Osteoporosis of the joints: treatment, symptoms, types and diagnosis

The problem of osteoporosis existed in all periods of human development, but in the 20th-21st centuries the disease acquired the character of a “silent epidemic”. In modern medicine, osteoporosis is considered as a systemic disease, the main signs of which are structural changes in the microarchitecture of bone tissue and a decrease in bone mineral density (BMD). If a patient is diagnosed with osteoporosis, treatment is prescribed immediately. Without complex therapy, the disease is prone to steady progression and a decrease in BMD to critical levels, which is associated with a high risk of fractures.

Osteoporosis is not only a medical, but also a social problem. According to statistics, the disease ranks 4th in prevalence, second only to diabetes, cardiovascular diseases and cancer. Advanced osteoporosis is characterized by high mortality and disability.

Another important aspect is a significant decrease in the patient’s quality of life. In fact, doctors often assess the severity of the disease and the effectiveness of prescribed treatment methods only based on laboratory and instrumental data, forgetting about the patient’s well-being and complaints.

Causes of the appearance and development of the disease

The most common cause of osteoporosis is a calcium metabolism disorder due to some other disease. The second is disruptions in the process of bone regeneration, that is, in the activity of those cells that are responsible for the renewal of bone tissue.

Factors that increase the risk of “acquiring” such a disease can be divided into two groups: those that depend on the person and those that are independent.

Risk factors for developing osteoporosis:

• female,
• familial cases of osteoporosis,
• old age (after 65 years),
• menstrual irregularities,
• sedentary lifestyle,
• the use of corticosteroid hormones, anticonvulsants, heparin, thyroxine, antacids containing aluminum,
• short stature,
• thin bones,
• low weight (less than 57 kg).

Modifiable risk factors:

• smoking,
• alcohol abuse,
• caffeine abuse,
• sedentary lifestyle,
• low consumption of dairy products,
• insufficient calcium intake,
• vitamin D3 deficiency.

Symptoms of osteoporosis of the joints

The insidiousness of osteoporosis lies in the fact that people seek treatment when serious degenerative processes in the joints have already begun. This is due to the fact that in the first stages there are no signs of the disease. Only signs of calcium deficiency are noticeable, which few people pay attention to:

• increased heart rate;
• problems with nails and hair;
• cramping of the calves at night, similar to cramps;
• general weakness, fatigue;
• deterioration of teeth;
• losing weight for no reason.

As the disease progresses, the person begins to experience joint pain. They are first felt in the morning, immediately after sleep. This is called “morning stiffness” - it is difficult to get out of bed and “get going.” Pain also occurs during unusually strong physical activity for a person.

If these signs are left unattended, then the pain in the joints becomes long-lasting, and then permanent. She is getting stronger. If the hip joint is affected by osteoporosis, the pain can radiate to the groin, and if the knee joint, then throughout the entire leg.

In the final stages, fractures and displacements occur even without heavy load. This is usually when osteoporosis is discovered.

How to relieve pain with osteoporosis

It is important to answer the question of how to relieve pain during osteoporosis, be it an acute attack or chronic discomfort. There are three categories of drugs - anti-osteoporotic, non-steroidal and non-opioid analgesics.

Antiosteoporotic drugs

The use of such medications is aimed at eliminating the disease itself - the pain goes away precisely by restoring the strength and required thickness of the bone tissue. These include varieties such as Heparin and Cyclosporin.

Nonsteroidal anti-inflammatory drugs

This category includes drugs of local and systemic action. Among them are Voltaren, Ibuprofen and Diclofenac. Most often used when an inflammatory process begins. Suitable for application to joints and skin, for example in the lumbar region.

Non-opioid analgesics

The main advantage of such drugs for reducing pain is that they do not have a stupefying effect on a person. There are many types of such medications: Ibuprofen, Ketoprofen and others.

Degrees of osteoporosis of joints

Wearing a corset

Often patients are also prescribed to wear a corset. This is not a therapeutic method, but a good way to reduce back pain, since the spinal column is fixed and this prevents numerous pain manifestations from occurring.

