OSTEOPOROSIS
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Osteoporosis, or porous bone disease, is characterized by low bone mass and structural deterioration of bone tissue, resulting in reduced bone strength leading to an increased risk of fracture. The common site for osteoporotic fractures is the hip, spine & wrist.
The World Health Organization (WHO) operationally defines osteoporosis as a bone density that falls 2.5 standard deviations (SD) below the mean for healthy adults of the same age & sex.
In India, it has been presumed that 35% of postmenopausal women are at the risk of developing osteoporosis.
On average, a post-menopausal woman has a 40% to 50% chance of developing a fracture including a 15% chance of hip fracture in her lifetime.
More than 10% of hip fracture victims die within one year from various complications and nearly 50% of the survivors are incapacitated, some of them permanently.
In women, it is 3 times more common than men as they have low peak bone mass (PBM) and hormonal changes at Menopause.
Although the exact cause of osteoporosis is still unknown, the process by which bone becomes porous is well understood.
Early in life, bone is broken down and replaced continuously by the process of bone remodeling.
Lifestyle Factors |
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|---|---|---|---|
| Low Calcium Intake | Alcohol Abuse | High Salt Intake | Vit. D Insufficiency |
| Smoking | Excess Vit. A | Immobilization | Inadequate Physical Activity |
Genetic Factors |
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|---|---|---|---|
| Cystic Fibrosis | Homocystinuria | Osteogenesis Imperfecta | Ehlers-Danlos Syndrome |
| Gaucher’s Disease | Ideopathic Hypercalciuria | Porphyria | Hypophosphatasia |
| Marfan Syndrome | Riley-Day Syndrome | Hemochromatosis | Panhypopituitarism |
Hypogonadal States |
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|---|---|---|---|
| Androgen Insensitivity | Hyperprolactinemia | Athletic Amenorrhea | Anorexia Nervosa |
| Premature Menopause | Panhypopituitarism | Premature Ovarian Failure | Turner’s & Klinefelter’s Syndromes |
Endocrine Disorders |
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|---|---|---|
| Adrenal insufficiency | Cushing’s Syndrome | Diabetes Mellitus |
| Central Adiposity | Hyperparathyroidism | Thyrotoxicosis |
Gastrointestinal Disorders |
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|---|---|---|
| Celiac Disease | Gastric Bypass | Primary Biliary Cirrhosis |
| Inflammatory Bowel Disease | Malabsorption | GI Surgery |
Hematological Disorders |
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|---|---|---|
| Multiple Myeloma | Monoclonal Gammopathies | Sickle Cell Disease |
| Hemophilia | Leukemia & Lymphomas | Thalassemia |
Rheumatologic & Autoimmune Diseases |
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|---|---|
| Ankylosing Spondylitis | Lupus |
| Rheumatoid Arthritis | Other Rheumatologic & Autoimmune Disease |
Central Nervous System Disorders |
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|---|---|
| Epilepsy | Parkinson’s Disease |
| Spinal Cord Injury | Multiple Sclerosis |
Miscellaneous Conditions & Diseases |
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|---|---|---|---|
| HIV/AIDS | Congestive Heart Failure | Posttransplant Bone Disease | Depression |
| Sarcoidosis | Amyloidosis | End Stage Renal Disease | Weight Loss |
| Chronic Metabolic Acidosis | Hypercalciuria | Idiopathic Scoliosis | Muscular Dystrophy |
Medications |
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|---|---|---|---|
| Aluminum (in Antacids) | Glucocorticoids | Tamoxifen | Proton Pump Inhibitors |
| Anticoagulants (heparin) | Aromatase Inhibitors | Lithium | Depo-medroxyprogesterone |
| Anticonvulsants | Barbiturates | Chemotherapeutic Drugs | Methotrexate |
Patients with osteoporosis are asymptomatic until a fracture occurs.
But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include
A bone density test is as close as your doctor can come to predicting your future bone health. The test results will show if you have osteopenia or osteoporosis, and how susceptible your bones are to fracture. A bone density test is the best way to predict fracture risk.
