What is Osteoporosis Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure.
Os t eo po r o s i sc a us e sbon est ob ec o mewea me kandbr i t t l e— s o br i t t l et hataf al l orev enmi l ds t r es s esl i k ebendi ngov eror c oughi ngc anc aus eaf r ac t ur e.Os t eopor os i s r el at edf r ac t ur es mos tc ommonl yoc c uri nt hehi p,wr i s tors pi ne. Bonei sl i v i ngt i s suet hati sc ons t ant l ybei ngbr ok endownand r epl ac ed.Os t eopor os i soc c ur swhent hec r eat i onofnewbone does n' tk eepupwi t ht her emov al ofol dbone. Breaking a bone is a serious complication of osteoporosis, especially with older patients. Osteoporotic bone breaks are most likely to occur in the hip, spine or wrist, but other bones can break too. n addition to causing permanent pain, osteoporosis causes some patients to lose height. When osteoporosis affects vertebrae, or the bones of the spine, it often leads to a stooped or hunched posture. Osteoporosis may limit mobility, which often leads to feelings of isolation or depression. de pression. !dditionally, !dditionally, twenty percent of seniors who break a hip die within one year from either complications related to the broken bone itself or the surgery to repair it. "any patients re#uire long$term nursing home care.
Os t eopor os i saff ec t sme menandwomenofa l l r ac es .Butwhi t e andAsi anwome men— especi al l yol derwome menwhoar epast
menopaus e— ar eathi ghes tr i s k .Medi c at i ons ,heal t hydi etand wei ght bear i ngex er c i s ec anhel ppr ev entbonel os sor s t r engt henal r eadyweakbones .
RISK FACTORS/CAUSES Somer i s kf ac t or sf oros t eopor os i sar eoutofy ourc ont r ol , i nc l udi ng: •
Gender .Wo me na r emu c hmo r el i k e l yt od ev e l o p
os t eopor os i st hanar emen. •
Age. Theol dery ouget ,t hegr eat ery ourr i s kof
os t eopor os i s . •
Race . You' r eatgr eat es tr i s kofos t eopor os i si fy ou' r ewhi t e
orofAs i andes c ent . •
Fami l yhi st or y . Hav i ngapar entors i bl i ngwi t h
os t eopor os i sput sy ouatgr eat err i s k ,es pec i al l yi fy our mot herorf at herex per i enc edahi pf r ac t ur e. •
Bodyf r amesi z e. Menandwomenwhoha v es mal l body
f r amest endt oha v eahi gherr i s kbec aus et he yma yha v e l es sb onema s st odr a wf r om a st he yag e.
Hor monel evel s
Ost eopor osi si smor ecommoni npeopl ewhohavet oomuchor t ool i t t l eofc er t ai nhor monesi nt hei rbodi es .Ex ampl esi nc l ude:
•
Sexhor mones. Lo wer eds e xhor monel e v el st endt o
weak enbone.Ther educ t i onofoes t r ogenl ev el sat menopaus ei soneoft hes t r onges tr i s kf ac t or sf ordev el opi ng os t eopor os i s .Womenma yal s oex per i enc eadr opi n oes t r ogendur i ngc er t ai nc anc ert r eat ment s .Menex per i enc e agr adual r educ t i oni nt es t os t er onel ev el sast heyage.And s omet r eat ment sf orpr os t at ec anc err educ et es t os t er one l ev el si nmen. •
Thyr oi dpr obl ems. Toomucht hyr oi dhor monecancause
bonel os s .Thi sc anoc c uri fy ourt hy r oi di sov er ac t i v eori f y out ak et oomuc ht h yr oi dhor monemedi c at i ont ot r eatan under ac t i v et hy r oi d. •
Ot hergl ands. Os t eopor os i shasal s obeenas s oc i at ed
wi t hov er ac t i v epar at hy r oi dandadr enal gl ands .
Di et ar yf act or s
Os t eopor os i si smor el i k el yt ooc c uri npeopl ewhohav e: •
Low cal ci um i nt ake. Al i f el ongl ac kofc al c i um pl ay sa
maj orr ol ei nt hedev el opmentofos t eopor os i s .Lowc al c i um i nt ak ec ont r i but est odi mi ni s hedbonedens i t y ,ear l ybone l os sandani nc r eas edr i s koff r ac t ur es . •
Ea t i ngdi s or de r s. Peop l ewhoha v eanor e x i aar eat
hi gherr i s kofos t eopor os i s .Lowf oodi nt ak ec anr educ et he numberofc al or i esandamountofpr ot ei nandc al c i um i nges t ed.I nwomen,anor ex i ac ans t opmens t r uat i on,l eadi ng t oweak e rbones .I nmen,anor e x i al o wer st heamountofs e x hor monesi nt hebodyandcanweakenbone.
