OSTEOPOROSIS

OSTEOPOROSIS INFORMATION

 

Osteoporosis is the thinning of bone tissue and loss of bone density over time

General information about Osteoporosis

Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue

and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency or advanced age. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density.

Osteoporosis is a serious public health problem. Some 28 million people in the United States are affected by this potentially debilitating disease, which is responsible for 1.5 million fractures (broken bones) annually. These fractures, which are often the first sign of the disease, can affect any bone, but the most common locations are the hip, spine, and wrist. Breaks in the hip and spine are of special concern because they almost always require hospitalization and major surgery, and may lead to other serious consequences, including permanent disability and even death.

Information on how Osteoporosis developes

 

To understand osteoporosis, it is helpful to understand the basics of bone formation. Bone is living tissue that's constantly being renewed in a two-stage process (resorption and formation) that occurs throughout life. In the resorption stage, old bone is broken down and removed by cells called osteoclasts. In the formation stage, cells called osteoblasts build new bone to replace the old. During childhood and early adulthood, more bone is produced than removed, reaching its maximum mass and strength by the mid-30s. After that, bone is lost at a faster pace than it's formed, so the amount of bone in the skeleton begins to slowly decline. Most cases of osteoporosis occur as an acceleration of this normal aging process. That's referred to as primary osteoporosis. The condition can also be caused by other disease processes or prolonged use of certain medications that result in bone loss--if so, it's

called secondary osteoporosis.

Information on how Osteoporosis occurs

 

Osteoporosis occurs most often in older people and in women after menopause. It affects nearly half of all those, men and women, over the age of 75. Women, however, are five times more likely than men to develop the disease. They have smaller, thinner bones than men to begin with, and they lose bone mass more rapidly after menopause (usually around age 50), when they stop producing a bone-protecting hormone called estrogen. In the five to seven years following menopause, women can lose about 20% of their bone mass. By age 65 or 70, though, men and women lose bone mass at the same rate. As an increasing number of men reach an older age, there's more awareness that osteoporosis is an important health issue for them as well.

 

 

Researchers estimate that about 20% of American women over the age of 50 have osteoporosis. In addition, another 30% of them have osteopenia, which is abnormally low bone density that may eventually deteriorate into osteoporosis, if not treated.

 

About half of all women over the age of 50 will suffer a fracture of the hip, wrist, or vertebra.

 

Women who are white, especially those with a family history of osteoporosis, have a greater risk of developing osteoporosis. Other risk factors include smoking, eating disorders, low body weight, low amount of calcium in the diet, heavy alcohol consumption, early menopause, absence of menstrual periods (amenorrhea), and use of certain medications, such as steroids and anticonvulsants

 

OSTEOPOROSIS SYMPTOMS

There are no symptoms in the early stages of the Osteoporosis.

Symptoms occurring late in Osteoporosis include:

Fractures of the vertebrae, wrists, or hips (usually the first indication)

Low back pain Neck pain Bone pain or tenderness Loss of height over time Stooped posture

 

OSTEOPOROSIS TREATMENT

Treatments for osteoporosis focus on slowing down or stopping bone loss, preventing bone fractures by minimizing the risk of falls, and controlling pain associated with the disease.

 

There are several different kinds of drugs used to treat osteoporosis. They vary in their side effects, benefits, and costs.

Bisphosphonates in Osteoporosis Treatment

 

Bisphosphonates are a type of drug used for both the prevention and treatment of osteoporosis in postmenopausal women. The two bisphosphonates currently approved for osteoporosis -- alendronate (Fosamax) and risedronate (Actonel) -- prevent existing bone loss and reduce the risk of spinal and hip fractures.

 

While side effects are generally mild, potential side effects include stomach upset and irritation of the esophagus. Because bisphosphonates are difficult to absorb, these medicines should be taken on an empty stomach. The patient should not lie down or consume food or beverages (other than water) for at least 30 minutes after taking the medicine. The physician may also recommend taking calcium and Vitamin D supplements.

