OSTEOPOROSIS

Osteoporosis is a systemic skeletal disorder characterized by low bone mass. It is a disorder of

the bones in which the bones become brittle, weak, and easily damaged or broken. A decrease in
the mineralization and strength of the bones over time causes osteoporosis. It is characterized by

 a decrease in the density of bone,

 decreasing its strength and resulting in fragile bones.

Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge.
This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in
the bones.

Cause – Risk factors for osteoporotic fracture can be split between non-modifiable and
(potentially) modifiable. In addition, osteoporosis is a recognized complication of specific
diseases and disorders.

Non-modifiable

1) Age & Sex:The most important risk factors for osteoporosis are advanced age (in both men
and women) and female sex; estrogen deficiency following menopause or surgical removal of
the ovaries is correlated with a rapid reduction in bone mineral density, while in men, a decrease
than
in testosterone levels has a comparable (but less pronounced) effect ^Female gender

2) Ethnicity: While osteoporosis occurs in people from all ethnic

groups, European or Asian ancestry predisposes for osteoporosis.

3) Heredity: Those with a family history of fracture or osteoporosis are at an increased risk;
the heritability of the fracture, as well as low bone mineral density, is relatively high, ranging
from 25 to 80%. At least 30 genes are associated with the development of osteoporosis.

4) Personal history of fracture as an adult: Those who have already had a fracture are at least
twice as likely to have another fracture compared to someone of the same age and sex.

5) Build: A small stature is also a non-modifiable risk factor associated with the development of
(
osteoporosis.Thin and small body frame)

6) Diseases:
  Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from
bowel diseases, such as celiac sprue.
 Low estrogen levels in women (which may occur in menopause or with early surgical
removal of both ovaries)
 Low testosterone levels in men (hypogonadism)
 Chemotherapy that can cause early menopause due to its toxic effects on the ovaries.
 Amenorrhea (loss of the menstrual period) in young women is associated with low
estrogen and osteoporosis; amenorrhea can occur in women who undergo extremely
vigorous exercise training and in women with very low body fat (for example, women
with anorexia nervosa)
 Chronic inflammation, due to chronic inflammatory arthritis or diseases, such
as rheumatoid arthritis or liver diseases
 Immobility, such as after a stroke, or from any condition that interferes with walking.
 Hyperthyroidism, a condition wherein too much thyroid hormone is produced by the
thyroid gland (as in Grave's disease) or is ingested as thyroid hormone medication.
 ( Hyperparathyroidism is a disease wherein there is excessive parathyroid hormone
production by the parathyroid gland, a small gland located near or within the thyroid
gland. Normally, parathyroid hormone maintains blood calcium levels by, in part,
removing calcium from the bone.) In untreated hyperparathyroidism, excessive
parathyroid hormone causes too much calcium to be removed from the bone, which can
lead to osteoporosis.
 Poor nutrition and poor general health, especially associated with chronic inflammation
or bowel disease

7) Effect of Drugs:Certain medications can cause osteoporosis. These medicines include long-
term use of heparin (a blood thinner), anti-seizure medicine such as phenytoin (Dilantin) and
phenobarbital, and long-term use of oral corticosteroids (such as prednisone).

Potentially modifiable
1) Excessive alcohol: Although small amounts of alcohol are probably beneficial (bone
density increases with increasing alcohol intake), chronic heavy drinking (alcohol intake
greater than three units/day) probably increases fracture risk despite any beneficial effects
on bone density.

2) Vitamin D deficiency: Low circulating Vitamin D is common among the elderly

worldwide. Mild vitamin D insufficiency is associated with increased parathyroid
massA
hormone (PTH) production. PTH increases bone resorption, leading to low bone loss.
 positive association exists between serum 1,25-(OH)2 cholecalciferol levels and bone
mineral density, while PTH is negatively associated with bone mineral density.

3) Tobacco smoking: Many studies have associated smoking with decreased bone health,
but the mechanisms are unclear. Tobacco smoking has been proposed to inhibit the
activity of osteoblasts, and is an independent risk factor for osteoporosis. Smoking also
results in increased breakdown of exogenous estrogen, lower body weight and earlier
menopause, all of which contribute to lower bone mineral density.

4) Malnutrition: Nutrition has an important and complex role in maintenance of good

bone.

 Identified risk factors include low dietary calcium and/or phosphorus,

magnesium, zinc, fluoride, copper, vitamins A, K, E and C (and D where skin
exposure to sunlight provides an inadequate supply).

 Excess sodium is a risk factor. High blood acidity may be diet-related, and is a
known antagonist of bone. Some have identified low protein intake as associated
with lower peak bone mass during adolescence and lower bone mineral density in
elderly populations.

 Conversely, some have identified low protein intake as a positive factor, protein is
among the causes of dietary acidity.

 Imbalance of omega-6 to omega-3 polyunsaturated fats is yet another identified

risk factor.

