Osteoporosis- Symptoms, Risk Factors, Prevention and Treatment
Osteoporosis – is a condition in which bones become weak and brittle. Body constantly forms new bone cells and replace the old bone cells. In osteoporosis, new bone formation does not keep pace with removal of old bone and removal happen at a faster speed as compared to new bone formation.
General Features
- Low bone mass and structural deterioration of bone tissue.
- Affects men and women after 50 years of age but
- Women more likely to develop osteoporosis because of loss of estrogen at menopause.
- Osteoporosis makes person more prone to fractures.
- Of the fractures, most common are vertebral, hip, wrist and other sites.
- Incidence of osteoporosis is going to increase because of aging of population.
Consequences of fractures are very troublesome.
Vertebral and hip or femur fractures are associated with
- decrease in lung capacity,
- impaired sleep,
- increase in chronic pain,
- functional impairment,
- dependence and risk of falls.
Adverse effects of fractures on overall health, functioning and quality of life are immense and are associated with increased morbidity and mortality.
Symptoms
- Dull aches and pains in various parts of body which get worse with activity.
- In case of vertebral collapse, person may have a hunched back.
- Person may have reduced mobility due to pains at multiple sites.
Risk factors
Major risk factors for osteoporosis include
- Prolonged use of certain medications like Steroid, Antiepileptic medicines etc.
- Rheumatoid Arthritis
- Advanced age and decreased Physical Activity
- Smoking and excessive Alcohol drinking
- History of Hip fracture in a parent.
- Previous fracture as an adult after trivial fall
Diagnosis
- Assessment of BMD (Bone mineral density)
- DXA is gold standard test for BMD measurement.
- DXA assessment for BMD corelate strongly to bone strength, response to therapy and is corelated with reduction in fracture risk.
Indication for BMD test or DXA scan are
- High Risk Population Screening
- Men 70 years or older
- Women 65 years or older
- Post-menopausal women less than 65 who have other risk factors
- Persons with Risk Factors
- Fragility fracture
- Disease associated with low bone mass or bone loss
- Medications associated with low bone mass or bone loss
- Others
- For monitoring therapy during treatment
Diagnostic Classifications of Osteoporosis
- T Score of -2.5 or below (Normal -1.0 or greater, Osteopenia between -1.0 to -2.5)
- Z score for Premenopausal women, men <50 years and children (Z score ascertained by Computed tomography and not by DXA).
Prevention of Osteoporosis
Below are some of the ways to prevent this condition
- Supplemental calcium. Recommended Calcium intake is 1200 to 1500 mg/day. If diet does not provide recommended calcium, then calcium supplements should be taken. Calcium Carbonate is widely available as supplement (Calcium Citrate used in person with history of kidney calcium oxalate stones).
- Supplemental Vitamin D. Recommended Vitamin D intake is 1000 to 1500 IU units/day. Supplement of 700-800 IU/day associated with significant benefit in reducing osteoporotic fractures.
- Regular physical Activity and avoiding sedentary lifestyle.
- Healthy Life style measures like stopping smoking and moderation of alcohol intake.
- Avoiding certain medication for a prolonged duration like steroids, Cancer medication, Antidepressants and medicines for acidity or gastritis.
- Muscle strengthening and Balance training to reduce risk of falls and thus reducing risk of fracture in the vulnerable population.
Treatment
Goal of treatment of osteoporosis is prevention of fractures.
This is achieved by
- prevention of falls
- strengthening the bones.
Treatment is started when T-score is -2.5 or less and not treating if t-score is greater than -1.5.
For t-score between -1.5 and -2.5, treatment is started if clinical risk factors for fracture are present.
Medicinal Treatment
Treatment with medication is prolonged and needs to be followed rigorously.
Antiresorptive Drugs– reduce bone turnover, resorption cavities filled with osteoids with mineralization.
- Alendronate, ibandronate, Risedronate
- Estrogen
- Raloxifene
- Calcitonin
Anabolic Drugs-increases bone turnover (increases more bone formation compared to bone resorption) with increased osteoblasts and increased bone formation and bone strength.
- Teriparatide (20mcg/day)
Minimally Invasive Surgery (Kyphoplasty)
May be required in some cases of collapse fracture of spine vertebra
- when it causes severe pain and
- in some cases to diagnose the cause of collapse
Knowledge of Osteoporosis is important to prevent avoidable morbidity or body sufferings at the advanced age. Identifying population at risk, major risk factors and preventive measures for osteoporosis are important in management. Medication along with Physical therapy and weight bearing exercises makes the treatment of osteoporosis effective.
References: Reducing Fracture Risk: Strategies for the prevention and Treatment of Osteoporosis; A Supplement to Clinical Endocrinology News. For/ Cycle 01/ 2008/ 03