 

Actonel is approved for use in men with osteoporosis. Both Actonel and Fosamax prevent and treat osteoporosis in men and women taking daily steroids for chronic conditions like asthma and arthritis.

Raloxifenein Osteoporosis Treatment

 

Raloxifene (Evista) is another drug used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. (It does not appear to prevent other fractures, including those in the hip.) It may have protective effects against heart disease and breast cancer, though more studies are required.

 

The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

Harmone replacement therapy in Osteoporosis Treatment

 

A woman's body produces less estrogen during and after menopause, which may affect her bone strength. Based on early studies, many physicians used to believe that HRT might be beneficial for reducing the risk of heart disease and bone fractures caused by osteoporosis in addition to treating menopausal symptoms. The results of a new study, called the Women's Health Initiative (WHI), has led physicians to revise their recommendations regarding HRT.

 

The WHI, started in 1993, enrolled 161,809 women between the ages of 50-79 in 40 different medical centers. Part of the study was intended to examine the health benefits and the risks of hormone replacement therapy, including the risks of breast cancer, heart attacks, strokes, and blood clots.

 

In July 2002, one component of the WHI, which studied the use of estrogen and progestin in women who had a uterus, was stopped early because the health risks exceeded the health benefits. The use of estrogen-only therapy in women who no longer have a uterus still continues.

 

The WHI study showed that women taking HRT had 34% fewer hip fractures and 24% fewer fractures than women not receiving hormones. However, the main reason for stopping the estrogen-progestin study was because of a 26% increase in breast cancer in women taking HRT, as well as increases in heart attacks, strokes, and thromboembolic events (blood clots).

 

Women who are considering taking HRT to prevent osteoporosis should discuss with their physician their individual risk of coronary heart disease, stroke, blood clots, and breast cancer.

Calcitonin in in Osteoporosis Treatment

 

Calcitonin, marketed under the names Miacalcin (nasal spray) and Calcimar (injectable), is a medication that slows the rate of bone loss and relieves bone pain. The main side effects of calcitonin

are nasal irritation from the spray form, and nausea from the injectable form.

 

While calcitonin slows bone loss and reduces the risk of fractures, it appears to be less effective than ERT or biphosphonates. As with some of the other newer medications, it is significantly more expensive than ERT.

Exercise in Osteoporosis Treatment

 

Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Studies show that exercises requiring muscles to pull on bones cause the bones to retain and, perhaps, even gain density. Researchers found that women who walk a mile a day have four to seven more years of bone in reserve than women who don't. Some of the recommended exercises include:

Weight-bearing exercises -- walking, jogging, playing tennis, dancing

Resistance exercises -- free weights, weight machines, rubber stretch bands

Balancing exercises -- tai chi, yoga

Riding stationary bicycles

Using rowing machines

Walking

Jogging

 

Any exercise that presents a risk of falling should be avoided!

Diet in Osteoporosis Treatment

 

A diet that includes an adequate amount of calcium, Vitamin D, and protein should be maintained. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses for bone formation and maintenance is available.

 

Supplemental calcium should be taken as needed to achieve recommended daily calcium dietary intake. Current recommendations are for nonpregnant, menstruating women to consume 1000mg/day, pregnant women need 1200mg/day, and postmenopausal or nursing mothers should consume 1500 mg/day.

 

High-calcium foods include low-fat milk, yogurt, ice cream and cheese, tofu, salmon and sardines (with the bones), and leafy green vegetables, such as spinach and collard greens. Vitamin D aids in calcium absorption and 400-800 IU per day should be taken by all individuals with increased risk of calcium deficiency and osteoporosis.

 

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

Monitoring your Osteoporosis Treatment

 

Your response to treatment can be monitored with serial bone mineral density measurements every 1-2 years, though such monitoring is controversial and expensive. In the future, less elaborate measurements of bone turnover may become a standard means for following osteoporosis.

