Introduction:
Osteoporosis refers to a reduction in bone strength. The defining characteristics of a bone include its strength and quality. Osteoporosis can affect strength, quality, or both of these characteristics. Osteoporosis is a major cause of pathological fractures in postmenopausal women and the elderly. Although earlier it was believed that it was an inevitable accompaniment of aging, recent data indicate that it is largely preventable.
Who Is at Risk?
Everybody does not develop osteoporosis. Certain populations are especially vulnerable to developing osteoporosis.
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These include females, postmenopausal women, people over 50 years of age, and those having a positive family history of osteoporosis.
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Estrogen plays a protective role against the development of osteoporosis in women. This explains why postmenopausal women are at a greater risk for osteoporosis.
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Tall, slender, and thin women also run the risk of developing osteoporosis.
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Women represent a vulnerable populace as they have a smaller peak bone mass as compared to men, and they tend to lose bone mass more rapidly as they age.
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A diet lacking in vitamin D and calcium also makes us prone to osteoporosis.
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Certain medications like Glucocorticoids, blood thinners like Heparin, immunosuppressants like Cyclosporine, and anticonvulsants also increase the risk of osteoporosis.
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An inactive lifestyle, excessive smoking, and alcohol usage are additional risk factors.
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Medical conditions like hyperparathyroidism, malignancy, chronic renal and hepatic diseases, amenorrhea, and early menopause are also important risk factors.
How to Know That I Have Osteoporosis?
Osteoporosis is a silent disease. Most often, the individual is not aware of its existence until he suffers a fracture. These fractures occur with the slightest impact and happen during activities like bending, lifting weights, coughing, or with other minor stresses. Hence, these fractures are called pathological fractures. This commonly results in the collapse of the spinal vertebrae. The presenting symptoms include severe back pain, a reduction in the height of a person due to the collapsed vertebrae, and the assumption of a stopped or hunched posture.
Investigations to Confirm Osteoporosis:
The approach to the diagnosis should be holistic and comprehensive.
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Other medical diagnoses which can act as contributory factors need to be ruled out. Physical examination is of vital importance.
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An inquiry is made into the lifestyle habits and patterns of the individual. Family history is also ascertained.
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Careful consideration is also given to the drugs that the individual might be taking. Inquiries are also made about the dietary patterns and falls or fractures sustained in the past. Apart from the usual blood and urine tests, an x-ray of the spine is ordered to rule out spinal deformities.
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The gold standard investigation which confirms the diagnosis is the DEXA scan. It stands for dual-energy x-ray absorptiometry, which measures the bone mineral density. Minerals impart hardness to a bone, and the bone mineral density is ascertained by a score known as the T-score. Specific cut-off values exist which confirm the diagnosis.
What Are the Treatment Options for Osteoporosis?
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The primary goal of the treatment should be the prevention of fractures and falls.
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A comprehensive nutrition plan is put into place. This includes supplementation with calcium, vitamin D, and vitamin K. Optimum calorie consumption is stressed.
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Medications aim to achieve one or more of the following goals. Reducing bone loss, increasing bone mineral density, and ensuring new bone growth. After weighing the pros and cons, drugs that may be causing bone mineral loss will be stopped.
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Lifestyle changes include getting optimum exercise, which ensures reduced age-related bone loss. Data have consistently shown that exercise also increases bone density. Quitting smoking and alcohol is highly beneficial.
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Prevention of falls is also vital. Doormats are used outside the bathroom to prevent falls. Outdoor and indoor canes may be used for additional support. Flooring that is least susceptible to cause slips and falls is encouraged, especially in the bathrooms.
How Is Osteoporosis Treated?
Specific Interventions and Drugs for Osteoporosis
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Bisphosphonates
These are medications that inhibit osteoclastic activity. Osteoclasts are cells that accelerate bone loss. Commonly used bisphosphonates include Alendronate, Pamidronate, Etidronate, Zoledronic acid, and Risedronate.
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Parathormone Analogue
This is available in the form of an injection. The generic name of this analogue is Teriparatide. Usage beyond two years is not recommended. This is particularly employed in postmenopausal women and men who are at high risk for fractures.
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Strontium Ranelate
This is a RANK ligand (RANKL) inhibitor and is beneficial in postmenopausal women.
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SERMs
These are selective estrogen receptor modulators. These act as estrogen agonists in some tissues and block estrogen's effects in some other tissues. These are not estrogen preparations but they have estrogen-like effects in certain tissues.
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Calcitonin
This is involved in the metabolism of calcium. It also plays a part in bone metabolism. This is used in women who are at least five years postmenopausal.
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Hormone Replacement Therapy (HRT)
This is used for both the prevention of osteoporosis in high-risk women and also to treat the hot flushes of menopause.
How Does Osteoporosis Impact Daily Life?
Osteoporosis can affect daily life by increasing the risk of fractures, causing chronic pain, limiting mobility and independence, fostering fear of falling, impacting mental health, necessitating lifestyle changes, and imposing financial burdens. Apart from these, the patient may lose the ability to dress up, walk and stand up.
How About the Survival Rate of Osteoporosis?
Osteoporosis itself is not typically a direct cause of death. However, complications related to osteoporosis, such as fractures, can contribute to mortality, especially in older adults. For example, hip fractures in older individuals can lead to complications such as pneumonia, blood clots, or infections, which can increase the risk of mortality.
According to the International Osteoporosis Foundation, approximately 20 % of older individuals who experience a hip fracture die within one year, and many others experience a significant decline in quality of life. However, it’s important to note that mortality rates can vary depending on factors such as age, overall health, and access to medical care.
Conclusion:
Osteoporosis comes with its fair share of emotional effects. Since mobility gets impaired, people feel disabled. This paves the way for a host of negative mood states like anxiety, depression, panic, and phobia. It is vital to liaise with a mental health professional who will offer appropriate treatment to improve the overall quality of life. Such liaison also helps the patient to better cope with the crisis. In summary, osteoporosis represents an important public health problem, and the aphorism 'prevention is better than cure' sounds very apt in dealing with osteoporosis.