Why osteoporosis and osteopenia are fast turning into diseases of the young

Did you know that osteoporosis causes more than 8.9 million fractures worldwide every year? what is frightening is many of these fractures are now taking place among the youth due to deficit diet and poor lifestyle coupled with genetic predisposition. Both osteoporosis and osteopenia are two forms of bone loss conditions, with the latter being a precursor to the former. To distinguish between the two a bone mineral density test is usually performed.

What is the difference between osteoporosis and osteopenia?

A BMD (bone mineral density) t-score between -1 sd and -2.5 sd indicates osteopenia with a high chance of osteoporosis. On the other hand, a t-score of -2.5 sd and below stands for osteoporosis. A higher bone density (above -1sd) is usually indicative of stronger bones. Fragility index is more accurate way to assess the risk of fractures.

In osteoporosis the bone loss or weakening of bones take place over a long period of time, and results in unexpected fractures and severe bone problems. Disfigurement, fractures in the spine, loss of mobility and independence are usual characteristics of this bone disease once it progresses further.

Prevention is better than cure, always!

To keep bones strong and healthy, calcium and phosphate is continuously absorbed by the body. But after 30, the body?s ability to absorb calcium slows down and there?s a decrease in the production of new bones. In contrast, bone desorption (the process of transferring calcium from the bone to the blood) continues unabated.

When the body starts absorbing the store of calcium in the bones to meets its needs, it leads to calcium depletion and is one of the causes of the weakening of the bone.

At present, the age limit (50-60 years) for osteoporosis has seen a drop with many younger people increasingly suffering from the ailment. Factors like unhealthy lifestyle, late-night shifts, smoking and alcohol consumption have been found to be the culprits behind the rise in osteoporosis cases among the young. Recent studies have identified vitamin d deficiency as a major factor for poor bone health and bone mass density in the young.

How to keep your bones strong and healthy? and manage osteo - penia/porosis complications:

Bone loss can be prevented by adopting these very simple but effective ways:

- exercising can help in building strong bones and muscles, while preventing bone loss.

- maintaining a calcium intake of 1000 mg for pre-menopausal women and 1200 mg for women post menopause.

- staying out in the sun for 20 minutes to produce requisite amount of vitamin d for calcium absorption and using supplements of vitamin d.

- there are many safe medicines available to prevent and treat osteoporosis like alendronates, calcitonin, parathyroid, teriparatide preparation etc.

- in osteoporosis induced /associated fractures we have to to modify implants to negate weak purchase of implants in bone and improve mobility. We have been using these modifications in established osteopenia/porosis case in fractures treatment/joint replacement/ arthroscopic fixations and MIS spine fracture management.


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Are Osteoporosis and Osteopenia fast turning into diseases of the young?

The bones are a porous matrix which is filled with minerals like calcium and phosphorus which make them strong. Over a period of time, the mineral content is lost and therefore the matrix gets brittle. Bones are more likely to fracture in these people.

Causes/Risk factors:

The bones get fragile and brittle with age in most people, and people over 60 years of age are likely to be affected
Asian women about the age of 45 are prone to osteoporosis
Reduced vitamin D intake (either by sun exposure or through diet) also makes bone porous and prone to fracture
Sedentary lifestyle with minimal or no exercise
Lower levels of estrogen, especially post menopause
Cigarette smoking
Reduced testosterone levels
With fracture, there is severe pain, loss of mobility, and need for prolonged nursing.
Foods which can help control/prevent osteoporosis:

Yoghurt: Derived from milk, it is rich in animal protein and also contains good amounts of vitamin D and B2, calcium, phosphorus, and magnesium. It helps in maintaining estrogen levels during menopause, thereby preventing osteoporosis. They also provide a good supply of gut bacteria, which improves immunity.
Milk: Similar to yoghurt, this is also rich in various minerals that are essential for bone health. The vitamin D in it also improves calcium absorption, thereby prolonging the occurrence of osteoporosis.
Fish and meat: Lean meat and fish are good sources of oils and protein and form an essential part of diet for preventing osteoporosis. Sardines and salmon are ideal as the tiny fish are rich sources of calcium.
Eggs: This contains good amounts of natural protein, minerals, and vitamins essential for bone health. It also helps in estrogen formation, which has a bone-protective effect.
Cabbage: Any form of cabbage is good for preventing osteoporosis. It promotes bone metabolism and has calcium which help in strong bone formation.
Bananas: Another effective food in preventing osteoporosis, it helps improve absorption of calcium and other essential nutrients to ensure bones are formed and maintain health. It also has natural oils, potassium, and vitamins A and C in good quantity.
Almonds: It forms an integral part of preventing osteoporosis by increasing bone density and promoting bone health. It also has good oil content, which is also essential for bone health.
Legumes: Beans and other legumes are rich source of proteins and minerals and therefore prevent onset of osteoporosis.
Chickpeas: Another great source of various minerals and vitamins, it is very low in calories and sugar and is great to lose weight. It also improves bone health by increasing density.

