Osteoporosis

What is Osteoporosis?

Osteoporosis is a condition portrayed by the reduction in bone density and its strength which result in fragile bones. Osteoporosis causes abnormally porous bones that will be compressible (sponge- like). In addition, it weakens the bones which will result in frequent fractures of the bones. 

The normal constituents of the bone are the proteins, collagen and calcium. All these elements give the bone its strength. With osteoporosis  the bones are weakened so much so that even a minor injury can lead to fractures which wouldn’t be the case with a normal person. Two-forms of fracture in osteoporosis can be seen: cracking (hip fractures) and collapsing (vertebral compression fractures). These fractures can arise in almost any bone in the skeletal system; but in osteoporosis the more common ones are the spine, hips, wrists, ribs and so on.

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Statistics

44 million people are said to have low bone density in the United Sates alone, in which 10 million have osteoporosis and 34 million have osteopenia. This is about 55% of the total U.S population (50 years and older). It is said that one in two Caucasian women will have a bone fracture as a result of osteoporosis. It is also stated that 20% of those who had a hip fracture will die in the following year. With ageing, in America, osteoporosis related fractures will increase exponentially.  As a result, pain, suffering, impact on general health and economic costs will rise.

Signs and Symptoms

A person who has osteoporosis may not show any signs; as osteoporosis is said to go undetected for decades sometimes. The condition does not show any symptoms until the bone fractures. The symptom that come along with bone fractures is the pain. On an important note, the symptoms that arise in men are similar to those which arise in women.

Spine fractures can cause excruciating pain, which is “band-like”. The pain will spread out from the back of the body to its sides. If a person undergoes repeated spinal fractures he or she will be prone to lower back pain, loss of height and/or spine curving due to the collapse of the vertebrae. A minimal trauma in osteoporosis refers to the fracture that arise while doing normal activity like walking (feet stress fractures). On the other hand, hip fractures occur due to falls like slipping and tripping accidents. Due to poor healing of the bone, hip fractures tend to heal slowly after surgical repair.

Consequences of Osteoporosis 

Bone fractures due to osteoporosis lead to pain, decreased quality of life, loss of workdays and disability. It is shown that approximately 30% of patients who sustained a hip injury due to osteoporosis will be in need of long term nursing-home care. Pneumonia and blood clots (in leg veins) that can go up to the lungs (pulmonary embolism due to long bed rest after a hip injury) are some of the consequences of osteoporosis that may arise in the elderly patients. Osteoporosis has been associated with increased risk of death too. Around 20% of women who had a hip fracture are said to die in the following year after the hip injury. A person who has had a spinal fracture is supposed to be at a high risk of attaining a similar fracture in the next few years. In addition, about 20% of postmenopausal women who had a vertebral fracture in the past are said suffer from a new fracture (vertebral) in the following year.  

Prevention of Hip Fractures in the Elderly

Elderly people are prone to hip fractures which arise due to osteoporosis. Therefore, the FDA has proposed and approved hip protector garments for the elderly with osteoporosis. This would prevent hip fractures. Brand names of such garments include Hipsaver and Safehip. These can be useful for selected patients, the ones who are in nursing homes due to osteoporosis. However, the renal extent of protection against these hip fractures which can be acquired by the use of such garments is disputable.

In addition, it is necessary to check for wear and tear of canes or other supporting aids for walking in elderly patients who use such equipments. Rubber tips of canes should be checked often. If say, the rubber tips wear off, the elderly person is in risk of slipping  which can lead to other harmful conditions, including hip fractures.

Causes and Risk Factors

  • Gender (female)
  • Race- Caucasian or Asian
  • Body frame- Thin and small body frame
  • Family history -family members having osteoporosis
  • Personal history- of fractures as an adult
  • Smoking cigarettes.
  • Excessive alcohol consumption
  • Exercise (Lacking)
  • Low calcium diet
  • Poor general health and nutrition
  • Malabsorption- due to conditions like celiac sprue
  • Low levels of oestrogen (in women due to menopause or removal of ovaries)
  • Low levels of testosterone in men (due to hypogonadism)
  • Chemotherapy
  • Amenorrhea (no menstrual periods)
  • Chronic inflammation (rheumatoid arthritis or diseases of the liver).
  • Immobility (stroke or conditions that inhibit or interfere with walking)
  • Hyperthyroidism
  • Hyperparathyroidism
  • Vitamin E deficiency
  • Certain medications

