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Osteoporosis

Rheumatology :: Dermatomyositis :: Juvenile Idiopathic Arthritis :: Psoriatic Arthritis::
Scleroderma :: Systemic Lupus Erythematosus

What is osteoporosis?

"Osteo" means ‘bone’ and "porous" means ‘pores’ or 'holes', meaning 'holes in bones'. It is a common condition in which bones become weak and are at risk of breaking easily compared to normal bones. It affects both men and women, mainly in old age.

Osteoporosis is a "silent" condition and may remain without any symptoms in some patients. It may come to attention only when weak bone breaks. Usually this happens at the spine, wrist and hip. Such fractures lead to long-term pain and disability and may even cause death. Hence, the main goal of treating osteoporosis is to prevent these fractures.

What causes osteoporosis?

Bone is living tissue that is in a constant state of cycling - old bone is removed and new bone is formed. Osteoporosis results from loss of bone mass and from a change in bone structure. With ageing, bone loss exceeds bone replacement eventually making them thinner and weaker. This may be accelerated sometimes by certain diseases (eg. Rheumatological diseases).

What are the risk factors for osteoporosis?

Many risk factors for developing osteoporosis have been identified. Some of these risk factors can be changed, but not others. It is important to identify risk factors in each patient and treat them.

Major risk factors for osteoporosis include:

  • Older age
  • Race: Asian ethnic background
  • Small bone structure
  • Family history of osteoporosis - an osteoporosis-related fracture in a parent or sibling
  • Prior fracture due to a low-level injury, particularly after age 50

Risk factors that you may be able to change include:

  • Low levels of sex hormone, mainly estrogen in women (e.g., due to menopause)
  • Eating disorders such as anorexia nervosa (reduced eating) and bulimia (excessive eating)
  • Cigarette smoking and Alcohol abuse
  • Low calcium and vitamin D, due to low intake in diet or inadequate absorption
  • Sedentary (inactive) lifestyle or immobility with no physical activity
  • Certain medication like steroids, heparin:
  • Inflammatory arthritis

Who gets osteoporosis?

Osteoporosis occurs in both men and women. It is more common in older women. Asian women are known to be at increased risk compared to some other races. People over age 50 are at greatest risk. , Thus, osteoporosis can occur at any age, in men as well as women, and in all ethnic groups.

How is osteoporosis diagnosed?

Osteoporosis is diagnosed by measuring bone mineral density by DXA (Dual-energy X-ray Absorptiometry). Bone mineral density - often called BMD - is the amount of bone that is present in a given area of the skeleton. It is measured at different parts of body. Often the measurements are made at the spine, hip and wrist, including a part of the hip called the femoral neck.

The test for measuring BMD is quick and painless. It is similar to an X-ray, but use of radiation is much less. However, pregnant women should not undergo this test to avoid any harm to the fetus.

DXA test results are scored compared with the BMD of young, healthy people. These results in a measure called a T-score. Based on the T-score, various grades of bone loss such as osteopenia and osteoporosis can be diagnosed.

How is osteoporosis treated?

Diet rich in

  • Calcium. The National Osteoporosis Foundation recommends 1,000 mg per day for most adults and 1,200 mg per day for women over age 50 or men over age 70.
  • Vitamin D. The recommended daily dose is 400 - 800 International Units (called IU) for adults younger than age 50, and 800-1,000 IU for those ages 50 and older. (These are the current guidelines from the National Osteoporosis Foundation.) Dose should be adjusted depending on blood level of vitamin D.
  • Physical activity. Weight-bearing exercises, Walking are important.

Medications

Teriparatide: Teriparatide is a form of parathyroid hormone. It helps to stimulate bone formation. It is useful for treatment of osteoporosis in postmenopausal women and men at high risk of osteoporotic fracture and also for treatment of glucocorticoid-induced osteoporosis. It is given as a daily injection can be used for up to two years.

Bisphosphonates: These class of drugs are called "antiresorptive" drugs. They help to slow bone loss. They can decrease the risk of fractures.

Calcitonin: This is actually a hormone from the thyroid gland. It is given most often as a nasal spray or as an injection. It helps to prevent vertebral fractures. It is also helpful in controlling pain after an osteoporotic vertebral fracture. Certain other medications useful in osteoporosis treatment are:

  • Estrogen or Hormone replacement therapy
  • Selective Estrogen receptor modulators
  • Strontium Ranelate
  • Denosumab