Osteoporosis - How A Healthy Diet Can Reduce Its Risk?

Osteoporosis is a Latin word for  porous bones . A healthy bone holds tiny spaces within it resembling a honey comb. Osteoporosis causes an expansion in the dimension of these spaces so much so that the bone loses out on its density and strength, at the same time turning brittle and thin on the outer part. People afflicted with osteoporosis are prone to experiencing fractures at the slightest stimulation while engaging in daily chores. It usually affects one s wrists, hip and the spine, thus rendering a stooped posture, loss in height and back pain as a result of a collapsed vertebra. Factors such as lowered estrogen count in women and testosterone in men, long term use of certain medications, certain medical conditions such as damage to the liver or the kidneys and a sedentary lifestyle along with excessive tobacco and alcohol consumption make one vulnerable to osteoporosis.

Tips To Help you manage and prevent it-

Medications: Zoledronic acid, Ibandronate, Risedronate and Alendronate are some of the widely used medicines to combat the risks of fracture. However, these medicines carry considerable side-effects, for instance adnominal pain, nausea or a heart-burn like sensation. Ipriflavone, a laboratory manufactured product, in combination with calcium can be used as an alternative medicine to inhibit bone loss and alleviate pain.

Quit smoking: Smoking escalates the rate of bone loss and the chances of sustaining another fracture.

Refrain from excessive alcohol intake: Alcohol meddles with one s bone formation. Also, excessive alcohol intake might cause one to feel tipsy and thus fall down, aggravating risks of injuries and fractures even more.

Be careful while walking: Choose low or flat heeled footwear with soles that do not slip. Watch your step. Be careful with rugs, slippery surfaces, electrical cords or other scattered substances which might make you trip over and fall. Install  grab bars  in your house so that you can hold on to them if you suddenly feel unsteady on the feet.

How Can You Deal With Osteoporosis?

Osteoporosis is a condition which usually results due to a decrease in bone density. In this condition, the bones become weak and brittle. Fractures are a common result of osteoporosis. Usually, symptoms or signs do not show up until the condition progresses to its advanced stages.

Since osteoporosis is usually irreversible and incurable, preventing the fractures is considered to be extremely important.

Who is at risk of osteoporosis?
All men and women have some risk of developing 'thinning' of the bones (osteoporosis) as they become older, particularly over the age of 60. As mentioned above, women are more at risk than men. The following situations may also lead to excessive bone loss and so increase your risk of developing osteoporosis. If you:

Are a woman who had the menopause before 45 years of age
Have already had a bone fracture after a minor fall or bump
Have a strong family history of osteoporosis.
Have a body mass index (BMI) of 19 or less (that is, you are very underweight)
Have irregular periods
Have taken, or are taking, a steroid medicine (such as prednisolone) for three months or more
Are a smoker
Have an alcohol intake of more than four units per day
Lack calcium and/or vitamin D (due to a poor diet and/or little exposure to sunlight).
Are mostly inactive
Ways To Treat Osteporosis

Osteoporosis in women can be treated using Hormone Replacement Therapy (HRT). The therapy makes use of either a combination of progestin and oestrogen or simply, oestrogen. However, it is possible that certain combinations have side-effects that might give rise to other medical conditions. Therefore, proper consultation with an orthopedist is an essential pre-requisite so that the condition of osteoporosis as well the side effects may be addressed before proceeding with Hormone Replacement Therapy.

There are a number of medications that can be used which have long-term effects on osteoporosis. However, the schedule for intake of these medicines should be followed diligently. Failing to adhere to the schedule could lead to serious complications. For example, the intake of Risedronate medications (prevent bone loss) should be scheduled once every month, failing which can cause ulcers in the food pipe. Raloxifene has effects which are similar to oestrogen but does not exhibit any serious side effects. Teriparatide can be used to treat osteoporosis in people who have a high risk of suffering from bone fractures.

Don't rely entirely on medication as the only treatment for your osteoporosis. These practices also are important:

Exercise. Weight-bearing physical activity and exercises that improve balance and posture can strengthen bones and reduce the chance of a fracture. The more active and fit you are as you age, the less likely you are to fall and break a bone.
Good nutrition. Eat a healthy diet and make certain that you're getting enough calcium and vitamin D. Being underweight or losing a lot of weight unintentionally is associated with poorer bone health and a higher risk of fracture   even if you're taking a bisphosphonate.
Quit smoking. Smoking cigarettes speed up bone loss.
Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

How To Cure Osteoporosis?

Osteoporosis is a skeletal disorder, which causes fragility of bones. In the absence of proper prevention and treatment modalities, osteoporosis can cause a painless progression and subsequent fractures. Such fractures (broken bones) mostly occur in the hip, spine, or wrist. As per several past data-driven studies conducted in the United States of America, 1.5 million new fractures are witnessed in people with osteoporosis every year. Of these, spine fractures are seen in 700,000; hip fractures in 300,000; wrist fractures in 250,000; and fractures of other bones in 250,000 people.

