, the presence of overweight, diseases and pathological conditions that limit the ability to move independently - prolonged bed rest in the treatment of chronic somatic pathology, the consequences of past cerebrovascular accidents and heart attacks.

Risk factors for osteoporosis in the postmenopausal period are age over 65, Caucasian race, early menopause, underweight, a history of dishormonal disorders, smoking, and alcohol abuse. The influence of heredity is not excluded - the disease is more often detected in women whose close relatives suffered from osteoporosis or had frequent fractures. The likelihood of damage to the skeletal system also increases with more than three months of taking glucocorticoid drugs that affect calcium metabolism.

Pathogenesis

In postmenopausal osteoporosis, the balance between osteosynthesis and osteoresorption, the main mechanisms of bone tissue remodeling, is disturbed. Against the background of estrogen deficiency, the secretion of calcitonin, a thyroid hormone, which is a functional parathyroid hormone antagonist, decreases, and the sensitivity of bone tissue to the resorptive action of parathyroid hormone increases. The main effect of parathyroid hormone is an increase in the concentration of calcium in the blood due to increased transport through the intestinal wall, reabsorption from primary urine and osteoresorption. In parallel with this, osteoclasts are activated - cells that destroy bone tissue, insulin-like growth factors 1 and 2, osteoprotogerin, transforming β-factor, colony-stimulating factor and other cytokines that enhance bone resorption.

Additional elements of pathogenesis that contribute to the development of osteoporosis are the deterioration of mineral absorption due to subatrophy of the intestinal epithelium and vitamin D deficiency, for sufficient secretion of which a longer exposure to the sun is required. A decrease in motor activity in the postmenopausal period leads to a decrease in dynamic loads on the musculoskeletal system, which also slows down the processes of its remodeling. The situation is exacerbated by the deterioration of calcium absorption in the intestines and its increased excretion in the urine when taking glucocorticoids, often used in the treatment of endocrine, autoimmune, inflammatory and other diseases that affect elderly patients.

Symptoms of postmenopausal osteoporosis

In almost half of women, the disease is asymptomatic and is detected only after a fracture caused by minor trauma. In other cases, the symptoms progress gradually. As the bone mass is lost, the patient begins to feel pain in the lumbosacral region, which intensifies when lifting heavy objects, turning, walking. Subsequently, there is a feeling of heaviness in the interscapular space, pain in the pelvic ring, long tubular bones of the leg. To get rid of pain and discomfort, additional rest in the supine position is required throughout the day.

The increase in the intensity of painful sensations leads to the fact that over time they disturb the patient even at rest. Usually, a violation of posture and curvature of the spine is accompanied by kyphosis. Often, postmenopausal women with osteoporosis complain of weakness, fatigue during physical exertion. Compression fractures of the lower thoracic and upper lumbar vertebrae with a decrease in their height, spontaneous fractures or fractures of the ankles, bones of the forearm, and femoral neck become extreme forms of manifestation of the pathology. characteristic feature- a decrease in height by several centimeters per year.

Complications

The most serious consequence of postmenopausal osteoporosis is disability due to curvature of the spine and frequent fractures of the extremities, aggravated by constant pain in the bones. It is difficult for the patient to move not only over long distances, but also around the house, take care of herself, and perform simple household activities. A significant deterioration in the quality of life can provoke emotional disorders - anxiety, tearfulness, hypochondria, a tendency to a depressive response. Some women with osteoporosis have long-term insomnia.

Diagnostics

If compression changes in the spine or typical fractures of the extremities are detected in a postmenopausal patient, osteoporosis must first be excluded. For diagnostic purposes, methods are used to assess the architectonics of bone tissue and the degree of calcium saturation, as well as to detect biochemical markers of bone damage. The most informative are:

• Densitometry. Modern dual-energy X-ray osteodensitometers determine with high accuracy how much reduced bone density is. With their help, it is easy to assess the mineralization of "marker" bones (forearm, hip joint, lumbar vertebrae) and the whole body. The method is applicable for diagnostics early stages postmenopausal osteoporosis. Instead of the classic dual-energy study, ultrasound screening of bone density (echodensitometry), CT densitometry can be performed.
• Biochemical blood test. In the course of laboratory tests, the content of calcium, phosphorus and some specific markers are determined, indicating a violation of bone remodeling. With an increase in age-related bone resorption, the level of alkaline phosphatase, osteocalcin in the blood, and deoxypyridonolin in the urine increases. When correlated with creatinine excretion, the determination of calcium in the urine is quite specific, the content of which increases with increased resorptive processes in bone tissue.
• Hormone analysis. Since postmenopausal osteoporosis is pathogenetically associated with age-related hormonal imbalance, it is indicative for diagnosis to study the level of thyrocalcitonin (TKT) and parathyrin. With an involutive disorder of bone resorption, the concentration of calcitonin in the blood decreases, while the level of parathyroid hormone remains normal or low. A control study of the content of sex hormones confirms the natural age-related hypoestrogenism.

Differential diagnosis is carried out with senile and secondary osteoporosis, malignant bone tumors and bone metastases, multiple myeloma, fibrous dysplasia, Paget's disease, common traumatic fractures, scoliosis, spinal osteochondropathy, peripheral neuropathy. If necessary, the patient is consulted by an orthopedist, traumatologist, endocrinologist.

Treatment of postmenopausal osteoporosis

The main goal of therapy is to prevent possible fractures by improving the mineralization and architectonics of the bones while improving the quality of life of patients. For this, complex anti-osteoporotic therapy is used, aimed at various links in the pathogenesis of the disease. The standard treatment regimen for osteoporosis caused by postmenopausal changes in a woman's body includes the following groups of drugs:

• Bone resorption inhibitors. Estrogens, their combinations with progestins or androgens prevent premature bone destruction and are recommended when maintaining menopausal manifestations in the first years of postmenopause. If there are contraindications or the patient refuses to take sex hormones, it is possible to replace them with phytoestrogens, selective modulators of estrogen activity or estrogen receptors. In addition to hormone replacement therapy, calcitonin, bisphosphonates, and strontium preparations have the effect of slowing down resorption.
• Bone stimulants. Strengthening osteogenesis contributes to the appointment of parathyroid hormone, anabolic steroids, androgens, somatotropin, fluorides. Accelerated bone remodeling with the use of these drugs is achieved by activating osteoblasts, enhancing anabolic processes, and stimulating hydroxylation. It should be borne in mind that in postmenopausal disorders, the use of such drugs is limited by a number of contraindications and possible complications.
• Means of multifaceted action. The mineralization and architectonics of bone tissue improves when taking calcium supplements, especially in combination with vitamin D, which makes it possible to classify such drugs as basic. The osseino-hydroxylate complex and flavone compounds also have a versatile effect on the processes of osteogenesis and bone destruction, which, with a minimal likelihood of complications, effectively inhibit the function of osteoclasts responsible for resorption and demineralization, stimulating osteoblastic osteopoiesis.