 

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

Surgeries used in Osteoporosis Treatment

 

There are no surgeries specifically for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebra from becoming fractured by strengthening the bones in your spinal column. The procedure involves injecting a fast-hardening glue into the regions that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

 

 

 

 

OSTEOPOROSIS PREVENTION

 

Building strong bones, especially before the age of 35, and maintaining a healthy lifestyle are the best ways of preventing osteoporosis. To build as much bone mass as early as possible in life, and to help slow the rate of bone loss later in life:

Diet in Osteoporosis Prevention

 

Experts recommend 1,500 milligrams (mg) of calcium per day for adolescents, pregnant or breast-feeding women, older adults (over 65), and postmenopausal women not using hormone replacement therapy. All others should get 1,000 mg per day. Foods are the best source for this important mineral. Milk, cheese, and yogurt have the highest amounts. Other foods that are high in calcium are green leafy vegetables, tofu, shellfish, Brazil nuts, sardines, and almonds.

Calcium supplements in Osteoporosis Prevention

 

Many people, especially those who don't like or can't eat dairy foods, don't get enough calcium in their diets and may need to take a calcium supplement. Supplements vary in the amount of calcium they contain. Those with calcium carbonate have the most amount of useful calcium. Supplements should be taken with meals and accompanied by six to eight glasses of water a day.

Vitamin D in Osteoporosis Prevention

 

Vitamin D helps the body absorb calcium. People can get vitamin D from sunshine with a quick (15-20 minute) walk each day or from foods such as liver, fish oil, and vitamin-D fortified milk. During the winter months it may be necessary to take supplements. Four hundred mg. daily is usually the recommended amount.

Avoid smoking and alcohol to help prevent Osteoporosis

 

Smoking reduces bone mass, as does heavy drinking. To reduce risk, do not smok and limit alcoholic drinks to no more than two per day. An alcoholic drink is one-and-a-half ounces of hard liquor, 12 ounces of beer, or five ounces of wine.

The role of exercise in Osteoporosis Prevention

 

Exercising regularly builds and strengthens bones. Weight-bearing exercises--where bones and muscles work against gravity--are best. These include aerobics, dancing, jogging, stair climbing, tennis, walking, and lifting weights. People who have osteoporosis may want to attempt gentle exercise, such as walking, rather than jogging or fast-paced aerobics, which increase the chance of falling. Try to exercise three to four times per week for 20-30 minutes each time.

 

 

 

 

OSTEOPOROSIS CAUSES

Osteoporosis is the most common type of bone disease. There are currently an estimated 10 million Americans suffering from osteoporosis, as well as another 18 million who have low bone mass, or osteopenia.

Osteoporosis Causes - description of Osteoporosis Causes

Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both.

Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient, or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

As people age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. Both situations can result in brittle, fragile bones that are subject to fractures, even in the absence of trauma.

Usually, the loss occurs gradually over years. Many times, a person will sustain a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and the damage is profound.

The leading causes are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men. Women, especially those over the age of 50, get osteoporosis more often than men.

Leading causes of Osteoporosis

 

Other causes include corticosteroid excess from Cushing's syndrome, hyperthyroidism, hyperparathyroidism, being confined to a bed, and bone cancers.

Researchers estimate that about 20% of American women over the age of 50 have osteoporosis. In addition, another 30% of them have osteopenia, which is abnormally low bone density that may eventually deteriorate into osteoporosis, if not treated.

 

About half of all women over the age of 50 will suffer a fracture of the hip, wrist, or vertebra.

Women who are white, especially those with a family history of osteoporosis, have a greater risk of developing osteoporosis. Other risk factors include smoking, eating disorders, low body weight, low amount of calcium in the diet, heavy alcohol consumption, early menopause, absence of menstrual

periods (amenorrhea), and use of certain medications, such as steroids and anticonvulsants

Risk factors that can cause Osteoporosis

Age. Osteoporosis is more likely as people grow older and their bones lose tissue.

Gender. Women are more likely to have osteoporosis because they are smaller and so start out with less bone. They also lose bone tissue more rapidly as they age. While women commonly lose 30-50% of their bone mass over their lifetimes, men lose only 20-33% of theirs.

Race. Caucasian and Asian women are most at risk for the disease, but African American and Hispanic women can get it too.

