Wednesday, October 19, 2011

Know About Osteoporosis

Osteoporosis or “porous bone” - a common metabolic bone disorder affecting 200 million people worldwide –is a slow progressing and silent disease that becomes symptomatic with a fracture.  Osteoporosis affects both men and women, usually as they grow older. Adequate steps taken can reduce the risk of developing osteoporosis and avoid the debilitating bone fracture, which occurs because of the disease.
About Osteoporosis             
Osteoporosis is a metabolic bone disorder characterised by low bone density and deterioration of bone micro architecture that reduces bone strength and increases the risk of fracture especially of the hip, spine and wrist.
Human bone is involved in the process of continuous remodelling, comprising of bone resorption and new bone formation. Osteoporosis is the result of imbalance in bone remodelling. In osteoporosis, there is too much bone loss and too little repair or vice-a-versa, resulting in low bone mass. This causes the bones to become thinner and structurally weaker. This imbalance gets more pronounced with advancing age and hence elderly people are more susceptible to osteoporosis.
Causes/Risk Factors for Osteoporosis
The causes and risk factors for osteoporosis are many. A few of them are listed below:
  • Previous fracture at <50 yrs
  • Parent or sibling with previous fractures
  • Cigarette smoking
  • Senility
  • Malnutrition
  • Low calcium intake
  • Hormonal disturbance
  • Excessive alcohol intake
  • Physical inactivity
  • Excessive intake of certain medications like steroids
Osteoporosis is a disorder with many obvious symptoms. Some of these symptoms are:
  • Pain in the bones
  • Fractures with little or no trauma
  • Loss of height (as much as 6 inches over time)
  • Low back pain due to fracture of bones of the spine (lower)
  • Neck pain (fracture of bones of spine in the neck)
  • Stooped posture
Diagnosis of Osteoporosis
Diagnosis of osteoporosis is basically done with DEXA (Dual energy X-ray (absorptiometry), which is a simple test that measures the bone mineral density (BMD) in different parts of the body such as spine and hips. It is a quick and painless test similar to having an X-ray taken bit uses much less radiation. The results of the DEXA test are scored in comparison to the BMD of young healthy individuals resulting in a measurement called T score. Bone density is considered normal if the T score is between 1.0 and -1.0
 The World Health Organisation (WHO) has defined bone disease based on BMD T scores:
  • Osteopenia (low bone mass): Tscore between -1 and -2.5
  • Osteoporosis: T score greater than or equal to -2.5
  • Established osteoporosis: T score less than -2.5 and the presence of fracture
Treatment for Osteoporosis
Treatment of osteoporosis is a two-step process, which are:
 Goals of Treatment:
A part of the treatment includes setting up the goals, which include:
  • Maintain bone mass and integrity
  • Slow down the bone loss
  • Treat the symptomatic problems and its sequel
Maintain Bone Health:
The next part is to maintain the deteriorating bone density:
  • Life style adjustments
  • Minimise use of alcohol
  • Stop smoking
  • Reduce the intake of coffee
  • Avoid carbonated beverages
  • Supplemental calcium and vitamin D
  • Enough calcium in the diet (1000mg per day of calcium for adults under the age of 50 and 1200mg  per day of calcium for those 50 and older)
  • Taking adequate vitamin D, which is important for calcium absorption and for maintaining muscle strength. The recommended dosage is 400-800IU per day for adults lesser than 50 and 800- 1000IU for those age 50 and older)
  • Physical exercise programmes tailored to the needs of the individual patient. This includes balance training, postural training, resistance training, stretching and weight bearing aerobic exercise. In patients with severe osteoporosis, activities that require vigorous flexing or rotation of the spine should be avoided.
Medications used in the prevention and treatment of osteoporosis are those which either reduce the bone loss (antiresorptive) or increase the bone growth (anabolic). These include:
  • Bisphosphonates (alendronate, risedronate, ibandronate and zolendronic acid): These have been approved for the prevention and treatment of postmenopausal osteoporosis in women and osteoporosis in men.
  • Calcitonin: This medication is given usually as a nasal spray or as an injection under the skin. This is helpful in controlling the pain after an osteoporotic vertebral fracture.
  • Estrogen or Hormone Replacement Therapy: This medication reduces the risk of osteoporosis and osteoporotic fracture. This increases the risk for breast cancer, stroke, and heart attack.
  • Selective Oestrogen Receptor Modulators (SERMs): This medication mimics the good effects of oestrogen in bone without the serious side effects (breast cancer).
  • Teripartide (forteo): This medication is a form of parathyroid hormone that helps to stimulate the bone formation.
Few Points to Remember…
  • In Osteoporosis, the bones are weak and break easily, resulting in severe limitation of activities and bring down the quality of life as well increase the risk of death, especially after 65 years.
  • Osteoporosis occurs in both sexes but is more common in women.
  • Osteoporosis may not be outwardly apparent until a fracture occurs. It can be detected before the first fracture, if the risk factors are identified and BMD test are done in time.
  • It is never too early to adopt preventive measures or too late to begin treatment to prevent further fracture.
  • Leading a healthy lifestyle, having a balanced & regular check up with your Physician or Rheumatologist are the key points to prevent Osteoporosis
  • The more you know about the prevention and treatment of osteoporosis the better are your chances of staying active and independent. 

