Systemic osteoporosis: ICD-10 code, symptoms and treatment

A progressive systemic disease of the skeleton, which is characterized by a decrease in bone mass per unit volume and disruption of the structure of bone tissue, which leads to increased fragility of bones and increases the risk of fractures, is called osteoporosis. According to ICD-10, the disease is coded M81 (osteoporosis without pathological fracture). Diagnosis of osteoporosis at the Yusupov Hospital is carried out using modern methods of instrumental and laboratory research.

To treat the disease, rheumatologists use the latest medications that are highly effective and have minimal side effects. Rehabilitators use the entire range of rehabilitation therapy. Severe cases of osteoporosis are discussed at a meeting of the Expert Council. Doctors and candidates of medical sciences, doctors of the highest category take part in its work. Leading specialists in the field of rheumatology and collegiately develop an individual treatment plan for each patient suffering from osteoporosis.

Signs and symptoms of osteoporosis

Osteoporosis is a disease that produces few symptoms in the early stages. Signs of pathology appear as bone tissue weakens:

• back pain that occurs with osteoporosis due to destruction of the vertebra;
• slouch;
• reduction in human height;
• fractures even with minor impact (femoral neck fractures are especially dangerous - in 20-25% of cases they lead to death in the first 6 months after injury, and in 40-45% - to disability);
• loose gum tissue;
• pain in the joints, lower back;
• rapid fatigue due to physical exertion;
• discomfort when staying in one position for a long time;
• frequent bowel movements;
• thoracic kyphosis;
• heartburn;
• inability to take a full breath due to chest pain, feeling that there is not enough air;
• accelerated tooth decay;
• leg cramps.

You should consult a doctor for a preventative check if any of these symptoms occur, as well as in the following cases:

• treatment with corticosteroids for several months;
• the beginning of menopause;
• hip fracture in old age.

Early screening for osteoporosis is possible using a blood test, according to which we present the normal indicators according to the following criteria:

• total calcium – from 2.2 to 2.65 mmol/l;
• inorganic phosphorus – from 0.85 to 1.45 µmol/l;
• parathyroid hormone – from 9.5 to 75 pg/ml or from 0.7 to 5.6 pmol/l;
• DPID: for men (nmol DPID/mol creatinine) – from 2.3 to 5.4, for women – from 3 to 7.4;
• osteocalcin (ng/ml): for men - from 12 to 52, for women before menopause - from 6.5 to 42.3, for women after menopause - from 5.4 to 59.1.

Osteoporosis does not manifest itself until 20 to 30% of bone mass is lost. Therefore, after the age of 40, it is recommended to consult an endocrinologist for diagnostics once a year.

Types, forms and degrees of osteoporosis

This disease is classified according to several criteria. First of all, it is considered whether it is an independent (primary) disorder or a symptom of another disease (secondary).

Primary osteoporosis

This is juvenile, postmenopausal, idiopathic, senile osteoprosis.

• The juvenile type of the disease is typical for children and young people, is rare, and is most often caused by birth defects. The main manifestations are severe pain in the legs and back, curvature of the thoracic spine, and visible growth retardation. There is a tendency to compression fractures.
• The postmenopausal form is associated with accelerated bone loss in women 15 to 20 years after menstruation ceases. During this period, estrogens are produced in insufficient quantities and metabolism is disrupted. The disease can be acute or chronic and is accompanied by the occurrence of fractures of bones with a predominantly trabecular structure (vertebrae, distal parts of the radius) i Postnikova S.L. Features of postmenopausal osteoporosis / S.L. Postnikova // General Medicine. - 2004. - No. 4. - P. 41-45. .
• The idiopathic variety is more common in men, but in some cases it is diagnosed in women. The risk group by age is people 20-50 years old. The disease develops smoothly, primarily manifested by periodic pain in the spine, compression fractures are likely.
• Senile osteoporosis is associated with the aging of the body and occurs in both men and women after 70 years of age. Early symptoms are decreased vision, muscle weakness, and migraines. It manifests itself as loss of bone mass in both trabecular and cortical bone, which leads to femoral neck fractures i Postnikova S.L. Features of postmenopausal osteoporosis / S.L. Postnikova // General Medicine. - 2004. - No. 4. - P. 41-45. .

