Osteoporosis – a Silent Epidemic of XXI Century: Secondary Forms

Abstract

The objective of the study was to determine the main causes of osteoporosis in chronic kidney disease, chronic obstructive pulmonary disease, pulmonary sarcoidosis and understand how the disease develops in these conditions.
 Materials and Methods. To study the mechanisms of developing secondary osteoporosis, a literature review was conducted.
 Results. Secondary forms of osteoporosis account for approximately 15-20% of reported cases and result mainly from concomitant diseases or from using drugs that have a negative effect on bone tissue. Despite its inert and stable appearance, bone tissue is a metabolically active, continuously renewing system. Throughout life, it continuously undergoes remodeling cycles involving the two main processes: the first one is called bone resorption and involves the breakdown of old bone followed by the destruction and removal of both the mineral substance and the organic matrix from resorption sites; the second one is called new bone formation and involves bone matrix synthesis and its subsequent mineralization. The imbalance between these two processes, the predominance of bone resorption over bone formation, is the key link in the pathogenesis of osteoporosis. Such an imbalance reflects the impairment of the major mechanisms of systemic hormonal and local (cytokine) regulation of cellular activity and occurs in secondary osteoporosis.
 Conclusions. To date, at the stage of providing medical care to patients with chronic bronchopulmonary diseases and chronic kidney disease, inadequate attention is paid to timely diagnosis and treatment of concomitant osteoporosis. The latter often develops as a secondary condition due to systemic inflammation, severe hypoxia, low physical activity, taking inhaled and systemic glucocorticoids. Its signs are not clinically apparent; hence, it is referred to as the ‘silent epidemic. Since osteoporosis has no pathognomonic symptoms and its clinical presentation is rather vague, in patients with chronic bronchopulmonary diseases and chronic kidney disease, its early diagnosis by determining mineral bone density is recommended to prevent the development of severe complications, including low-energy fractures.