Osteoporosis

Why Bone Health is Important? 

When you think about staying healthy, you probably think about making lifestyle changes to prevent conditions like cancer and heart disease. Keeping your bones healthy to prevent osteoporosis may not be at the top of your wellness list.

Osteoporosis is a silent disease of the bones that makes them weaken and prone to fracture. With every major osteoporosis fracture, the risk of death doubles. Yet it is not taken seriously the world over,"

What is Osteoporosis? 

The lumbar disc starts degenerating form the early 20s and progresses based on the genetic predisposition of the individual. This degeneration is universal and is part of the ageing process. Lumbar disc herniation is the failure of the tensile annulus (tough outer covering of the disc) to contain the central nucleus pulposus (central jelly like disc material). This usually occurs due to weakening of the annulus as part of degeneration process.

What are the symptoms of osteoporosis? 

• Absolutely nothing until you break a bone. It is something like cholesterol, which can be high but you have no symptom until you have a heart attack or you drop dead.
• You can't feel your bones becoming weaker.
• You could have osteoporosis now or be at risk for it without realizing it.
• Often, breaking a bone is the first clue that you have osteoporosis. Or, maybe you notice that you are getting shorter or your upper back is curving forward. At this point the disease may be advanced.
• Fortunately, a bone mineral density test can tell if you have osteoporosis before you have these symptoms. This makes it possible to treat the disease early to prevent broken bones.

What causes osteoporosis? 

• Older age (starting in the mid-30s but accelerating with advancing age)
• Small bone structure
• Family history of osteoporosis
• Previous fracture following a low-level trauma, especially after age 50
• Sex hormone deficiency, particularly estrogen deficiency, both in women (e.g. menopause) and men
• Cigarette smoking
• Alcohol abuse
• Low dietary intake or absorption of calcium and vitamin D Sedentary lifestyle or immobility
• Medications: glucocorticoid medications such as prednisone
• Certain diseases can affect bone, such as endocrine disorders (hyperthyroidism, hyperparathyroidism, Cushing's disease, etc.) and inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, etc.)
• Low BMD Score

How is osteoporosis diagnosed? 

A medical evaluation to diagnose osteoporosis and estimate your risk of breaking a bone may involve one or more of the following steps:

• Medical history
• Physical examination
• Bone density test
• FRAX® score
• Laboratory tests
• X-rays

Medical History:

Your healthcare provider will ask questions to better understand your risk. He or she may look at the following factors:

• Your age
• Your gender
• Whether you have reached menopause (women)
• Your personal history of broken bones as an adult
• Your family history of broken bones and osteoporosis
• Whether you smoke or drink too much alcohol
• Your dietary habits, including how much calcium and vitamin D you get
• Your exercise and physical activity habits
• Whether you have had an eating disorder such as anorexia nervosa
• Whether you have had regular periods (premenopausal women)
• Your testosterone levels (men)
• Whether you take any medicines or have any medical conditions that may cause bone loss

Physical Examination:

Your healthcare provider may measure you to see if you have lost height and examine your spine to see if it is curving forward. After the age of 50, you should have your height checked without shoes every year at the same healthcare provider's office.

X-Rays:

When osteoporosis results in multiple broken bones in the spine, the spine shortens and height loss or posture changes can occur. Breaks in the spine are also called compression fractures or vertebral fractures. After a person breaks bones in the spine, the posture may appear "stooped" or "hunched." These posture changes are known as kyphosis. When it is severe, it is also called a Dowager's hump. Some people feel no pain after they break one or more bones in the spine.

Your healthcare provider may suggest an x-ray of your spine if you:

• Lose 1/2 inch or more in height in one year
• Have stooped or hunched posture
• Develop back pain
• Experience a height loss of 1 ½ inches or more from your original height

Because x-rays can only detect bone loss after 25 - 40 percent of bone density is lost, these tests are not used to diagnose osteoporosis.

BMD: 

A simple test that measures bone mineral density (BMD) at different parts of your body, such as your spine and your hip, can help determine if you have osteoporosis. Dual energy X-ray absorptiometry (DXA) is the best current test to measure BMD.

The test is quick and painless. It is similar to having an X-ray taken, but uses much less radiation.

Your bone density is considered normal if the T-score is between 1.0 and -1.0.

If your T-score is –2.5 or lower, you are considered to have osteoporosis and, therefore, are at high risk for a fracture.

PREVENTION, WHY HEALTHY LIVING IS IMPORTANT 

Thirty years ago, most people thought osteoporosis and the broken bones it can cause were a part of normal aging. That view has changed. Researchers today know a lot about how you can protect your bones throughout your life.

Getting enough calcium, vitamin D and regular exercise are important for your bones.

On the other hand, eating poorly, smoking, drinking too much alcohol or not exercising can cause bone loss and osteoporosis.

TREATMENT OPTIONS 

Universal public health measures (calcium/vitamin D/ exercise) are recommended in all patients regardless of BMD, as they are efficacious, safe and cost-effective.

There are lots of treatments now that are very well studied and shown to be effective and largely safe.

Consult your doctor and your doctor will prescribe you medicine according to severity of Osteoporosis.

LIVING WITH OSTEOPOROSIS: 

• Moving Safely and Protecting spine.
• Preventing falls & broken bones
• Remember to wear appropriate shoes both indoors and out.
• Use hand rails as you go up and down steps.
• Use a walker or cane as needed.
• Install grab bars on the bathroom walls beside the shower and toilet.
• You should also check to make sure you are not taking a medication that affects your balance or causes drops in your blood pressure. Both can increase your risk of falling. Also, have your vision and hearing checked.

What are Bisphosphonates? 

Bisphosphonates are the primary drugs used to both prevent and treat osteoporosis in postmenopausal women.

• Bisphosphonates taken by mouth include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Most are taken by mouth, usually once a week or once a month.
• Bisphosphonates given through a vein (intravenously) are taken less often.

What is Calcitonin? 

Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection. The main side effects are nasal irritation from the spray form and nausea from the injectable form. Calcitonin appears to be less effective than bisphosphonates.

What is Hormone replacement therapy? 

Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis and are not approved to treat a woman who has already been diagnosed with the condition. Sometimes, if estrogen has helped a woman, and she cannot take other options for preventing or treating osteoporosis, the doctor may recommend that she continue using hormone therapy. If you are considering taking hormone therapy to prevent osteoporosis, discuss the risks with your doctor.

What is Parathyroid Hormone? 

Teriparatide (Forteo) is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. You can give yourself the shots at home.

What is Vertebroplasty? 

Vertebroplasty (picture 3) is a procedure, which can be used to treat any small fractures in your spinal column due to osteoporosis. The procedure involves injecting a fast-hardening glue into the areas 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.)