Effective treatment of osteoporosis in postmenopausal women is impossible without lifestyle and dietary changes. Elderly patients are recommended moderate physical activity with the exception of falls, heavy lifting, sudden movements. It is necessary to add calcium-rich foods to the diet - milk, cottage cheese, hard cheese, legumes, fish, and other seafood, refusing to abuse coffee and alcoholic beverages.

Forecast and prevention

Although postmenopausal osteoporosis is a progressive disease, regular supportive care and a healthy lifestyle can greatly reduce the chance of fractures. As a preventive measure, postmenopausal women are recommended to take calcium supplements containing vitamin D, dosed insolation, diet correction, sufficient physical activity, taking into account the age norm, smoking cessation, limited consumption of products containing caffeine (coffee, tea, chocolate, cola, energy drinks) . When signs of osteoporosis are identified, corsets and hip protectors can become effective protection against stress that provokes fractures.

After the onset of menopause, a number of changes occur in the body of a woman, which are more related to the restructuring of the balance of hormones. This affects the state of almost all body systems, including bone tissue. Hypoestrogenism caused by metabolic disorders often leads to the destruction of bone tissue, which causes osteoporosis. To prevent the development of the disease, effective prevention is necessary.

Postmenopausal osteoporosis: main causes

According to statistics, 33% of women aged 50 years have a decrease in the mineral density of the tissue. Primary postmenstrual osteoporosis is one of the most common types of osteoporotic disease.

Osteoporosis after menopause is quite common. It manifests itself as increased fragility of bones and a tendency to fracture. Diagnosis of pathology occurs after the appearance of fractures. The main cause of postmenopausal osteoporosis is the decline in ovarian function associated with age-related changes.

The decrease in skeletal mass begins already from 35-40 years. This is due to the onset of menopause, when estrogen production decreases, so timely prevention is necessary to prevent the disease.

Postmenopausal osteoporosis: what is it and what provokes it?

Postmenopausal osteoporosis is accelerated bone loss associated with the cessation of menstruation. Further disruption of bone microarchitectonics may be associated with lifestyle changes. The main reasons for the development of pathology include:

• Decreased estrogen production. Female hormones are actively involved in the process of assimilation of calcium - one of the building materials of bones. With a lack of this element, the bones begin to collapse.
• Wrong nutrition. A lack of calcium can be caused by an unbalanced diet, when there is not enough dairy products, fish, meat, vegetables, legumes, and fruits in the diet.
• Insufficient physical activity. With age, a woman becomes less mobile. Excess weight, various diseases that exclude the possibility of independent movement, and bed rest can aggravate the situation.
• Age over 65 years. Women over the age of 65 are most at risk of developing osteoporosis.

The risk of developing the disease increases with a hereditary predisposition, a strong decrease in body weight, smoking, and excessive alcohol consumption.

Postmenopausal osteoporosis: diagnosis and symptoms

In most women, the pathology proceeds without symptoms. Diagnosis occurs already at the time of the fracture, provoked by minor trauma.

Symptoms of postmenstrual osteoporosis progress gradually. As the bone mass decreases, pain in the lumbar region begins to appear, which intensifies at the time of movement, weight lifting.

To get rid of pain and discomfort in the back during the day, you need additional rest in a horizontal position.

Other symptoms of osteoporosis include:

• fatigue, feeling of heaviness in the spine;
• pain in the bones in the pelvis, legs;
• compression fractures of the spine, radius bones, ankles, femurs that occur with the slightest falls and bumps;
• violation of the correct posture.

One of the tell-tale signs of postmenopausal osteoporosis is a fracture, or a few centimeters of height loss over the course of a year.

Postmenopausal osteoporosis: the formulation of the diagnosis, how to determine the violation

Diagnosis of postmenopausal osteoporosis consists in the delivery of tests and some procedures, including:

• analysis of the symptoms and complaints of the patient;
• study of information regarding diseases of relatives;
• analysis of gynecological diseases, surgeries, the number of pregnancies and their interruptions;
• determining at what age menstruation began and ended;
• performing dual-energy X-ray absorptiometry, which determines bone density
• analysis of daily urine for calcium levels;
• blood chemistry;
• study of biochemical indicators of bone damage.

Postmenopausal osteoporosis: treatment and prevention

One of the most effective options for the treatment of postmenopausal osteoporosis is bisphosphonates (drugs in the structure of which the oxygen atom has been replaced by a carbon atom).

Treatment of postmenopausal osteoporosis is aimed at maintaining and increasing bone mass. The therapy includes the following components:

• therapeutic exercises and a diet rich in dairy products, legumes, seafood;
• wearing special orthopedic products that reduce the risk of fractures;
• one of effective treatments postmenopausal osteoporosis - preparations with a high content of calcium and vitamin D;
• improvement of hormonal balance due to hormone therapy;
• taking drugs whose action is aimed at slowing down the destruction of bone tissue - these are, for example, bisphosphonates for the treatment of postmenopausal osteoporosis;
• the appointment of funds to enhance bone formation.

After the diagnosis of postmenopausal osteoporosis is formulated, emergency therapy is required, which will help to avoid various complications.

Preventive measures are always recommended to rule out the symptoms of postmenopausal osteoporosis treatment. Timely visits to the doctor, a balanced diet, physical activity are the main guarantee of disease prevention.

Clinical recommendations for postmenopausal osteoporosis include not only proper nutrition and an active lifestyle, but also additional intake of calcium and vitamin D supplements, which should be carried out at times of increased risk of bone depletion: childhood, pregnancy, menopause. It is also important to give up bad habits, reduce caffeine intake, dose exposure to the sun, and undergo gynecological examinations on time. You can go through the diagnosis and consult with a specialist.