Dr. R. Kirthi
MD DM (Rheumatology)
Consultant Rheumatologist
Global Hospitals & Health City

Sunday, October 16, 2011


With World Trauma Day being celebrated every year on October 17th, Global Hospitals is issuing a few important points essential to trauma care. These are:

Critical Period: It is defined as the period during which all efforts are made to save a life before irreversible pathological changes can occur. This period may range from the time of injury to definitive treatment in a hospital. The first platinum 10 minutes becomes important to make Critical Period effective. If appropriate action is taken during the Critical Period to restore airway, breathing and circulation, life-saving attempt would turn out to be productive and rewarding. 

Cardiopulmonary Resuscitation or CPR: It has been found to be very effective when initiated as soon as possible after the trauma (within minutes).CPR includes Chest Compressions and Mouth-to-Mouth rescue. Chest compressions are performed by applying downward pressure to the chest wall with the hands positioned in a specific way over the breast bone. These compressions cause blood to be pumped from the heart to other vital organs. Mouth-to-mouth rescue breathing is the quickest way to get oxygen into a person's lungs when a patient is not breathing. It is important to alternate chest compressions with rescue breathing while performing CPR.

Preventing Blood Loss: Severe bleeding can be life threatening. Applying direct pressure to the external bleeding can stop almost any form of bleeding. This is the most important first aid to be given. Always wash hands before and after giving first aid to avoid infections. Try to use latex gloves when treating a bleeding victim.

Broken Bones: If the injury includes fracture or broken bones, then try to keep the person still and calm. Reassure the victim and evaluate for the presence of other injuries. Call for medical help and allow the medical personnel to take over if there is an immediate response. 

Wednesday, October 12, 2011

On the Arthritis Day: Art of Living with Arthritis

Every morning your joints scream pain. You are no longer able to take those long walk you have always loved. You dread when winter sets in. Your days seem to open with pain and close with aches. Life is no longer the bed of roses it used to be, but has turned into a tryst with 

Living with Arthritis can be difficult but not it is impossible. With the right medication, help and support, there is hope for every Arthritis patient.

Common belief seems to be that nothing can be done about arthritis. This is a myth. There are a variety of medications that have been introduced to the market within the last year to treat various types of arthritis. It is critical that one gets an early and accurate diagnosis to minimize the effects of arthritis.

One may not be able to prevent arthritis but those who have arthritis can take part in a treatment plan tailored to meet their individual needs. The first step is to make sure you have a proper and correct diagnosis.  Your doctor can diagnose arthritis based on the overall pattern of symptoms, medical history, physical exam, x-rays and lab tests.
Arthritis can cause anxiety and weakness. To combat anxiety and weakness, relaxation exercises can be done on a regular basis. However, one must not exert and must be able to find a balance between work and activity.

There are other techniques used to manage arthritis. These include planning ahead to make work easier, maintaining proper body posture and practicing joint protection techniques with the help and support of your doctor.

You must also ensure that you take a balanced diet with emphasis on having foods that help keep bones healthy such as nuts, fish, milk, and other calcium-rich foods.
Proper medication, healthy diet and balanced physical activity can help your bones reach optimum performance.