Diagnosing Osteoporosis

An X-ray can show osteoporosis, if present, as it will reveal the thinner and lighter bones (than normal) which arise in osteoporosis. However, at this stage at least 30% of the bones have already been affected. Also, they are not very accurate in indicating the density of the bone. Therefore, the National Osteoporosis Foundation, the American Medical Association and other organisation have proposed the use of a dual-energy X-ray absorption scan (known as DXA) for osteoporosis diagnosis. DXA has the ability to measure the density of the bone in the hip, spine and forearm regions and the test only takes about 15 minutes. In addition, it exposes the patient to minimal amount of radiation and is more precise.  

After the bone density is obtained it will be compared to the average peak bone density (same sex, same age).  This value or score is known as the “T score”. Osteoporosis is characterised by the T score of -2.5 or below. Osteopenia (between normal and osteoporosis) is characterised by the T score of -1 to -2.5.

Who should have bone testing?

The National Osteoporosis Foundation have stated that certain groups of people should consider a DXA testing:

  • All postmenopausal women over 65 years of age, who are at risk of attaining osteoporosis
  • All women over 65  years of age and older.
  • Postmenopausal women with fractures.
  • Women who have any medical conditions related to osteoporosis. A medical doctor can review your conditions and list out the ones which are linked to osteoporosis.
  • Women who decide to undergo osteoporosis treatment can undergo a DXA to find out if she has osteoporosis.

Treatment and Prevention 

Treatment for osteoporosis is mainly dependant on preventing the fractures of the bones by decreasing bone loss and by increasing bone density and bone strength. The risk of acquiring such fractures can be reduced by early detection and treatment. However, the available treatments today for osteoporosis are not able to completely cure the condition. That is to say rebuilding bones that have been severely weakened by osteoporosis is very difficult. Consequently, prevention becomes very important, as important as the treatment. The following are some of the treatments and preventions methods:

  • Lifestyle changes- Quitting cigarette smoking, reducing consumption of alcohol, regular exercises and having a balanced diet which contains appropriate levels of calcium and vitamin D.
  • Medications- which will increase bone strength and stop bone loss. Medications that will increase the formation of bones can be taken too.

 

Video of Osteoporosis

There are many health benefits linked to regular exercises. Having said that, exercise will not bring about considerable bone density in a patient. For osteoporosis, exercise helps by decreasing the risk associated with falls. This is related to acquiring proper balance and  improved muscle strength. Moreover, research has not yielded any results on what kind of exercise will be best for an individual suffering from osteoporosis or the duration of an exercise which should be performed to get the beneficial results. Most medical doctors talk in favour of weight bearing exercises (walking). Although, exercise is good it should be noted that it is crucial to avoid exercises that can injure the already weakened bones of osteoporosis. Physician’s monitoring and prescription of exercises is necessary in patients who are over 40 years of age and those with heart diseases, diabetes mellitus, high blood pressure, obesity, etc. Vigorous exercises, like marathon running, is not good for the bones. Osteoporosis may be promoted due to marathon running in young women which may lead to weight loss and loss of menstrual periods.  

Calcium Supplements

For strong and healthy  bone formation one should take adequate amount of calcium from childhood and adolescence regardless of the gender. It is important to note that calcium alone is not sufficient to treat osteoporosis. National Institute of Health Consensus Conference of Osteoporosis recommends the following for all people (with or without osteoporosis):

  • Children (1-10 years)- 800 mg/day
  • Men, Premenopausal women, Postmenopausal women (taking oestrogen)- 1000 mg/day
  • Teenagers and young adults (11-24 years)- 1200 mg/day
  • Postmenopausal women not taking oestrogen- 1500 mg/day
  • Pregnant and nursing mothers- 1200-1500 mg/day

The total calcium intake for a day should not go beyond 2000 mg.

