Osteoporosis is a skeletal disease characterized by reduced bone mass and disturbed microarchitecture of bones. This results in increased bone fragility and increased risk of fracture. Bone is living tissue that constantly breaks down and replaces. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.
It is an illness of the older population, important because of the high prevalence of bone fractures. Fractures of spine, neck, femurs and forearms are the most common.
According to the Intenational Osteoporosis Foundation, one in three women and one in eight men suffer from osteoporosis worldwide.
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Two types of osteoporosis
Type I or postmenopausal osteoporosis occurs as a result of estrogen deficiency, leading to accelerated bone loss. In the first 5-7 years of menopause, the total bone mass is lost at a rate of about 1-5% per year. The lack of estrogen in the body makes the bones sensitive to the effect of parathyroid hormone (PTH). This hormone tends to increase the level of calcium in the blood, thus causing the loss of calcium from the bone. Also, the osteoclast activity is increased in this type of osteoporosis. These are the cells that break down the bones.
Type II or senile osteoporosis occurs over the age of 70 in men and women. It occurs due to decreased bone formation and decreased synthesis of the active form of vitamin D. Bone loss results in an increased risk of bone fracture.
In addition to these primary forms, various drugs (especially corticosteroids) and endocrinological disorders, eating disorders that cause malnutrition and inflammatory bowel diseases can cause osteoporosis. Smoking, excessive drinking, etc. can contribute.
Risk factors for developing osteoporosis include:
Steroids (especially if taken by mouth) – Steroids (corticosteroids) are used to treat a number of inflammatory conditions including rheumatoid arthritis. They can affect the production of bone by reducing the amount of calcium absorbed from the gut and increasing calcium loss through the kidneys.
Lack of estrogen in the body – If you have an early menopause (before the age of 45) or a hysterectomy, this increases your risk of developing osteoporosis. This is because they cause your body’s estrogen production to reduce dramatically, so the process of bone loss will speed up.
Lack of weight-bearing exercise – Exercise encourages bone development, and lack of exercise means you’ll be more at risk of losing calcium from the bones and so developing osteoporosis. Muscle and bone health are linked so it’s also important to keep up your muscle strength. However, women who exercise so much that their periods stop are also at a higher risk because their estrogen levels will be reduced.
Poor diet – If your diet doesn’t include enough calcium or vitamin D, or if you’re very underweight, you’ll be at greater risk of osteoporosis.
Heavy smoking – Tobacco is directly toxic to bones. In women it lowers the estrogen level and may cause early menopause. In men, smoking lowers testosterone activity and this can also weaken the bones.
Heavy drinking – Drinking a lot of alcohol reduces the body’s ability to make bone. It also increases the risk of breaking a bone as a result of a fall.
Family history – Osteoporosis does run in families, probably because there are inherited factors that affect bone development.
Patients may experience height loss and increased spinal flexion, but osteoporosis is generally an asymptomatic disease until bone fracture occurs. The most important consequence of this disease is bone fracture. Therefore, disease prevention is extremely important. Typical fracture sites that occur even after the smallest injury are vertebrae, neck fractures, thigh bones, and forearms.
Some people have back problems if the bones of the spine (vertebrae) become weak and lose height. They usually happen around the mid or lower back and can occur without any injury. If this affects several vertebrae, your spine will start to curve and you may become shorter. Sometimes vertebral crush fractures can make breathing difficult simply because there’s less space under the ribs.
Timely identification of patients at risk of fracture and the implementation of preventive measures such as dietary changes and physical activity are very important. The treatmentof osteoporosis includes calcitonin, selective estrogen receptor modulators and bisphosphonates. They reduce bone resorption without or with very little effect on bone construction.
Bisphosphonates – for premenopausal osteoporosis. Apply this with caution because of possible damage to the esophageal mucosa.
Calcitonin – treatment and prevention of osteoporosis in patients who do not tolerate bisphosphonate treatment. Also, it has analgesic effects on fracture sites.
Androgens (male sex hormones) – for osteoporosis in men with hypogonadism (which causes decreased secretion of male sex hormones).
Selective Estrogen Receptor Modulators (SERMS) – they act as estrogens on bone, reducing their breakdown. They are also protective against coronary artery disease, breast cancer and endometrial cancer.
The treatment for resulting fractures surgical orthopedic treatments.
Diet and nutrition
For postmenopausal women and men over 65 and others with risk factors for osteoporosis, we recommend taking 1500 mg of calcium and 800 IU of vitamin D daily.
The best sources of calcium are:
- dairy products such as milk, cheese and yogurt (low-fat ones are best)
- calcium-enriched types of milk made from soya, rice or oats
- fish that are eaten with the bones, such as tinned sardines.
Other sources of calcium include:
- leafy green vegetables such as cabbage, kale, broccoli, watercress
- beans and chick peas
- some nuts, seeds and dried fruits.
If you don’t eat many dairy products or calcium-enriched substitutes, then you may need a calcium supplement. We recommend you discuss this with your doctor or a dietitian.
The body needs vitamin D to absorb and process calcium. There’s some evidence that arthritis progresses more quickly in people who don’t have enough vitamin D. Its another name is the “sunshine vitamin”. It is because the body produces it when we expose the skin to sunlight.
The body can also obtain vitamin D from some foods, especially from oily fish, or from supplements such as fish liver oil. However, it’s important not to take too much fish liver oil.
We encourage people in certain groups at risk of not having enough exposure to sunlight, or whose skin is not able to absorb enough vitamin D from the level of sunshine, to take a daily supplement of 10 micrograms all year round.
For many people, calcium and vitamin D supplements are prescribed together with other osteoporosis treatments.
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