• What is Osteoporosis?
• Known Causes
• Symptoms
• Detection
• Conventional treatments

What is Osteoporosis?

Osteoporosis, or porous bone, is a disease characterised by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist. Men as well as women suffer from osteoporosis, a disease that can be prevented and treated.

Facts and Figures: -

• Osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women.
• In the U.S. today, 10 million individuals already have osteoporosis and 18 million more have low bone mass, placing them at increased risk for this disease.
• One out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime.
• More than 2 million American men suffer from osteoporosis, and millions more are at risk.
• Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year.
• Osteoporosis can strike at any age.
• Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites.
• Estimated national direct expenditures (hospitals and nursing homes) for osteoporosis and related fractures is $14 billion each year.

What is Bone? Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft frame work, and calcium phosphate, a mineral that adds strength and hardens the frame work. This combination of collagen and calcium makes bone strong yet flexible to withstand stress. More than 99% of the body's calcium is contained in the bones and teeth. The remaining 1% is found in the blood.

Throughout your lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation continues at a pace faster than resorption until peak bone mass (maximum bone density and strength) is reached during the mid-20s. After age 30, bone resorption slowly begins to exceed bone formation. Bone loss is most rapid in the first few years after menopause but persists into the postmenopausal years. Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs too slowly. Osteoporosis is more likely to develop if you did not reach optimal bone mass during your bone building years.

Known Causes

Certain factors are linked to the development of osteoporosis or contribute to an individual's likelihood of developing the disease. These are called "risk factors." Many people with osteoporosis have several of these risk factors, but others who develop osteoporosis have no identified risk factors. There are some risk factors that you cannot change, and others that you can:

Risk factors you cannot change:

• Gender - Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause.
• Age - the older you are, the greater your risk of osteoporosis. Your bones become less dense and weaker as you age.
• Body size - Small, thin-boned women are at greater risk.
• Ethnicity - Caucasian and Asian women are at highest risk. African-American and Latino women have a lower but significant risk.
• Family history - Susceptibility to fracture may be, in part, hereditary. People whose parents have a history of fractures also seem to have reduced bone mass and may be at risk for fractures.

Risk factors you can change: -

• Sex hormones: abnormal absence of menstrual periods (amenorrhea), low estrogen level (menopause), and low testosterone level in men.
• Anorexia.
• A lifetime diet low in calcium and vitamin D.
• Use of certain medications , such as glucocorticoids or some anticonvulsants.
• An inactive lifestyle or extended bed rest.
• Cigarette smoking.
• Excessive use of alcohol.

Medications that cause bone loss: - The long-term use of glucocorticoids (medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn's disease, lupus, and other diseases of the lungs, kidneys, and liver) can lead to a loss of bone density and fractures. Other forms of drug therapy that can cause bone loss include long-term treatment with certain antiseizure drugs, such as phenytoin (Dilantin), barbiturates, and valproate (Depakote); gonadotropin releasing hormone (GnRH) analogs used to treat endometriosis; excessive use of aluminium-containing antacids; certain cancer treatments; and excessive thyroid hormone. It is important to discuss the use of these drugs with your physician, and not to stop or alter your medication dose on your own.

Symptoms

Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip fracture or a vertebra to collapse. Collapsed vertebra may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis, or severely stooped posture.

Detection

Following a comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. Bone mineral density (BMD) tests measure bone density in the spine, wrist, and/or hip (the most common sites of fractures due to osteoporosis), while others measure bone in the heel or hand. These tests are painless, non-invasive, and safe. Bone density tests can:

• Detect low bone density before a fracture occurs.
• Confirm a diagnosis of osteoporosis if you have already fractured.
• Predict your chances of fracturing in the future.
• Determine your rate of bone loss and/or monitor the effects of treatment if the test is conducted at intervals of a year or more.

Conventional treatment

A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your physician may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk.

The Therapeutic Role of Medication: - Currently, estrogen, calcitonin, and alendronate are approved by the U.S. Food and Drug Administration (FDA), for the treatment of postmenopausal osteoporosis. Estrogen, raloxifene and alendronate are approved for the prevention of the disease.

Estrogen: - Estrogen replacement therapy (ERT) has been shown to reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip and spinal fractures in postmenopausal women. ERT is administered most commonly in the form of a pill or skin patch and is effective even when started after age 70. When estrogen is taken alone, it can increase a woman's risk of developing cancer of the uterine lining (endometrial cancer).

To eliminate this risk, physicians prescribe the hormone progestin in combination with estrogen (hormone replacement therapy or HRT) for those women who have not had a hysterectomy. ERT/HRT relieves menopause symptoms and has been shown to have beneficial effects on both the skeleton and heart.

Experts recommend ERT for women at high risk for osteoporosis. ERT is approved for both the prevention and treatment of osteoporosis. ERT is especially recommended for women whose ovaries were removed before age 50. Estrogen replacement should also be considered by women who have experienced natural menopause and have multiple osteoporosis risk factors, such as early menopause, family history of osteoporosis, or below normal bone mass for their age. As with all drugs, the decision to use estrogen should be made after discussing the benefits and risks and your own situation with your doctor.

Raloxifene: - Raloxifene (brand name "Evista") is a drug that was recently approved for the prevention of osteoporosis. It is from a new class of drugs called Selective Estrogen Receptor Modulators (SERMs) that appear to prevent bone loss at the spine, hip, and total body. Raloxifene's effect on the spine does not appear to be as powerful as either estrogen replacement therapy or alendronate, but its effect on the hip and total body are more comparable. While side-effects are not common with raloxifene, those reported include hot flashes and deep vein thrombosis, the latter of which is also associated with estrogen therapy. Additional research studies on raloxifene will be ongoing for several more years.

Alendronate: - Alendronate (brand name "Fosamax") is a medication from the class of drugs called bisphosphonates. Like estrogen, alendronate is approved for both the prevention and treatment of osteoporosis. In postmenopausal women with osteoporosis, the bisphosphonate alendronate reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of both spine fractures and hip fractures. Side effects from alendronate are uncommon, but may include abdominal or musculo-skeletal pain, nausea, heartburn, or irritation of the oesophagus. The medication should be taken on an empty stomach and with a full glass of water first thing in the morning. After taking alendronate, it is important to wait in an upright position for at least one-half hour, or preferably one hour, before the first food, beverage, or medication of the day.

Calcitonin: - Calcitonin is a naturally occurring non-sex hormone involved in calcium regulation and bone metabolism. In women who are at least 5 years beyond menopause, calcitonin slows bone loss, increases spinal bone density, and according to anecdotal reports, relieves the pain associated with bone fractures. Calcitonin reduces the risk of spinal fractures and may reduce hip fracture risk as well. Studies on fracture reduction are ongoing. Calcitonin is currently available as an injection or nasal spray. While it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea, and skin rash. The only side effect reported with nasal calcitonin is a runny nose.

Fall Prevention is a special concern for men and women with osteoporosis. Falls can increase the likelihood of fracturing a bone in the hip, wrist, spine or other part of the skeleton. In addition to the environmental factors listed below, falls can also be caused by impaired vision and/or balance, chronic diseases that impair mental or physical functioning, and certain medications, such as sedatives and antidepressants. It is important that individuals with osteoporosis be aware of any physical changes they may be experiencing that affect their balance or gait, and that they discuss these changes with their health care provider.

Source: - The National Osteoporosis Foundation

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