Osteoporosis: we will expand and deepen the diagnosis, prevention and treatment!
Primary care doctors will be given an algorithm for early detection of osteoporosis
ABC MagazineOn April 23-24, 2011, the III All-Russian Conference of Regional Osteoporosis Centers was held in Yaroslavl.
At the meeting, it was decided to develop an all-Russian standard for the treatment of patients with hip fractures, to introduce an algorithm for the actions of a primary care physician when admitting a patient with suspected osteoporosis and an increased risk of falls, and to widely use available methods for diagnosing osteoporosis in Russia.
Osteoporosis is a disease in which bones lose their strength, become more fragile and can easily break. According to statistics, 34 million people in the Russian Federation are at risk of fractures associated with osteoporosis. Osteoporosis in our country is present in 14 million people, another 20 million have osteopenia (a decrease in the mass of mineralized bone tissue in various diseases). In the age group over 50, one in four women and one in three men have osteoporosis. Every minute in Russia there are 7 vertebral fractures caused by this disease, every 5 minutes there is a fracture of the femoral neck. However, osteoporosis is still not recognized as a socially significant disease in Russia.
Vice-President of the Russian Association for Osteoporosis, Professor Olga Ershova: "The fact that the disease is not recognized as socially significant in Russia does not allow us to have enough equipment, specialists and solve a number of issues related to hip fractures, endoprosthetics. We would very much like to see a standard of treatment for patients with hip fractures created. And we consider this one of our most important, most urgent tasks. It is also necessary to develop an algorithm for the therapist's actions at the reception of a patient with suspected osteoporosis, since the involvement of primary health care in the process of diagnosis and treatment of this disease is extremely important."
Early diagnosis of an increased risk of fractures is one of the most acute problems. As a rule, osteoporosis is asymptomatic and is detected only when the patient is admitted to the hospital with a fracture. The examination that allows you to determine the density of bone tissue – densitometry – is not paid by the state. There are few special devices – densitometers – in Russia, and they are unevenly distributed throughout the country. So, in 2009, 167 X–ray densitometers were registered in the Russian Federation, 52% of the devices are located in Moscow, 20% - in St. Petersburg. Meanwhile, according to international recommendations, there should be about 1,500 densitometers in Russia. Devices and special tests that can detect the tendency of an elderly person to fall are not used in general medical practice at all.
An equally difficult task is to organize treatment of patients in Russia corresponding to the world level. Thus, the operative method is the world standard for the treatment of hip fractures caused by falls of elderly people and osteoporosis. Meanwhile, in Russia, only a small percentage of patients can count on a free operation. According to the president of the Russian Association for Osteoporosis, Professor Olga Lesnyak, as a result of conservative treatment of hip fractures, 63% of patients over 60 years old die.
Almost the entire population of Russia is at risk of developing osteoporosis. The fact is that in order to absorb calcium, which is so necessary for bone strength and maintaining normal muscle tone, D-hormone is needed. It is formed in the process of complex chemical reactions from cholecalciferol (vitamin D), which, in turn, is synthesized in the skin under the influence of ultraviolet radiation, and also enters the body with some foods.
Vitamin D (coming from food or formed in the body during endogenous synthesis) as a result of two successive hydroxylation reactions of biologically inactive prehormonal forms undergoes transformation into active hormonal forms: the most important, qualitatively and quantitatively significant – 1α,25-dihydroxyvitamin D 3 (1α,25 (OH)2 D 3, also called D-hormone, calcitriol) and minor – 24.25(OH)2 D 3.
Vitamin D formation, its metabolism and main biological effects(From the article "Vitamin D, D-hormone and alfacalcidol:
medical, molecular biological and pharmacological aspects"
G.Y. Schwartz, Institute of Applied Pharmacology, Moscow //
Ukrainian Rheumatology Journal No. 3-2009 – VM).
The territory of Russia is located above 40 degrees north latitude, and from October to April, the possibility of synthesis of cholecalciferol in the skin is very limited here, as well as the consumption of dietary sources of vitamin D. Consequently, a huge part of the population is at risk of D-deficiency. At the same time, elderly people face another danger: due to the age-related decline in kidney function, the conversion of inactive vitamin D into physiologically active D-hormone is sharply reduced. Usually, special active metabolites of vitamin D, such as alfacalcidol, are used in these cases. Meanwhile, in medical practice, recommendations for the use of native and active forms of vitamin D exist only for children of the first two years of life, and there are no such recommendations for the elderly at all.
Experts who spoke at the conference noted that due to the inaccessibility of hardware diagnostics, other methods of early detection of the disease are of great importance at the moment. These include the FRAX technique developed by the World Health Organization. This is a certain test, answering the questions of which, it is possible to judge the level of absolute risk of fractures for each individual in the next 10 years. At the moment, this technique is in the process of development for Russia, so our specialists use the model of the country closest in epidemiological indicators – Finland. According to Olga Lesnyak, in the future, this technique may well replace densitometry, at least at the level of primary health care: "A new paradigm has come in the prevention and treatment of osteoporosis – from the treatment of low mineral density, the focus has shifted to identifying the risk of fractures."
The conference participants agreed that it is necessary to build clear admission schemes for patients with suspected osteoporosis and an increased risk of falls and fractures, make advanced diagnostic and treatment methods available to a wide range of patients, expand the network of specialized centers and seek recognition of the problem of fractures in the elderly in Russia as a priority for healthcare.
Portal "Eternal youth" http://vechnayamolodost.ru28.04.2011