 Diet low in calcium and vitamin D is the main factor. When vitamin D is
lacking, the body cannot absorb adequate amounts of calcium from the diet to
prevent osteoporosis. Vitamin D deficiency can result from dietary deficiency,
lack of sunlight, or lack of intestinal absorption of the vitamin such as occurs
in celiac sprue and primary biliary cirrhosis.

5) Underweight/inactive/Sedentary life style: Bone remodeling occurs in response to

physical stress, so physical inactivity can lead to significant bone loss. Weight
bearing exercise can increase peak bone mass achieved in adolescence, and a highly
significant correlation between bone strength and muscle strength has been determined.

6) Endurance training: In female endurance athletes, large volumes of training can lead to
decreased bone density and an increased risk of osteoporosis. This effect might be caused
by intense training suppressing menstruation, producing amenorrhea, and it is part of
the female athlete triad.
7) Heavy metals: A strong association between cadmium and lead with bone disease has
been established. high
Low-level exposure to cadmium is associated with an increased loss of
bone mineral density readily in both genders, leading to pain and increased risk of
fractures, especially in the elderly and in females. Higher cadmium exposure results
in osteomalacia (softening of the bone).

8) Soft drinks: Some studies indicate soft drinks (many of which contain phosphoric acid)
may increase risk of osteoporosis, at least in women. Others suggest soft drinks may
displace calcium-containing drinks from the diet rather than directly causing
osteoporosis.

Symptoms-

Osteoporosis can be present without any symptoms for decades because osteoporosis
doesn't cause symptoms until bone breaks (fractures).Moreover, some osteoporotic
fractures may escape detection for years when they do not cause symptoms. Therefore,
patients may not be aware of their osteoporosis until they suffer a painful fracture

 Osteoporosis itself has no symptoms; its main consequence is the increased risk of bone
fractures. Osteoporotic fractures occur in situations where healthy people would not
normally break a bone; they are therefore regarded as fragility fractures. Typical
fragility fractures occur in the vertebral column, rib, hip and wrist, although osteoporosis-
related fractures can occur in almost any skeletal bone.The fracture can be either in the
form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the
vertebrae of the spine).
 The symptom associated with osteoporotic fractures usually is pain; the location of
the pain depends on the location of the fracture. Fractures of the spine (vertebra) can
cause severe "band-like" pain that radiates from the back to the sides of the body.
 Over the years, repeated spinal fractures can lead to chronic lower back pain as well as
loss of height and/or curving of the spine due to collapse of the vertebrae. The collapse
gives individuals a hunched-back appearance of the upper back, often called a
"dowager hump".
 A fracture that occurs during the course of normal activity is called a minimal trauma,
or stress fracture. For example, some patients with osteoporosis develop stress fractures
of the feet while walking or stepping off a curb. Hip fractures typically occur as a result
 of a fall. With osteoporosis, hip fractures can occur as a result of trivial slip-and-fall
accidents.

The following are osteoporosis treatment and prevention measures for optimal health of the
bone:

Treatment:
The goal of treatment of osteoporosis is the prevention of bone fractures by reducing bone loss
or, preferably, by increasing bone density and strength. Although early detection and timely
treatment of osteoporosis can substantially decrease the risk of future fractures, none of the
available treatments for osteoporosis are complete cures. Hip fractures also may heal slowly or
poorly after surgical repair because of poor healing of the bone. In other words, it is difficult to
completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of
osteoporosis is as important as treatment.

Preventive measures:
 Lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol
intake, exercising regularly, and consuming a balanced diet with adequate calcium and
vitamin D.

 Medications that stop bone loss and increase bone strength, such
as alendronate (Fosamax), ), calcitonin (Calcimar)

 Medications that increase bone formation such as teriparatide (Forteo)

 Exercise has a wide variety of beneficial health effects. However, exercise does not bring
about substantial increases in bone density. The benefit of exercise for osteoporosis has
mostly to do with decreasing the risk of falls, probably because balance is improved
and/or muscle strength is increased. Research has not yet determined what type of
exercise is best for osteoporosis or for how long it should be continued. Until research
has answered these questions, most doctors recommend weight-bearing exercise, such as
walking, preferably daily for optimal health.

 Calcium supplements for osteoporosis

 Building strong and healthy bones requires an adequate dietary intake of calcium
beginning in childhood and adolescence for both sexes. Most importantly, however, a
high dietary calcium intake or taking calcium supplements alone is not sufficient in
treating osteoporosis and should not be viewed as an alternative to or substituted for more
potent prescription medications for osteoporosis. In the first several years after
menopause, rapid bone loss may occur even if calcium supplements are taken. The
following calcium intake has been recommended by the National Institutes of Health
Consensus Conference on Osteoporosis for all people, with or without osteoporosis:

 800 mg/day for children 1-10 years of age

 1,000 mg/day for men, premenopausal women, and postmenopausal women also
taking estrogen.