•
Gast r oi nt est i nalsur ger y . Ar educ t i oni nt hes i z eofy our
s t omac horaby pas sorr emov al ofpar toft hei nt es t i nel i mi t s t heamountofs ur f ac ear eaav ai l abl et oabs or bnut r i ent s , i nc l udi ngc al c i um. St er oi dsandot hermedi cat i ons Longt er m us eofor al ori nj ec t edc or t i c os t er oi dmedi c at i ons , s uc haspr edni s oneandc or t i s one,i nt er f er eswi t ht heboner ebui l di ngpr oc es s.Os t eopor os i shasal s obeenas s oc i at edwi t h medi c at i onsus edt oc ombatorpr e v ent : •
Sei z ur es
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Gas t r i cr efl ux
•
Canc er
•
Tr ans pl antr ej ec t i on
Li f est yl echoi ces
Somebadhabi t sc ani nc r eas ey ourr i s kofos t eopor os i s . Ex a mpl esi nc l ude: •
Sedent ar yl i f est yl e. Peopl ewhos pendal otoft i mes i t t i ng
hav eahi gherr i s kofos t eopor os i st handot hos ewhoar e mor eac t i v e.Anywei ght bear i ngex er c i s eandac t i v i t i est hat pr omot ebal anc eandgoodpos t ur ear ebenefi c i al f ory o ur bones ,butwal k i ng,r unni ng,j umpi ng,danc i ngand wei ght l i f t i ngs eem par t i c ul ar l yhel pf ul .
•
Excessi veal coholconsumpt i on. Reg ul a rc o ns u mp t i o n
ofmor et hant woal c ohol i cdr i nk sadayi nc r eas esy ourr i s kof os t eopor os i s . •
Tobaccouse. Theex ac tr ol et obac copl ay si n
os t eopor os i si s n' tc l ear l yunder s t ood,buti thasbeens hown t hatt obac c ous ec ont r i but est oweakbones .
SYMPTOMPS
%nlike other diseases, osteoporosis has no visible symptoms of pre$effects. ! person is often not aware that he or she has osteoporosis until a fracture occurs. Onc ebonesha v ebeen
we ak e n edb yo s t e op or o s i s ,y o uma yh a v es i g nsa n ds y mp t o ms t hati nc l ude: •
Bac kpai n,c aus edbyaf r ac t ur edorc ol l aps edv er t ebr a
•
Los sofhei ghtov ert i me
•
As t oopedpos t ur e
•
Abonef r ac t ur et hatoc c ur smuc hmor eeas i l yt han e x pec t ed
DIAGONASIS AND TREATMENT
TESTS: !lmost &'( of bone density is determined by heredity and )'( by lifestyle. Bone mineral density tests *B"+ shows how dense bones are and whether you have osteoporosis. -his information helps determine which prevention or treatment steps are needed.
Blood Test Markers Whether youre being screened or treated for osteoporosis, your doctor may order a blood or urine test to see the metabolism of bone. -his provides clues to the progression of your disease.
Bone Densitometr Bone densitometry is a test like an /$ray that #uickly and accurately measures the density of bone. Bo ned en s i t yc a nb eme as u r e db yama c hi n et h atu s esl o wl e v e l sofX-
r ay st odet er mi net hepr opor t i onofmi ner al i nbones .I nmos tc as es ,onl yaf ew bonesar ec hec k ed— us ual l yi nt hehi p,wr i s tands pi ne.
CURE:
-here is no !"re for osteo#orosis. -he goal of treatment is to protect and strengthen the bones. Treatment usually includes a combination of drugs and lifestyle changes to help slow the rate of bone re$absorption by the body.
Bisphosphonates These are the most common osteoporosis drug treatments. They include the following •
Alendronate (Fosamax) is an oral medication people typically take once per week.
