How to prevent osteoporosis?

In today's data on the causes, patterns and mechanisms of the formation of osteopenic conditions, a powerful potential is laid, allowing to create methods and determine the tactics of treatment at various stages of development of osteopenia.

The strategy of prevention and treatment of osteoporosis is based on different approaches and "targets". The overall goal of the strategy should be to reduce the number of fractures in the population or improve the prognosis for those who have already undergone fracture (a population approach to prevention and treatment). An example of a successful population approach to prevention is vaccination in a number of infectious diseases (smallpox, polio, etc.). Unfortunately, an effective population approach to anti-osteoporotic measures is not currently developed. Another approach is individual, aimed at patients belonging to any risk group (primary prevention), who have low bone mass, but have not yet had a fracture (secondary prevention), or who have already undergone it (tertiary prevention or treatment).

[1], [2], [3], [4], [5]

Primary prevention of osteoporosis

Primary prevention can be used at all stages of life. It should be based on the identification of risk groups for the development of osteoporosis and fractures using some screening methods (identification of risk factors followed by densitometry using existing techniques or BM bone formation and / or resorption). It should be emphasized that the level of bone metabolism can be an "independent" risk factor for bone loss.

Given that the vast majority of fractures occur in older age groups, one of the methods to reduce the individual risk of fractures throughout life in the population is primarily the increase in bone mass at an earlier age in order to influence the long-term prognosis. To achieve the effect, the application of such measures must be long and meet the requirement of a risk / safety relationship in favor of safety. Unfortunately, most of the risk / safety studies of anti-osteoporotic interventions conducted to date are not prospective, randomized, controlled, but observational, which reduces their value relative to long-term prognosis. Practically there are no works evaluating the role of a complex of factors, both positive and negative, that affect the bone system of the individual, and also highlight the economic side of the issue, primarily the correlation between the real cost of primary osteoporosis prevention programs and the potential benefits from it in the future (reduced risk of fractures, disability and disability). Undoubtedly, a change in lifestyle can have a positive effect, in particular, the refusal to smoke and alcohol abuse, regular exercise, the inclusion of foods rich in calcium, vitamins, correction of dyshormonal disorders.

Secondary and tertiary prevention of osteoporosis

Secondary prevention is based on the identification of "preclinical" cases, i.e. Patients with low bone mass or an "independent" risk of fractures. The tactics of determination are similar to those for primary prevention. Tertiary prevention primarily involves the alertness of first-line doctors, rheumatologists, orthopedic traumatologists and related specialists regarding the risk of repeated fractures in individuals with low bone mass.

Prevention of falls is an obligatory part of preventive measures, since with increased fragility of the skeleton any fall can be complicated by a fracture. Ways of preventing falls are actively being developed: physical exercises, training of the vestibular apparatus, modulation of external and internal risk factors, and in some cases the use of special "protectors" for the hip, various corsets, etc.

When treating a patient with osteoporosis, the doctor should first of all try to reduce the rate of skeletal loss of the mineral component and stabilize the bone mass. Anti-osteoporetics therapy should be effective for a long period, have a minimum of side effects. Depending on the nature of the clinical manifestation and the severity of osteoporosis, the physician can choose the optimal tactics of prevention and treatment or a combination of both.

Rheumatologists should pay much attention to the interaction of anti-osteoporotic drugs with the most commonly used in the treatment of osteoarthritis and co-orthopedics - NSAIDs and SCS.

Therapy of osteopenia and osteoporosis should be based on the following principles:

1. Etiologic (treatment of the underlying disease, against which osteopenia or osteoporosis arose);
2. Pathogenetic (medicamentous therapy of osteoporosis);
3. Symptomatic (first of all, a decrease in the severity of the pain syndrome);
4. Additional methods - diet, physiotherapy procedures, exercise therapy, massage, balneotherapy.