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It is extremely important for women to know everything about their health - especially for primary self-diagnosis. This rapid test will allow you to better listen to the state of your body and not miss important signals in order to understand whether you need to contact a specialist and make an appointment.

Postmenopausal osteoporosis is a pathology of skeletal bones, accompanied by their increased fragility and fragility, susceptibility to fractures. Its development begins due to the gradual extinction of ovarian function, which is observed after 35-40 years.

Since the cessation of menstruation (regular uterine bleeding due to physiological rejection of the endometrium lining the uterus), the decrease in skeletal mass and strength accelerates significantly. The development of osteoporosis, associated with a lack of female sex hormones estrogens, is recorded in 85% of cases and occurs mainly in white and Asian women.

Causes

Osteoporosis belongs to the "honorable" fourth place, the first three are already occupied by cardiovascular, oncological and bronchopulmonary pathologies. The following factors contribute to bone demineralization:

• late onset (after 15 years) and earlier cessation (up to 45 years) of menstruation;
• low body weight, slenderness at BMI
• elderly age;
• genetic predisposition;
• fractures, including old ones that happened several years ago;
• operations on the ovaries, primarily bilateral oophorectomy (removal of both appendages);
• lack of menstruation for more than a year, cycle disorders in reproductive age;
• the birth of three or more children;
• long lactation period, more than 6 months;
• deficiency of calcium and vitamin D in the diet;
• too high physical activity or, conversely, a sedentary lifestyle;
• drinking coffee, strong tea and alcoholic beverages in large doses;
• long-term therapy with glucocorticosteroid hormones, for example, in renal pathologies.

The mechanism of the effect of estrogens on bones remains poorly understood. However, there is no doubt that these hormones, coupled with physical activity and a balanced diet, are the main factors that determine the mass and quality of bone structures.

The value of sex hormones and their deficiency is especially important in adolescence, fertile and menopause. The formation of the skeleton is highly dependent on the ratio of female and male hormones, and the activation of intraosseous metabolism can be traced in the increasing increase in the skeleton.

Bone mass peaks between the ages of twenty and thirty. While maintaining all the protection factors, which include physical activity, good nutrition and the synthesis of sex hormones in sufficient quantities, conditions are created for normal and natural aging of bones.

In osteoporosis, the bones become loose and brittle, and even a slight blow can cause a fracture.

This process starts after a woman reaches 40-45 years of age, during the first 5-10 years, the production of hormones gradually but steadily falls. As a result, bone metabolism is accelerated, and there is a loss of bone substance from 3 to 5% annually. The ratio of maximum bone density and the rate of bone loss determines the risk of developing postmenopausal osteoporosis.

A drop in the level of female sex hormones leads to an acceleration of bone metabolism due to increased resorption processes. This, in turn, causes a decrease in bone mineral density. Estrogen hormones play a very important role in the regulation of bone metabolism, but the key reasons for this process are genetic.

Symptoms

In more than half of the cases, postmenopausal osteoporosis occurs in a latent, latent form. A woman learns about the disease only after a fracture has occurred, for which there were no special reasons.

The main complaints of patients who have noticed suspicious symptoms after menopause are the following:

• pain in the lower back and between the shoulder blades, aggravated after exercise and walking;
• weakness and fatigue;
• violation of posture, curvature of the spine, decrease in growth.

As the disease progresses, the pain syndrome becomes stronger and becomes unrelenting. Often the cause of pain is microfractures of the trabeculae (spongy bone substance) that occur after heavy lifting or a sudden movement.

The most commonly diagnosed fractures are the lumbar and thoracic vertebrae, wrist, ankle, and hip. In the future, the vertebrae are deformed, the muscles weaken, and kyphosis is formed. thoracic spine.

With a fracture of the vertebrae, not only the height of a person decreases, but motor activity is also greatly reduced, up to the inability to self-service. If the growth has become less than 2 cm, then this is a good reason to suspect the development of osteoporosis.

Classification

Osteoporosis can be primary and secondary. The primary form of the disease develops in 85% of cases and does not always have an obvious cause.

Postmenopausal osteoporosis is primary, the secondary form occurs against the background of the following conditions:

• endocrine pathologies;
• diseases of the gastrointestinal tract;
• prolonged immobility;
• chronic kidney failure;
• reception hormonal drugs and Heparin for 3 or more months;
• hematological diseases.

Diagnostics

After the initial examination and history taking, the patient is assigned laboratory and instrumental studies. To assess the condition of the bone tissue, dual-energy radiodensitometry is most often performed. This method, not without reason, is considered the most effective in the postmenopausal period, since it allows you to determine the mineral density of the bones of the axial skeleton and thigh.

Densitometry is a modern method for determining bone density using X-rays.

Ultrasound densitometry is somewhat less commonly prescribed. X-ray examination is advisable only with a loss of bone mass of more than 30%.

If osteoporosis is suspected, it is necessary to pass a general and biochemical analysis of blood and urine. According to indications can be assigned:

• blood test for hormones (FSH, estradiol, thyroid-stimulating hormone);
• coagulogram (to assess blood clotting);
• Ultrasound of internal organs, mammography;
• X-ray of the spine in oblique projection (thoracic and lumbar).

In rare cases, the doctor directs for an MRI of the spine and the passage of genetic tests. The most significant indicators in the blood are the level of calcium and calcitonin, according to the results of urine analysis, the content of hydroxyproline, type 1 collagen stelopeptides and serum osteocalcin is detected.

Treatment

The main goal of osteoporosis therapy is to reduce bone loss, normalize indicators of bone homeostasis markers, improve bone quality and reduce the incidence of fractures. The fulfillment of all these conditions allows to improve the quality of life of patients, relieving them of pain and returning the possibility of normal physical activity.

A well-designed treatment regimen for menopause can improve the processes of bone remodeling, to achieve this goal, several groups of drugs are used:

• hormone replacement therapy, HRT. It is carried out mainly with combined preparations with low doses of estrogen and progesterone. The exception is patients whose uterus has been removed, in which case estrogen monotherapy is sufficient;
• bisphosphonates and calcitonins have an antiresorptive effect;
• vitamin D metabolites;
• Osteokhin (Ipriflavon) refers to drugs of natural origin that have a beneficial effect on the balance of osteosynthesis and osteoresorption;
• in rare cases, anabolic steroids, growth hormone, androgens and fluorides are prescribed. These drugs are also able to enhance the process of formation of new bone tissue;
• Calcium carbonate in combination with Colecalciferol is recommended to be taken for a long time, throughout life.

