Cases Answered on Osteoporosis

  1. WHAT IS OSTEOPOROSIS?
    It is a condition where there is thinning of bone with loss of bone strength. There is increased susceptibility of fracture. The risk of osteoporosis is much greater for women because of less bone mass. Fractures associated with osteoporosis occur commonly in Spine. Because of the increasing age of population, there is an increasing risk of fracture.
  2. OSTEOPOROSIS IS A SILENT EPIDEMIC. WHY?
    Until a fracture occurs patients are usually unaware that they have osteoporosis. Osteoporosis is confirmed usually with a fracture since bone loss is not symptomatic. Hence emphasis should be on detecting and treating the condition before the occurrence of fracture.
  3. WHY IS IT IMPORTANT TO DETECT OSTEOPOROSIS?
    Osteoporotic hip fractures are associated with a high incidence of death rate (20% in 1st year). The cause of death is not the fracture but due to co existent general health, the frailty of patients, increase in chance of infections, bed sores, blood clots. Those who survive fractures may have great difficulty in returning to the previous capabilities.
  4. WHAT ARE THE RISK FACTORS FOR OSTEOPOROSIS?
    Women are more prone to osteoporosis then men. Bone density in women falls after the menopause. There is an increased risk of vertebral or hip fracture in the daughters of women who have had such fractures. Asians are more prone for fractures when compared to those from Africa. Small, thin men and women are at an increased risk of osteoporosis and fracture than taller, heavier people.In women bone density and strength is linked to the exposure to the female hormone. Hence delayed puberty and early menopause increase the risk of osteoporosis. The same applies to men, who have less exposure to male hormone, testosterone. One of the commonest causes of decreased testosterone in men is alcoholism.

    Diet with low calcium leads to a high risk of osteoporosis. Vitamin D is very crucial in the normal absorption of calcium. About 15-20 minutes of exposure to sunlight per day should be sufficient to stock up vitamin D. Since elderly people are often unable to get outside and may not be taking a diet adequate in vitamin D. In this situation body maintains calcium by mobilizing calcium form bone and hence will precipitate osteoporosis. Supplementation of the diet with vitamin D together with calcium in the elderly may stave of the risk of osteoporosis. Good physical activity helps in bone attaining maximal strength. Those who are immobile or unable to exercise can become osteoporotic.

    Smoking appears to increase the risk of fractures in both men and women. Menopause sets in early in women who smoke. Excessive intake of alcohol is associated with osteoporosis.

  5. WHAT ARE THE CHANGES THAT OCCUR IN BONE IN OSTEOPOROSIS?In post menopausal women, bone is lost from the skeleton, due to a disturbance in the usual balance between bone formation and bone loss. This culminates in an overall loss of bone. In addition to it, the structure of remaining bone is defective, mainly due to loss of of the cancellous component of bone with resultant increased liability of fracture. Thus the cancellous bone like vertebra becomes more susceptible to fracture.
  6. WHAT ARE THE EARLY WARNING SIGNS OF OSTEOPOROSIS?
    • fracture after a minor fall, also known as a fragility fracture.
    • Height loss because bone is lost from the spine this leads to collapse and consequent loss of height. This may be associated with a curvature or a twist of the spine.
    • Back pain: episodes of severe back pain lasting for several weeks is suggestive of spinal fracture. An x ray may help to elucidate the cause of back pain and the associated deformities.
  7. CAN OSTEOPOROSIS BE PREVENTED?
    The risk of developing osteoporosis in later life can be reduced by maximizing the bone marrow in early adult life and reducing the rate of bone loss in later life. The rate and extent of bone loss can be reduced by increasing the calcium and vitamin D intake in diet especially for the elderly group.. Dairy products are good sources of calcium and some diary products are supplemented with vitamin D. Calcium taken as a component of food stuff is better absorbed than when taken as a mineral supplement. Vitamin D is found in abundance in cod-liver oil, oily fish such as sardines, salmon and tuna. Some food stuffs like margarine are artificially fortified with vitamin D.
  8. HOW DO SPINAL FRACTURES OCCUR?
    Most spinal fractures occur silently i.e. they do not cause pain and are often brought to light by chance such as x-rays carried out because of loss of height in spinal curvature. A third of patients with vertebral fractures have acute episodes of back pain at the junction of upper and lower spine. The pain can com eon over a matter of few days but usually is dramatic, severe and sudden in inset. The pain is usually worse with prolonged standing, bending, stooping or lifting. Those patients who have had more than one vertebral fracture have an increased risk of chronic pain after recovering from acute pain of the fracture.
  9. WHAT ARE THE DRUGS AVAILABLE TO PREVENT AND TO TREAT OSTEOPOROSIS?
    Other than calcium and vitamin D, which are dietary supplements than drugs, the treatments available include hormone replacement therapy (HRT) in females, drugs with hormone like actions such as tibolone, and rolixifine, bisphosphonates and calcitonin. In men testosterone can be looked upon as the male equivalent of female HRT.
  10. HOW ARE SPINAL FRACTURES TREATED?
    The first priority is to control the acute pain. This usually requires strong analgesics. The usual side effect is constipation. When the pain is very severe, additional treatment such as calcitonin may be necessary. Once acute pain has been controlled then patients should be mobilized early to prevent problems associated with prolonged immobility. A surgical procedure called percutaneous vertebroplasty may be used to relieve pain. This technique of injecting bone cement into the vertebral fracture site through a hole drilled into the vertebra from the back usually under local anesthesia. It is very effective in alleviating pain and patient can be sent home the same day