Figure type. Women with small bones and those who are thin are more liable to have osteoporosis.

Early menopause. Women who stop menstruating early because of heredity, surgery or lots of physical exercise may lose large amounts of bone tissue early in life. Conditions such as anorexia and bulimia may also lead to early menopause and osteoporosis.

Lifestyle. People who smoke or drink too much, or don't get enough exercise have an increased chance of getting osteoporosis.

Diet. Those who don't get enough calcium or protein may be more likely to have osteoporosis. That's why people who constantly diet are more prone to the disease.

Osteoporosis is a major cause of bone fractures and breaks

 

Osteoporosis is often called the "silent" disease, because bone loss occurs without symptoms. People often don't know they have the disease until a bone breaks, frequently in a minor fall that wouldn't normally cause a fracture. A common occurrence is compression fractures of the spine. These can happen even after a seemingly normal activity, such as bending or twisting to pick up a light object. The fractures can cause severe back pain, but sometimes they go unnoticed--either way, the vertebrae collapse down on themselves, and the person actually loses height. The hunchback appearance of many elderly women, sometimes called "dowager's" hump or "widow's" hump, is due to this effect of osteoporosis on the vertebrae

 

 

OSTEOPOROSIS DIAGNOSIS

Certain types of doctors may have more training and experience than others in diagnosing and treating people with osteoporosis. These include a geriatrician, who specializes in treating the aged; an endocrinologist, who specializes in treating diseases of the body's endocrine system (glands and hormones); and an orthopedic surgeon, who treats fractures, such as those caused by osteoporosis.

Test used in Osteoporosis Diagnosis

Bone mineral density (BMD) testing -- as performed in dual-energy x-ray absorptiometry (DEXA) -- measures the demineralization of the bones. This has become the gold standard for evaluation for osteoporosis. BMD testing should be performed on all postmenopausal women with fractures, all women under 65 with an additional risk factor for osteoporosis (besides menopause), and all women 65 and over.

A spine CT can show demineralization. Quantitative computed tomography (QCT) can evaluate bone density, but is less available and is more expensive than DEXA.

A spine or hip x-ray may show fracture or vertebral collapse in severe cases.

Measuring the amount of calcium in your urine can provide some evidence of increased bone turnover, but is of limited value. A number of newer tests to evaluate bone turnover are becoming available, including measurement of urinary N-telopeptide (Osteomark). In the future, these may enhance your physician's ability to diagnose early osteoporosis.

More detailed information about Osteoporosis Diagnosis

 

Before making a diagnosis of osteoporosis, the doctor usually takes a complete medical history, conducts a physical exam, and orders x rays, as well as blood and urine tests, to rule out other diseases that cause loss of bone mass. The doctor may also recommend a bone density test. This is the only way to know for certain if osteoporosis is present. It can also show how far the disease has progressed.

 

Several diagnostic tools are available to measure the density of a bone. The ordinary x ray is one, though it's the least accurate for early detection of osteoporosis, because it doesn't reveal bone loss until the disease is advanced and most of the damage has already been done. Two other tools that are more likely to catch osteoporosis at an early stage are computed tomography scans (CT scans) and machines called densitometers, which are designed specifically to measure bone density.

 

The CT scan, which takes a large number of x rays of the same spot from different angles, is an accurate test, but uses higher levels of radiation than other methods. The most accurate and advanced of the densitometers uses a technique called DEXA (dual energy x-ray absorptiometry). With the DEXA scan, a double x-ray beam takes pictures of the spine, hip, or entire body. It takes about 20 minutes to do, is painless, and exposes the patient to only a small amount of radiation--about one-fiftieth that of a chest x ray.

 

Doctors don't routinely recommend the test, partly because access to densitometers is still not widely available. People should talk to their doctors about their risk factors for osteoporosis and if, and when, they should get the test. Ideally, women should have bone density measured at menopause, and periodically afterward, depending on the condition of their bones. Men should be tested around age 65. Men and women with additional risk factors, such as those who take certain medications, may need to be tested earlier.