The duration of hormone replacement therapy is at least three to five years, it is best to start it already during the perimenopause. It is at this time that bone loss accelerates due to the fading of ovarian function. It is worth noting that older women are prescribed a half dose of hormonal agents, since this is quite enough to reliably protect the bones.

If the patient's age is more than 60 years, then the drugs of choice are bisphosphonates or Calcitonin, as well as selective estrogen receptor modulators and Strontium Ranelat (Bivalos).

The use of hormone replacement therapy has a number of advantages and helps to improve not only the condition of the bones. Taking medications of the estrogen-progestin group greatly contributes to reducing the intensity of the autonomic symptoms of menopausal syndrome up to their complete disappearance.

In addition, HRT is an excellent prevention of urogenital disorders and malignant neoplasms of the colon. Women who take hormones for medicinal purposes also note an improvement in the condition of the skin and hair, an increase in muscle tone.

Bivalos (Strontium Ranelat) stimulates the formation of new bone tissue and slows down the process of their destruction

For the relief of acute pain in vertebral fractures, Calcitonin is prescribed in the form of a spray. The drug is administered intranasally every day for several years.

If a woman is prescribed hormonal treatment, then the first control examination is carried out after 3 months. In the future, it is necessary to visit a doctor every six months, and once a year to do mammography, osteodensitometry, ultrasound of the pelvic organs and a cytology test (cervical cytological smear).

Surgical treatment of postmenopausal osteoporosis is carried out only with complications, in particular with a fracture of the femoral neck.

No matter how trite it may sound, but the best prevention of osteoporosis is a healthy lifestyle. Particular attention should be paid to diet and regular physical activity. The menu should have enough calcium-containing foods. These include all types of dairy and sour-milk products, as well as dried apricots, sardines, almonds and sesame seeds.

Vitamin D has the ability to increase the absorption of calcium by almost 70% and reduce the rate of its excretion from the body. Synthesis of vitamin D occurs under the influence of sunlight, but living in regions with low solar activity can cause its deficiency. You can compensate for the deficiency with the help of products, for example, fish oil and liver.

Osteoporosis is a common chronic systemic disease of the skeleton, which is characterized by a decrease in bone mass and disturbances in the microarchitectonics of bone tissue. These changes lead to bone fragility and, consequently, to a tendency to fracture. For osteoporosis, compression fractures of the vertebrae and the following fractures of the peripheral skeleton are most characteristic: the distal forearm, the proximal femur (neck or transtrochanteric region), and the neck of the shoulder.

A WHO report (2007) provides evidence of a high prevalence of this disease in various populations. Thus, osteoporosis is the cause of 8.9 million fractures occurring in the world annually. The lifetime risk of breaking a forearm, hip or spine is 30-40%, which corresponds to the risk coronary disease hearts. It is also important that osteoporosis occupies one of the leading places among diseases leading to immobility, disability and death. The vast majority of cases of osteoporosis occur in postmenopausal women (postmenopausal osteoporosis).

According to calculations, in Russian Federation 14 million people (10% of the country's population) suffer from osteoporosis, another 20 million have osteopenia. Thus, in Russia, 24% (34 million) of the population is in the group of potential risk of osteoporotic fractures. At the same time, every minute in the country in people over 50 years old, 7 fractures of the vertebrae occur, every 5 minutes - a fracture of the femoral neck.

Diagnosis of postmenopausal osteoporosis and subsequent treatment is based on clinical manifestations and an assessment of the risk of fracture. Postmenopausal osteoporosis can be diagnosed clinically based on the patient's minor traumatic fracture. The very fact of having such a fracture in history is evidence that the risk of subsequent fractures is very high. In addition, the risk of fracture can be assessed by densitometric examination of bone tissue (X-ray dual energy absorptiometry), as well as by calculating the 10-year absolute risk of fractures (FRAX) at http://www.shef.ac.uk/FRAX/index.jsp ?lang=rs . The FRAX calculator determines the likelihood of osteoporotic bone fractures based on the presence of clinical risk factors for osteoporosis and fractures in a patient, and the calculation is possible even without a densitometric study.

The main cause of bone loss in postmenopausal women is estrogen deficiency. Already in the first 5 years of postmenopause, the annual loss of bone mass in the spine is about 3%. Postmenopausal osteoporosis develops due to a significant increase in the rate of bone tissue remodeling due to the fact that estrogen deficiency leads to an increase in the number and activity of osteoclasts. The associated increased resorption, not compensated by adequate bone formation, leads to irreversible bone loss. High activity of osteoclasts causes perforation of trabeculae at the site of resorption, which leads to disturbances in the microarchitectonics of the bone and a decrease in its density. Thus, pharmacological correction of these pathogenetic mechanisms should be aimed at suppressing excessive bone resorption by osteoclasts and stimulating bone formation by osteoblasts.

Treatment of postmenopausal osteoporosis

The main goal of osteoporosis treatment is to prevent fractures. Based on the essence of the disease itself, this goal is achieved by increasing bone mineral density and improving its quality. In addition, a patient with pain syndrome must be adequately anesthetized, especially for patients with spinal lesions. One of the most important tasks of treatment is also the prevention of falls.

The effectiveness of the drug in the treatment of osteoporosis must be proven in multicenter, randomized, double-blind, placebo-controlled studies in which the primary endpoint is a reduction in the number of fractures characteristic of osteoporosis. A decrease in bone resorption markers and an increase in bone mineral density should also be demonstrated during long-term treatment (3-5 years). According to the recommendations of the Russian Osteoporosis Association, nitrogen-containing bisphosphonates and strontium ranelate are the first-line drugs for the treatment of osteoporosis. Recently, a new drug, denosumab, has joined them.

Bisphosphonates are stable analogues of naturally occurring pyrophosphates. They are embedded in the bone matrix, remain there for a long time and suppress bone resorption by reducing the activity of osteoclasts. Bisphosphonates are now an established method for the prevention and treatment of osteoporosis in both men and women. Studies successfully conducted in tens of thousands of patients have shown that bisphosphonates are safe, well tolerated, have few side effects, inhibit bone resorption, increase bone mineral density (BMD), and reduce the risk of fracture.

