OSTEOPOROSIS : PREVENTION AND TREATMENT

Case 1 : A 65yr old women develops severe pain in the lower back while trying to lift her grandson from the floor. She was then rushed to the hospital and on investigating was found to have osteoporotic collapse of lumbar vetrebrae.

Case 2 : A 72 yr old female sustained a small twisting jerk while walking over the uneven surface and developed sharp pain in the hip region followed by difficulty in walking and when examined was found to have fracture in the hip.

These cases are just to exemplify that Osteoporosis may not cause any apparent symptoms. Patients may not know they have osteoporosis until they break (fracture) a bone.

Osteoporosis is defined as a systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Although the diagnosis of the disease relies on the quantitative assessment of bone mineral density, which is a major determinant of bone strength, the clinical significance of osteoporosis lies in the fractures that arise.

Common sites for osteoporotic fracture are the spine, hip, distal forearm and proximal humerus. The remaining lifetime probability in women, at menopause, of a fracture at any one of these sites exceeds that of breast cancer.

Osteoporotic fractures are a major cause of morbidity in the population. Hip fractures cause acute pain and loss of function, and nearly always lead to hospitalisation. Recovery is slow, and rehabilitation is often incomplete, with many patients permanently institutionalised in nursing homes. Vertebral fractures may cause acute pain and loss of function but may also occur without serious symptoms. Vertebral fractures often recur, however, and the consequent disability increases with the number of fractures. Distal radial fractures also lead to acute pain and loss of function, but functional recovery is usually good or excellent.

A dual energy X-ray absorptiometry (DEXA or DXA) scan can be used as a screening test for osteopenia (bone loss that precedes osteoporosis). This test measures bone density in the hip, wrist and spine and is more precise than an X-ray.

The National Osteoporosis Foundation recommends the following groups of people should have Dual energy X-ray absorptiometry (DEXA or DXA) scans to screen for osteoporosis:

All women age 65 and older

All postmenopausal women under age 65 who have risk factors for osteoporosis

Postmenopausal women with fractures

Women with a medical condition associated with osteoporosis

How Is Osteoporosis Treated and Prevented?

There is no current cure for osteoporosis. Osteoporosis treatment involves stopping further bone loss, and strengthening bones that show signs of weakness. Prevention of osteoporosis is key.

Prevention and Treatment:

1. Exercise : Exercise is important in helping improve muscle strength and balance. Consult your doctor for the type and duration of exercise that is right for you

It is also important to consider other medical problems that may also be present (heart disease, diabetes, high blood pressure) before starting any exercise program.

2. Quit Smoking and Curtail Alcohol

3. Calcium Supplements

4. Calcium-Fortified Foods

5. Vitamin D


Treatment: Medications

There are several types of medications used to treat osteoporosis.

Antiresorptive drugs

Menopausal estrogen hormone therapy.

Selective estrogen receptor modulators (SERMs).

Anabolic drugs: these are the only drugs that actually build bone mass. Teriparatide, a form of parathyroid hormone, is one example of this type of drug