Statistics show that the average woman in the United States consume calcium less than 500 mg per day. This is less than the amounts which are recommended. Calcium can always be consumed by drinking more milk, eating more yoghurt or cottage cheese or by taking calcium supplements. Other sources of calcium include the calcium-fortified foods (orange juice). Moreover, calcium supplements are usually safe and well tolerated. Indigestion and constipation are the associated side effects. If these side effects occur with consumption of calcium carbonate supplements, then an alternative, calcium citrate can be consumed.

Vitamin D

Vitamin D is obtained by the diet and the skin which relies on adequate sunlight exposure. Importance of vitamin D:

  • Helps in dietary calcium absorption from the intestines.
  • Vitamin D deficiency can lead to osteomalacia (calcium depleted bone) which will weaken the bones further and increase risk of fractures.
  • Vitamin D with adequate levels of calcium has shown to improve bone density and decrease the risk of fractures. This has been demonstrated in studies involving postmenopausal women but not in premenopausal women.

In the United States vitamin D deficiency is common where a study conducted in the general medical ward showed that 57% of patients had vitamin D deficiency. Approximately 50% of elderly women are said to consume vitamin D which is far less than the recommended value. The Food and Nutrition Board of the Institute of Medicine has recommended the following vitamin D intake:

  • Men and Women over 71 years- 800IU/day
  • Women (other ages), men and children- 600IU/day
  • Infants (under 12 months)- 400IU/day

Appropriate levels of calcium and vitamin D are important for bone health. However, excessive vitamin D levels can result in toxicity, high levels of calcium levels in blood and urine and may cause kidney stones. It is important to note that calcium and vitamin D alone are not sufficient in treating osteoporosis, other treatments should be considered too.

Hormone Therapy (Menopausal Hormonal Therapy)

The use of oestrogen hormone therapy after menopause has ben shown to prevent loss of bones and fractures and increase density of bones. This therapy is helpful in avoiding osteoporosis in postmenopausal women. Oestrogen can be taken orally or as a skin patch. In addition, it is available with progesterone as patches and pills. Progesterone is administered with oestrogen to prevent cancer of the uterus which may come about due to administration of oestrogen alone. Women who have surgically  removed their uterus may take oestrogen only. Currently, effects of nasally transporting oestrogen and lower doses of oestrogen and progesterone are being researched.

Most importantly, due to adverse effects arising due to this therapy it is not recommended as a long term therapy. It is only used as a short term therapy, mainly for menopausal women to relieve them from hot flashes. The adverse effects include increased risk of heart attacks, blood clots (in veins), stroke and breast cancer. 

Complications of Osteoporosis

The prime concern and complication of osteoporosis is the fracture of the bone. Recurrent bone fractures can result in collapse and deterioration of the skeletal system. Spinal (vertebral) fractures can thrust the bone into nearby nerves and/or spinal cord which could be detrimental. Neurosurgery will be required to correct this state. Vertebroplasty (kyphoplasty) procedures can also be applied for osteoporotic vertebral fractures. The procedure focuses on reforming the structure of the vertebra by using cement (methylmethacrylate). Recurrent vertebral compression fractures will result in deformity of the spine (chest area) which can be quite severe. It will lead to breathing difficulties and loss of height. It can also increase risk of respiratory infections due to compromised spine.

Prognosis

The prognosis of osteoporosis patients depends on the area of the fracture. The outlook will be generally good  if treatment is administered in early stages. Hip fractures is a dangerous repercussion of osteoporosis in the elderly. Statistics show that only one-third of hip fracture sufferers will regain function of the fractured area as it was before the fracture. The future is promising for osteoporosis as newer medication,  different methods of delivery of medication and research will bring about better alternatives to treat this condition.

Conclusion

Osteoporosis is a condition portrayed by the reduction in bone density and its strength resulting in fragile bones. This condition weakens bones and increases the risk of fractures. The prime risk factors for osteoporosis include genetics, lack of exercise, vitamin D and calcium deficiency, prone to fractures as an adult,smoking cigarettes, excessive consumption of alcohol, rheumatoid arthritis, small and thin body frame, etc. Patients do not tend to have any symptoms until they sustain a fracture. You can diagnose osteoporosis with the help of X-rays which can be further confirmed by bone density measuring tests. Osteoporosis is treated with medication, lifestyle changes, exercise and a diet which comprise adequate amounts of calcium and vitamin D.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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The Team Manager Web Diseases

 

 

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