Osteoporosis

Definition

Osteoporosis is when bones become weak and brittle. If left unchecked, it can lead to bone breaks and fractures. Any bone can be affected, but of special concern are fractures of the hip, spine, and wrist.

Osteoporosis – A Close Up Look

Causes

Throughout life, old bone is removed and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger, and denser. Peak bone mass is reached at around age 30. From that point, more bone is lost than replaced. If not treated, bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if full bone mass was not achieved during the bone-building years.

Bone density also plays a role in bone health. Bone density is determined by the amount of calcium, phosphorus and other minerals within the bone framework. As the mineral content of a bone (especially calcium) decreases, the bone weakens. Getting enough calcium and vitamins and exercising regularly can keep bones strong throughout life.

Risk Factors

There are many risk factors that may increase your chance of developing osteoporosis. Some of the risk factors include:

Age (risk increases with age)
Low weight
Smoking
Alcohol abuse
History of falls
Certain conditions, such as:

Rheumatoid arthritis
Cardiovascular disease
Type 2 diabetes
Asthma
Liver disease
Eating disorder
Depression

Use of certain medicines (e.g., antidepressants, warfarin, coumadin, long-term heparin, corticosteroids, thyroid medicine, anticonvulsants, antacids)
Low hormone levels (low estrogen levels in women, low testosterone levels in men)
Inactive lifestyle
Certain restrictive diets (eg, not getting enough calcium or Vitamin D)
Too little sunlight (The effect of sun on the skin is a primary source of Vitamin D.)
Cancer, including lymphoma and multiple myeloma

More women than men develop osteoporosis. Some specific risk factors that affect women include:

Family history of osteoporosis
Postmenopausal
Amenorrhea (no menstrual periods)
Gastrointestinal malabsorption
Having another endocrine disorder (eg, thyroid disorder, diabetes)

Symptoms

Symptoms include:

Pain when bones break or collapse
Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
Loss of height with stooped posture (kyphosis)

Kyphosis – Comparing Spinal Alignments

http://services.epnet.com/GetImage.aspx/getImage.aspx?ImageIID=2541

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Early signs of osteoporosis can be seen with bone density testing:

Dual-energy x-ray absorptiometry — measures bone density in the entire body

For older men, the American College of Physicians (ACP) recommends that your doctor check for risk factors for osteoporosis. The ACP also recommends that you have this test if you are at an increased risk and are a candidate for drug therapy. Ask your doctor about what is right for you.

Single-energy x-ray absorptiometry — measures bone density in the arm or heel
Dental x-rays of bone
Ultrasound bone density measurement — measures bone density in fingers, heels, and leg bones

Other tests may include:

Blood and urine tests — to test for calcium levels or substances created when bone is broken down

Treatment

Treatment includes:

Nutrition

Decrease your intake of caffeinated beverages and alcohol. Eat a balanced diet rich in calcium and Vitamin D. Calcium is in:

Dairy products
Green leafy vegetables
Canned fish with bones
Calcium-fortified products

Smoking

Do not smoke. If you smoke, quit.

Exercise

Exercise improves bone health. It also increases muscle strength, coordination, and balance. Do weight-bearing and strength-training exercises for maximum benefit. Balance training may prevent falls and fractures.

Dietary Supplements

People who cannot eat enough calcium from food might want to take calcium supplements. Calcium citrate has the best absorption and is well-tolerated. Other vitamins and minerals may be recommended, including Vitamin D, magnesium, potassium, and Vitamin K. A study showed that Japanese postmenopausal women who took Vitamin K supplements had a reduced rate of fractures. Talk to your doctor before taking herbs or supplements.

Safety Measures

Falls can increase the chance of fracture in someone with osteoporosis. Here are ways to prevent falls:

Use a cane or walker for stability.
Wear rubber-soled shoes for traction.
Use plastic or carpet runners when possible.
Keep rooms free of clutter.
Install grab bars in bathrooms.

Prevention

Building strong bones throughout the early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis:

A balanced diet rich in calcium and Vitamin D
Weight-bearing exercise
Healthy lifestyle (eg, no smoking, drinking alcohol only in moderation)
Bone density testing and supplements or medicines where appropriate

RESOURCES:

The National Institutes of Health Osteoporosis and Related Bone Diseases
http://www.osteo.org/

National Osteoporosis Foundation
http://www.nof.org/

CANADIAN RESOURCES:

Osteoporosis Canada
www.osteoporosis.ca/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm/

REFERENCES:

Fall prevention. National Osteoporosis Foundation website. Available at: http://www.nof.org/patientinfo/fall_prevention.htm . Accessed June 10, 2008.

Ho-Pham LT, Nguyen ND, Nguyen TV. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr. 2009;90:943-950.

Khosla L, Melton LJ. Clinical practice: osteopenia. N Engl J Med . 2007;356:2293-2300.

Nelson M. Strong Women, Strong Bones: Everything You Need to Prevent, Treat, and Beat Osteoporosis . New York, NY: Putnam; 2000.

Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 2010. Accessed March 12, 2010.

Osteoporosis: frequently asked questions. Womens Health.gov. Available at: http://www.womenshealth.gov/FAQ/osteoporosis.cfm#c. Updated September 22, 2009. Accessed December 22, 2009.

Osteoporosis: risk factors. Mayo Clinic website. Available here.

Prevention: who's at risk? National Osteoporosis Foundation website. Available at: http://www.nof.org/patientinfo/fall_prevention.htm . Accessed December 22, 2009.

Sambrook P, Cooper C. Osteoporosis. Lancet . 2006;367:2010-2018.

10/6/2006 DynaMed's Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Cockayne S, Adamson J, Lanham-New S, et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med . 2006;166:1256-1261.

5/16/2008 DynaMed's Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med . 2008;148:680-684.

1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis.CMAJ. 2009;180:32-39. Epub 2008 Dec 10.

12/29/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ. 2009;339:b4229.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Copyright © 2010 EBSCO Publishing All rights reserved.

Tuesday, June 1, 2010

Osteoporosis