The World Health Organization (WHO) describes osteoporosis as a generalized disease that changes the microarchitecture of the bone tissue and decreases the bone mass. Bones become more fragile, the patient’s body height is decreased, the back of the patient is crooked, and generalized pain is present. A patient with osteoporosis often complains of “having pain all over the body”. The complaints should be considered, and fractures (collapse of the vertebra, fracture of the head of the femur or the wrist) developing secondary to osteoporosis should be prevented. Diagnostic tests include bone density measurement in the area of the lumbar vertebra and the head of the femoral neck (DEXA), and laboratory tests. Therapy is the following: the patient should be administered the appropriate dose of calcium and vitamin D, exposure to sunshine can be beneficial as well as the consumption of a healthy diet, and medical therapy if needed.
Degenerative osteoarthritis is an abnormality of unknown origin in the joints. Genetic factors, life style, occupation, diet, and advancing age definitely have a role in the development of this condition. The lining of the joint becomes thicker and inflamed, and ruptures and indentions develop in the hyaline cartilage. Cysts and spurs are formed in the bones. The ligaments get fibrous and looser. The given joint is getting more painful with the presence of muscle spasms and limited range of motion. The joint gradually becomes stiff and deformed. Both the muscle strength and the muscle bulk are decreased. In patients with the suspected condition, physical examination and imaging studies (X-ray, ultrasound and/or CT and MRI scans) should be performed. Follow-up of the patient is crucial. The aim of the therapy is to maintain the present status of the patient and prevent the deterioration of the condition. Treatment may be medical therapy and/or injection therapy, therapeutic exercises as well as corrective bone surgeries to protect the joint. In severe cases, a joint implant (prosthesis) might be necessary.
The “shelf life” of the implanted prosthesis should always be considered. Optimally, it is 10 to 20 years depending on the affected body part. If the prosthesis is displaced, the reason should be revealed. The complication may be of biological or mechanical in nature. In certain cases, conservative therapy may be the best option, but in the majority of the cases, repeated surgery is needed. If the complaints are caused by an infection, or the prosthesis “gets dislodged”, acute surgical intervention is needed.
The treatment of fractures is a challenge for traumatologists. In most of the cases, the use of a plaster cast or bone fusing operation can result in complete healing. Although it can happen that the process is prolonged and a pseudoarthrosis may develop, the fractured bone is fused in an abnormal position or with deformity, and the implanted prosthesis may also get displaced. That is why professional primary care and follow-up is vital. If the patient develops complications, corrective bone surgery may be needed, and in case of bone loss, the bone or the implant should be replaced. Every patient needs treatment tailored to his or her needs.
Injection therapies may be administered to treat joint diseases or soft tissue abnormalities. As to our present knowledge, there is no complete cure for degenerative joint disease. During the regeneration of the damaged hyaline cartilage, fibrous cartilage is formed. The administration of available hyaluronic acid injections may protect the hyaline cartilage, prevent further damage, promote regeneration, and the increase of the range of motion as they can all decrease the pain. The effect of hyaluronic injection therapy lasts for 6 to 12 months. Injections given directly into the soft tissues, especially into the bursa, aim at ceasing the inflammation. In fortunate cases, even one injection may lead to the cessation of the inflammation. But it may also happen that the patient needs 2 to 3 further injections.