Osteoporosis has been primarily considered a disease common among older women (>45 years) but men are by no means immune. It sets in women after menopause and in men after andropause when the bone protecting hormones (Estrogen in females and Testosterone in males) become deficient and the loss of bone mass initiates.
Risk Factors:
- Aging
- Being female;
- Low body weight;
- Low sex hormones/ menopause;
- Smoking/ alcohol consumption;
- Lack of exercise;
- Poor exposure to sunlight;
- Family history – family member with history of osteoporosis/ fragile fractures;
- Poor dietary history – deficiency of calcium, vit. D;
- Ethnicity – Hispanic women at highest risk
Symptoms of Osteoporosis:
- No signs until a bone breaks;
- Persistent, unexplained back pain;
- Spinal deformities;
- Recurrent fractures;
- Fractures from minimal trauma;
- Experiencing chronic medical trauma;
- Loss in height due to compressed and weakened vertebrae;
Diagnosis:
A full medical history, including signs, symptoms and family history should be taken. If osteoporosis is suspected a specialised x-ray to measure the bone density is usually recommended.Bone density testing is usually undertaken using dual energy x-ray absorptiometry (DEXA). This is a specialised x-ray scanning technique that emits only very low levels of radiation (approximately 1% of the radiation required for a chest x-ray).
This precise and painless test takes only 5-10 minutes and requires the person to lie on a special table while the DEXA machine passes over them. The density of bone is measured at different locations (usually the lower spine and hip) and a formula is used to calculate the overall bone density. Individual bone density is graded by comparing it to the average bone density for a person of similar age, size and gender.
In some cases, bone density can also be measured using computerised tomography (CT scanning) or ultrasound scanning, though these methods tend to be less precise.
Treatment:
Treatment for osteoporosis will depend upon the results of bone density scans, age, gender, medical history and the severity of the condition. Treatment most commonly involves lifestyle changes and medications and aims to maximise bone density and reduce the risk of bone fracture.LIFESTYLE CHANGES
Exercise:
If possible, regular weight bearing exercise (eg: walking, tennis, golf) should be maintained as it can help to reduce bone loss and stimulate new bone formation. To be of benefit, doctors recommend at least 30 minutes of exercise at least three times a week. Prior to beginning any new exercise it is important to consult a doctor to ensure that the proposed exercise is safe to undertake.Diet:
As the body cannot make its own calcium, a diet high in calcium is necessary and helps to slow the rate of bone loss. Vitamin D is also essential as it enables calcium to be effectively absorbed by the body. Eating a balanced diet that includes calcium and vitamin D-rich foods is important in supplying the bones with the calcium required. Foods high in calcium include dairy products, dark green vegetables, beans, legumes, fish (especially sardines or salmon which are eaten with the bones), soybean products, cereals and nuts. It is recommended that at least 1000mg of calcium is taken in each day. Foods high in vitamin D include sardines, tuna, eggs and liver.Smoking, alcohol and caffeine:
Smokers will be advised to stop smoking. Minimizing alcohol and caffeine intake (eg: tea, coffee, cola drinks) may also be recommended as caffeine interferes with the absorption of calcium.Exposure to sunlight:
Regular but moderate exposure to sunlight helps to produce vitamin D in the body. Note, excess sun exposure poses other health risks. If adequate sun exposure is not present, oral supplements for Vit. D should be given.
Reducing the risk of fractures:
It is important to take extra care with movement and daily activities in order to minimise the risk of fractures. This can include using mobility aids if unsteady on the feet, removing objects or hazards that can lead to falls (eg: loose floor rugs), installing hand rails in areas such as entranceways and bathrooms, and using non-slip mats in the bath or shower. Padding to protect vulnerable parts of the body eg: the hips, can also help in the prevention of fractures.MEDICATIONS
Calcium:
If dietary intake of calcium is insufficient, calcium supplements may be prescribed in order to increase the amount of calcium available in the body. A dosage of 1000mg per day in usually recommended.Vitamin D:
As vitamin D is important for the effective absorption of calcium into the bones, vitamin D supplements such as calciferol are usually given in conjunction with calcium supplements. An activated form of vitamin D called calcitriol (Rocaltrol) has also been shown to be beneficial.Bisphosphonates:
These non-hormonal medications can increase bone density by reducing the rate of bone loss. They have been shown to reduce the fracture rate in people with osteoporosis. These medications are usually given in an alternating cycle with calcium supplements.HRT:
Hormone replacement therapy (HRT) medications that include oestrogen are sometimes recommended for women with osteoporosis. HRT has been shown to reduce bone loss and may increase bone density. While HRT has obvious benefits in the treatment and prevention of osteoporosis, recent research has indicated that there are risks with long term HRT use. It is therefore important that the patient and their practitioner discuss the benefits and risks of taking the medication.Prevention
Prevention is better than treatment and evidence suggests that maximising bone density in early and middle life helps to reduce the risk of osteoporosis in later life. Steps that can be taken to help prevent osteoporosis include:- Not smoking
- Limiting alcohol intake
- Undertaking regular weight bearing exercise
- Maintaining a healthy body weight
- Adequate intake of calcium and Vit.D through out life span
- Considering HRT for women during menopause
A healthy lifestyle, balanced diet and proper exercise are the key to the prevention of osteoporosis instead of waiting for fracture to happen and then start the treatment. Though older women are affected more as compared to men, precautions should be taken by both the sexes so as to lead a healthy and happy life.
Posts
