Bone osteoporosis classification, diagnosis, treatment, complications

Bone osteoporosis is most often affected by the elderly. According to statistics, 50-85% of women over 65 years of age and almost 100% of people over 85 years of age are affected by it. The disease often develops in people leading a sedentary lifestyle. Among persons engaged in physical labor, it is identified much less often.

The main cause of osteoporosis is a violation of bone remodeling. Normally, its structure is maintained thanks to the coordinated work of osteoblasts and osteoclasts. The former are responsible for the mineralization of the cancellous bone, the latter are responsible for its destruction. With a normal ratio of these cells in a person, a full renewal of bone tissue occurs. With increasing activity of osteoclasts, bones begin to rapidly lose mineral density (BMD).

Under certain conditions, one osteoclast can destroy the amount of bone tissue synthesized by 100 osteoblasts. To remineralize the lacunae formed by osteoclasts in 10 days, osteoblasts will need 2,5-3 months.

The mechanism of development of osteoporosis

The bones of our body are formed by two types of bone tissue: compact and spongy. The first consists of parallel plates and has a uniform structure. It is very strong and covers the bones outside.

The compact layer is much thicker in the middle parts of the long tubular bones (femur, humerus, greater and peroneal, radial, ulnar). This explains the low frequency of osteoporotic fractures in the area of ​​their diaphysis.

The heads of large, all flat and short bones are covered with a very thin layer of compact substance, under which there is a lot of spongy tissue. The latter consists of plates located at an angle to each other, has a porous structure. It is she who with particular ease loses the IPC.

With osteoporosis, the bone plates become thinner or even die. As a result, the layer of compact substance becomes thinner, and the spongy substance liquefies and loses its density. The bones become very fragile, which is why they break easily.

Types of Osteoporosis

Doctors attribute osteoporosis to multifactorial diseases. This means that pathology develops under the influence of many provoking factors. Doctors were able to identify the main causes of a progressive decrease in bone density.

Types of osteoporosis depending on the development mechanism:

  • primary. It occurs due to an imbalance between osteoblasts and osteoclasts. In men, the disease develops due to a slowdown in bone formation, and in women due to its accelerated destruction;
  • secondary. It develops against the background of a violation of calcium-forfor metabolism. In this case, the bones are destroyed due to the lack of “building” material necessary to maintain their normal density.

The disease can develop due to the simultaneous acceleration of bone resorption and a lack of minerals in the body. With age and during menopause, resorptive processes are noticeably accelerated.

Persons older than 50 years per year lose 0,5-1% of bone tissue. In women, in the first year after menopause, the loss is 10%, and then 2-5%.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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It occurs due to the natural aging of the body. The development of pathology contributes to the low motor activity of people in old age. It was previously believed that bone decalcification leads to senile osteoporosis. However, in the course of scientific research it turned out that the disease develops due to osteoclastic resorption caused by inactivity. In humans, trabeculae and the cortical layer become thinner, and bone tissue is replaced by fat.

All bones of the human skeleton need a constant load. It is necessary to maintain their normal structure and prevent bone resorption.


It develops against the background of hormonal changes that occur in women during menopause. It leads to increased loss of calcium by the body and malfunctions in bone remodeling. All this leads to the development of osteoporosis and pathological fractures in the future.


It affects people who are forced to take steroid hormones for a long time. Corticosteroids inhibit the formation of bone tissue by disrupting the differentiation of osteoblasts, negatively affect the bones in many other ways.

The main mechanisms of action of steroids:

  • inhibition of the functional activity of osteoblasts and stimulation of their apoptosis;
  • increased activity of osteoclasts;
  • inhibition of calcium absorption in the intestine, stimulation of its excretion in the urine;
  • effects on hormone levels that regulate bone remodeling (calcitonin, parathyroid hormone);
  • the formation of small areas of aseptic necrosis in the bones.

In some cases, treatment with corticosteroids is not the primary cause of osteoporosis. Pathology often develops against a background of diseases requiring the use of steroids (collagenoses, bronchial asthma, Crohn’s disease, etc.). Taking medication in this case only further contributes to bone destruction.


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In people who abuse alcohol, physiological regeneration and IPC are impaired. The reason is increased excretion of calcium, impaired metabolism of vitamin D. In many patients, an increase in the level of interleukin-6 and antibodies to their own tissues is detected. These substances increase the functional activity of osteoclasts and trigger active resorption processes.

Symptoms of the disease

Osteoporosis has an almost asymptomatic course, which makes it extremely dangerous. In the literature, the disease is called a “silent”, “silent” epidemic. Why is that?

Initially, the disease manifests itself only as increased fatigue and decreased performance. People do not pay attention to these symptoms or do not attach importance to them. In the initial stages of pain in osteoporosis occur in a small number of patients. They are nonspecific, because of which they can be confused with manifestations of arthrosis, osteochondrosis, or other diseases of the skeleton.

