Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.


Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.

"Тrauma" Том 17, №2, 2016

Back to issue

Optimization of Treatment and Diagnosis in Patients with Osteoporosis

Authors: Ihnatiev O.M., Polivoda O.M., Turchyn M.I., Shanyhin A.V. - Odessa National Medical University, Odessa, Ukraine

Categories: Traumatology and orthopedics

Sections: Specialist manual

print version


Summary

Обстежено 250 пацієнтів віком від 19 до 89 років (49 чоловіків та 201 жінка) із різним ступенем втрати мінеральної щільності кісткової тканини. За методами лікування пацієнти були розділені на три групи: група А — з метою лікування використовувалася кінезотерапія в поєднанні з медикаментозною терапією; група Б — ДЕНС- і кінезотерапія в комплексі зі схемою медикаментозного лікування; контрольна група — медикаментозна терапія. Установлено, що відновлення кістково-м’язової системи в пацієнтів основних груп А і Б настає швидше, ніж у пацієнтів контрольної групи, однак найбільш швидке зростання показників мінеральної щільності кісткової тканини спостерігалося в пацієнтів основної групи Б.
Визначена залежність інтегральних показників клінічних проявів і порушень кістково-м’язової системи від ступеня деформації тіл хребців та NSF Index.
Запропоновано диференційний підхід до вибору індивідуальних фізичних вправ, пов’язаних із дією на скелет динамічного та статичного осьового навантаження, з урахуванням різниці сили м’язів згиначів і розгиначів.

Обследовано 250 пациентов в возрасте от 19 до 89 лет (49 мужчин и 201 женщина) с разной степенью потери минеральной плотности костной ткани. По методам лечения пациенты были разделены на три группы: группа А — с целью лечения использовалась кинезотерапия в сочетании с медикаментозной терапией; группа Б — ДЕНС- и кинезотерапия в комплексе со схемой медикаментозного лечения; контрольная группа — медикаментозная терапия. Установлено, что восстановление костно-мышечной системы у пациентов основных групп А и Б наступает быстрее, чем у пациентов контрольной группы, однако наиболее быстрый рост показателей минеральной плотности костной ткани наблюдался у пациентов основной группы Б.
Выявлена зависимость интегральных показателей клинических проявлений и нарушений костно-мышечной системы от степени деформации тел позвонков и NSF Index.
Предложен дифференциальный подход к выбору индивидуальных физических упражнений, связанных с воздействием на скелет динамической и статической осевой нагрузки, с учетом разницы силы мышц сгибателей и разгибателей.

The study involved 250 patients aged 19 to 89 years (49 men and 201 women) with varying degrees of bone mineral loss. According to the methods of treatment, patients were divided into three groups: group A — kinesitherapy in combination with a standard medical regimen was used; group B — the use of kinezi- and DENS-therapy in combination with a medical regimen; control group — drug therapy. It was found that the recovery of the musculoskeletal system in patients of group A and B is faster than in the control group, but the most rapid growth rates of bone mineral density were observed in patients of the group B.
A dependence of integral indicators of clinical manifestations and disorders of the musculoskeletal system on the degree of vertebral bodies deformation and NSF Index was determined.
Differential approach to the choice of the individual exercises related to the impact on the skeleton of dynamic and static axial load is proposed taking into account the difference in strength of the flexor and extensor muscles.


Keywords

остеопороз, остеопенія, індекс травматичного ризику, бальна оцінка.

остеопороз, остеопения, индекс травматического риска, балльная оценка.

osteoporosis, osteopenia, traumatic risk index, score.

The problem of osteoporosis by medical-social value ranked fourth among all diseases non-infectious origin. Osteoporosis in many cases is the cause of early disability of people of working age, so the problem requires the development of new methods and schemes of early diagnosis and treatment to improve bone health and reduce the risk of fractures..

It is known that there were a large number of studies that examine the effectiveness of exercise for the rehabilitation of patients with osteoporosis, and the definition of diagnostic criteria based on the degree of manifestation of the disease, but scientists consensus was never reached. In this regard, need to study the modern problems of diagnostics, treatment and rehabilitation of patients with osteoporosis is obvious.

Objective: To improve the efficiency of diagnosis and treatment of osteoporosis and osteopenia in the conditions of complex use of DANCE and kinesitherapy on standard medical scheme.

Material and methods

Surveyed 250 patients aged 19 to 89 years with varying degrees of loss of mineral bone density.

During treatments, patients were divided into three groups depending on the treatment methods: group A (n = 81) - the use of kinesitherapy in combination with a standard medical regimen; group B (n = 109) - the use of kinezo- and DENS-therapy in combination with a standard medical regimen; clinical control group (n = 60) - the use of standard medical therapy.

Evaluation of the effectiveness of the treatment was performed before therapy, after 6 and 12 months.

At all stages of the research conducted medical history, assessment of the objective and subjective conditions of the patient, laboratory diagnostics (biochemical blood analysis, C-terminal telopeptide (CTX), instrumental tests (ultrasound densitometry), X-ray morphometric researches of vertebras, functional studies (NSF Index) .