Currently, several bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid) are used in clinical practice with various routes and regimens of administration. The best known and well studied bisphosphonate is alendronate. Its clinical efficacy has been proven in qualitative studies in patients with osteoporosis, in particular in the presence of vertebral fractures (recommendation grade A). It is also effective in preventing osteoporosis in postmenopausal women with osteopenia (recommendation grade A). On average, alendronate reduces the risk of fractures of various locations by 50%, and the risk of multiple vertebral fractures by 90%. The drug is prescribed at a dose of 70 mg (1 tab.) once a week. In postmenopausal osteoporosis, risedronate 35 mg per week is also used.

Bisphosphonates have low bioavailability and also have a number of side effects, in particular, can cause inflammatory lesions and erosions of the lower esophagus. To prevent this side effect and increase bioavailability, a bisphosphonate tablet should be taken in the morning on an empty stomach with 1-1.5 glasses of water, after which do not take a horizontal position and do not eat for 40-60 minutes. Such a complex regimen, unfortunately, leads to low adherence of patients to compliance with the recommendations. It is known that after a year only 30% of those patients who take bisphosphonates daily, and about 45% of those who take them once a week, continue treatment.

Recently, new bisphosphonates have appeared that have shown high efficacy and good tolerability with less frequent use, which increases compliance and adherence of patients to treatment. This is ibandronate, which is taken orally as a tablet 150 mg once a month or intravenously at a dose of 3 mg every 3 months, is indicated for postmenopausal osteoporosis; and zoledronic acid given once a year (5 mg).

Strontium ranelate is the first anti-osteoporotic drug that has a dual mechanism of action: it simultaneously stimulates bone formation and inhibits bone resorption. Strontium ranelate restores the balance of bone metabolism in favor of the formation of new and strong bone tissue, which provides early and long-term efficacy in the prevention of fractures of the spine and peripheral skeleton in postmenopausal osteoporosis. The drug is taken in powder (sachet 2 g) once a day, preferably at night, it must first be dissolved in a glass of water. Treatment with strontium ranelate, as with other drugs for osteoporosis, must be combined with calcium and vitamin D, but taken no earlier than 2 hours after calcium.

Denosumab is a new distinct class of drugs. It is a biological product that is a monoclonal antibody to the kappa-B factor activator receptor ligand (RANKL). The receptor itself (RANK) is the most important link in the activation of osteoclasts, however, without the presence of a ligand (RANKL), its activation does not occur. It has been shown that excessive production of RANKL by osteoblasts underlies the development of postmenopausal osteoporosis. It leads to the formation a large number and excessive activity of osteoclasts, which manifests itself in increased bone resorption. Blockade of RANKL by the corresponding monoclonal antibody, which is denosumab, leads to a rapid decrease in the concentration of bone resorption markers in blood serum and an increase in bone mineral density in all parts of the skeleton. These processes are accompanied by a reduced risk of fractures, including fractures of the spine, proximal femur, and other non-vertebral fractures. Denosumab is injected subcutaneously through a syringe tube already filled with the drug once every 6 months.

Before prescribing anti-osteoporotic drugs, it is necessary to examine serum calcium and creatinine clearance. Low serum calcium levels are most commonly caused by vitamin D deficiency and are fully corrected when given with adequate dietary and/or drug calcium intake. With creatinine clearance less than 30 ml / min, bisphosphonates and strontium ranelate are not prescribed. However, denosumab can be prescribed for chronic renal failure, while dose adjustment is not required.

Treatment of osteoporosis with any of these drugs should be long - at least 3-5 years. An obligatory component of any treatment regimen for osteoporosis is an adequate intake of calcium and vitamin D, although they have no independent value in the treatment of the disease, except for the prevention of hip fracture in elderly patients with vitamin D deficiency.

The daily requirement of calcium depends on the age of the patient and ranges from 800 to 1500 mg of ionized calcium. Dairy products are the main source of calcium. In addition, calcium is found in green leafy vegetables, cereals and soft fish bones, but in significantly lower amounts than in dairy products. To cover the daily need for calcium, it is enough to eat 6 glasses of low-fat milk or dairy products, or 200 g of hard cheese, or 1.5 kg of low-fat cottage cheese. In the case of low intake of calcium from food, which most often happens when dairy products are intolerant or unwilling to include them in the diet, in order to prevent osteoporosis (or if the disease has already developed), it is necessary to add calcium to food in the form of drugs. More than 70% of Russian residents consume less than half of the calcium required by age with food, which needs to be corrected.

Vitamin D is a group of steroid hormones that are formed in the body from dietary vitamins D2 and D3 and synthesized in the skin under the influence of ultraviolet rays (UVB) of vitamin D3. Vitamin D is an important regulator of bone metabolism. It enhances calcium absorption in the gastrointestinal tract, reduces calcium excretion in the kidneys, improves bone quality and enhances bone repair. A very important effect of vitamin D is to increase muscle strength and coordination. Co-administration of vitamin D3 with calcium has been shown to significantly reduce the risk of falls and, in older women, to reduce the incidence of hip fracture. Recently, evidence has emerged that vitamin D deficiency may be associated with the development of other diseases, such as arterial hypertension, diabetes, multiple sclerosis, tumors of various localizations, etc.

People living north of the 40th latitude, during 3-4 winter months (and in some areas up to 6 months) are not exposed to sunlight, which means that during this time vitamin D is not synthesized in their skin. It is believed that for inhabitants of the northern latitudes, sunlight is not enough without taking vitamin D with food. However, vitamin D contains only a limited number of food products. These are fatty fish (herring, mackerel, salmon), fish oil, liver and fat of aquatic mammals.

It is known that in older people the ability of the skin to produce D3 is reduced. There is evidence that its absorption in the intestine also decreases with age. In addition, many people in older age groups do not leave the house due to chronic diseases that cause shortness of breath or joint pain, which limits their insolation. All this makes the additional administration of vitamin D extremely important. It is worth recalling that the intake of vitamin D must necessarily accompany the pathogenetic treatment of osteoporosis with antiresorptive agents or strontium ranelate. An additional benefit is the reduction in the risk of falls while taking vitamin D supplements, which plays a positive role in the prevention of fractures. The daily dose of vitamin D should be at least 800 IU. Vitamin D is desirable to add to calcium preparations, since it increases the absorption of calcium in the gastrointestinal tract by 50-80%. It should be noted that an adequate intake of calcium and vitamin D is important at any time in a woman's life and should not be limited to postmenopausal women. With a lack of dairy products in the diet, as well as in late winter - early summer, it is useful to additionally take calcium and vitamin D supplements.

