Osteoporosis refers to a condition of decrease in total bone mass. It is a crippling painful bone disease which majorly causes fractures in postmenopausal women and older adults in general. The loss of bone substance causes the bone to become mechanically weakened and prone to either spontaneous fractures or fractures from minimal trauma.
The demographic risk factors are female gender, increasing age, white race, oophorectomy, prolonged immobility and insufficient dietary calcium. Risk increases with smoking and alcoholism and it decreases with adequate physical activity and fluoride and vitamin D ingestion.
Adults normally begin losing bone between 30 to 40 years of age. When bone loss exceeds bone formation, the bones fracture under common, everyday stress. Although resorption affects the entire skeletal system, osteoporosis occurs mostly in the bones of spine, hips and wrist. Overtime, wedging and fractures of the vertebrae produce gradual loss of weight and a humped back known as Dowager’s hump or Kyphosis develops. The usual first signs are back pain or spontaneous fractures.
This disease often goes unnoticed because it cannot be detected by conventional radiography until more than 25% to 40% of calcium in the bone is lost. It is usually evident when the patient is 60 to 65 years of age. Serum calcium, phosphorus and alkaline phosphatase levels remain normal although alkaline phosphatase may be elevated after a fracture.
It is eight times moreyog in women than men for the following reasons:
- Women have lower calcium intake than men throughout their lives
- Women have less bone mass because of their generally smaller frame size
- Resorption begins at an earlier age in women and is accelerated at menopause
- Pregnancy and breast feeding deplete a woman’s skeletal reserve unless calcium intake is adequate
- Longevity increases the likelihood of osteoporosis and women live longer than men
Many medications are known to decrease calcium retention. This list includes aluminum containing antacids, caffeine, corticosteroids, nicotine and tetracycline. At the time these medicines are prescribed the patient should be informed of the possible side effects. Specific diseases associated with osteoporosis include intestinal malabsorption, kidney disease, rheumatoid arthritis, advanced alcoholism, cirrhosis of liver and diabetes mellitus.
Prevention of osteoporosis focuses on adequate calcium intake (1000mg/day in premenopausal women and postmenopausal women taking estrogen and 1500mg/day in postmenopausal women who are not taking supplements of estrogen) and regular exercise to strengthen the bones. If the dietary intake of calcium is inadequate, then the supplementary calcium should be taken. Calcium supplements inhibits age-related bone loss however no new bone is formed. Foods that are high in calcium include whole and yoghurt, skim milk, cottage cheese, turnip greens, sardines, ice-cream and spinach.
Estrogen therapy after menopause is used to prevent osteoporosis. It has been shown to increase the risk of endometrial cancer, however the recent research indicates that this can be prevented by a combination therapy with the use of a cyclic estrogen progesterone regimen. Even though the exact mechanism for the protective function of estrogen is not known it is believed that estrogen sensitizes the skeleton to the effects of parathyroid hormone, resulting in decreased bone resorption. Estrogen replacement continues to have significant beneficial effects for 10 to 15 years after menopause.
Etidronate disodium (stedronate), a bisphosphonate that inhibits osteoclast-mediated bone resorption is currently under investigation as a treatment for osteoporosis. Intermittent cyclical therapy with etidronate significantly increases vertebral bone mass and decreases the rate of vertebral fracture in women with postmenopausal osteoporosis.
The same measures used to prevent osteoporosis like weight bearing exercise and adequate calcium intakes are also beneficial in treating osteoporosis. Although loss of bone mass cannot be significantly reversed, further loss can be prevented if the three part program is followed.
Efforts are made to keep clients with osteoporosis ambulatory to prevent further loss of bone substance as a result of immobility. Treatment also involves protecting areas of potential pathological fractures. For example: A corset can be used by the client to prevent vertebral collapse.