 Results

According to the indications of ultrasonic examination found that before treatment in group B the number of patients with severe osteoporosis was higher (86.2%) than in the other two groups (group A - 72.8%, control group - 80%). After 12 months, it was found that the percentage of patients with osteoporosis in group A was - 54.3% in Group B - 60.55% Control group - 53.33%. This indicated the presence of positive dynamics on the background of the recommended treatment in each of the study groups.

Assessing the value of neurospinal index was found that NSF Index – “less than 70” in Groups A and B was higher (43.2% and 45.87%) than in control group (18.33%).

During the observation period marked improvement NSF Index. After 12 months of treatment NSF Index in all study groups was in satisfactory condition.

The number of patients with NSF Index «good» or higher at the beginning of treatment in the control group was 21.67%, after 12 months 86.67% in group A - 7.4%, and after 12 months 79.01% and group B - 9.17%, after 12 months 74.31%.

It has been found that the clinical symptoms were more pronounced in patients with a higher degree of compression of the vertebrae and a higher index of traumatic risk at NSF Index indicators - «mediocre" (70-79). Table 2 shows the performance level of compression of vertebrae, index of traumatic risk and NSF Index.

A more severe degree of compression is seen in women in group B and the control group over the age of 60 years, and in group A "from 46 to 60 years." In men, the degree of compression of the vertebrae in the control group was most pronounced in the age group of "31 to 45" in Groups A and B in the range from 46 to 60 years. The overall assessment of all patients in each group the degree of compression of the vertebrae did not differ.

On the basis of indicators of the degree of deformation depending on the vertebral bodies and NSF Index has been allocated a new indicator, called a traumatic or scoring index.

Indicators of biochemical markers of bone resorption before treatment were above normal in 45.7% of patients of group A (STh- 0.61 ± 0.03 g / l), in patients of group B – 49.87 % (CTX– 0,63±0,02 g/l) in the control group -44,2% (CTX– 0,60±0,03 µg/l), this indicates an accelerated loss of bone mineral density.

After 12 months of treatment was found to reduce the number of patients whose CTX level in the blood above the norm: Group A - 21.17% (CTx - 0,58 ± 0,03 mg / l), group B - 17.81% (CTx - 0,60 ± 0,03 mg / l), the control group - 37.13% (CTx - 0,59 ± 0,03 mg / l).

Conclusions

The dependence of the integral indicators of clinical manifestations and disorders of the musculoskeletal system of the degree of deformation of the vertebral bodies and NSF Index is defined.

A differentiated approach to the choice of individual exercise-related effect on the skeleton of dynamic and static axial loads, taking into account differences in muscle strength flexors and extensors is offered.

The integrated use of DANCE and kinesiotherapy combined with bone-seeking agents enhances bone mineral density, reduces pain, improves the "quality" of bone tissue.

Also, in patients receiving combined therapy improved quality of life due to the expansion of motor abilities. The proposed scheme of treatment is also effective as a prevention of fractures, thereby reducing disability in patients and preserving their health.


Bibliography

1. Поворознюк В.В., Орлик Т.В., Крєслов Є.О. Сучасний погляд на проблему остеопорозу в чоловіків в Україні // Боль. Суставы. Позвоночник. — 2012. — 2 (6). — С. 42-49.

2. Игнатьев А.М., Турчин Н.И. Оценка функционального состояния костно-мышечной системы при остеопении и остеопорозе // Вестник морской медицины. — 2015. — Вып. 1. — С. 11-17.

3. Clarke B.L. Physiology of bone loss / B.L. Clarke, S. Khosla // Radiologic Clinics of North America. — 2010. — Vol. 48, № 3. — Р. 483-495.

4. Dose-Effectiveness Relationships Determining the Efficacy of Ibandronate for Management of Osteoporosis: A Meta-Analysis / Y. Hou, K. Gu, C. Xu [et al.] // Medicine (Baltimore). — 2015. — Vol. 94, № 26. — Р. e1007.


1.     Povoroznyuk V.V., Orlyk T.V., Kryeslov Ye.O. Suchasnyy pohlyad na problemu osteoporozu u cholovikiv v Ukrayini. // Bol'. Sustavi. Pozvonochnyk. – 2012. – 2 (6):. – s. 42 -49.

2.     A.M. Yhnt'ev, Turchyn N.Y. «Otsenka funktsyonal'noho sostoyanyya kostno-mishechnoy systemы pry osteopenyy y osteoporoze». Vestnyk morskoy medytsyni, vipusk #1 – 2015. s. 11-17.

3.     Clarke B. L. Physiology of bone loss / B. L. Clarke, S. Khosla // Radiologic Clinics of North America. – 2010. – Vol. 48, # 3. – R. 483–495.

4.     Dose–Effectiveness Relationships Determining the Efficacy of Ibandronate for Management of Osteoporosis : A Meta–Analysis / Y. Hou, K. Gu, C. Xu [et al.] // Medicine (Baltimore). – 2015. – Vol. 94, # 26. – R. e1007.


Back to issue