**6. Background factors**

The main background factors that can exacerbate bone tissue metabolism impairment at the site of bone infection are: generalized osteoporosis, D-deficit, D-insufficiency, and secondary hyperparathyreosis. These factors exacerbate also the condition of patients with bone infection, lowering the regenerative potential of bone tissue. On the scheme, these factors are marked as yellow blocks.


Thus, because of the excessive PTH action on bone tissue, two major effects, that can be "found out" using markers, occur [38–40]:


**145**

*Metabolic Disorders in Patients with Chronic Osteomyelitis: Etiology and Pathogenesis*

Removal of calcium and phosphates exceeds not only the physiological values or amounts, but also the compensative intake with the food leading to progressive lowering of bone tissue quality in general and its mineralization in particular. To cope successfully with these changes, the secondary parathyreosis should be treated and compensative therapy, including calcium, phosphates, and hormone

In this part of the chapter, the etiopathogenetic mechanisms of bone tissue metabolism impairment are discussed, as well as reasons for change of laboratory-

The mentioned markers have a direct link with metabolic impairments of a certain type. Such impairments can be found in different diseases, especially in

The therapy of metabolic bone tissue impairments due to bone (orthopedic) infection should combine etiopathogenetic and compensating approaches. For example, bisphosphonates can be recommended for use in addition to antibiotic therapy and surgery, as well as calcium, D hormone, and other drugs because of the

Nowadays, the published data on epidemiology of metabolic diseases in healthy volunteers and orthopedic patients without bone infection (except patients with osteoporosis and related diseases) are scarce. Therefore, these data cannot serve as statistical material for comparison with data in patients with

Accordingly, our work is limited to patients with bone infection (chronic osteomyelitis and related diseases) already diagnosed. The dynamics of the parameters

In 2019, we published a retrospective study; the aim was to evaluate dynamics and values of markers and parameters of bone metabolism [16], which included 112 patients with infected pseudarthroses of long bones (humerus, femur, tibia) developing as an exacerbation of chronic osteomyelitis. The study had three main

• Gaining the whole "picture" of metabolic bone tissue disorders in these

• Studying the dynamics of corresponding marker level and parameters.

and without bone metabolism correction therapy).

received the same therapy except correction of bone metabolism.

• Comparing the duration of consolidation of pseudarthroses after surgical treatment, antibiotic treatment, and using external fixation apparatus (with

We formed two groups of 56 patients each using anatomical segment-stratified randomization. The main group received not only surgery and antibiotic therapy but also medication for correction of impaired bone metabolism. The control group

was studied with addition of metabolic disorders therapy and without it.

patients with chronic osteomyelitis and other forms of bone infection.

bisphosphonates' ability to decrease the osteoclasts' activity.

*DOI: http://dx.doi.org/10.5772/intechopen.92052*

D medication, introduced.

**8. Our experience**

bone infection.

purposes:

patients.

**7. Summary of scheme review**

measured bone metabolism markers and their levels.

As a result, calcium and phosphates are being literally "washed out" of the bone in amounts more than physiological. After that, they are secreted out of the organism through urine. A bright example is an increase in vertebral bodies fractures risk in patients with primary hyperparathyreosis. Even simple densitometry can help to diagnose the lowered bone density and trabecular thinning. *Metabolic Disorders in Patients with Chronic Osteomyelitis: Etiology and Pathogenesis DOI: http://dx.doi.org/10.5772/intechopen.92052*

Removal of calcium and phosphates exceeds not only the physiological values or amounts, but also the compensative intake with the food leading to progressive lowering of bone tissue quality in general and its mineralization in particular. To cope successfully with these changes, the secondary parathyreosis should be treated and compensative therapy, including calcium, phosphates, and hormone D medication, introduced.
