OSTEOPOROSIS

OSTEOPOROSIS:

Introduction:

  • Osteoporosis is a condition which happens when the bone density gets decreases and the body stops producing as much bone as it did before.
  • It is a skeletal disorder. Low estrogen level or poor nutrition especially low calcium intake can lead to osteoporosis.
  • It is the weakening of bones due to the loss of bone density and improper bone formation.
  • It can affect both males and females, but it is more likely to occur in women after menopause because of the sudden decrease in estrogen, the hormone that normally protects against osteoporosis.
  • As the bones become weaker, there is higher risk of fracture during a fall or even in fairly minor knock.

Definition:

It means “porous bones”; bones become weaker which increases the risk fractures especially in the region of hip, spinal vertebrae and wrist. Osteoporosis is a condition that deteriorates the bones and makes it brittle due to low bone mass and loss of bone tissue. As a result, it makes the person extremely susceptible to fractures. These types of fractures are called fragile fractures.

                             

Types of Bones tissues:

Bones provides the body with structure, support and protection for internal organs. It is composed of calcium and other minerals that provide strength and rigidity. It also consist of bone marrow which the site of formation of blood cells. Every bone consists of two types of bone tissue:

  1. Cortical Bone: A thick outer cover or shell that gives bones smooth and solid appearance.
  2. Trabecular bone: A strong mesh exists inside the shell.

These types of bones are assisted by nerve and blood supply whereas the fat and bone marrow covers all the spaces. There are certain bones at the end of the long bones such as the ones in the legs and the arms.

Osteopenia:

It is also known as precursor of osteoporosis. In this condition, bones are not fragile as in osteoporosis, but they are weaker than the older bone. This condition is characterized by the body’s inability to make new tissues as quickly it reabsorbs old bone tissues. This makes the bones weaker. It is frequently seen in people above the age of 30. It is commonly inherited among the family members and women are more prone to this condition.

Causes of Osteoporosis:

There are following factors which are categorized in such a way:

  1. Unavoidable factor:
  2. Age:
  3. Risk increase after the mid-30s.
  4. Sex hormones like estrogen get reduced.
  5. Ethnicity; white people and Asians are more prone to this disease.
  6. Bone structure; being fall or slim increases the risk.
  7. Genetic factors; close family members or persons with hip fracture are more prone to osteoporosis.
  8. Fracture history: Persons who previously experienced fracture after the age of 50 years.
  9. Diet and lifestyle:
  10. Eating disorders like anorexia or bulimia nervosa or orthorexia.
  11. Tobacco smoking.
  12. Excessive alcohol intake.
  13. Low levels or low intake of calcium, magnesium, vitamin D, mal-absorption or the use of some medicines.
  14. Inactivity or immobility.
  15. Drugs and health condition:
  16. Research published in 2015 suggests that transgender women who receive hormone treatment (HT) may be at higher risk of osteoporosis. However, using anti-androgens for a year before starting HT may reduce this risk.
  17. Low peak bone mass.
  18. Low estrogen and testosterone levels in men and women or hormonal imbalance.
  19. Thyroid disorders such as hyperthyroidism.
  20. Kidney disease like anorexia.
  21. Surgical removal of ovaries.
  22. Conditions that increase the risk include; cancer, COPD, chronic kidney disease, some autoimmune disease includes rheumatoid arthritis and ankylosing spondylitis.
  23. Some of the following medications that raise the risk are:
  24. Glucocorticoides and corticosteroids; it includes prednisone and prednisolone.
  25. Thyroid hormone
  26. Anticoagulants and blood thinners includes heparin and warfarin.
  27. Proteins pump inhibitors (PPIs) and other antacids that adversely affect mineral status.
  28. Some antidepressants medications.
  29. Some vitamin A (retinoid) medications.
  30. Thiazide diuretics.
  31. Thiazollidenediones; used to treat Type-2 Diabetes.

                           

Symptoms:

In the initial phase of osteoporosis, there are no visible symptoms or signs seen in patents, but over the time the following symptoms begin to appear. Such symptoms are;

  1. Height loss: Under normal circumstances, height loss is a part of growth. As a person ages the discs in the spinal cord shrink and contract and this causes loss of height in osteoporosis patient. But a person suffering with osteoporosis might experience height loss suddenly.
  2. Fractures: It is the most dangerous aspect of this disease. It can cause deliberately acute and chronic pain. It might be hard to link this disease with fractures as these are asymptomatic. In some cases, the fractures of the long bones acutely impair mobility and might necessitate surgery.
  3. Broken wrists: A broken wrists is the first symptom which suggests the presence of osteoporosis. Women are more prone to wrist fractures after menopause. Usually people shoot their arm to the front as a reflex action stop their fall. Healthy bones should be able to resist a simple fall but fracture is an indication of osteoporosis.
  4. Broken hip: When hip fractures, the top of the thigh bone is the site where the break happens. People in late 70s or 80s are more at risk of this type of injury. A broken hip can be very painful and extremely debilitating in most cases and necessitate an operation. In such cases complications may arise due to an old age resultantly which affects the recovery.

Diagnosis:

  • It is necessary to check the patient’s family history.
  • Doctor will develop a scan to measure BMD (Bone and Mineral Density).
  • DEXA can indicate likelihood of fractures occurring due to osteoporosis.
  • There are two types of devices that can carry out DEXA scan;
  • A central device which scan hip and spine bone mineral density while the patient be in straight position.
  • A peripheral device or mobile machine that test bone in the wrist, head or finger.
  • Some other tests includes LVA (Lateral Vertebral Assessment) may be recommended for an older patient or who has back pain.
  • Ultrasound scan of the heel bone is another way for the assessment. It can be carried out in primary care setting.

Treatment:

The main aim of osteoporosis is as follows:

  • Maintain healthy bone density and bone mass.
  • To prevent fractures.
  • Helps in reducing pain.
  • Treatment mainly emphasizes the person’s ability to continue with the daily life.
  • Drug therapy; it includes bisphosphonates; this is the antiresorptive drugs that slow bone loss and reduce fracture risk.
  • Estrogen agonists and antagonists, also known as selective estrogen, they are the receptor modulators, SERMS; for example raloxifene (evista). They can reduce the risk of spine fractures in women after menopause.
  • Calcitonin (calcimor, miacalcia): This helps in the prevention of spinal fractures in post-menopausal women and it can help in managing pain if fracture occurs.
  • Parathyroid hormone; for example, eripanatide (fortea); this is approved for people with a high risk of fracture as it stimulate bone formation.
  • RANK ligand (RANKL) inhibitors; such as denosurmab (xgeva); this is an Immune therapy and a new type of osteoporosis treatment.

                               

Prevention:

  1. Calcium and vitamin D: Calcium is essential for bones and ensures an adequate calcium intake is important.  Vitamin D plays a key role which helps in calcium absorption. Dietary sources are preferable; it includes;

                          

  1. Dairy products such as milk, cheese and yogurt.
  2. Green leafy vegetables such as kale and broccoli.
  3. Fish with soft bones such as tinned salmon and tuna.
  4. Fortified breakfast cereals.

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