novi koncept ljecenja skeletnih bolesti

Prof. Dalibor Krpan, MD, PhD

Chronic skeletal diseases, among which the most common are osteoarthritis (arthrosis) and osteoporosis, are the biggest public health problem of our civilization. Despite this fact, which has been repeatedly confirmed by numerous statistics from the World Health Organization (WHT) and data showing that the complications of these diseases represent one of the biggest financial burdens on state economies, skeletal diseases were ignored for many years and considered a consequence of normal aging.

COMMON HEALTH PRACTICE IS REDUCED ONLY TO PARTIAL AND SYMPTOMATIC THERAPY, WITHOUT A SATISFACTORY EFFECT FOR THE PATIENT

Therapy was usually only partial and symptomatic, no attention was paid to prevention, and there was no significant professional interest in that area. Unfortunately, even today, the situation has not changed significantly. After a certain increase in interest in the problem of osteoporosis that took place at the end of the nineties, stimulated above all by the introduction of drugs and the interest of pharmaceutical companies, in recent years we have once again witnessed a loss of interest of the public and the profession in the difficult problem of osteoporosis. This is certainly a consequence of some disappointment with the effect of drugs and the realization that osteoporosis is a much more complex problem than thought, which is why the interest of the pharmaceutical industry has decreased. However, at the same time, it is also the result of insufficient basic knowledge about bones, both by doctors and the population as a whole.

When it comes to osteoarthritis, nothing much has changed over the years. The fatalistic approach still dominates, that nothing can be done anyway, because it’s believed we cannot regenerate the cartilage, and we have nothing left but to temporarily reduce the discomfort with various methods of physical therapy, and in more severe cases, to implant prostheses and artificial joints. It is incredible how deeply rooted these attitudes are among the profession and doctors who have a hard time accepting new methods and knowledge. It’s as if they don’t want to admit that the previous approach to chronic diseases was insufficient.

Is it true that we really can’t treat our patients, who suffer from chronic bonesto-joint diseases, better? Actually, we very much can!

How is it that in some other areas, medicine has made great progress, and when it comes to skeletal diseases, we are still standing still?

We still don’t even have a profession that deals with the skeleton as a whole, but we are still divided into orthopedists, physiatrists, rheumatologists, endocrinologists, who each deal with bones in their “backyard”, and we forget that the skeleton is a unique organ. That it is not a set of bones and joints, but an indivisible whole that functions in a connected manner so that changes in one part of the skeleton are transmitted to the entire skeleton.

For example, osteoarthritis of the knee is not only a disease of the knee, because it leads to a significant disturbance of bio-mechanics and thus an overload on other joints with the consequent development of osteoarthritis on those joints. Because of this, the possible replacement of the knee with a prosthesis cannot solve the problem as a whole, so the pain in the knee after the operation may be less, but the pain in the hip or back will increase!

IT IS LESS KNOWN THAT DUE TO DISTURBED BIO-MECHANICAL BALANCE, AS A CONSEQUENCE OF OSTEOARTHRITIS, BONE QUALITY ALSO WORSE, WHICH INCREASES THE RISK OF FRACTURES.

IN SUCH CASES, DUE TO THE NUMEROUS CALCIFICATES THAT FOLLOW OSTEOARTHRITIS, WE WILL OFTEN NOT FIND A LOW MINERAL DENSITY ON A BONE DENSITOMY AND WE WILL NOT RECOGNIZE OSTEOPOROSIS, ALTHOUGH THAT IS EXACTLY WHAT IT IS ABOUT.

HOWEVER, IT IS WELL KNOWN THAT IN ALMOST 50% OF CASES OF FRACTURE DUE TO SMALL TRAUMA, WHICH IS A SURE SIGN OF POOR BONE QUALITY, THEREFORE OSTEOPOROSIS, A NORMAL BONE DENSITOMY FINDING IS FOUND

So, there is too much evidence that leads to the conclusion that we need to change something in the approach to chronic bone and joint diseases. Fortunately, in recent years, stimulated by the increasing interest of the industry and better funding, great progress has been made in the knowledge of skeletal biology and significantly increased treatment options with the introduction of new drugs and technologies. Now it is the turn of clinicians and the entire society to translate these new scientific knowledge and technological possibilities into clinical practice.

WHY DO WE NEED A NEW TREATMENT CONCEPT AND WHAT IS IT BASED ON?

Based on scientific studies and clinical experience, we can say the following:

  1. The skeleton is a unique organ, consisting of many bones and joints and at least three types of tissue: bone, cartilage and muscular-connective tissue (muscles, tendons, ligaments, fascia)
  2. The skeleton is affected by numerous factors that can be divided into genetic, bio- mechanical and metabolic. Since the structure of the bone is constantly changing through the process of bone remodeling, the structure and quality of the bone is the result of the simultaneous action of all these factors.
  3. The function of the skeleton as a whole depends on the structure and quality of all its parts, so it is always necessary to carry out integral treatment of the skeleton as a whole.
  4. Diagnostic procedures and imaging cannot accurately determine the condition of the skeleton, so it is necessary to assess the condition using a combination of several methods, predict risks and dynamics, and plan therapy based on this. For this, a good knowledge of the biology of the skeleton and the possibilities of certain diagnostic and therapeutic methods is necessary, which is why the education of doctors in this area, which is deficient, should be improved.
  5. Since it is not possible to use the same therapeutic agent or drug to act on all parts of the skeleton, the treatment must be carried out with a combination of several methods.

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