Osteoporosis is a disease of weakening of the bone which progresses to breaking of the bone. It is the most common reason for bone breaking in the elderly.
SIGNS & SYMPTOMS OF OSTEOPOROSIS
- Fractures are the most common manifestation of osteoporosis.
- Fractures of the wrist, spine, hip, shoulders & legs are the most common.
- Many problems can arise due to fractures;
- Acute or chronic pain
- Sudden onset of back pain
- Pain that radiates to the legs
- Spinal cord compression
- Rarely numbness of the anus
- Also rarely loss of bowel or bladder control
- Stooped posture
- Loss of height
- Decreased movement of arm & leg.
- Fractures like hip fracture require prompt surgery
- Deep Vein Thrombosis
- Pulmonary Embolism
- Reduction in bone density
- Problems in balance
- Risk of falls due to underlying conditions like Parkinson’s disease, dementia, loss of skeletal muscles, heart problems & hypotension, etc.
CAUSES & RISK FACTORS
- Old age
- Decrease in estrogen in women
- Decrease in testosterone in men
- Small posture
- Ethnicity, Europeans & Asians are more at risk.
- Excessive alcohol intake
- Smoking of tobacco
- Vitamin D deficiency
- Malnutrition, especially low dietary calcium
- High dietary protein from animals
- Being underweight
- Exposure to heavy metals
- Consumption of soft drinks
- Proton Pump inhibitors
- Diminished functional activity of the gonads
- Endocrine disorders like diabetes, thyroid disease & adrenal gland insufficiency
- Due to GIT disorders & diseases like Crohn’s Disease, Ulcerative Colitis, Lactose intolerance, celiac disease, etc.
- From surgery
- Due to disease like lupus, RA, spondylitis, sarcoidosis, etc.
- Chronic Kidney Disease
- Disorders & various cancer of the blood
Due to medications
- Steroid induced osteoporosis for example from prednisone.
- Anti-epileptic drugs
- Levothyroxine overdose
- Anti-cancer drugs for breast cancer
- Anti-metabolite drugs
- Progesterone injection
- GTRH agonists
- Anti-coagulant drugs
- Some classes of anti-diabetic drugs
- Chronic lithium therapy that is used for mood disorders.
DIAGNOSIS OF OSTEOPOROSIS
- Conventional Radiography is done for detection of decreased bone mass, fractures & for differential diagnosis.
- Dual energy X-ray absorptiometry or DEXA scan is the gold standard for detection of osteoporosis. The extent of the disease is classified on the basis of T score (Bone mineral density)
|Category||T-score range||% young women|
|Normal||T-score ≥ −1.0||85%|
|Osteopenia||−2.5 < T-score < −1.0||14%|
|Osteoporosis||T-score ≤ −2.5||0.6%|
|Severe osteoporosis||T-score ≤ −2.5 with fragility fracture.|
- Detection of chemical biomarkers that may be present at elevated levels such as calcium, phosphate, alkaline phosphatase & parathyroid hormone.
- Quantitative computer tomography for measurement of bone mineral density (BMD) values.
- Cheaper & quicker detection by quantitative ultrasound.
- Screening of women older than 65 and men older than 70 by a bone densitometer. Also screening of younger women at risk.
- Medications used for management of the condition & symptoms;
- Bisphosphonates when taken for 3 to 4 years show a reduction in incidence of future fractures for people who have already suffered fractures.
- The patients with higher risk factors are prescribed oral doses for 10 years.
- Alendronic acid for decreasing of risk of spine fractures.
- Teriparatide (a recombinant parathyroid hormone) has been shown to be effective in treatment of women with postmenopausal osteoporosis.
- Hormone replacement therapy only in women with post menopausal symptoms.
- Vit D3 supplements (Cholecalciferol) for more absorption of calcium.
PREVENTION & MANAGEMENT FOR OSTEOPOROSIS
- Intake of adequate Calcium
- Modification of diet to include dairy products, legumes, beans & green vegetables.
- 1000 mg intake of calcium is recommended.
- Enough exposure to sunlight for absorption & synthesis of Vitamin D, although this is not physiologically possible in the bus lives of people.
- Vitamin D3 supplements (800 IU/day) in the form of granules & tablets are prescribed for increased absorption of calcium from the diet.
- Intake of milk is to be controlled when Vit D3 supplements are taken.
- Vitamin K supplements & diet.
- Engaging oneself in physical exercise can improve the health of the bones.
- Use of hip protectors for people prone to falling & fractures.
- Physiotherapy for management of pain & improving muscle movement.