Possible Causes of Osteoporosis

Hormonal imbalances Pregnancy
Metabolic diseases Cancer
Age beyond 60-65 years
Symptoms of Osteoporosis-Induced Compression Fractures 
Significant upper or lower back pain
Changes in posture
Difficulty with breathing and digestion 
Decreased ability to walk 
An overall decrease in the quality of life Increased tendency for fracture of adjacent vertebrae
Treatment

Compression fractures are usually managed with pain medications; narcotic pain medicines are administered for a few months until the pain decreases. Also, few available medications are known to increase the bone density. It is hoped that by building the bone density, future fractures can be prevented. Another method is immobilization of the spine with a brace that helps decrease pain from a broken vertebra; however, such braces are helpful only for the fractures of the lower back.

Role of Kyphoplasty in the Management of Osteoporosis

Kyphoplasty is a procedure that involves a new technology whereby an osteoporotic compression fracture can be treated with relief in pain, restoration of the lost bone height, and immediate stabilization of the fracture with the injection of bone cement. 

How is kyphoplasty done?

The procedure is carried out via two A  incisions on each side of the affected vertebra. The technique utilizes X-ray equipment to place working tools into the collapsed vertebra. This step is followed by an insertion of an inflatable bone tamp or expander into the fractured vertebra on each side, after which, the balloons are slowly inflated, lifting up the fractured portion of the vertebra to a more normal height. The balloons are then deflated, and cement is slowly injected. Excellent restoration of fractures, which are less than 4-6 months old and better than 90% success at reducing pain associated with the broken vertebra, is seen with kyphoplasty. 

Which patients can benefit from kyphoplasty? 

Patients with a recent vertebral compression fracture due to osteoporosis 
Patients with fractures which are less than 4 months old
Patients with fractures who are on chronic prednisone or steroids 
Complications from this procedure have been primarily related to patients who have been on blood thinner medications. 
Potential complications also include cement leaking out of the vertebra and into inappropriate areas. 

Kyphoplasty In The Management Of Osteporosis!

Osteoporosis is a bone disease that happens when bone density decreases and the body stops producing as much bone as it did before. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. It can affect both males and females but it is most likely to occur in women after menopause, because of a sudden decrease in estrogen, the hormone that usually protects against osteoporosis.

Symptoms of Osteoporosis-

The early stages of osteoporosis do not cause any symptoms or warning signs. In most cases, people with osteoporosis do not know that they have the condition until they have a fracture. If symptoms do appear, some of the earliest ones may include receding gums, weakened grip strength, weak and brittle nails, back pain, loss of height over time, a stooped posture, and a bone fracture that occurs much more easily than expected.

Causes of Osteoporosis-
Some of the leading reasons behind osteoporosis include the following:

Age: The biggest cause of osteoporosis is age. It mostly affects people aged above 50.
Menopause: Another primary cause of osteoporosis in women, which occurs around the age of 45 to 55 years. Due to the changes in hormone levels associated with it, menopause can cause a woman s body to lose bone even more quickly.
Reduced sex hormones: Lower estrogen levels appear to make it harder for the bone to reproduce.
Ethnicity: White people and Asians are more susceptible than other ethnic groups.
Bone structure: Being tall or slim increases the risk of osteoporosis.
Vitamin D deficiency: In case of vitamin D deficiency, the body cannot absorb adequate amounts of calcium from the diet to prevent osteoporosis.
Risk Factors for Osteoporosis-
A number of factors can increase the likelihood of osteoporosis, these may include your age, race, lifestyle choices, and medical condition and its associated treatment. Some of the risk factors for osteoporosis are out of your control, including sex, age, race, family history, and body frame size. Osteoporosis is more common in people who have too much or little of certain hormones in their bodies. Examples include sex hormones, thyroid hormones, and hormones released by the adrenal glands. Osteoporosis is more likely to occur in people who have low calcium intake, eating disorder, and gastrointestinal surgery. Osteoporosis has also been associated with medications used to combat or prevent seizures, gastric reflux, cancer, and transplant rejection. Even lifestyle choices such as sedentary lifestyle, excessive alcohol consumption, and tobacco use can increase your risk of osteoporosis.

Prevention of Osteoporosis-
There are many risk factors for osteoporosis that you cannot control. These include being female, getting older, and having a family history of osteoporosis. There are some of the factors, however, that does fall within your control. Some of these ways to control osteoporosis include getting plenty of vitamin D and calcium, doing weight-bearing exercises, abstinence from smoking and for women, weighing the pros and cons of hormone therapy. If you are at an increased risk of osteoporosis, talk to your doctor about the best way to prevent it and do that as early as possible.

Osteoporosis - Symptoms You Must Not Ignore!

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