The bone atrophy (osteoporosis)

The bone atrophy (osteoporosis) is a generalized bone disease which implies quantitative and qualitative failure of the bony substance. The disease takes a turn for the worse and the bones will become more and more fragile.

The bone atrophy is a widespread disease which affects millions of people all over Europe.

Two kinds of it are known, namely the primary and the secondary form. In the primary form the women’s osteoporosis after menopause and the old-age osteoporosis are included. In background of the secondary form various diseases (rheumatological clinical pictures accompanying by inflammation, hormonal problems, resorption and eating disorders, kidney diseases, states causing akinesia, alcoholism, various drugs) are effective.

Risk factors of the bone atrophy:

• female sex,
• age over 45,
• white skin, early greying,
• thin build,
• immobility, life-style with poor mobility,
• increased consumption of alcohol, smoking,
• overconsumption of coffee and/or carbonated soft drink,
• states accompanying by lack of sex hormone, early menopause,
• in own anamnesis any bone fracture occurring because of little trauma,
• bone atrophy occurring in the family and/or typical fracture because of osteoporosis,
• chronic disease of liver, kidney, gastrointestinal and thyroid disease, transplantation,
• prolonged taking of certain medicines (e.g. steroid, anticoagulant, agent against epilepsy).

Symptoms of the bone atrophy

The bone atrophy is regarded also as „silent epidemic” because it does not often cause any other complaint until the first fracture. In case of any fracture occurred because of pain in lumbar region, diffuse motion sickness, progression of dorsal curvature of vertebral column, decrease of body height, abdominal pain not explained by other causes, recurring kidney stone, as well as in case of bone fracture owing to a little trauma this clinical picture must be expected.

The subsequent bone fractures must be regarded as the greatest health risk of the disease. In case of the hip fractures the mortality rate is just as high as for diabetes or breast cancer. After hip fractures only 25% of the patients can attain their state prior to the fracture and only after a proper rehabilitation. The bone atrophy can induce primarily fracture of wrist, vertebra, hip and upper arm.

Densitometric examination (Dexa)

The dexa-examination is an appropriate method for determination of the bone density and the mineral content of complete body, as well as it is suitable for calculation of the mass and ratio of adipose tissue and/or soft tissue. This examination can indicate the risk of bone atrophy before occurring serious complaints so that a proper medical treatment can be commenced before development of more serious problems.

(Prior to the examination a questionnaire covering family and personal antecedent related to the diseases, the bone fracture should be filled out. The relevant data will be entered in the data base of the computer. The densitometric examination (DEXA) is painless. The patients need to stay immovably lying on the machine for a few minutes).

Prevention

Some reduction of the bone mass occurs at all people and, in addition to the genetic factors, the extent of this mass loss is greatly influenced also by our lifestyle. Prevention and treatment of the disease is a complex mission which covers the diet abounding in calcium, the adequate supply of vitamin D, the kinesitherapeutic program ensuring maintenance of the bone- and muscle mass and supporting the movement co-ordination, the balneo-physiotherapy, relaxation promoting mitigation of the subsequent pains of joints/muscles.

Therapy

Aim of the therapy is to prevent bone fracture and „re-fracture”.

Consultancy for life-style, information to patients

It is important that the patient’s risk factors should be estimated and the possible risk factors should be eliminated, with special emphasis of the life-style with poor mobility.

To assure adequate intake of calcium and vitamin D

Adequate calcium-intake is required for the normal growth, for development of the maximal bone mass and/or for maintenance of the equilibrium related to the adult bone metabolism. Now in Hungary 400-600 mg calcium on average is consumed by one person each day, namely instead of the required 1000-1500 mg. The good diet abounding in calcium and replacement of calcium by proper medicament are essential.

Similarly the vitamin D is a determinative element for the bone-building thus its replacement by medicament and sufficient UV exposure (sunbathing) are also very important.

Kinesitherapy

The movement is one of the main stimulating agent of the bone-building cells thus the motion is a primary element for therapy of the bone atrophy. The motion forms giving vertical load on the vertebral column are the most efficient (walk, jogging, gymnastics, dance). It is useful for every patient when individual physical training corresponding to his/her general status and other diseases should be taught. Strengthening of the musculature, co-ordination of the motion, improvement of the balance sense all help in prevention of the falls so that all these hinder occurring of subsequent bone fractures.

Prevention of falls

For prevention of the falls the treatment of comorbidities, the adjustment of blood pressure and blood glucose level, the treatment of hearing, visual problems and vertiginous states are very important. If required, medical aids, stick, walking frame must be used. For reconstruction of the residential environment the adequate lighting, the making handicap accessibility, the friction-tight shaping, the installation of rails, handrails may be good solution.

Medicinal therapy

With prevention of the bone degradation and with increase of the bone-building the medicaments with various attack points help maintenance of the bone mass.

Physiotherapy, balneo-therapy

Of the physiotherapeutical methods the therapeutic gymnastics should be emphasized. In addition to the strengthening of muscle its aim is to stretch, to relax the muscles, to prevent occurring of contractions, to improve motion ranges, to improve co-ordination, to increase aerobe capacity and to treat disorders of the soft tissues.

Other physiotherapeutical treatments (traditional medication, bath in medicinal water, massage, packing) assist in mitigation of the pains and/or in relaxation of the muscles.

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