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Osteoporosis

Definition


Disease: Osteoporosis Osteoporosis
Category: Bones, joints, muscles diseases

Disease Definition:

The condition in which the bones become weak and brittle to the extent that they may fracture due to a fall or even mild stresses like coughing or bending over, is called osteoporosis, meaning porous bones.
When a person has low levels of calcium and other minerals in the bones, their bones become weak. Fractures are a common outcome of osteoporosis, most of them taking place in the hip, wrist or spine. Osteoporosis can affect men despite the fact that it is considered to be a women’s disease. Many people have low bone density, increasing their risk of developing osteoporosis.

 

A person could take steps to keep bones strong and healthy during life for it is never too late or too early to be doing something about osteoporosis.
 

Work Group:


Symptoms, Causes

Symptoms:

Often there isn’t any pain or other symptoms seen in the early stages of bone loss. But once osteoporosis weakens the bones, the affected person might have signs and symptoms for this condition such as the followings:

 

  • A stooped posture
  • Back pain that could be severe, as a result of a fractured or collapsed vertebra
  • Fracture of the vertebra, wrist, hip or other bone
  • Loss of height over time

 

Because osteoporosis seldom cause signs or symptoms in its early stages, a bone density test for the followings are recommended:

 

  • A man between the ages of 50 and 70 who has at least one osteoporosis risk factor.
  • A woman older than age 65 or a man older than age 70, regardless of risk factors
  • Older than age 50 with a history of a broken bone
  • A woman who experienced early menopause
  • A postmenopausal woman who has recently stopped taking hormone therapy
  • A postmenopausal woman with at least one risk factor for osteoporosis
  • People who take medications, such as prednisone, aromatase inhibitors or anti-seizure medications, which are related to osteoporosis


 

Causes:

The exact cause of osteoporosis is still not known, but scientists do know that the normal bone remodeling procedure is disrupted in this condition. In a procedure called remodeling or bone turnover, the bones continuously changes, where old bone is broken down (resorption) and new bone is formed. When a person is young, their body makes new bone faster than it breaks down old bone and their bone mass increases. People reach their peak bone mass around age 30. After that, bone remodeling goes on, but they lose slightly more than they gain.

 

Depending on how much bone mass the affected person has attained in their 20s and early 30s (peak bone mass) and how rapidly they lose it later, the likelihood of developing osteoporosis is understood. The higher a person’s peak bone mass is, the more bone they have “in the bank” and the less likely they are to grow osteoporosis as they get older.

 

The size and density of a bone determines its strength; bone density is due to the amount of calcium, phosphorus and other minerals bones include. When the bones include fewer minerals than normal, they will be less strong and finally lose their internal supporting structure. Bone density could also be affected by other factors, like hormone levels. Bone loss increases dramatically in women experiencing a drop of estrogen levels during menopause. A loss of bone mass in men results from low estrogen and testosterone levels.

 

Some of the risk factors that increase the risk of developing osteoporosis can be changed, while others cant:

 

RISK FACTORS THAT CAN BE CHANGED:

Low calcium intake:

Since low calcium intake leads to decreased bone density, early bone loss and a high risk of fractures; a lifelong lack of calcium plays a major role in the growth of osteoporosis.

Eating disorders: 

The risk of lower bone density is higher in men and women with bulimia or anorexia nervosa.

Tobacco use:

Using tobacco contributes to weak bones; however, the exact role of tobacco in the development of osteoporosis is still not known.

Sedentary lifestyle: 

People who spend a lot of time sitting are at an increased risk of osteoporosis than their more-active counterparts. Any weight-bearing exercise is beneficial for the bones, but walking, jumping, weightlifting, running and dancing seem specifically helpful for forming healthy bones.

Corticosteroid medications: 

Corticosteroid medications such as prednisone, cortisone, dexamethasone and prednisolone, when used for a long time, cause damage to bones. Chronic conditions, like asthma, lupus and rheumatoid arthritis are commonly treated with these drugs and the affected person might be unable to stop taking them to lessen their risk of osteoporosis. When a steroid medication is required to be taken for a long time, other medications could be recommended to help prevent bone loss after monitoring the bone density.

Excessive alcohol consumption:

Since alcohol could intervene with the body’s ability to absorb calcium, consumption of more than two alcoholic drinks a day on regular basis increases the risk of osteoporosis.

Other medications: 

The risk of osteoporosis increases with the long-term usage of aromatase inhibitors to treat breast cancer, the cancer treatment medication methotrexate, the antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the acid-blocking medications called proton pump inhibitors, aluminum-containing antacids and some anti-seizure medications.

 

RISK FACTORS THAT CAN’T BE CHANGED:

Getting older: 

The risk of osteoporosis increases as someone ages.