85% of cases of the disease relate to primary osteoporosis, mainly postmenopausal i Lesnyak O.M. Diagnosis, treatment and prevention of osteoporosis in general medical practice. Clinical recommendations / O.M. Lesnyak, N.V. Toroptseva // Russian family doctor. - 2014. - P. 4-17. .

Secondary osteoporosis

Secondary osteoporosis is a complication of various diseases (endocrine, inflammatory, hematological, gastroenterological) or drug therapy (for example, steroid).

Among the forms of secondary osteoporosis, the first place is occupied by glucocorticoid-induced osteoporosis (GIO), which develops in people of any age as a result of therapy with systemic glucocorticosteroids (SGCS).

In elderly patients, a decrease in bone density during long-term therapy with SGCS occurs 2-3 times faster than under physiological conditions. Osteoporotic fractures are reported in 30-50% of patients receiving long-term treatment with glucocorticosteroids. When taking glucocorticosteroids in a daily dose of >5 mc, the risk of fractures increases by 1.9 times compared to the general population, hip fractures by 2 times, vertebral fractures by almost 2.9 times i Baranova I.A. Glucocorticoid-induced osteoporosis / I.A. Baranova // Practical pulmonology. - 2008. - No. 1. - P. 3-9. .

Degrees of osteoporosis

• I (light). Bone density is slightly reduced, sometimes the patient experiences pain in the limbs or spine, and muscle tone decreases. Signs of low calcium levels in the body also appear: dry skin, hair loss, brittle nails.
• II (moderate). Structural changes in the bones are pronounced, the pain becomes constant, and due to damage to the spine, stooping appears. The pain syndrome intensifies with exercise, cramps appear in the calves, and disturbances in the functioning of the heart muscle.
• III (severe). Most of the bones are destroyed, the patient has poor posture, reduced height, and experiences constant severe back pain. Several parts of the spine are affected at once, increasing the risk of fracture of the femoral neck and collarbone.
• IV (very severe). On the x-ray, the bones are almost transparent, the vertebrae are “flattened”, and therefore the patient’s height is significantly reduced, the spinal canal is expanded, and the shape of the bones is changed. At this stage, the patient cannot care for himself.

By localization

The most severe form of the disease is damage to the spine. This increases the risk of getting a fracture and losing the ability to move. Based on localization, the following types of osteoporosis are distinguished:

• Cervical region. The length of the neck decreases, the angle of the head changes. Patients complain of dizziness, nausea, and muscle pain. There is a high risk of pinching the artery that supplies oxygen to the brain.
• Thoracic department. Posture changes noticeably, heart rate increases, and nails become brittle.
• Lumbar region. In this case, the lower back “sags” inward, which reduces the distance between the pelvis and ribs and causes an increase in the abdomen.

By joint damage

Osteoporosis can affect various joints:

• Hip. It is most often affected in old age and leads to disability due to the very low rate of bone tissue restoration. If combined with a spinal fracture, the patient becomes disabled.
• Knee. The cartilage wears out, movement becomes difficult, and severe pain occurs due to the fact that the bones are in contact with each other.
• Ankle. At the same time, it is difficult for a person not only to walk, but also to be at rest. My foot and lower leg hurt constantly.

