Osteoporosis

Definition

Osteoporosis is the thinning of bone tissue and loss of bone density over time.

Alternative Names

Thin bones

Causes, incidence, and risk factors

Osteoporosis is the most common type of bone disease. An estimated 10 million Americans have osteoporosis, as well as another 18 million who have low bone mass, or osteopenia, which may eventually lead to osteoporosis if not treated.

Researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will suffer a fracture of the hip, wrist, or vertebra (bones of the spine).

Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both.

Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

As you age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury.

Usually, the loss occurs gradually over years. Many times, a person will have a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and damage is severe.

The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women, especially those over the age of 50, get osteoporosis more often than men.

Other causes include:

• Being confined to a bed

• Bone cancer

• Cushing syndrome

• Excess corticosteroid levels due to on-going use of medicines for asthma, certain forms of arthritis or skin diseases, and COPD.

• Hyperthyroidism

• Hyperparathyroidism

White women, especially those with a family history of osteoporosis, have a greater-than-average risk of developing osteoporosis. Other risk factors include:

• Absence of menstrual periods (amenorrhea)

• Drinking large amount of alcohol

• Early menopause

• Eating disorders

• Low body weight

• Smoking

• Too little calcium in the diet

• Use of certain medications, including steroids and antiseizure drugs

Symptoms

There are no symptoms in the early stages of the disease.

Symptoms occurring late in the disease include:

• Bone pain or tenderness

• Fractures of the wrists or hips (usually the first sign)

• Loss of height over time

• Low back pain due to fractures of the spinal bones

• Neck pain due to fractures of the spinal bones

• Stooped posture

Signs and tests

Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. This test has become the gold standard for osteoporosis evaluation.

A spine CT can show loss of bone mineral density. Quantitative computed tomography (QCT) can evaluate bone density, but is not as available and is more expensive than a DEXA scan.

In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones. However, Simple x-rays of bones are not very accurate in predicting who is more likely to have osteoporosis.

A urinary calcium test can provide some evidence of increased bone turnover, but is of limited value. A number of newer tests to evaluate bone turnover are becoming available. Ask your health care provider which test is best for you.

Treatment

The goals of osteoporosis treatment are to:

• Control pain associated with the disease

• Slow down or stop bone loss

• Prevent bone fractures by minimizing the risk of falls

EXERCISE

Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Some of the recommended exercises include:

• Weight-bearing exercises -- walking, jogging, playing tennis, dancing

• Resistance exercises -- free weights, weight machines, stretch bands

• Balancing exercises -- tai chi, yoga

• Riding stationary bicycles

• Using rowing machines

• Walking

• Jogging

Any exercise that presents a risk of falling should be avoided!

DIET

You should follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include low-fat milk, yogurt, ice cream, cheese, tofu, salmon, sardines (with the bones), and leafy green vegetables, such as spinach and collard greens.

Your doctor may recommend calcium and vitamin D supplements. Vitamin D helps your body absorb calcium. Ask your doctor what dose is best for you.

STOP UNHEALTHY HABITS

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

PREVENT FALL

It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include wearing well-fitting shoes, avoiding walking alone on icy days, and using bars in the bathtub, when needed.

Complications

• Compression fractures of the spine

• Hip and wrist fractures

• Disability caused by severely weakened bones

• Loss of ability to walk due to hip fractures

Prevention

Calcium is essential for building and maintaining healthy bone. Vitamin D is also needed because it helps your body absorb calcium. Following a healthy, well-balanced diet can help you get these and other important nutrients throughout life.

Other tips for prevention:

• Don't smoke

• Avoid drinking excess alcohol

• Get regular exercise

A number of medications are approved for the prevention of osteoporosis.

THIS IS GENERAL INFORMATION ON DISEASE. PLEASE CONTACT YOUR DOCTOR FOR MORE DETAILS AND TREATMENT.

Compiled by –Santosh  Ghodinde ,Community Pharmacist, Dhanwantari Medical, Panvel.