Instead of a corset, you can wear cuffs or a strong bandage on other parts of the body. In case of damage to the spine in the cervical region, people wear hard collars.

Remember that the selection of a suitable corset should be carried out exclusively by a doctor. He knows all the anatomical features of the patient, as well as the intensity of his disease. As a result, he will be able to choose an option with the desired level of rigidity.

As you can see, the answer to the question of whether there is pain with osteoporosis can be answered in the affirmative. The main thing is to choose the right method for their relief and subsequent treatment of the disease.

Types of osteoporosis of joints

The disease is usually classified into 4 groups:

• postmenopausal (occurs in women during menopause);
• senile (typical for older people);
• secondary (against the background of other diseases);
• combined (a combination of two or even all of the listed types).

Osteoporosis also differs because of which joints are affected. Let's look at them separately.

Osteoporosis of the hip joint

This is the most serious and most common type - in 40% of cases, osteoporosis affects the hip joint. With it, damage to the hip joint is possible even with low loads, and the pathological itch itself can spread to the processes of the vertebral discs, skull bones, and ribs. In women, osteoporosis of the hip joints is detected more often than in men, as are other types of this disease.

Characteristic signs of damage to the hip joints:

• spasms in the entire skeletal muscles, usually at night, but can also occur during the day;
• change in posture;
• pain in the lower back, in the front and side of the thighs, aggravated by exercise;
• pain in the buttocks and groin (radiating), is sudden, paroxysmal in nature;
• lameness and changes in gait in order to eliminate discomfort, often this happens unconsciously;
• the absence of anything that could cause pain, that is, there is actually no reason for it;
• insomnia, deterioration of the person’s condition in general;
• weakness in the leg (usually manifests itself a year after the onset of the disease);
• deformation of the chest (if the process is widespread and advanced).

With osteoporosis of the hip joints, the risk of breaking the epiphysis of the femur, the femoral neck, and injury to the acetabulum (“bursa” of the joint) is highest.

This large joint is almost always under load - both dynamically and statically. Therefore, degenerative processes in it are especially dangerous and at the same time most frequent. The worst consequence of osteoporosis is a hip fracture. At a young age, it is still possible to recover, but it is very long and difficult - rehabilitation takes an average of a year. Only 8% of people return to normal life. And if an elderly person breaks his hip, he will remain disabled (75% of cases) for the rest of his life. The fatal outcome of such an injury is also possible - 20% of cases.

Osteoporosis of the knee joint

Osteoporosis of the knee joint can occur in children, but in most cases it occurs in people after 50 years of age. In the early stages there are no external changes, and usually a person notices that something is wrong when 30% of bone mass has already been lost. The knee joint is most susceptible to osteoporosis in obese people, in those who engage in traumatic sports (wrestling, hockey, football) or, conversely, constantly sit both at work and at home.

Symptoms of osteoporosis of the knees by stage:

I
:
there are no symptoms, only the general signs of calcium deficiency described above may appear.

II
:
the knees react with pain to changes in weather, they hurt after a long walk. This is a mild discomfort that is usually not alarming. In rare cases, leg cramps occur at night.

III
:
there is severe pain in the legs, especially severe in the morning. It is present both during exercise and at rest. The knees swell, patients hear a crunching sound in them.

IV
:
the knee is greatly enlarged in size, the joint is atrophied, and the appearance of the leg is changed. This is actually a disability.

Osteoporosis of the shoulder joint

This is a regional type of osteoporosis, that is, it does not spread throughout the body, but is localized only in the shoulders. Its causes are often systemic and autoimmune diseases - rheumatism, lupus erythematosus, rickets, scleroderma (systemic). This disease is also provoked by pathologies of internal organs, for example, general intoxication, liver and/or kidney failure. Often osteoporosis of the shoulder joint develops after surgery or trauma in this area, against the background of oncology (adenoma, sarcoma, etc.).

People usually notice problems with the shoulder joint in the later stages. The first sign is chronic or acute pain in the shoulders. May be accompanied by numbness of soft tissues and impaired motor function. These symptoms only get worse. The pain prevents you from sleeping and doing your usual things. The most severe pain is in the morning, it subsides or goes away if you move your shoulder a little. As the disease progresses, shoulder pain becomes constant and intensifies.