Prevention of osteopenia in children and adolescents at risk of developing osteoporosis

Currently, there is no doubt that osteopenia is one of the significant problems in pediatrics, affecting children of any age and both sexes. Osteopenia is a collective term used to describe low bone mass without regard to its causes or the nature of its structural changes. In clinical practice, three types of osteopenia are observed:

• osteomalacia - a decrease in the mineral component per unit volume of bone tissue, the accumulation of a non-mineralized organic matrix - osteoid. Osteomalacia is a classic sign of pronounced changes in the skeletal system during the period of the height and full-blown clinical picture of rickets;
• fibrocystic osteitis is a condition characterized by increased resorption of bone tissue with its replacement by fibrous tissue. This is a rare pathology characteristic of hyperparathyroidism;
• Osteoporosis is a systemic skeletal disease characterized by a decrease in bone mass and disruption of the microarchitecture of bone tissue, leading to increased bone fragility and a high risk of fractures.

Today, osteoporosis is considered a systemic metabolic disease. Great interest in it is due, on the one hand, to its prevalence, and on the other, to its consequences, i.e., fractures of the bones of the limbs and spine.

It is known that bone tissue is a dynamic system in which remodeling cycles (aging, destruction and formation of new bone) constantly occur throughout life. In childhood, bone undergoes the most intensive remodeling. The processes of growth, histological maturation and mineralization are especially pronounced at an early age, prepubertal and pubertal periods. These processes create a special situation for the bone when it becomes hypersensitive to any adverse effects [1].

Currently, the factors of decreased bone mineral density in children and adolescents have been quite well studied and systematized. In this case, genetic, hormonal, iatrogenic, and environmental (diet, lifestyle, physical activity) risk factors are identified [2]. The body's supply of calcium, one of the main biologically active minerals of bone tissue, is of decisive importance. It is calcium that is involved in the mineralization and formation of the skeleton.

There are some indications that the most intense effect of calcium on bone is observed in the prepubertal period [3]. The only source of calcium in the body is calcium-containing foods. However, it is known that the absorption and deposition of calcium in bone tissue is possible only in the presence of vitamin D, from which, through a series of metabolic transformations, an active metabolite is formed - calcitriol (1,25-dihydroxyvitamin D3). The latter is considered as one of the calcium-regulating hormones.

Calcitriol interacts with specific receptors in various organs and tissues and, thus, carries out the biological effects of vitamin D, the main of which are:

• stimulation of intestinal absorption of calcium and increase in calcium levels due to activation of the synthesis of calcium-binding protein, which actively transports calcium through the intestinal wall;
• increased intestinal absorption of phosphorus;
• stimulation of bone remodeling and bone matrix synthesis by direct action on osteoblast receptors, increasing their differentiation and functional activity;
• increased muscle strength, improved neuromuscular conduction [4].

In general, the significance of vitamin D and calcium deficiency in reducing bone mineral density is illustrated in the figure.

Recently, it has been noted that the modern quality of nutrition does not provide sufficient calcium into the growing child’s body. According to American researchers, only 25% of boys and 10% of girls consume sufficient amounts of calcium daily [5, 6]. In Russia, children and adolescents' daily calcium intake is clearly insufficient. For approximately half of them, this figure is about 50% of the age norm [2].

There is evidence of a decrease in the supply of vitamin D in young people, especially in winter [7]. According to statistics, in winter the incidence of hypovitaminosis D among adolescents is up to 80%. Insufficient insolation, unsystematic exposure to fresh air, a sedentary lifestyle, and insufficient intake of vitamin D from food lead to the formation of a “debt” in the body for vitamin D in children.

Pediatricians do not pay due attention to calcium and vitamin D deficiency in children and adolescents, but their presence can be suspected by collecting an anamnesis, including parents’ answers to the following questions.

1. Does the child's daily diet contain less than 3-4 dairy products (a glass of milk, yogurt, cottage cheese, cheese)?
2. Does the child not systematically receive eggs or fish (including fatty varieties)?
3. Is your hair falling out or splitting a lot?
4. Do your nails peel or break?
5. What is the condition of the teeth? Is your tooth enamel dull? Did caries start from the molars?
6. Did rickets occur at an early age with pronounced changes in the bones?

Even one positive answer (“yes”) may indicate a calcium deficiency in the child.

