Fracturas vertebrales una consecuencia común de la osteoporosis

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Sentí este dolor insoportable; dolor que nunca había sentido antes. Fue como un golpe tremendo por la espalda y caí al suelo… lo que significó que no podía levantarme.

La experiencia de María es compartida por los millones de personas con osteoporosis que han sufrido el terrible dolor causado por las fracturas de compresión vertebral. La fractura vertebral se produce cuando el hueso pierde densidad, se debilita y se derrumba. Al igual que María, muchas  personas que sufren tales fracturas se les dice que tienen “una hernia de disco ” y simplemente se prescribe reposo en cama, analgésicos y antiinflamatorios. Lamentablemente, muchos médicos subestiman las graves consecuencias de las fracturas vertebrales. Los estudios han demostrado que las fracturas vertebrales están asociadas con dolor, discapacidad, estadías prolongadas en el hospital, gastos importantes por medicamentos que calmen las molestias, e incluso la muerte.

Los efectos sobre la calidad de vida son importantes con el creciente número de fracturas vertebrales que no se diagnostican. Dos o más fracturas vertebrales resultan en la deformación espinal significante con la aparición de una “joroba”, pérdida de altura, y posterior disminución de la calidad de vida. A medida que la deformación espinal crece, la duración de la vida disminuye debido al dramático incremento en el dolor, la discapacidad y la depresión, sin embargo, las fracturas vertebrales permanecen reportadas muy debajo y se estima que menos de un tercio son realmente diagnosticadas (a pesar de que son el tipo más común de fracturas osteoporóticas en aproximadamente 4 a 5 mujeres mayores de 50 años, en las que se pueden encontrar una o más fracturas vertebrales (f.v.).

Obviamente hay una necesidad urgente para mejorar el diagnóstico y tratamiento de las mismas. Esto es muy importante debido a que la gente con f.v., tanto mínima como importante, son un riesgo con el aumento de fracturas adicionales. Dentro de los estudios que se han realizado se menciona que cerca del 20%  de las mujeres postmenopáusicas quienes experimentan una f.v., tendrán una fractura adicional en el próximo año. A nivel mundial hay una fractura ósea por osteoporosis cada 3 segundos. En América Latina, la OP y las fracturas relacionadas con ella están en aumento y en muchos países de la región, el número de fracturas será más del doble en el 2050.

Es obvio que la prevención de las fracturas múltiples podrían salvar a muchas personas de dolor, sufrimiento e incapacidad que este tipo de fracturas causan.

Pero, hay algo en común en las mujeres mexicanas, que son las que trato casi a diario, antes que nada niegan que tengan osteoporosis; ya que el médico familiar o general les realizó algunos estudios de laboratorio y les dijo que tenían una cifra de calcio perfecta. Ahora bien, el calcio sérico, cuyos valores normales van de 8.5 a 10.2 mg/dL., siempre tiene que estar “muy bien”. Todas las células necesitan este mineral para funcionar. El calcio ayuda a desarrollar huesos y dientes fuertes. Igualmente, es importante para el funcionamiento del corazón y que siga latiendo, ayuda con la contracción muscular, las señales nerviosas y la coagulación sanguínea.

Los huesos son el sitio principal de almacenamiento de calcio en el cuerpo. El calcio que el cuerpo necesita se obtiene únicamente a través de los alimentos que comemos o a través de suplementos, ya que el calcio no lo produce el organismo (es un mineral). Si no se consume suficiente calcio en la dieta o si el cuerpo no absorbe el calcio suficiente, los huesos se pueden debilitar o no desarrollarse apropiadamente. Que bueno que el calcio sérico (sanguíneo) este siempre bien y en cifras normales, porque sino el cuerpo empezaría a sufrir tremendamente.

Los huesos son un órgano vivo. Los huesos están siendo remodelados constantemente, el hueso viejo se absorbe (por medio de los osteoclastos) y se forma hueso nuevo por medio de los osteoblastos. Renovar todos los huesos del cuerpo toma aproximadamente diez años. Y aunque resulta increíble creerlo, si vivimos noventa años, nuestros huesos se habrán renovado unas nueve veces. Por esa razón es importante poner atención a la salud de los huesos en los niños en crecimiento, los adolescentes, periodo en el cual es necesario, depositar los nutrientes para que los huesos se vuelvan más resistentes, fuertes y con la densidad ósea suficiente para el resto de la vida. Y claro en los adultos, tendremos que continuar depositando calcio, magnesio, fósforo, etc. Es cierto, en esta edad, el metabolismo óseo (formación de hueso nuevo) es más lento, pero se realiza por años.

El cuerpo pierde continuamente iones fosfato y de calcio a través de los riñones y el tubo digestivo. Las células de otros tejidos corporales diferentes del tejido óseo, también requieren estas sustancias. Si no hay suficiente minerales en las dietas estos iones son tomados de los huesos y pasan a la sangre para ser transportadas a los tejidos que requieren de éstos. Esta pérdida deja a los huesos blandos, esponjosos y frágiles y con poca densidad ósea, lo que lleva poco a poco a la osteopenia (disminución de hueso) a la osteoporosis (OP) (hueso poroso y frágil).