Osteoporosis of the ankle joint

The foot and ankle joint bear all the load when we walk. Therefore, there is one of the highest risks of injury and the development of various diseases, including osteoporosis, which is very common. It leads to a decrease or cessation of working capacity, and can cause irreversible changes in the articular and periarticular tissues of the legs. And this is a direct path to disability.

Usually osteoporosis of the ankle is pronounced. These are severe pains that can only be relieved by the most powerful over-the-counter painkillers. As it progresses, the bones become so thin that a fracture is possible even just while walking. A person constantly experiences pain in the legs both during exercise and at rest. A so-called “compensatory gait” develops, meaning it changes to compensate for severe symptoms. The person begins to arch his legs in order not to feel pain. This can lead to lifelong deformation of the bones of the foot and tibia. Especially if osteoporosis has been present for several years without treatment.

Other symptoms of osteoporosis of the leg:

• discomfort in the ankle, aggravated by standing and walking;
• clubfoot;
• the need to control every step when walking, which is noticeable from the outside;
• frequent fractures even under low loads - jumping literally 30 cm up, quickly climbing stairs;
• heat in the legs, cramps at night and/or after standing or walking for a long time.

Osteoporosis of the elbow joint

This is a rare type of osteoporosis that usually develops in old age and/or as a result of an elbow injury. This is due to the fact that the elbow has a strong ligamentous apparatus and that this part of the body is not subject to high loads. It usually appears when irreversible deformations are already present. Symptoms:

• in the initial stages there are no or signs of calcium deficiency appear;
• stiffness and discomfort in the elbow because the cartilage in the elbow joint becomes thinner and the head of the tubular bone becomes closer to the walls of the articular cavity;
• pain that intensifies with exercise and then becomes constant;
• crunching when bending the elbow;
• swelling of the elbow, its significant increase;
• poor general condition – weakness, drowsiness.
• in the later stages - deformation of the elbow and arm bones, muscle atrophy in this area, shortening of the arms.

What is osteoporosis

Osteoporosis, also known as bone loss, is a metabolic skeletal disease in which bones lose their strength.
They become porous and brittle. The disease is asymptomatic. The first symptom may be a fracture of the spine or femoral neck. According to the World Health Organization (WHO), osteoporosis is one of the most common diseases of our time. Osteoporosis affects approximately one in four women over 50 years of age. The incidence of osteoporosis exceeds the incidence of breast cancer, stroke and heart attack.1

The main task for doctors and patients is to identify the disease as quickly as possible. If osteoporosis is diagnosed at an early stage, its symptoms can be effectively treated, although a cure is not yet possible.

Exercise and a healthy diet (vitamin D and calcium) are effective measures. The precursor to osteoporosis is osteopenia (decreased bone density). With regular monitoring and following your doctor's recommendations, osteopenia may never develop into osteoporosis. In case of progression, osteoporosis occurs and the need to visit the doctor again so that he can prescribe appropriate therapy.

How is joint osteoporosis diagnosed?

If you notice signs of such a disease, you need to contact a therapist, traumatologist or rheumatologist. The doctor will conduct an initial examination and refer you for examinations. The fastest, most comfortable and informative method is ultrasound densitometry. In just a couple of minutes, a conclusion is drawn about the density of bone tissue throughout the body.

May be assigned:

• radiography of the affected joints in two projections, which can reveal the transparency of the bones, spines on the surfaces of the joints, periarticular fractures;
• Ultrasound of joints;
• CT;
• MRI;
• blood tests for calcium, thyroid hormones, estrogens.

If a secondary type of osteoporosis is suspected, differential diagnosis is carried out to exclude those diseases that may be its cause.

Diagnostics

First of all, the doctor is interested in the presence of somatic diseases, lifestyle, and the presence of bone fractures. Laboratory tests are used to determine the level of calcium, phosphorus, vitamin D, hormone levels (estrogen testosterone), thyroid (parathyroid) hormone levels, tests that determine the excretory function of the kidneys.