Using a random sampling method, we conducted an open study of 45 adolescents aged 11 to 15 years, hospitalized in the somatic department of the Tushino Children's City Hospital for: autonomic dystonia syndrome - 30 people, arterial hypertension (essential) - 7 people, reactive arthritis - 4 people , bronchial asthma (non-attack period) - 4 people.

Among adolescents, males predominated (ratio 3.5: 1).

The examination included:

• identification of risk factors for osteopenic syndrome, clinical signs of calcium deficiency;
• assessment of daily calcium intake (calculation using tables based on the amount of calcium in food consumed at home for 3 days);
• study of biochemical indicators of phosphorus-calcium metabolism (the concentration of calcium, phosphorus, alkaline phosphatase in the blood; calcium in daily urine; the ratio of calcium content in the morning portion of urine to creatinine in the same portion of urine).

Examination of adolescents revealed the presence of risk factors for osteopenic syndrome. Among them are such environmental factors as smoking - in 4%, low physical activity - in 40.5%, excessive physical activity - in 16%, growth “jump” over the last year - in 24.5%, excess body weight - in 41% of teenagers.

Low consumption of calcium-containing foods was found in all 45 adolescents. At the same time, the daily calcium intake averaged 415 ± 80 mg/day, while the normal daily requirement for calcium at the age of 11–18 years was 1200–1500 mg (recommendations of the USSR Ministry of Health, 1991). The composition of the diet was unbalanced in protein in 40% of adolescents. In the genealogical history, there were fractures of the bones of the upper and lower extremities in first-degree relatives in 29% of adolescents. Chronic somatic pathology (bronchial asthma) as a risk factor - in 4 people.

Moreover, there were clinical signs of calcium deficiency in the form of changes in nails (layering, brittleness) - in 61%; multiple caries, changes in tooth enamel - 15%; hair loss, brittleness - in 5% of subjects.

From the results of the study of phosphorus-calcium metabolism it followed that the level of calcium and phosphorus in the blood corresponded to the age norm (Table 1). There was an increase in the activity of alkaline phosphatase, an enzyme that indirectly reflects the activity of the bone formation process. No other possible reasons for the increase in enzyme activity in the observed adolescents were identified.

Significant changes were observed in the calcium content in the urine, the daily excretion of which was below normal, indicating a deficiency of vitamin D, leading to impaired absorption of calcium in the intestine. There is an opinion that the determination of daily calcium excretion is used primarily to assess calcium absorption in the intestine [8].

A study of one of the available markers of bone tissue resorption - the molar ratio of calcium to creatinine in the morning urine - revealed its increase in 20 adolescents. These were adolescents with a family history of fractures in first-degree relatives, overweight, with low physical activity, and with the lowest dietary calcium intake. They had caries and changes in the condition of their nails.

Based on the results obtained, indicating the presence of risk factors, individual clinical signs of calcium deficiency, laboratory-confirmed calcium imbalance, high levels of alkaline phosphatase, and an increased molar calcium-creatinine index, the presence of osteopenia in the examined adolescents should be stated. Osteopenia was most pronounced in 20 of them. Osteopenia was characterized by increased bone metabolism, in which high resorption was not compensated by an increased process of bone formation.

The conducted studies confirm the position that the origins of osteoporosis should be sought in adolescence.

It has been established that early active prevention and treatment of osteopenia can significantly affect its prevalence, progression and reduction in the risk of fractures. According to experts from the World and European Osteoporosis Societies, special attention should be paid to the prevention of osteoporosis [9].

The main areas of prevention of osteoporosis in children and adolescents include:

• physical activity (isometric gymnastics, swimming);
• a diet high in calcium and vitamin D in foods (dairy products, fish), relatively low in salt;
• elimination of risk factors (for teenagers - giving up bad habits, coffee, heavy physical activity);
• treatment of somatic pathology (diseases of the gastrointestinal tract, kidneys, systemic connective tissue diseases);
• daily additional intake of vitamin D and calcium supplements.

