HEALTH TALK WITH BABARIMISA OLUWATOYIN
OSTEOPOROSIS
Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms.
Sufferers of these serious yet largely preventable injuries often experience severe pain, long-term disability and even early death.
After a hip fracture, 40% of individuals cannot walk independently, and 80% cannot perform basic activities such as shopping independently.
• 10-20% of hip fracture sufferers require permanent nursing homecare after the incident.
• In women over 45 years of age, osteoporosis accounts for more days in hospital than diabetes, heart attacks or breast cancer.
• In 2010, the cost of long-term disability from osteoporosis in the EU was 10.7 billion EUR.
• Osteoporotic fractures cause an annual global loss of 5.8 million healthy life years to disability.
• Worldwide, a bone breaks due to osteoporosis every three seconds.
• In Europe, India, Japan and the USA alone, there are an estimated 125 million people with osteoporosis.
• The number of people living with osteoporosis in all regions of the world is set to increase dramatically in the coming decades, due to ageing populations and lifestyle changes..
• The point prevalence of osteoporosis was 56.9% (males = 43.7% and females = 65.8%).
Risk Factors responsible for Osteoporosis
- According to the study, most significant factors associated with osteoporosis were increasing age, female sex, menopause, lack of formal education, lack of engagement in occupational activities and living with relatives/friends.
- Receiving social support from relatives and friends, non-participation in sporting activities at younger ages, prolonged use of medications for peptic ulcer disease, hospitalization on or after the age of 60 years and asthenic build were also found to be significant.
- Yearly increase in age shows a 6.9% increase in the odds of having osteoporosis.
Signs and Symptoms of Osteoporosis
• Osteoporosis can be present for years without any noticeable symptoms, but signs can include:
• Severe back pain
• Loss of height over time
• A stooped posture
• Bone fractures from minor injury
Investigations
• The diagnosis of osteoporosis can be made using conventional radiography and by measuring the bone mineral density (BMD)
• Bone Density Scan: The exam is used to measure bone mineral density (BMD).
• Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old), healthy adult women reference population.
• The following procedures can be performed to determine bone fractures due to osteoporosis:
• Bone x-ray: Bone x-ray produces images of bones within the body. It aids in the diagnosis of fractured bones, which are sometimes a result of osteoporosis.
• CT scan of the spine: CT scanning of the spine is performed to assess for alignment and fractures. It can be used to measure bone density and determine whether vertebral fractures are likely to occur.
• MRI of the spine: Magnetic resonance imaging of the spine
Prevention
• The goals of prevention are to: (i.) Prevent Fracture (ii.) Preserve bone mass
• Adequate intake of fruits and vegetables rich in calcium. These include dairy products like milk, cheese, almonds beans, lentils and sardines. Food rich in Vitamin D like beef, liver, egg yolk, salmon, mushrooms and shrimp are needed for strong bones.
• Appropriate intake of Calcium (required daily intake is 1,000mg) and vitamin D supplements
• Physical exercise, taking a walk daily for retired people, passive and active exercise for the bed ridden patients, or on prolonged hospital admission
• Reduce intake of alcohol, caffeine and cigarette
Management
The goals of management of osteoporosis are to (i.) restore bone mass (ii.) prevent fractures (iii.) maintain function
• A comprehensive management of osteoporosis focuses on proper nutrition of food rich in variety of minerals, Vitamin D and Calcium. The rate of bone mass loss can be slowed down with drugs and modification of lifestyles and risk factors
• Strengthening exercises which increase stability, educate patients about risk of fall and fractures, modifying of home environment for safety
• Acute back pain from vertebra compression should be treated with orthopaedic supports, analgesics, heat and massage when there is muscle spasm, avoid lifting of heavy objects.
Medications: Bisphosphonates - Alendronate
• It inhibits action of the osteoclast bone cells which are responsible for resorption of bone mass.
• Patient is going to take the drug for a long time and adherence is important, and must sit upright or walk round after taking the drug.
• Side effects: heart burn, dysphagia, chest pain, vomiting due to regurgitation, oesophagitis.
• Alfacalcidol – Vitamin D which decreases bone resorption, increases bone mineralisation and formation
• RANK ligand inhibitor (Denosumab) injection is used to prevent bone loss by blocking some receptors to decrease bone breakdown.
• Selective estrogen receptor modulators (SERMs) (Tamoxifen), which can activate estrogen's action in some cells, such as bone, liver and uterine cells.
• Surgery:
• Compression fractures in the vertebra can occur as a result of osteoporosis. In these cases, vertebroplasty and kyphoplasty, performed by a radiologist, may be an option to treat painful spine fractures.
• vertebroplasty, image guidance is used to inject a special cement mixture through a hollow needle into the fractured bone.
• In kyphoplasty, a balloon is inserted through the needle into the fractured bone to create a cavity. Once the balloon is removed, a cement mixture is injected into the cavity.
IN CONCLUSION
• Osteoporosis is often called a silent disease because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse.
• There is need for increased awareness among the general public about predisposing factors, prevention and availability of treatment for osteoporosis in order to reduce the morbidity and mortality associated with the condition.
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