Based on a medical examination, the doctor may recommend determining bone mineral density - densitometry. This examination method allows you to diagnose osteoporosis before bone tissue begins to deteriorate and allows you to predict the possibility of bone fractures in the future. In addition, determining bone density allows you to monitor the effectiveness of the treatment, as well as the degree of development of osteoporosis over time, and therefore densitometry must be carried out regularly (annually). There are several types of devices that allow you to determine bone density. All densitometry techniques are painless, non-invasive and safe. Comprehensive examination devices allow you to measure bone density in the hip, spine and entire body. Peripheral devices can measure density in the finger, wrist, knee, shin and heel.

Densitometers using DXA (dual energy X-ray absorptiometry) measure bone density in the spine, hip, or entire body. The density measurement is based on the different absorption of the x-ray beam depending on the density of the bone tissue. The X-ray radiation used in such densitometers is very low, and therefore the study is practically harmless to the patient and medical personnel.

Densitometers SXA (single-energy X-ray absorptiometry) is performed with a small X-ray machine and measures bone density at the heel of the shin and knee cap.

In addition, ultrasound densitometry can be used for screening. Typically, the ankle is examined using this method. If screening reveals certain abnormalities, a DXA densitometer test is required to confirm the diagnosis. Bone mineral density is determined by comparison with that of a healthy person of the appropriate age and gender. A significant decrease in density indicates the presence of osteoporosis and a high risk of bone fracture. Depending on the results of densitometry, the doctor prescribes the necessary treatment.

For patients who have borderline results, a new method of determining the 10-year probability of a bone fracture using a program called FRAX is especially useful. This calculation method takes into account all the risk factors for a given individual and determines their personal risk of fractures and, therefore, the need for treatment.

How to treat osteoporosis of the joints

Treatment for osteoporosis is long-term and can last for several months. It is carried out comprehensively - the diet is adjusted, special medications and physical therapy are prescribed. The main tasks that the doctor must solve are to correct calcium metabolism, eliminate pain, increase bone density, and prevent complications.

Diet

It is necessary to give up alcohol, caffeine, quit smoking or significantly reduce the number of cigarettes smoked (at least by half). Be sure to eat calcium-rich foods. Recommended daily intakes of calcium:

• children under 18 years of age – 1200 mg;
• women of fertile age – 800 mg;
• men – 800 mg;
• women during menopause – 1500 mg.

In addition to calcium, you need phosphorus (800-1000 mg per day), magnesium (400 to 800 mg), copper (3 mg), vitamin D (400 international units), vitamins B, A, C, K, and folic acid.

You need to eat fractionally, 4 times a day and in small or medium portions. It is important to eat at the same time.

Important! For better absorption of calcium from food, moderate physical activity is needed.

The diet should include 100-150 g of protein, no more, otherwise the gastrointestinal tract will be overloaded. You don't need an intense tan to get enough vitamin D. It is enough to walk for 30 minutes every day in the dim sun.

Table of recommended and prohibited products

Exercises

Exercise therapy gives a very good effect. The muscle corset is strengthened, blood circulation in the joints is stimulated. The doctor must select a list of exercises strictly individually. However, what is beneficial for everyone, without exception, is swimming in the pool.

Drug therapy

The main medications used as part of therapy:

• Non-steroidal anti-inflammatory drugs - for pain relief. These can be “Ibuprofen”, “Ketonal”, “Nise”.
• Calcium preparations – “Calcium D3 Nycomed”, “Myocalxix”, etc.
• Vitamin D in the form of supplements – “Ultra-D”, etc.
• Inhibitors of bone destruction - bisphosphonates (zoledronic acid), calcitonin, estrogens (for women with their deficiency).
• Drugs that stimulate bone formation - anabolics, androgens, growth hormones.

Physiotherapy

The complex of physiotherapeutic measures includes general massage, paraffin therapy, ultrasound with hydrocortisone, magnetic therapy, mud treatment, electrophoresis with Novocaine (to relieve local pain).