It should be noted that taking vitamin D alone without calcium, as well as calcium without vitamin D, does not have as positive an effect on bone mineral density as their combined use.

There are several calcium salts - chloride, citrate, lactate, gluconate, carbonate, etc. The dose of the drug is calculated individually, depending on age and the degree of consumption of calcium-containing products (Table 2).

To minimize possible side effects (flatulence, constipation), as well as improve absorption, calcium supplements are best prescribed during or after meals.

A single dose should not exceed 500–600 mg of elemental calcium.

Simultaneously with calcium supplements, one of the vitamin D preparations is prescribed: Aquadetrim (an aqueous solution of vitamin D); vigantol (oil solution of vitamin D), ergocalciferol (oil solution of vitamin D2) (Table 3).

It must be borne in mind that the actual daily requirement for vitamin D depends on many factors, which must be taken into account when choosing an individual dose. The most significant factors include: climatic conditions; season; area of ​​skin not covered by clothing; consumption of fatty fish (herring, mackerel, salmon); severity of phosphorus-calcium metabolism disorders; the nature of the concomitant pathology.

Of the vitamin D preparations, the most commonly prescribed is aquadetrim (an aqueous solution of vitamin D3) - 1 drop contains 500 IU of colecalciferol.

The drug characterizes:

• rapid absorption in the intestine (compared to an oil solution);
• longer action of the aqueous solution;
• proven clinical effectiveness and safety of use, no side effects.

The drug does not cause dysfunction of the gastrointestinal tract and can be used in cases where an oil solution is not recommended (for malabsorption syndrome). Aquadetrim is included in the preferential list.

To prevent osteopenia, various combination drugs containing calcium and vitamin D preparations are widely used as the basic treatment of osteoporosis. But due to the rather high cost of treatment with combination drugs, many patients, unfortunately, do not undergo the course of treatment recommended by the doctor. An analysis of cost minimization for calcium and vitamin D preparations revealed significant advantages of using vitamin D (aquadetrim) and calcium salts in individual monomedicinal forms [10]. This is especially important, since for the prevention and treatment of osteopenia, calcium and vitamin D supplements are prescribed for an indefinite period.

Thus, osteopenia in children and adolescents is not inevitable. Timely comprehensive prevention, including the administration of calcium and vitamin D supplements, has a beneficial effect on the processes of bone tissue remodeling during the period of formation of maximum bone mass.

Literature

1. Rudenko E. V. Osteoporosis, diagnosis, treatment and prevention. Minsk, 2001. 153 p.
2. Shcheplyagina L. A., Moiseeva T. Yu., Kruglova I. V., Bogatyreva A. O. Problems of adolescence. M., 2003. pp. 291–321.
3. Shcheplyagina L. A. Decrease in bone mineral density in children and the possibility of its correction//Dr. RU. 2005. No. 2. P. 32.
4. Dreval A.V., Marchenkova L.A. Vitamin D and calcium preparations in the prevention and treatment of osteoporosis: methodological recommendations. M., 2003. 48 p.
5. Saggese G., Baroncelli GI, Bertelloni S. Osteoporosis in children and adolescents: diagnosis, risk factors and prevention//J. Pediatr. Endocrinol. Metab. 2001; 14(7):833–859.
6. Van der Sluis IM, de Muinck Keizer-Schrama SM Osteoporosis in childhood: bone density of children in health and disease//J. Pediatr. Endocrinol. Metab. 2001; 14 (7): 817–832.
7. Nasonov E. L. Osteoporosis: standards of diagnosis and treatment // Consilium medicum. Directory of a polyclinic doctor. 2002. No. 2. P. 17–20.
8. Ermakova I. P., Pronchenko I. A. Modern biochemical markers in the diagnosis of osteoporosis // Osteoporosis and osteopathy. 1998. No. 1. pp. 24–26.
9. Benevolenskaya L.I. et al. Vitrum osteomag in the prevention of osteoporosis in postmenopausal women: results of a comparative open multicenter study // Therapeutic archive. 2004. T. 76. No. 11. P. 88–93.
10. Osteoporosis. Diagnosis, prevention and treatment: clinical recommendations / ed. L. I. Benevolenskaya. M., 2005. P. 123.