Being a woman: 

Women are twice more likely to experience fractures from osteoporosis than men. 

Family history:

A person’s risk of osteoporosis will be increased in case there’s a family history of fractures or a parent or sibling with osteoporosis.

Race: 

White people or people of Asian descent have an increased risk of osteoporosis.

Medical conditions and procedures that affect bone health: 

The body’s ability to absorb calcium may be affected by weight-loss surgery and stomach surgery (gastrectomy). Conditions such as Crohn’s disease, celiac disease, hyperparathyroidism and Cushing’s disease, a seldom occurring disorder in which the patient’s adrenal glands produce excessive corticosteroid hormones, also increase the risk of osteoporosis.

Thyroid hormone:

Additionally, too much thyroid hormone could result in bone loss. This could take place either because the patient takes excess amounts of thyroid hormone drugs to treat an underactive thyroid (hypothyroidism) or because the thyroid is overactive (hyperthyroidism).

Frame size:

Extraordinarily thin Men and women with a body mass index of 19 or less, or those who have small body frames seem to have an increased risk for they might have less bone mass to draw from as they get older.
 

Complications

Complications:

The most often occurring and serious complication of osteoporosis is fractures. They usually take place in the spine or hip, which are the bones that directly support a person’s weight. Hip fractures usually result from a fall and wrist fractures from falls are common. Although mostly people do relatively well with modern surgical treatment, but hip fractures could cause disability and even death from postoperative complications, particularly in older adults. 
Spinal fractures could sometimes occur even when the patient hasn’t fallen or injured themselves. The bones in the back (vertebrae) could simply weaken to the extent that they start compressing or collapsing. Compression fractures could result in severe pain and end up needing a long recovery. A person could lose height as their posture becomes stooped in case he/she has many such fractures.
 

Treatments:

MEDICATIONS:

Several medications are available to help slow bone loss and maintain bone mass, such as:

Bisphosphonates: 

This group of medications can inhibit bone breakdown, preserve bone mass, and even raise bone density in the spine and hip, decreasing the risk of fractures; in a sense, they work like estrogen. Alendronate, ibandronate, risedronate and zoledronic acid are examples of bisphosphonates.

 

Young adults, men and people with steroid-induced osteoporosis may especially benefit from these medications. Additionally, they’re used to keep off osteoporosis in people who need long-term steroid treatment for a disease like asthma or arthritis. Nausea, difficulty swallowing, abdominal pain and the risk of an inflamed esophagus or esophageal ulcers are included in severe side effects. Fewer stomach problems may be caused in case bisphosphonates are taken once a week or once a month. Periodic intravenous infusions of bisphosphonate preparations might be recommended in case someone can’t tolerate oral bisphosphonates.
In addition, there have been reports of serious side effects with bisphosphonates, like visual disturbances, osteonecrosis of the jaw and irregular heartbeats. The dentist should be informed if the patient is taking any medications prior to any dental surgery, which is why the patient has to discuss the pros and cons of these medications with the doctor.

Calcitonin: 

Calcitonin decreases bone resorption and might slow bone loss; it is a hormone produced by the thyroid gland. Spine fractures may also be prevented by this medication, which could also provide some pain relief from compression fractures. Although calcitonin is available as an injection, but it’s usually used as a nasal spray. Calcitonin is usually reserved for people who are unable to take other medications because it isn’t as potent as bisphosphonates. Nasal irritation is a potential side effect.

Raloxifene: 

Without the risks such as a high risk of uterine cancer and potentially breast cancer that are related with estrogen, raloxifene has the same beneficial effects of estrogen on bone density in postmenopausal women. Raloxifene belongs to a class of medications called selective estrogen receptor modulators (SERMs). A common side effect of raloxifene includes hot flashes, and the affected person shouldn’t be using this medication when having a history of blood clots. Although a small study has found that this medication may also be helpful in preserving bone density in men, but until now it isn’t recommended for use in men.

Teriparatide:

Being an analog of parathyroid hormone, this strong medication treats osteoporosis in men who are at an increased risk of fractures and in postmenopausal women. While other drugs stop further bone loss, this medication stimulates the growth of new bone. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Treatment with this medication is recommended only for two years or less because its long-term effects are still not known. 

 

HORMONE THERAPY:

Bone density could be maintained by estrogen, particularly when started soon after menopause. Yet, the risk of breast cancer, blood clots, endometrial cancer and possibly heart disease is increased with the use of hormone therapy. Hormone therapy is usually not a first-choice treatment anymore, due to concerns about its safety and because other treatments are available.

 

PHYSICAL THERAPY:

Physical therapy programs might help the patient build bone strength and improve their posture, balance and muscle strength, making falls less likely, in addition to hormones or medications.
 

Prognosis:

Not available

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