In addition to the above first-line treatment of osteoporosis, salmon calcitonin, a synthetic analogue of the thyroid hormone calcitonin, which is involved in the regulation of calcium homeostasis, can be used in some cases. A feature of the drug Miacalcic containing salmon calcitonin is that it reduces the risk of fractures in the absence of pronounced BMD dynamics, which is explained by its positive effect on the quality of bone tissue (its microarchitectonics). The risk of new vertebral fractures in the treatment of Myacalcic is reduced by 36%. At the same time, the drug has another property that is widely used in clinical practice: Myacalcic has a pronounced analgesic effect in pain caused by fractures.

Hormone replacement therapy (HRT) with female sex hormones is highly effective in postmenopausal women with low mineral density (osteopenia) in preventing osteoporosis and vertebral and other fractures, including the femoral neck (recommendation grade A). However, it is known that the risks of its use may outweigh the benefits. Thus, it has been shown that long-term use (more than 5 years) is associated with the risk of developing breast cancer, coronary heart disease and stroke (recommendation grade A). In addition, one of the serious side effects of hormone replacement therapy is venous thrombosis (A). Therefore, when prescribing this treatment, the patient should be warned about possible complications.

At the same time, HRT is a first-line prophylactic therapy in women with menopause up to 45 years of age (recommendation level D), as well as an agent that effectively relieves clinical autonomic symptoms characteristic of menopause. In any case, the issue of prescribing HRT to a patient requires a thorough gynecological and mammological examination and monitoring.

In order to monitor the effectiveness of the treatment of osteoporosis with an interval of 1-2 years, an assessment of bone mineral density is carried out. At the same time, an increase in mineral density or even the absence of negative dynamics is interpreted as a manifestation of the fact that the treatment is effective. If possible, it is useful to study the dynamics of bone resorption markers (for example, degradation products of type I collagen - N-telopeptide (NTX) in the urine or C-telopeptide (CTX) in the blood serum): before the start of therapy and after 3 months. A decrease in their level by 30% indicates the effectiveness of the treatment, as well as that the patient is taking it correctly. If, while taking the recommended treatment, the patient does not experience a decrease in the level of resorption markers, or a decrease in bone mineral density, or a low-traumatic fracture occurs, the physician should evaluate the following factors before concluding that the treatment is ineffective. First, check whether the patient is taking treatment, if so, how much constantly and whether she takes breaks. Secondly, whether she takes it correctly (observing the regimen and frequency of administration) and whether the treatment with anti-osteoporotic drugs is accompanied by the intake of vitamin D and calcium. As experience shows, it is in these simple things that the cause of inefficiency most often lies.

In general, low compliance is a major problem in the treatment of osteoporosis. They manifest themselves in non-fulfillment or incomplete fulfillment of medical recommendations on diet and physical activity, complete refusal of treatment, interruption of the started therapy. Even the creation of easy-to-take dosage forms (prescribed once a week, once a year, drugs with fewer side effects, etc.) does not lead to a significant improvement in compliance rates. One of possible causes- incorrect or incomplete ideas of patients about osteoporosis, misunderstanding of the goals and methods of its treatment. So, according to the results of our study, out of 128 surveyed patients with osteoporosis, 54 people. (42%) were unaware that skipping a prescribed medication increases the risk of fractures; 118 respondents (92%) believed that only taking vitamin D and calcium in therapeutic doses was enough to prevent fractures; 55 people (43%) were sure that pharmacotherapy allows them to stop doing physical exercises. At the same time, the vast majority (> 90%) of the doctors who treated these patients noted that at each or almost each consultation they provide information to patients on these issues. Low awareness led to a decrease in patients' motivation: patients did not see the benefits of osteoporosis treatment, and one in three of them did not take anti-osteoporotic drugs.

In addition, other factors worsen compliance: the severe physical condition of the patient; financial difficulties; lack of family support; negative experience (fracture occurred against the background of prescribed therapy); denial by the patient of personal responsibility for their health. A special place among these factors is occupied by psychosocial components, primarily the presence of a depressive disorder in a patient. According to population studies, about 42% of the population have depressive symptoms above the threshold level, and in older age groups this figure rises to 76%.

The relationship between osteoporosis and depressive disorders is complex and multilevel. There are a number of common risk factors and pathogenetic components associated with both diseases: female gender, advanced age, chronic pain, chronic disabling diseases, malnutrition (low weight or, conversely, abdominal obesity), prolonged immobilization, sleep disturbances, a tendency to fall from - for frailty, hypercortisolemia, vitamin D deficiency, etc. Older-specific risk factors for depression that are also related to osteoporosis, falls and fractures - visual and hearing impairment, sleep disturbances, recent identification of a new disease, smoking and alcohol abuse. The last two are proven risk factors for osteoporosis. It has been proven that depressive disorders lead to a decrease in bone mineral density and an increase in the risk of fractures. In turn, depression worsens the course of osteoporosis, slowing down rehabilitation and reducing adherence to treatment.

The features of the clinical picture of this pathology in the elderly make it difficult to diagnose depression. This is the absence or minimal severity of sadness, melancholy, complaints of a bad mood and manifestation only (or predominantly) of somatic disorders: persistent pain of different localization, autonomic dysfunction, deterioration in physical performance, changes in sleep, appetite, weight. All of the above dictates the need for timely targeted detection and treatment of depression in patients with osteoporosis, as well as the detection and treatment of osteoporosis in patients with depression in the general medical network, which is consistent with WHO recommendations, but is not yet a daily practice.

On the other hand, low compliance in osteoporosis may be due to the lack of skills of doctors in counseling a patient with this pathology. Common mistakes are the abuse of medical terms, a directive (paternalistic) approach to prescribing recommendations, ignoring the psychological characteristics and circumstances of the patient's life, excessive attempts to "push" the patient to make the only correct (from the doctor's point of view) decision, cultural, language barriers, etc. Therefore, today there is a need for doctors to acquire the skills of behavioral counseling. Such counseling is aimed at lifestyle modification and systematic medication in a patient who does not yet have symptoms of the disease (and problems associated with it), but at a high risk of complications. The key features of behavioral counseling in osteoporosis are the doctor's ability to determine the patient's level of knowledge about his illness and individual risk of fractures, the ability to assess the patient's readiness for treatment, find the patient's individual sources of motivation, and competently encourage the patient to change behavior (diet, exercise, medication).