N. A. Korovina , professor, doctor of medical sciences T. N. Tvorogova , associate professor, candidate of medical sciences RMAPO, Moscow

Diagnosis of osteoporosis

You can check the condition of the body and confirm or exclude the diagnosis of osteoporosis using laboratory tests and instrumental studies, of which the simplest and most informative is densitometry.

Lab tests:

• calcium in urine;
• clinical blood test;
• alkaline phosphatase (biochemistry indicator);
• TSH;
• markers of bone destruction;
• for men – testosterone.

Instrumental methods:

• radiography;
• densitometry;
• bone biopsy;
• bone scintigraphy;
• MRI.

How to check for osteoporosis using densitometry?

Ultrasound densitometry is a quick and painless diagnostic method. During the procedure, the speed of propagation of ultrasound waves through bone tissue is measured. Ultrasound travels faster through denser bones. The result of the study is recorded by a computer, the indicators are compared with the norm. The session lasts 2-3 minutes, and a conclusion is immediately issued.

To carry out this diagnosis, a Sonost-3000 densitometer is used - expert-level equipment that can detect loss of even 2-5% of bone mass.

Densitometry is recommended:

• nulliparous women;
• women over 45 years old;
• women who have given birth to 2 or more children;
• during early menopause;
• in case of menstrual irregularities;
• if you have bad habits;
• men over 50 years old;
• in case of deficiency of sex hormones.

You definitely need to undergo ultrasound densitometry if:

• Fractures often occur;
• there was a long course of glucocorticosteroids, diuretics, anticonvulsants and anticoagulants;
• diagnosed with hyperparathyroidism or other dysfunction of the parathyroid glands.

Also indicated are:

• change in posture;
• bone and muscle pain due to changing weather;
• pain in the lower back and chest with static load;
• senile stoop;
• night cramps in the legs;
• tooth decay;
• decreased growth;
• body weight deficiency;
• osteoporosis in close relatives;
• low testosterone levels in men;
• and etc.

Osteoporosis therapy and clinical recommendations

First of all, you need to know which doctor treats osteoporosis: since the causes of the disease can be different, different specialists can treat it - a rheumatologist, an orthopedic traumatologist, an endocrinologist.

Effective treatment of osteoporosis (both early and after 50 years) may include physiotherapeutic procedures, medication, lifestyle and diet adjustments, and physical exercise.

Drug therapy

• Taking vitamin D and calcium supplements. Consumption of these elements in the right dosages leads to a rapid increase in bone mineral density and a decrease in the incidence of fractures.
• Bisphosphonates. Treatment with these drugs reduces the risk of fractures by 30-50% and increases bone density.
• Hormone therapy (replacement). It is carried out for the prevention and treatment of the postmenopausal form of the disease. Treatment leads to the cessation of bone thinning, the prevention of fractures, and the elimination of urogenital and autonomic complications of menopause.
• Calcitonins. They inhibit bone tissue resorption and have a pronounced analgesic effect.
• Ossein-hydroxyapatite complex. Normalizes calcium homeostasis, improves bone metabolism, stimulates bone formation, restores the balance between the processes of bone formation and resorption.

Non-drug therapy

• Wearing a corset (orthoses)

Indicated for back pain and compression fractures of the spine. The corset should be worn constantly or intermittently, always taking it off at night.

• Physical education, walking, aerobic exercise.

Regular walks in the fresh air are beneficial. Loads should not be excessive; it is necessary to exclude power sports and those that involve the likelihood of mechanical impacts (for example, playing with a ball).