The test uses X-rays to measure how many grams of calcium and other bone minerals are in a square centimeter of bone. Generally, the higher the mineral content, the denser the bone is. And the denser bones are, the less likely they are to fracture.
Bone density testing uses a device called a bone densitometer. Most densitometers measure how much of a low-energy X-ray beam is absorbed as it passes through bone, in comparison to the absorption as the beam passes through the soft tissues next to the bone. The amount of X-ray energy that enters the bone is also compared with the amount of energy that leaves the bone. Denser bone absorbs more of the X-ray beam.
These machines, typically found in hospitals and medical centers, are used to measure the density of the central, stabilizing parts of the skeleton, such as the spine and hip. This type of densitometer provides the most accurate bone density testing and can predict your potential risk of fracture.
A DXA machine uses two different X-ray beams to increase the precision of what it’s measuring. As you lie on a padded platform, two mechanical arms containing an X-ray source and detector above and below your body are aligned. DXA is most often performed on the narrow neck of the upper leg bone (femur), just below the hip joint, as well as the lumbar vertebrae, which form the lower part of the spine. DXA testing is painless and takes only a few minutes.
This instrument measures bone density using computerized tomography (CT). Similar to having a CT scan, you lie on a movable padded table that slides into a large cylinder, where X-ray images are obtained from all angles. QCT is most often used to measure density in the vertebrae and the part of the femur below the hip.
Smaller devices are used to measure bone density on the periphery of the skeleton, such as in the wrist and heel bone. Although they are more portable, these densitometers are less accurate at predicting fracture risk. If your test on a peripheral device is positive for osteopenia or osteoporosis, then your doctor might recommend a follow-up scan of your spine or hip to confirm the diagnosis.
This procedure is often called heel ultrasound because it typically measures bone density in the heel bone. Instead of X-ray radiation, QUS sends high-frequency sound waves through your heel while you rest your bare foot on the instrument. This type of densitometer measures the reflection of sound waves. Denser bone reflects sound waves back to the device sooner.
This device is a compact, portable DXA scanner. Using X-rays, pDXA measures bone density in the wrist or heel. Although it’s quick and accurate, this testing can be expensive.
This portable version of QCT measures the bone density of the wrist or hand. This test is also expensive, and it produces a higher radiation exposure than do other tests.
Other types of testing, including 3-D imaging and high-resolution magnetic resonance imaging (MRI), are also under investigation.
Treatment is based on the following factors:
If you’ve been diagnosed with osteoporosis because you’ve had a broken bone, you should still receive treatment to try to reduce your risk of further broken bones.
A number of different medicines are used to treat osteoporosis (and sometimes osteopenia).
Bisphosphonates slow the rate that bone is broken down in your body. This maintains bone density and reduces your risk of a broken bone.
There are a number of different bisphosphonates, including:
They’re given as a tablet or injection.
Bisphosphonates usually take 6 to 12 months to work, and you may need to take them for 5 years or longer.
You may also be prescribed Calcium and Vitamin D supplements to take at a different time to the bisphosphonate.
SERMs are medicines that have a similar effect on bone as the hormone estrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine.
Raloxifene is the only type of SERM available for treating osteoporosis. It’s taken as a daily tablet.
Parathyroid hormone treatments (such as teriparatide) are used to stimulate cells that create new bone. They’re given by injection.
Calcium is the main mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones.
Vitamin D helps the body absorb calcium. All adults should have 10 micrograms of vitamin D a day.
HRT has shown to keep bones strong and reduce the risk of breaking a bone during treatment.
Hormone Therapy is not recommended for treating osteoporosis as it increases the risk of developing:
They prevent impact on the pelvis. The different types of Hip Protectors are:
The goals of surgical treatment of osteoporotic fractures include:
– Rapid Mobilization
– Return to normal Function & Activities
– Avoid too many manipulations
– Progressive Physiotherapy
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