In general, possible ways to improve compliance in osteoporosis are seen in the following areas. Firstly, it is an improvement in the quality of interaction between the doctor and the patient. Thus, a number of studies testify to the effectiveness of educational programs for doctors (on the identification and treatment of depression, training in conducting preventive motivational interviews, etc.), although this issue requires further study. Secondly, educational programs have proven themselves well - the so-called "Health Schools for Patients with Osteoporosis". In addition, long-term management of a patient with osteoporosis by one doctor is desirable, which allows monitoring risk factors, observing and consulting him in dynamics, correcting therapy taking into account comorbidities, psychological support and work with the family. The competence of a general practitioner allows the best way to carry out such work, however, any qualified specialist can take on the functions of a “doctor-manager” and carry out high-quality treatment of a patient with osteoporosis.

Literature

1. Kanis J.A. On behalf of the World Health Organization Scientific Group (2007). Assessment of osteoporosis at the primary health care level. technical report. World Health Organization Collaborating Center for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by University of Sheffield.
2. Lesnyak O. M. Audit of the state of the problem of osteoporosis in the Russian Federation // Preventive medicine. 2011, vol. 14, no. 2, 7-10.
3. Osteoporosis / Ed. O. M. Lesnyak, L. I. Benevolenskaya. 2nd ed., revised. and additional (Series "Clinical recommendations"). M.: GEOTAR-Media, 2011. 272 ​​p.
4. Zakroeva A. G. Andriyanova O. V., Solodovnikov A. G. Comparative study of mental health indicators and their associations with risk factors for chronic non-communicable diseases in rural and urban populations // Ural Medical Journal. 2009; 2: 83-93.
5. Chang-Quan H., Xue-Mei.Z., Bi-Rong D., Zhen-Chan L., Ji-Rong Y., Qing-Xiu L. Health status and risk for depression among the elderly: a meta-analysis of published literature // Age Aging. 2010; 39:23-30.
6. Paudel M. L., Taylor B. C., Diem S. J., Stone K. L., Ancoli-Israel S., Redline S., Ensrud K. E. Osteoporotic Fractures in Men Study Group. Association between depressive symptoms and sleep disturbances in community-dwelling older men // Am Geriatr Soc. 2008; 56(7): 1228-1235.
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O. M. Lesnyak,doctor medical sciences, Professor
A. G. Zakroeva, Candidate of Medical Sciences, Associate Professor

GBOU VPO UGMA of the Ministry of Health and Social Development of Russia, Ekaterinburg

Osteoporosis that occurs in the postmenopausal period is an extremely important and socially significant problem. modern world. Before proceeding to the analysis of the basic principles of therapy for this disease, it is necessary to carefully analyze some issues.

What is postmenopausal osteoporosis?

Postmenopausal osteoporosis is a chronically progressive systemic, metabolic disease of the skeleton due to a decrease in the content minerals in human bone tissue, against the background of age-related decline in ovarian function.

This defeat is very insidious, since outwardly it practically does not manifest itself in any way. Only in the later stages can a woman be bothered by pain in the joints, back, until everything develops into frequent fractures.

In the first 5 years after menopause, the skeletal system loses almost a third of the mineral components, and given the increase in the general age of the population, the problem of menopausal osteoporosis is becoming increasingly important.

Causes

The main reasons for the development of the disease are considered to be:

• Decreased levels of the female hormone estrogen. One of the functions of the hormone estrogen is to participate in the regulation of mineral metabolism, including calcium metabolism, which is the main element of the human musculoskeletal system. After the extinction of the reproductive function, the level of estrogen in the body decreases, which means that the level of the main component of the skeletal system decreases. As a result, it becomes porous, soft, ceases to withstand loads. This is called menopausal osteoporosis. .
• Irrational nutrition. Another factor whose importance is often underestimated. Experts note that the majority of those suffering from this pathology follow an extremely inadequate diet. Such people, as a rule, consume insufficient amounts of dairy products, meat, greens, beans, vegetables. In addition, they do not compensate for this deficiency, which inevitably leads to calcium deficiency in the body.
• Low mobility. With age, the physical activity of most people, including women, decreases markedly. There can be many reasons: severe, excess weight, consequences of injuries and medical emergencies in the past. All this also leads to a decrease in time spent outside, which entails a decrease in the production in the body, which is a necessary component for the successful absorption of calcium and maintaining bone density.

What factors predispose to postmenopausal osteoporosis?

The risk groups include people:

• over 65 years old;
• who have had early menopause;
• abusing smoking;
• abusing alcoholic beverages;
• having hormonal disorders, especially disorders of thyroid hormones, adrenal glands, pituitary gland;
• having a genetic predisposition.

Detailed mechanism of occurrence of menopausal osteoporosis

in bone tissue healthy person processes of remodeling, that is, restructuring, are constantly taking place. Cells continuously re-form and resorb bone. This balance is maintained by a number of hormones that are closely dependent on each other.

After the completion of the period of functioning of the reproductive function of a woman, the ovaries cease to perform their tasks, including the production of sex hormones, in particular estrogen. The synthesis of estrogen is associated with the synthesis of calcitonin, which, in turn, reduces the level of parathyroid hormone.

Parathyroid hormone increases the content of calcium ions in the blood due to increased absorption in the intestine, due to resorption of bone tissue and a decrease in its excretion in the urine.

As mentioned above, malnutrition and insufficient physical activity provide a deficiency in calcium intake in the body. Therefore, the only result will be permanent destruction of the bone.

Additional reasons will be a deficiency of vitamin D, which is directly involved in the absorption of calcium; insufficient bowel function due to the inevitable aging processes, which is the cause of insufficient absorption of calcium from food; low mobility, disrupting adequate blood supply to the bones.

What are the symptoms of postmenopausal osteoporosis?

Unfortunately, due to its asymptomatic nature, menopausal osteoporosis cannot be self-diagnosed. As a rule, such a diagnosis is made in a medical institution after a woman enters there with a spontaneous fracture.

Primary signs that are usually ignored are − pain in the lower back, back, pelvis, legs, joints which appears after physical activity and goes away after rest fatigue, leg muscles. Over time, these symptoms bother a woman more and more often.