Forecast

The disease cannot be completely cured, so it is necessary to maintain a course of therapy and monitor changes in bone structure

Systemic osteoporosis is a severe chronic disease. Timely detection of pathology and adequate therapy help stop the process of bone tissue destruction and improve the patient’s quality of life. However, the diagnosis remains with the person for life, so patients may be recommended ongoing maintenance therapy. Patients with osteoporosis should take care of themselves and avoid injuries and bone damage.

Complications from osteoporosis

The main complication is injuries to the musculoskeletal system, especially compression fractures of the spine and microfractures due to sudden compression of the joints. In this case, a large load is not necessary; you can simply trip and fall, resulting in a fracture.

, compression of the spinal cord and nerve endings may occur . Because of this, loss of sensitivity in various parts of the body, as well as paralysis and disability, is possible.

Fractures are especially dangerous in old age - only 9% of people (according to statistics for the Russian Federation) return to normal life after this.

Osteoporosis can also have the following consequences:

• impediment to growth, which is especially important for a child or adolescent;
• decrease in height - approximately 2-4 cm per year;
• poor posture – “hump” in the thoracic region (thoracic kyphosis);
• disruption of internal organs due to incorrect posture.

Reasons for the development of pathology

Systemic osteoporosis is an age-related disease, so the main reason for its development is the natural aging of the body. The disease develops as a result of impaired absorption of minerals, slower metabolism and deterioration of bone tissue regeneration processes.

Risk factors for developing pathology:

• age over 60 years,
• female,
• the onset of menopause,
• metabolic disease,
• endocrine pathologies,
• chronic diseases,
• taking certain types of medications.

In men, the disease may be associated with a lack of testosterone and severe intoxication. Osteoporosis can result from radiation and chemotherapy. The pathology also develops against the background of weakened immunity during long-term treatment with corticosteroids.

In osteoporosis, mineralization is impaired and bone tissue is gradually destroyed. This is due, first of all, to a lack of calcium and phosphorus. Impaired absorption of these substances occurs due to imbalance of hormones, changes in metabolism, chronic pathologies of the stomach and intestines.

Calcium deficiency occurs due to poor nutrition.

The main reason for the development of this pathology is the slowdown of metabolic processes. The destruction of bone cells occurs faster than their formation. As a result, bone tissue regenerates less well, so any damage heals much more slowly. Loss of bone density leads to the formation of peculiar pores, which make bones brittle and brittle.

Read also: Exudative synovitis: causes of development and symptoms, principles of treatment

There are primary and secondary osteoporosis. Primary osteoporosis is an independent disease and occurs due to the onset of menopause (postmenopausal) or natural aging (senile osteoporosis). A separate idiopathic form of pathology is distinguished. This osteoporosis can occur at any age, and its exact causes are unknown.

Secondary osteoporosis occurs against the background of:

• diabetes mellitus,
• hypocalcemia,
• rheumatoid arthritis,
• hypogonadism,
• acromegaly,
• thyroid diseases.

Systemic osteoporosis is characterized by slow progression and long-term asymptomatic course, which greatly complicates its timely detection and treatment.

Sources

1. Baranova I.A. Glucocorticoid-induced osteoporosis / I.A. Baranova // Practical pulmonology. - 2008. - No. 1. - P. 3-9.
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3. Zulkarneev R.A. Prevention and treatment of osteoporosis / R.A. Zulkarneev, R.R. Zulkarneev // Kazan Medical Journal. - 2003. - T. 84. - No. 3. - P. 230-232.
4. Lesnyak O.M. Diagnosis, treatment and prevention of osteoporosis in general medical practice. Clinical recommendations / O.M. Lesnyak, N.V. Toroptseva // Russian family doctor. - 2014. - P. 4-17.
5. Postnikova S.L. Features of postmenopausal osteoporosis / S.L. Postnikova // General Medicine. - 2004. - No. 4. - P. 41-45.
6. Rodionova I.V. Systemic osteoporosis and osteoporosis of the lower jaw / I.V. Rodionova [and others] // Nurse. - 2015. - No. 5. - P. 32-34.