Добре дошли в сайта на д-р Севдалина Ламбова, дм, ревматолог





            The osteoporosis is a disease characterized by decreased bone mineral density, compromised bone microarchitecture and increased risk of fractures. It is usually clinically silent until a fracture occurs. Fractures are usually dramatic clinical events except some cases of vertebral fractures. Hip fractures are with the worse prognosis and are associated with high mortality rate. Osteoporotic fractures occur after minimal trauma (trauma, which usually does not lead to fracture such as fall from own height) or spontaneously (atraumatic fractures). Consequences of verterbral fractures include loss of height, chronic back pain, thorax deformation (kyphosis).


            It is estimated that one in two women and one in five men over the age of 50 year old are at risk of sustaining osteoporotic fractures. The frequency of osteoporosis and osteoporotic fractures is significantly higher in women, which is associated mainly with changes in bone methabolism that develop after menopause.


            The diagnosis of osteoporosis is based on presence of a fragility fracture on X-ray (after minimal trauma or atraumatic fracture) or in cases of T-score ≤ -2.5 at bone densitometry in lumbar vertebrae, femoral neck or total hip. The condition is defined as osteopenia (low bone mass) when T-score is between -1 and -2.5. Many patients with osteopenia have sustained osteoporotic fracture. These cases are defined as complicated osteoporosis with fragility fracture.


            The dual-energy X-ray absorptiometry (DEXA) is currently a gold standard for assessment of bone mineral density. The parameter “T-score” is calculated, which is standard deviation difference between the patient’s bone mineral density compared with that of young adult sex-matched population. You will receive instructions about the appropriate localization of the investigation according to individual features of your bony skeleton and age for obtaining the most precise result. If you present at the consultation an external examination you will receive interpretation of the results and will undergo a complex assessment of your condition. The complex evaluation of the condition includes measurement of laboratory markers for bone metabolism. Dr Sevdalina Lambova is a certified clinical densitometrist by the International Society for Clinical Densitometry).


            The main aim of antiosteoporotic treatment is to reduce fracture risk. After diagnosing osteoporosis you will be assessed for your individual fracture risk. A screening for secondary causes for osteoporosis will be performed (endocrine, renal, haematologic or other disease).


            You will receive instructions for the appropriate hygienic-dietary regimen (diet and physical activity).


            The final decision for therapeutic plan (drug choice, duration of treatment) is mutually made by the rheumatologists and the patient according to the patient status, the results from the investigations and the individual circumstances in every single case.


            The main antiosteoporotic drugs are oral and intravenous bisphosphonates, inhibitors of RANK-ligand (denosumab), strontium renelate, alfacalcidol etc. After initiation of treatment you will receive instruction for the necessity of follow-up, evaluation the therapeutic effect, the possible drug adverse events, interval of monitoring and time frame of future assessment for treatment continuation.


                                                                       Dr Sevdalina Lambova, MD, PhD