It may also be alarming curvature of the spine in the form of a “hump”, a decrease in height by several centimeters per year, weight loss without changing volumes and proportions.

Untimely referral to a specialist leads to spontaneous fractures of the femoral neck, forearms, lower legs, and thoracic spine. All this together can lead to severe disability of a person and a violation of his mental health.

How is the diagnosis carried out?

After collecting an anamnesis and identifying risk factors for the occurrence of menopausal osteoporosis, the specialist prescribes studies designed to assess the condition of the bone tissue, as well as to detect signs of its destruction in blood tests.

The most common methods:

• Densitometry. It is carried out using an apparatus, the action of which is based on x-ray radiation. It evaluates bone density. The same study is available with the help of ultrasound diagnostics, as well as with the help of computed tomography. Parts of the skeleton most susceptible to osteoporosis: spine, hip joint, pelvic bones, humerus, radius bones, hands, feet.
• Blood chemistry. Here they pay attention to the amount of calcium, phosphorus, alkaline phosphatase, osteocalcin, which are direct evidence of bone destruction. In some cases, it is additionally carried out for calcium content.
• Blood test for hormone levels. First of all, the level of thyrocalcitonin and parathyrin, thyroid hormones responsible for calcium balance in the body, is determined. An additional study of the content of sex hormones makes it possible to make the final diagnosis of menopausal osteoporosis.

What drugs are used for treatment?

Modern methods of therapy for postmenopausal osteoporosis are aimed at eliminating links pathological process. Drugs increase bone mineralization, stop resorption processes and prevent complications.

Main groups:

1. Bone stimulants. This group includes hormonal and steroid drugs, minerals. They act on the hormonal regulation of bone destruction and stimulate cells to form new tissue.
2. Drugs with multifaceted action. These, first of all, include calcium preparations in combination with vitamin D. This combination contributes to adequate absorption of the mineral, which allows the body to successfully use it to build new bone tissue. Flavonoid compounds and osseino-hydroxylate complexes inhibit the processes of destruction of the skeleton, inhibiting the activity of the cells responsible for this.
3. Medicines that prevent the mechanisms of bone resorption. In addition to hormonal drugs, this group includes bisphosphonates. It also includes hormonal agents: estrogens and progestins, calcitonin.

Bisphosphonates as the main link in the treatment of menopausal osteoporosis

In simple terms, the mechanism of bisphosphonate drugs is to suppress the functions of osteoblasts, cells that destroy bone tissue. That is, they act on the final link of osteoporosis.

These medicines have been used for a long time, since the middle of the twentieth century. Since then, many new drugs have been invented that can be divided into three generations.

The use of bisphosphonates has also become possible in the treatment of oncological diseases, since they are able to prevent tumor metastasis.

All drugs based on bisphosphonates can be divided into two large groups:

• nitrogen-free
• nitrogen-containing

Due to their molecular structure, they have features in the mechanism of action, which determines the scope of their application in the treatment of menopausal osteoporosis.

Bisphosphonate preparations belonging to this group contain a number of active substances in their composition that determine their properties, pharmacodynamics and pharmacokinetics:

• Alendronate sodium is the basis for second-generation drugs. This is a specific regulator of bone tissue metabolism, which has a non-hormonal nature. Therefore, bisphosphonate preparations with this active ingredient can be used in both men and women.
• ibandronic acid(INN) or ibandronate sodium is the basis of a number of third-generation drugs. It is indicated for women who have entered a complicated menopausal phase, for the prevention of osteoporosis, as well as in the case of pathological high content calcium ions to the blood. For men, the use of bisphosphonates from this group is not recommended.
• Zoledronic acid. Its unique property lies in its molecular affinity with the structure of bone tissue, which determines the selective action of these drugs. Studies have found that bisphosphonate preparations containing zoledronic acid also have anticancer effects.

Nitrogen free

Representatives of this group belong to the first generation. But do not think that these are outdated and ineffective drugs. The use of nitrogen-free bisphosphonates is still widely used in the treatment of menopausal osteoporosis.

• Sodium tiludronate. It is widely used in the treatment of patients with deforming osteodystrophy and Paget's disease. It slows down the destruction of bone tissue, promotes the accumulation of calcium and phosphates in it, increasing the percentage of mineral substances.
• Sodium etidronate. It is prescribed for Paget's disease, osteoporosis, increased calcium ions in the blood.
• Clodronate. Affects the final links of menopausal osteoporosis: it inhibits the process of resorption of bone tissue and prevents the leaching of calcium from it. This compound is able to integrate into the structure of the skeleton, changing it chemical composition strengthening bonds between molecules.

Rules for taking bisphosphonates

These medicinal substances are classified as potent, and therefore their purpose, dose and regimen should be strictly controlled by the doctor. In order for the selected therapy to be as effective as possible and not cause side effects, it is necessary to adhere to the following rules for the use of bisphosphonates:

• take the drug on an empty stomach, half an hour before breakfast;
• drink plenty of tablets with clean water;
• within an hour do not take a horizontal position;
• preparations containing calcium in combination with vitamin D should be consumed 2-3 hours after the use of bisphosphonates.

Complications and side effects of bisphosphonate drugs

Any serious disease requires effective and powerful medicines. Despite the high efficiency, the use of bisphosphonates is often accompanied by a number of undesirable manifestations and the occurrence of pathological conditions:

• damage to the kidney tissue;
• hypocalcemia, that is, a condition in which there are too few calcium ions in the blood;
• ulcerative lesions of the gastrointestinal tract;
• digestive disorders;
• violations of the heart;
• increased risk of developing osteonecrosis as a result of trauma, including in the jaw area after the extraction and treatment of teeth;
• allergic reactions;
• skin reactions;
• muscle pain, general malaise, joint pain, fever;
• visual impairment.

Ways to prevent menopausal osteoporosis

No matter how trite it may sound, it is much easier and cheaper to prevent the development of some kind of pathological condition than to treat it. Basic conditions for reducing the risk of developing osteoporosis:

• Maintaining a healthy lifestyle. Quitting smoking and alcohol will greatly contribute to the long-term preservation of the functions of all organ systems.
• Optimal mode of physical activity. Physical inactivity causes the development of degenerative processes in the musculoskeletal system, including bone tissue.
• Balanced diet. Every day with food, the body must receive all the necessary minerals and trace elements. Fat-reducing diets may also contribute to the development of osteoporosis in later life.

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