The first sign of the disease is often an acute pain syndrome associated with a fracture of the vertebra or a long tubular bone.

Features of bone pain in osteoporosis:

  • usually localized in the lumbar region and between the shoulder blades;
  • are episodic in nature, occur after lifting weights or awkward movements;
  • amplified after long walking, hard work or being in a forced position;
  • can be localized along the long tubular bones, in the area of ​​joints and soft tissues;
  • able to respond to weather changes, massage, overwork and even negative emotions.

A pronounced pain syndrome usually appears in people suffering from osteoporosis for more than 5-10 years. Together with it, patients have a pronounced spinal deformity. In the later stages, an increase in thoracic kyphosis and lumbar lordosis can be seen even with the naked eye.

Signs of osteoporotic vertebral fracture:
  • acute pain in the back, radiating to the chest, abdomen and hips;
  • sharp restriction of spinal mobility;
  • maintaining a high intensity of pain for 1-2 weeks;
  • slow regression of symptoms within 2-3 months.

How to check bone status for osteoporosis

To diagnose the disease, it is necessary to measure the mineral density of bone tissue. In medicine, this study is called densitometry. It can be performed using ultrasound, radiography or computed tomography. The study is performed on an outpatient basis, and the whole procedure takes 10-20 minutes. On average, densitometry costs about 4000 rubles.

In the later stages, osteoporosis is diagnosed using conventional radiography. An experienced orthopedist can easily detect radiological changes characteristic of the disease. Unfortunately, such an examination is uninformative with initial changes in the bones.

For people older than 50 years, doctors advise checking bones for osteoporosis at least once every two years. This will help assess the dynamics of changes in the BMD and diagnose the disease in time.

Osteoporotic Fracture Risk Factors

The strength of bone tissue is the main indicator that determines the appearance of fractures. The risk directly depends on the BMD in the spine and femoral neck. The lower the mineral density, the less traumatic force is enough to violate the integrity of the bone.

Key risk factors:

  1. Bone These include a decrease in BMD, a decrease in bone mass, impaired trabeculae adhesion and the presence of microtraumatic injuries.
  2. Extra bone. The tendency to fall caused by age-related discoordination, vision problems, diseases of the cardiovascular or musculoskeletal system.

In older people, falling from a height of growth in 87% of cases leads to fractures of the proximal femur. In addition, domestic injuries can cause damage to the vertebrae, the distal third of the forearm and heel.

Early detection of a decrease in BMD allows timely prevention of osteoporosis. Regular intake of the right medicine helps to slow down the development of osteoporosis and avoid many troubles.

Preparations for the treatment of osteoporosis

Treatment of the disease includes pathogenetic and symptomatic therapy. The first is aimed at increasing BMD and preventing fractures, the second is aimed at eliminating the pain syndrome and improving the well-being of the patient. Pathogenetic treatment is most effective for osteoporosis of 1-2 degrees.

GroupRepresentativesThe mechanism of action and purpose of application
  • Diclofenac
  • Nimesil
  • Meloksikam
  • Ibuprofen
Stop the pain syndrome, which is a frequent companion of osteoporosis. Doctors prescribe these medications to improve the patient’s well-being. Analgesics are not able to inhibit the development of the disease
Locally irritating agents in the form of ointments and gels
  • Finalgon
  • Viprosal In
  • Efcamon
They cause a burning sensation and a powerful rush of blood to the tissues. They have a distracting effect, relieving pain. Due to the stimulation of blood circulation, slightly contribute to the regeneration of bone tissue
  • Fosamax
  • Xidiphone
  • Miacalcic
  • Kliogest
  • Femoston
In various ways, bone resorption is inhibited. In different clinical situations, doctors prescribe various drugs to patients. For example, women in menopause require estrogen-containing drugs, men require bisphosphonates
Bone formation stimulants
  • Fluocalcic
  • Ossin
  • Forsteo
Restore the normal structure and BMD due to the stimulation of osteoblasts. Saturate bones with the necessary phosphorus and calcium. Drugs of this group are used for the pathogenetic treatment of the disease
Drugs affecting bone formation and resorption
  • Calcium-D3-Nycomed
  • Osteogenone
  • Calcepan
  • Complivit-Calcium-D3
They have a complex effect, while affecting osteoblasts, osteoclasts and calcium-phosphorus metabolism. These medications are often included in the comprehensive treatment of osteoporosis.

Non-drug treatments

Experts advise that physical exercises and walking be included in the therapy regimen. They improve the flexibility of the spine and coordination of movements, increase muscle strength and endurance. It is proved that regular power loads relieve back pain, reduce the need for analgesics. And better coordination helps prevent spontaneous falls and avoid fractures.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles