Osteoporosis

Osteoporosis is to do with the weakening of bones. The bone mass density (BMD) decreases, increasing the risk of fractures. The first-level of BMD loss is known as osteopenia which, if undetected and untreated, proceeds to osteoporosis The most common areas at high risk for fractures are ribs, spine and wrists

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SymptomsCausesTypesPrognosisDiagnosisTreatment
  • Back pain, caused by a fractured or collapsed vertebra.
  • Loss of height over time.
  • A stooped posture.
  • A bone fracture that occurs much more easily than expected.

 

  • Women are at a greater risk than men.
  • White or Asian women especially those with a family member with osteoporosis, have a greater risk of developing osteoporosis.
  • Women who are postmenopausal are at greater risk.
  • Cigarette smoking.
  • Eating disorders such as anorexia nervosa or bulimia.
  • Low amounts of calcium in the diet.
  • Heavy alcohol consumption.
  • Inactive lifestyle,
  • Use of certain medications, such as corticosteroids and anticonvulsants, are also risk factors.
  • Rheumatoid arthritis.
  • Having a parent that has/had osteoporosis.

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There are two types of osteoporosis:

(I). Primary, osteoporosis occurs spontaneously and contains three subtypes.

a) Postmenopausal Osteoporosis (Type I Osteoporosis)

  • Normally occurs in individuals between the ages of 50 and 75.
  • It is caused by a lack of oestrogen.  Although it is more likely to occur in women, postmenopausal osteoporosis also occurs in men with low levels of testosterone.
  • Increased risk factors for postmenopausal osteoporosis include:
  • low body weight, which is usually associated with smaller bones and lower estrogenic levels
  • advanced age
  • women where menopause occurred early in life
  • anorexia

b) Involuntional or Senile Osteoporosis (Type II Osteoporosis)

Type 2 Osteoporosis typically occurs in patients over the age of 60 and is associated with the normal process of aging.  As individuals age, it is common to lose bone density.  Involuntional osteoporosis often results in fractures of the neck, vertebrae, humerus, tibia and pelvis.

c) Idiopathic Osteoporosis

This type of osteoporosis is uncommon.  It is associated with occurrence in children and young adults.

(II). Secondary osteoporosis, which is caused by an uncommon or unknown condition that causes temporary bone loss in the upper portion of the thighbone (femur).

Although osteoporosis patients have an increased mortality rate due to the complications of fracture, it is rarely lethal.Hip fractures are responsible for the most serious consequences of osteoporosis.Between 35 and 50% of all women over 50, had at least one vertebral fracture. Wrist fractures are the third most common type of osteoporotic fractures.Fragility fractures of the ribs are common in men as young as age 35. These are often overlooked as signs of osteoporosis.Apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life.The condition is responsible for millions of fractures annually, mostly involving the lumbar vertebrae, hip, and wrist. Fragility fractures of ribs are also common in men.Recovery from fractures in individuals with osteoporosis can be slow. There is no single treatment or cure for osteoporosis, although drug therapies are available that slow and fraught with complications, leading to a poor outcome.

Osteoporosis is diagnosed clinically or radio graphically.

  • Osteoporosis is most commonly diagnosed with a T-score of −2.5 or below as determined by central DEXA scan of the total hip, femoral neck, or lumbar spine.
  • Quantitative computed tomography can be used to assess BMD, but is limited by radiation exposure and cost.
  • Quantitative calcaneal ultrasonography and peripheral DEXA, which measures BMD in the heel, finger, and forearm, are more portable and less costly than central DEXA and can effectively predict fracture risk. Their results, however, do not correlate well enough with central DEXA to be used diagnostically, and they have not been shown to be useful in monitoring treatment over time.
  • Biochemical markers of bone turnover in the serum or urine are not currently recommended for diagnosis.
  • Formal home safety evaluations and physical therapy treatments are beneficial.
  • Eliminating medications that can affect alertness and balance is critical.The use of hip protectors is no longer considered effective.
  • A multifactorial approach that addresses vision deficits, balance and gait abnormalities, cognitive impairment, and dizziness is the cornerstone of fall prevention.
  • A daily intake of at least 1,200 mg of calcium is recommended for all women with osteoporosis.
  • A single dose of calcium supplement should contain 500 mg or less of elemental calcium, necessitating multiple daily doses
  • Calcium carbonate is the least expensive, requires acid for absorption, and should be taken with meals.
  • Calcium citrate is more expensive and does not need to be taken with meals.

The absorption of numerous medications, most notably levothyroxine, fluoroquinolones, tetracycline, phenytoin (Dilantin), angiotensin-converting enzyme inhibitors, iron, and bisphosphonates, can be significantly decreased when given with calcium. These medications should be given several hours before or after calcium supplements.

 

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