Osteoporosis - Preventive Measures

Osteoporosis

Definition • Osteoporosis is a condition 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 Osteoporosis

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Definition

• Osteoporosis is defined as a progressive skeletal disorder, characterised by low bone mass & microarchitectural deterioration of bone tissue, leading to a consequent increase in bone fragility, & susceptibility to fracture

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Definition • Fractures of the wrist, spine, and hip are most commonly involved. • Fractures of the ribs, humerus and pelvis are not uncommon.

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Definition Two categories of osteoporosis exist: primary and secondary osteoporosis.

Primary Osteoporosis • The most common form of osteoporosis. • Includes postmenopausal osteoporosis (type 1) and age-associated osteoporosis (type 2), formerly termed senile osteoporosis.

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Definition Secondary Osteoporosis • Loss of bone is caused by an identifiable agent or disease process such as an inflammatory disorder, bone marrow cellularity disorder, and corticosteroid use.

• steroids decrease the amount of calcium absorbed by the intestine • steroids increase calcium excretion through the kidneys

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Risk Factors National Osteoporosis Foundation Physician Guidelines for Risk Factors for Osteoporotic Fracture • Current cigarette smoking • Low body weight « 127 pounds) • Alcoholism – depress osteoblast function • Estrogen deficiency • Prolonged amenorrhea (> 1 yr) • Early menopause «45 yr) • Lifelong low calcium intake • Recurrent falls • Poor health/fragility • Inadequate physicalOsteoporosis activity

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Risk Factors • In men, excessive drinking reduces testrosterone. Since testrosterone is necessary for the work of osteoblasts, it means that less bone is formed. • In women, excessive drinking can interfere with their menstrual cycle.

Irregular periods lead to bone loss

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Risk Factors • Long term use of high dose corticosteroid tablets for conditions such as RA & asthma – interfere with the lifespan of the osteogenic cells • Close family history of osteoporosis • Medical conditions such thyroid problems • Hyperthyroidism occurs when the thyroid gland becomes overactive, & the excess of thyroxine – causes the rate of remodelling & loss of BMD to increase Osteoporosis

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Risk Factors • Malabsorption problems ( coelic disease, crohn’s disease, intestinal diseases or gastric surgery - affects the persons ability to absorb the essential vitamins & minerals from food • Eating disorders such as anorexia nervosa, bulimia – malnourished in calcium – lead to decline in body function & production of hormones – estrogen – causing menstruation to cease

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Symptoms & Clinical Features • Osteoporosis can be present without any symptoms for decades because osteoporosis doesn't cause symptoms until bone fractures.

• Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture.

• The symptom associated with osteoporotic fractures usually is pain; the location of the pain depends on the location of the fracture Osteoporosis

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Symptoms & Clinical Features • 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 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" because it commonly is seen in elderly women Osteoporosis

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Symptoms & Clinical Features • 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 accidents.

• Hip fractures also may heal slowly or poorly after surgical repair because of poor healing of the bone.

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Osteoporosis: The Diagnosis X-Ray Tests • If you have back pain, your doctor may order an x ray of your spine to determine whether you have had a fracture.

• An x ray also may be appropriate if you have experienced a loss of height or a change in posture.

• However, because an x ray can detect bone loss only after 30 percent of the skeleton has been depleted, the presence of osteoporosis may be missed Osteoporosis

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Osteoporosis: The Diagnosis BMD test is called a dual-energy x-ray absorptiometry, or DXA test.

• BMD tests provide doctors with a measurement called a T-score, a number value that results from comparing your bone density to optimal bone density.

• When a T-score appears as a negative number (such as –1, –2 or –2.5), it indicates low bone mass. The greater the negative the number, the greater is the risk of fracture.

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Osteoporosis: The Diagnosis Bone Scans • For some people, the doctor may order a bone scan.

• A bone scan is different from the BMD test, although the term "bone scan" often is used incorrectly to describe a bone density test.

• A bone scan involves injecting the patient with a dye that allows a scanner to identify differences in the conditions of various areas of bone tissue. A bone scan can show the doctor changes in bone tissue that may indicate cancer, bone lesions, inflammation, or new fractures Osteoporosis

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Osteoporosis: The Diagnosis

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The most common blood tests evaluate: blood calcium levels blood vitamin D levels thyroid function parathyroid hormone levels To measure estrogen (in women) testosterone levels (in men) Osteoporosis

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Preventive Measures • Adequate weight-bearing physical activity for 3-4 hr a wk.

• Avoid low body weight or excessive thinness.

• Avoid excess alcohol intake.

• Lifelong appropriate calcium and vitamin D intake.

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Preventive Measures

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Adequate calcium intake guidelines Life stage group Infants –( 6 month) (6 – 12 Month) Young children (1-3yr)

Estimated adequate calcium intake 210 270 500

Older Children (4-8yr)

1800

Adolescents & young adults (9-18yr) Men & women(19-50yr), above 51yr

1300

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1000 1200 20

Prevention of falls in osteoporotic patients • Night lights in bathrooms and hallways.

• Nonskid soles for shoes.

• Nonslip mats under rug.

• Equip tub, shower, and toilet areas with grab bars.

• Rise cautiously from a supine position.

• Ensure stairway rails are sturdy.

• Keep a flashlight by the bedside.

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Exercise for osteoporosis Three types of exercise for osteoporosis are: • Weight-bearing • Resistance • Flexibility

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Exercise for osteoporosis • Exercises designed to prevent or treat osteoporosis by strengthening your muscles and bones and improving your posture and balance.

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