Decirle a los pacientes que “ya no deben consumir calcio, porque su cuerpo ya no lo absorbe”, es una de las mayores mentiras que decimos los médicos.

Segunda mentira: “ya la cure de la osteoporosis”, la OP no se cura, se controla solamente, por favor hay que entender esto. Y esto nos lleva a decir que no voy a prevenir la OP, pero si voy a prevenir las fracturas de diferentes huesos, debido a la misma OP.

En todas las pacientes que trato de osteoporosis, hay un síntoma común, “el dolor en la espalda” o el  “dolor en la espina”. Pero, y aquí viene lo bueno, cada una tiene un justificación para ese dolor:

Que cargó bolsas pesadas cuando fue al mercado sobre ruedas.

Lavó mucha ropa y subió a la azotea para secarla al sol.

Planchó mucha ropa, estuvo mucho tiempo de pie preparando la comida.

Cargó muchas bolsas del súper.

Todas sin excepción “le achacan” a sus actividades diarias “el dolor” de espalda.

Nunca se ponen a considerar que es porque están con osteoporosis.

A todas les han dichos sus hijas o sus nietos: “mamá, abuela, te estás haciendo cada día más chiquita”. Y ellas lo toman como algo natural, al envejecer, se vuelve uno más chiquito y jorobado. ¡No!, no es así, estamos ya en un estado de osteopenia-osteoporosis, y no estamos haciendo nada por evitarla.

La cantidad que deberíamos ingerir de calcio varía con la edad, pero podemos considerar que en los niños una ingesta de 600mg a 800mg. De calcio diario es adecuado. En adolescentes de 1gr a 1.200mg, en adolescentes embarazadas hasta 1.5gr. y en adultos 1gr a 1.200mg. sería lo adecuado. ¿Pero cómo calcularlo? Piensen que 1 gramo de calcio que es igual a 1000mg. En especie, es alrededor de 4 vasos de leche a día. Habrá personas que me digan que la leche no la pueden ni ver en fotografía. ¡Está bien! Son intolerantes a la lactosa, sacarosa, fructuosa, galactosa y a todas las ¡osas! Bien.

Sin embargo, todas las leches de origen lácteo, ¡todas! Excepto la leche condensada o la de soya (que es vil aceite), tienen la misma cantidad de calcio por litro; pueden ser deslactosadas, libres de azúcar, libres de calorías, etc. Pero su cantidad mineral de calcio sigue igual. Sin embargo, el yogurt y el requesón por ejemplo, no tienen lactosa. Y un vaso de yogurt natural con frutas, tiene alrededor de 450mg de calcio, o sea que dos yogures al día significarían 900mg. de calcio, casi los 1000mg que son requeridos por el organismo. ¿A poco no es fácil empezar a tomar la suficiente cantidad de calcio al día.

En los siguientes ediciones de esta página hablaremos más sobre este problema de la osteoporosis (OP). La mayoría de nosotros consideramos que la OP es una enfermedad que viene con la edad y caracterizada por una progresiva y silenciosa pérdida de masa ósea, llevando a una fragilidad de los huesos y aumentando el riesgo de fractura, sobre todo en vértebras, articulación de cadera y antebrazo (muñeca sobre todo). La OP es frecuente en mujeres postmenopáusicas, que las llevan primero a dolor en columna dorsal sobre todo, dolor crónico y pérdida de la independencia para manejarse solas. La enfermedad afecta a una de  cada tres mujeres y a uno de cada cino hombres, por arriba de los 50-55 años (dependiendo de los factores de riesgo). La toma de una densitometría ósea central de columna y cadera sobre todo en poblaciones de riesgo y el tratamiento adecuado es la mejor forma de prevenir fracturas serias.

En México, 1 de cada 4 personas, tiene osteopenia u osteoporosis. De las personas que llegan a sufrir una fractura de cadera, una de cada tres se muere al año, 4 de ellas no podrán caminar por sí mismas, y 8 de ellas no podrán valerse por si mismas aunque sea para ir de compras al súper.

Desafortunadamente, hago este llamado a nuestras mujeres mexicanas que pudieran tener este medio de comunicación, a nuestras mujeres mexicanas a las que no les llegue esta información, se verán lastimadas por esta enfermedad. Las autoridades de salud actuales, a las que les importa más quitar becas a médicos en preparación, quitar insumos, medicamentos y cerrar hospitales, no les importará que sufran fracturas o que se mueran. Mientras ayudan a sostener a un gobierno  populista y nazista. En donde, parafraseando un slogan que fue por mucho tiempo significado del IMSS, a este gobierno le “Importa Madre Su Salud”.

Así es que por favor, les pido hagan lo necesario para seguir consumiendo calcio, realicen su densitometría y acudan con médicos que las puedan tratar.

Dr. José Luis Sánchez Mejía

Ortopedia y Traumatología.

Referencia:

www.iofbonehealth.org

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