How do you prevent osteoporosis?

The currently available data on the causes, patterns and mechanisms of the formation of osteopenic conditions contain powerful potential that allows us to create methods and determine treatment tactics at various stages of osteopenia development.

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

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Primary prevention of osteoporosis

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

Considering that the vast majority of fractures occur in older individuals, one of the methods for reducing the individual risk of fractures throughout life in the population is, first of all, increasing bone mass at an earlier age in order to influence the long-term prognosis. To achieve the effect, the use of such measures should be long-term and satisfy the requirement for a risk/safety ratio in favor of safety. Unfortunately, most of the studies of the risk/safety of antiosteoporotic measures conducted to date are not prospective randomized controlled studies, but observational, which reduces their value in relation to long-term prognosis. There are practically no studies that would assess the role of a set of factors, both positive and negative, affecting the skeletal system of an individual, and would also cover the economic side of the issue, primarily the ratio of the real cost of primary osteoporosis prevention programs and the potential benefit from it in the future (reduced risk of fractures, disability and invalidity). There is no doubt that a positive effect can be achieved by changing your lifestyle, in particular, quitting smoking and alcohol abuse, regular exercise, including foods rich in calcium and vitamins in your diet, and correcting hormonal imbalances.

Secondary and tertiary prevention of osteoporosis

Secondary prevention is based on the identification of “preclinical” cases, i.e. patients with low bone mass or “independent” risk of fractures. The tactics of identification are similar to those for primary prevention. Tertiary prevention primarily involves alertness of primary care physicians, rheumatologists, orthopedic traumatologists and related specialists to the risk of recurrent fractures in individuals with low bone mass.

Fall prevention is an essential part of preventive measures, since with increased skeletal fragility any fall can be complicated by a fracture. Ways to prevent falls are being actively developed: these include physical exercises, vestibular apparatus training, modulation of external and internal risk factors, and in some cases the use of special hip "protectors", various corsets, etc.

When treating a patient with osteoporosis, the doctor should try to reduce the rate of mineral loss by the skeleton and stabilize bone mass. Antiosteoporotic therapy should be effective over a long period and have a minimum of side effects. Depending on the nature of the clinical manifestation and severity of osteoporosis, the doctor can choose the optimal tactics of prevention and treatment or a combination of both.

Rheumatologists should pay great attention to the interaction of antiosteoporotic drugs with the most commonly used drugs in the treatment of osteoarthritis and osteoporosis - NSAIDs and GCS.

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

1. Etiological (treatment of the underlying disease that led to osteopenia or osteoporosis);
2. Pathogenetic (drug therapy for osteoporosis);
3. Symptomatic (primarily reduction in the severity of pain syndrome);
4. Additional methods - diet, physiotherapy procedures, exercise therapy, massage, balneotherapy.