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Health Centre

Osteoporosis
  • Introduction
  • Cause and Pathogenesis
  • Symptoms and Signs
  • Investigations and Diagnosis
  • Treatment and Prognosis
  • Prevention

  • Introduction

    Osteoporosis is a condition that causes the bones to soften, resulting in skeletal weakness and fractures. It is characterised by a generalised, and progressive decrease of bone mass as bone resorption exceeds bone formation. It may be caused by various factors including dietary deficiencies, endocrine imbalances, drugs, disease, old age etc. Postmenopausal women are the most susceptible to primary osteoporosis with an estimated 32% of these women developing the disease. Osteoporosis is one of the most common causes that result in bone fractures, especially in the elderly.


    Cause and Pathogenesis

    The cause of primary osteoporosis is not known. However the factors that contribute include a deficient calcium intake, early menopause, sedentary life-style without adequate exercise, and a familial history of the disease. Secondary osteoporosis may be caused by endocrine disorders such as hypogonadism, hyperthyroidism, hyperparathyroidism, and diabetes mellitus. Prolonged use of chemical substances like corticosteroids, nicotine, barbiturates, or heparin can also lead to osteoporosis. Underlying chronic disease (renal or hepatic disease, malabsorption syndrome, pulmonary disease, rheumatoid arthritis, or sarcoidosis etc), and weightlessness or immobility for a prolonged duration contribute to osteoporosis. The disease occurs as bone resorption exceeds bone formation, the bone tissue mass progressively decreases but the bone is morphologically normal. The cortical thickness decreases, as do the number and size of bone trabeculae with normal osteoid seams.

    Symptoms and Signs

    The individuals affected by the condition are usually asymptomatic early in the disease. The initial symptom is usually a dull, aching, constant pain that is felt in the bones, particularly the back and chest regions. The pain may radiate down the leg and lower limbs, and muscle spasms may be present. As the spinal column mass decreases, dorsal kyphosis (antero-posterior curving of the spinal column) occurs and cervical lordosis also increases, leading to multiple compression fractures of the spine and a reduction in height of the patient. Other fractures occur with minimal or no trauma due to the excessive weakness of the bones. Potential complications result from immobility, from increased fractures and deformity from spinal crushing may occur.


    Investigations and Diagnosis

    Clinically, the characteristic complaint is bone pain. X-ray examination of the bones revealing decreased radio density is a characteristic finding. Also, Photon Absorptiometry, and quantitative Computed Tomography (CT-Scan) showing decreased bone density of the spine, aids in the diagnosis of the condition. Endocrine tests and hormonal levels can also be assayed to detect any imbalances. Serum Calcium levels are also monitored regularly to detect any lowering in Calcium levels.

    Treatment and Prognosis

    The aims of general treatment are to prevent further bone loss, to increase formation of bone, and to prevent fractures. In some patients bone loss has been decreased or stopped with an increased intake of calcium supplements and vitamin D. For women, treatment with estrogen or estrogen combined with progestin has been effective in reducing and preventing further bone loss. Research indicates that the compound sodium fluoride, given with calcium and vitamin D, stimulates bone formation. A regular exercise regimen is necessary, including weight-bearing, hyperextension and resistance exercises to slow calcium loss and strengthen the weakened musculature. Hot compresses and massage for muscle spasm are effective in relieving pain and spasms. Orthopaedic prosthesis may need to be provided for the back and neck to prevent stress fractures and to provide support. Walking aids may be needed. A high-protein diet is necessary. The regular monitoring of calcium levels is essential.

    Estrogen-Progesterone combinations for postmenopausal women are administered. Non-Steroidal Anti-Inflammatory Drugs (NSAID) are used for relief of pain. Also, Biphosphonates and growth factors may be used to treat the condition. Surgical treatment is done for correcting any deformities or fractures of the bones. Osteoporosis patients must be given prompt treatment and must avoid undue stress that may result in fracture of the bones. Physiotherapy and counselling are also important in the treatment of the disease.


    Prevention

    Treatment of the causative factors like endocrine disorders, and toxic drug use can help to prevent the condition in patients in whom the disorder arises because of these reasons. A diet rich in calcium can help reduce or prevent the bone resorption. Dietary calcium is absorbed better than calcium from supplements. Many calcium-rich foods are also high in protein, vitamin D, phosphorus, and fibres.

    The following foods provide a good source of calcium - milk, yogurt, ice cream, cheese, fish, dark green vegetables, cauliflower. Children need 400 to 700 mg of calcium per day. The requirement increases to 1,300 mg per day for adolescents and about 1,000 mg per day for adults. After menopause, women need 1,500 mg of calcium per day. About 400 international units (IU) of vitamin D is needed daily. Vitamin D-fortified milk and multiple vitamin supplements are good sources of vitamin D. Regular clinical examination and monitoring of Serum Calcium levels is also essential for early detection of the disease.


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