Osteoporosis
As I sit in orthopaedic opd I come across many geriatric patients , some have back pain resulting from recent fractures sustained from trivial fall recently or from old causes.
What is osteoporosis?
Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones.
Normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone to fracture. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.
The following are factors that will increase the risk of developing osteoporosis:
- Female gender
- Caucasian or Asian race
- Thin and small body frame
- Family history of osteoporosis (for example, having a mother with an osteoporotic hip fracture doubles your risk of hip fracture)
- Personal history of fracture as an adult
- Cigarette smoking
- Excessive alcohol consumption
- Lack of exercise
- Diet low in calcium
- Poor nutrition and poor general health, especially associated with chronic inflammation or bowel disease
- Malabsorption from bowel diseases, such as celiac sprue that can be associated with skin diseases, such as dermatitis herpetiformis
- Low estrogen levels in women
- Low testosterone levels in men (hypogonadism)
- Chemotherapy that can cause early menopause due to its toxic effects on the ovaries
- Amenorrhea (loss of the menstrual period) in young women is associated with low estrogen and osteoporosis; amenorrhea can occur in women who undergo extremely vigorous exercise trainin
- Chronic inflammation, due to chronic inflammatory arthritis or diseases, such as rheumatoid arthritis or liver diseases
- Immobility, such as after a stroke, or from any condition that interferes with walking
- Hyperthyroidism, a condition wherein too much thyroid hormone is produced by the thyroid gland (as in Grave’s disease) or is ingested as thyroid hormone medication
- Hyperparathyroidism .
- vitamin D deficiency
- Certain medications can cause osteoporosis. These medicines include long-term use of heparin (a blood thinner), antiseizure medicine such as phenytoin (Dilantin) and phenobarbital, and long-term use of oral corticosteroids (such as prednisone).
Signs and symptoms
- 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
Treatment
Although we can’t completely reverse osteoporosis, there are ways to manage it. Some of those methods are things we can do every day through diet and exercise. doctor may also recommend that taking medicine.
Diet: Calcium and Vitamin D
Food sources of calcium include nonfat milk, low-fat yogurt, plant-based milks or orange juices that are fortified with calcium, broccoli, cauliflower, salmon, tofu, and leafy green vegetables.
How much calcium do you need?
1,000 milligrams of calcium each day if age 19-50. 1,200 milligrams per day if a woman age 51 or older, or a man age 71 and older.
Exercise
Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased. Research has not yet determined what type of exercise is best for osteoporosis or for how long it should be continued. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily for optimal health.
Which medications are commonly used for osteoporosis treatment?
Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:
- Alendronate
- Risedronate
- Ibandronate
- Zoledronic acid
Hormones, such as estrogen, and some hormone-like medications approved for preventing and treating osteoporosis, such as raloxifene, also play a role in osteoporosis treatment. However, fewer women use estrogen replacement therapy now because it may increase the risk of heart attacks and some types of cancer.
How do most osteoporosis medications work?
Osteoporosis medications slow bone breakdown. Healthy bones continuously break down and rebuild.
Osteoporosis medications basically put a brake on the process. These drugs effectively maintain bone density and decrease the risk of breaking a bone as a result of osteoporosis
What are common side effects of bisphosphonate pills?
The main side effects of bisphosphonate pills are stomach upset and heartburn.
To ease these potential side effects, take the medication with a tall glass of water on an empty stomach. Don’t lie down or bend over or eat for 30 to 60 minutes to avoid the medicine washing back up into the esophagus. When the recommended wait time is over, eat to neutralize the remaining medication.
If a postmenopausal woman has other menopausal symptoms such as hot flashes and vaginal dryness, HRT (Hormone replacement therapy) will be the proper choice for these menopausal symptoms as well as for the prevention of osteoporosis. After the menopausal symptoms have passed, some other nonestrogen prescription medication will be considered for the longer term.
If the prevention and treatment of osteoporosis is the only issue under consideration, then bisphosphonates such as alendronate, ibandronate, or risedronate are more effective than menopausal hormone therapy in preventing osteoporotic fractures and less likely to be associated with substantial adverse effects.
So far, bisphosphonates are the most well-studied and effective category of prescription medication for treating postmenopausal
A few serious esophageal conditions preclude the use of oral bisphosphonates, specifically esophageal stricture or achalasia. In these two conditions, it is likely that the bisphosphonate tablets will be retained in the esophagus and lead to esophageal inflammation, ulceration, and scarring.. Caution also is advised when there is gastritis, duodenitis, or ulcers
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