Osteoporosis
Osteoporosis is a progressive disease of the bones in which bone mass and architecture is lost and the bones become brittle and fracture easily. An earlier and less severe phase of osteoporosis is known as osteopenia. More than 1.3 million fractures occur each year in the United States because of osteoporosis. With early diagnosis and treatment of bone loss, the risk of fractures can be significantly reduced.
Risk factors
Risk factors for osteoporosis include: Low calcium intake, low vitamin D, low vitamin B12. Dysfunction of the hormones that regulate bone function: parathyroid hormone (PTH) Calcitonin, thyroid hormones, the sex hormones estrogen and testosterone. Early menopause and late menarche. Low body weight (less than 127 lbs). Medications: steroids (prednisone, prednisolone), heparin, anti-seizure medications. Race (Caucasian, Asian), age, gender (female). A sedentary lifestyle. Cigarette smoking, excessive alcohol usage, excessive caffeine intake. Chronic inflammatory conditions (RA, psoriatic arthritis). Personal history of a fragility bone fracture (breaking a bone after falling from standing height or less). Family history of osteoporosis.
Signs and symptoms:
There are usually no symptoms until a fracture occurs. Common sites for fractures include the spine, the hips and the wrists. Vertebral fractures may produce back pain or loss of height (if loss is more than 1.5 inches, it is highly predictive of vertebral fractures) with an increased curvature of the spine (kyphosis). This may further compress the abdomen causing it to bulge forward. Such patients may note that their abdomen appear larger than before without a real weight gain. Many vertebral fractures are found during a chest or abdominal x-ray done for other reasons. One third of vertebral fractures may lead to a sudden onset of severe back pain, which may completely resolve over several weeks or may be replaced by a chronic dull ache or pain. All hip fractures are symptomatic and are a major cause of disability and increase the risk of death. Fifteen to twenty percent of patients with fractures die within 1 year and seventy percent of survivors live a compromised lifestyle. Osteoporosis may lead to fractures near the wrist that occur when the hand is outstretched to stop a fall. Diagnosis: The most common method used to determine whether a person is at risk for or already has osteoporosis is to test Bone mineral density (BMD) by an X-ray DXA scan, and to determine a T score. Normal BMD has a T-score of 0 to -1 and does not require treatment. Osteopenia has a T-score of -1 to -2.4 and needs treatment to prevent progression to osteoporosis. Osteoporosis has a T-score of -2.5 or below. BMD testing is recommended in: All women over the age of 65 or women under the age of 65 who have one or more risk factors for osteoporotic fracture in addition to menopause. Men over 70 years of age. Adults with a history of fragility fractures. Adults with predisposing conditions for a low bone mass (Cushing's syndrome, hyperthyroidism, hyperparathyroidism, rheumatoid arthritis, or gastrointestinal diseases such as inflammatory bowel disease or celiac disease). Adults on medications associated with low bone mass.
Treatment:
Calcium and vitamin D are essential in helping to maintain healthy bones. Daily calcium intake (from diet plus supplement) should be at least 1000 mg for men and pre-menopausal women, and 1500 mg in postmenopausal women who do not take estrogens. Daily vitamin D intake should be about 800 International Units (IU). Weight bearing exercise like walking is also essential to prevent osteoporosis by increasing bone mass and muscle strength. Preventing falls significantly decrease the risk of osteoporotic fractures in the elderly. A new formula (FRAX) has been developed by WHO to calculate the 10-year risk of hip and osteoporotic fractures . Medical treatment is recommended in: Postmenopausal women and men over 50 years of age with a history of hip or vertebral fracture or with osteoporosis (T-score ≤-2.5), patients with osteopenia (T-score between -1.0 and -2.5) that exhibit other risk factors. Osteoporosis is treated with medications that inhibit the breakdown of bone and decrease bone loss like Alendronate (Fosamax ), Risedronate (Actonel), oral Ibandronate or oral or IV Boniva. An alternative is a yearly fifteen minute IV infusion called Zoledronic acid ZA (Reclast). A good alternative for postmenopausal women also at risk for breast cancer is Raloxifene (Evista). Calcitonin (nasal spray or sc injection) a hormone naturally produced by the thyroid gland helps to regulate calcium concentrations in the body and may be used temporarily as an analgesic for those who have acute, intense onset of pain due to vertebral fractures. Forteo is the only medication available at this time that promotes new bone formation.