Treatment of osteoporosis

Currently, we can confidently say that the treatment of osteoporosis

should be carried out in specialized centers with significant experience in managing patients with this pathology. Osteoporosis is a complex multifactorial problem, the development of which is caused by endocrine, age-related, and behavioral factors; therefore, doctors of several specialties (endocrinologist, rheumatologist, cardiologist, neurologist) often take part in the treatment of osteoporosis. At the same time, one doctor must be in charge, must be the “conductor” of this orchestra, must know how to treat osteoporosis and determine examination tactics, as well as decide which specialists should be involved in consultations if necessary. Most often, this doctor is an endocrinologist - it is endocrinologists who most often treat osteoporosis these days.

The North-Western Center for Endocrinology, as a specialized endocrinology center, provides comprehensive diagnosis and treatment of osteoporosis in St. Petersburg, Vyborg and other cities of the Leningrad region. The center's endocrinologists independently perform ultrasound densitometry on patients, which allows them to quickly establish a diagnosis and determine how to treat osteoporosis, as well as objectively evaluate the results of the therapy.

The main goals in the treatment of osteoporosis are increasing bone mass (by increasing the deposition of new bone tissue and reducing the destruction of existing bone tissue), preventing the development of fractures, reducing or completely eliminating pain, and ensuring optimal motor mode for patients.

Treatment of osteoporosis consists of several important and interconnected stages:

• First of all, the main diseases that cause osteoporosis are treated (thyrotoxicosis, hypothyroidism, Itsenko-Cushing syndrome and disease, hypogonadism, etc.);
• therapy aimed at increasing bone mass (calcium preparations, vitamin D, drugs from the bisphosphonate group - Fosamax, Forosa, Fosavance, Zometa, Aklasta, Bonviva, etc.);
• drugs aimed at reducing the intensity of pain.

In this article, we will not dwell in detail on therapy aimed at treating the underlying disease, if any, as this will take too much time. Let's discuss the modern concept of treating osteoporosis, aimed at increasing bone mass.

Currently, combination treatment of osteoporosis using:

• vitamin D preparations (aquadetrim, vigantol), or activated forms of vitamin D (alfacalcidol, alpha D3-Teva, etalfa);
• calcium preparations (containing calcium carbonate or calcium citrate);
• drugs from the bisphosphonate group.

If the first two groups of drugs (vitamin D and calcium) are aimed at increasing the formation of bone tissue by increasing the supply of calcium to the patient’s body, then the second group (bisphosphonates) is aimed at suppressing bone resorption (bone breakdown). The main effect of bisphosphonates is to block the work of osteoclasts, the cells responsible for the destruction of bone tissue. Currently, even very long-term, up to 10 years, use of bisphosphonates is considered safe. The cheapest and most studied drug from this group is sodium alendronate (Fosamax, Forosa), which is taken once a week. Other drugs that appeared later allow you to take them once a month, or once every few months. Bisphosphonates for osteoporosis are the main “strike force” of doctors, due to their effectiveness and safety.

Correctly selected treatment for osteoporosis allows you to increase bone density by 5-10% per year, which greatly reduces the risk of developing fractures. It should only be recalled that this therapy is long-term, designed to last for years of use. You should not think that treatment for one or two months will give any noticeable result.

Consequences and complications of osteoporosis of the joints

A complication of this disease is fractures even with low load, the most dangerous of which is a fracture of the femoral neck. To exclude such complications, you need to wear protectors for damaged joints, avoid strong physical exertion and those impacts that can lead to injuries (jumping, running, etc.).

Important! If you are taking medications that cause dizziness, talk to your doctor about stopping them or adjusting the dose. When you feel dizzy, there is a risk of falling and getting a fracture.

Prevention of osteoporosis of joints

First of all, you need to see a doctor as soon as possible - as soon as you experience the first discomfort in the joints. People at risk are recommended to undergo preventive densitometry once a year and donate blood for calcium. The latter test must be taken regularly even in case of long-term therapy with glucocorticosteroids and hormones.

It is important not to abuse alcohol, eat foods rich in calcium, do light exercise regularly, maintain a normal weight, and limit caffeine-containing drinks.