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