•
Ibandronate (Bonia) is aailable as a monthly oral
•
tablet or as an intraenous in!ection that you get four times per year. "isedronate (Actonel) is aailable in daily# weekly#
•
bimonthly# or monthly doses. $oledronic acid ("eclast) is aailable as an intraenous infusion that you get once eery one or two years. The side e%ects of these drugs can include acid re&ux# nausea# and stomach pain. In some cases# they can cause bone damage in the !aw# or !aw osteonecrosis. This side e%ect is rare and occurs more often in people n g who take high doses of bisphosphonates. Usi bi s phos phonat et her ap yf ormor et hanfi v ey e ar shasbeenl i nk edt oar ar e pr obl em i nwhi c ht hemi ddl eoft het hi ghbonec r ac k sandmi ghtev enbr eak c ompl et el y . Bi s phos phonat esal s oha vet hepot ent i al t oaff ec tt hej awbone.
Antibodies Denosumab is an antibody. It links to a protein inoled in your body's process of bone reabsorption. This antibody slows bone reabsorption. It also maintains bone density. It's aailable as an in!ection that you get eery six months. The side e%ects can include • • • • •
skin irritation muscle sti%ness pain spasms fatigue
• •
excessie sweating bone fractures in rare cases
*ormone therapy +ostmenopausal women are at a high risk for osteoporosis. ,estrogen helps protect bones# and oestrogen production drops during menopause. For women in menopause# hormone therapy# or hormone replacement therapy# is a treatment option. Typically# doctors don't use it as a -rst line of defence because it increases your risk of • • • •
a stroke a heart attack breast cancer blood clots
Ral ox i f ene( Ev i s t a)mi mi c ses t r ogen' sbenefi ci al effec t sonbonedens i t yi n pos t menopaus al women,wi t houts omeoft her i s k sas s oc i at edwi t hes t r ogen. T ak i ngt hi sdr ugma yal s or educ et her i s kofs omet y pesofbr eas tc anc er .Hot fl as hesar eac ommons i deeff ec t .Ral o x i f eneal s oma yi nc r eas ey ourr i s kof bl oodc l ot s . I nmen,os t eopor os i sma ybel i nk edwi t hagr adual ager el at eddec l i nei n t es t os t er onel ev el s .T es t os t er oner epl ac ementt her apyc anhel pi nc r eas ebone dens i t y , butos t eopor os i smedi c at i onshav ebeenbet t ers t udi edi nmenwi t h os t eopor os i sandar er ec ommendedal oneori naddi t i ont ot es t os t er one.
Thyrocalcitonin
This is a hormone the thyroid gland makes. It helps regulate calcium leels in the body. octors use synthetic thyrocalcitonin# or calcitonin (Fortical# /iacalcin)# to treat spinal osteoporosis in people who can't take bisphosphonates. It can also ease the pain in some people who hae spinal compression fractures. The drug is aailable by nasal spray or in!ection. 0ide e%ects from nose sprays may include a runny nose or nosebleeds.
Parathyroid hormone (PTH) This hormone controls calcium and phosphate leels in bone. Treatments with a synthetic +T* (Forteo) can promote new bone growth. This drug is aailable as a daily in!ection in combination with calcium and itamin supplements. This drug is expensie and generally resered for people with seere osteoporosis who hae poor tolerance for other treatments.
1ifestyle changes 2alcium and itamin 3etting plenty of calcium and itamin in your diet can help slow bone loss. 2alciumrich foods include • • • •
dairy products dark green egetables enriched grains and breads soy products
/ost cereals and orange !uices are now aailable with added calcium as well. 4itamin helps your body absorb the calcium it needs. The 5ational Institute of Arthritis and /usculoskeletal and 0kin iseases (5IA/0) recommends that women aged 6789 and men aged 67:9 should take 6#999 milligrams (mg) of calcium per day. They recommend that women aged 86:9 and eeryone oer :9 should take 6#;99 mg of calcium per day. The 5IA/0 recommends adults under age :9 should take <99 international units (I=) of itamin per day and adults oer age :9 should take >99 I= of itamin per day.
+hysical actiity ?xercise helps strengthen your bones. @hateer the form# physical actiity helps slow agerelated bone loss and can slightly improe bone density in some cases. ?xercise can also help improe your posture and balance# lowering your risk of falls. Fewer falls can mean fewer fractures. 0trength training bene-ts the bones in your arms and upper spine. This can mean free weights# weight machines# or resistance bands. @eightbearing exercise like walking or !ogging# and lowimpact aerobics such as elliptical training or biking can also be bene-cial.
Both can help strengthen the bones in your legs# hips# and lower spine.
