Precision X-ray diagnosis of osteoporosis in representatives of risk groups for the appearance and development of varicose disease of the lower limbs
Authors: Druzhinin Valentin N. , Suvorov Vadim G. , Cherniy Aleksandr N. , Troinyakov Sergey N. 
Published: December 2020

Introduction. Varicose disease of the lower limbs (VDLL) is an independent disease and is an important medical and social problem due to its widespread and tendency to progress among people of working age and mainly in the female half of the population. Features of professional activity are risks in the form of static loads of a constant nature or weightlifting and other risk factors (for example, genetic predisposition, hormonal imbalance during pregnancy and menopause, obesity, diabetes mellitus, hypercoagulation, treatment with hormonal drugs, irrational nutrition, alcohol abuse, the presence of osteopenia and osteoporosis (OP). A feature of the disease is the presence of concomitant (often combined) pathology of the musculoskeletal system, which is characterized, as a rule, by early manifestation, relatively rapid progression, and complicated course. Radiologically, relatively often revealed pathology of the feet (flat feet, hallux valgus and deformity of the 1st finger) and degenerative-dystopian changes in the spine (osteochondrosis, spondyloarthritis, spondylosis, scoliosis, kyphosis). The most pronounced combined pathology of the musculoskeletal system is observed in patients with active trophic disorders. Considering the comorbidity of the disease, changes in regional hemodynamics and microcirculation in the lower limbs undoubtedly affect the indicators of hemostasis, carbohydrate, lipid and mineral metabolism. Therefore, a significant interest to improve the diagnosis of OP are often present in the form of a clinical syndrome, which is characterized by decrease in bone density, a violation of their micro-and increased fragility, due to the metabolic disorders of bone tissue with a predominance of catabolism over the processes of bone formation and increased risk of fractures. The state of bone mineral saturation, in particular in the female half of the population, depending on the severity of venous insufficiency remains insufficiently studied. Treatment of VDLL and its concomitant OP syndrome is not always a solvable problem, so the optimization of the diagnosis of this disease, especially at the initial stages, as well as in the process of dynamic monitoring and control of the effectiveness of therapeutic and preventive measures remains relevant. The aim of the study was to study the diagnostic possibilities of using radiometry (radiocomparametry and digital osteodensitometry) for precision assessment of mineral saturation of the spongy structure of the calcaneus in patients at risk for the appearance and development of VDLL. Materials and methods. As part of the general clinical examination, special comparative X-ray studies of the state of mineral saturation and dimensional characteristics of bone trabeculae of the spongy structure of the calcaneus were performed in 129 women with clinical signs of VDLL, which in accordance with the international classification of CEAP were divided into stages: C1 - 36 people, C2 - 32 people, C3 - 39 people, C4 - 30 people, C5 - 22 people. The comparison group included 119 practically healthy women, comparable to the main group by age, work experience and morbid history. The X-ray diagnostic complex included, in addition to convective (routine) radiography of various parts of the osteoarticular apparatus, performed only according to indications, the following methods: interactive radiography (digital low-dose radiography) of the foot with a calibrated wedge-a standard of density, a posteriori testometric X-ray parametry of bone trabeculae of spongy structures of the calcaneus. Modern equipment was used: digital X-ray diagnostic complexes DR-GEBrivo), AXIOMLuminas (Siemens), dichromatic osteodensitometer "PRODIGY" (Lunar). Results. As part of the general clinical examination, X-ray examinations were performed before the implementation of therapeutic measures and after 24 months. Radiometric indicators of mineral saturation and thickness of trabeculae of the spongy structure of the calcaneus showed a direct dependence on age, reaching maximum values in the age category of 25-30 years with a clear tendency to decrease in older age groups. The mineralization parameters relative to the control were initially reduced, revealing variability depending on the severity of the main pathological process (from relatively high at C1 to relatively low at C5). There was also a pattern of increasing levels of mineralization and thickness of bone trabeculae depending on the period of observation (in fact, on the volume of complex therapeutic and preventive measures) in almost all patients, but mainly in groups C4, C5. Subjective symptoms and objective clinical picture of the condition of the examined patients with the presence of VDLL and OP syndrome correlated with the data of osteorentgenometry. Conclusions. The examined women, whose production activity makes them belong to the risk group for the appearance and development of VDLL, have a opioid structure of the calcaneus. The use in complex clinical and radiological diagnostics of the methodical technique of precision assessment of mineral saturation in (mg/mm2) and thickness of bone trabeculae (mm) makes it possible to objectify the reconstruction of the bone structure at the submacroscopic level of its visualization. Quantitative densitometric indicators of changes in the spongy structure of the calcaneus can be considered as markers of the severity of the condition and the direction of the course of VDLL with concomitant OP. Postprocessing radiometry the calcaneus performed on digital radiographs and the screens of computers using programs "LINS MAKHAON workstation of the DOCTOR" available, not associated with additional radiation exposure and, therefore, can be widely applied both at the stage of primary diagnosis of the health status of the studied patients and in monitoring the effectiveness of remedial measures.