Osteoporosis and its management

Hello students and friends, today we are going to learn about osteoporosis, which is the most common bone disease which can occur with an increase in age.

Here we will discuss their risk factors, clinical features, investigations, and management.

• Osteoporosis is a condition in which new bone formation doesn't occur with the removal of old bone.
• The bone becomes weak and brittle in this condition.
• This is the most common bone disease characterized by reduced bone mineral density.
• Risk of fracture increase with an increase in age.
• Women affect(30%) more than men(12%).
• The bone turnover throughout life depends on the balance between bone formation(by osteoblasts) and bone reabsorption(by osteoclasts). When the rate of bone reabsorption exceeds the rate of formation of bone, then osteoporosis occurs.
• After menopause, bone reabsorption in women increases as there is an increase in loss of bone, and estrogen deficiency occurs.
• After menopause, the risk of osteoporosis and fracture increases as some women attained a low peak bone mass after menopause.
• Fracture risk increases.
• The individual shows a stooped posture or curved back.

CAUSES

1. Menopause in females.
2. Protein deficiency
3. Malnutrition
4. Long term steroid therapy
5. Cushing syndrome
6. Phenobarbitone therapy

RISK FACTORS FOR OSTEOPOROSIS

1. Drugs- Corticosteroids(reduce bone formation by inhibiting osteoblast function & promoting apoptosis in osteoblasts & osteocytes), anticonvulsants.
2. Endocrine diseases- Early menopause, hyperthyroidism, Cushing syndrome.
3. Inflammatory diseases- Rheumatoid arthritis, ankylosing spondylitis, Inflammatory bowel disease.
4. Respiratory diseases- Cystic fibrosis, COPD.
5. Gastrointestinal diseases- Chronic liver disease, malabsorption,
6. Miscellaneous- Poor diet, smoking, HIV, myeloma.

• Most important cause - corticosteroid therapy.
• Risk increases when the dose of prednisolone exceeds 7.5mg daily for more than 3 months.
• Corticosteroids inhibit intestinal calcium absorption 
• Corticosteroids also lead to secondary hyperparathyroidism because of the renal calcium leakage and thus reduce in serum calcium level.
• Osteoclastic bone reabsorption also gets increased.
• If the steroids dose becomes high then hypogonadism occurs.
• Risk factors can be split between-

1. Nonmodifiable
2. Modifiable

Nonmodifiable:

• Age of an individual.
• Sex(as females are more prone to osteoporosis because of estrogen deficiency, males also have decreased testosterone levels but they are less suffered as compared to women).
• Family history. 
• If the height of an individual is short then the individual is more prone to osteoporosis.
• If an individual suffers from a fracture earlier are likely to have another fracture.

Modifiable:

• Alcohol intake
• Deficiency of VITAMIN D
• Malnutrition
• Antacids
• Lack of exercises
• Tobacco smoking.

Medical disorders:

• Kidney diseases
• Immobility in the body of an individual
• Parkinson's disease
• Rheumatological disorders
• Disorders which are inherited through genes
• Disorders in blood

CLINICAL FEATURES

• Asymptomatic until a fracture occurs.
• Loss of strength.
• Most frequent site: forearm(colles' fracture), dorso-lumbar spine, hip fracture.
• Pain
• Slight height loss & increased kyphosis.

INVESTIGATIONS

1. DEXA(dual-energy X-Ray absorptiometry)- For the Bone mineral density of the lumbar spine and hip.
2. For measuring bone density-

• T- score.
• Z- score.
• Osteoporosis is diagnosed when the T-score value falls to -2.5 or below.
• T- score above -1.0 is regarded as normal.

      3. Neutron activation analysis.

      4. bone biopsy.

Other tests include- Blood test

• TFTs(thyroid function test).
• Immunoglobulins.
• ESR(erythrocyte sedimentation rate).
• 25(OH) vitamin D.
• Sex hormone & Gonadotrophin level.
• Calcium phosphate.

MANAGEMENT

• MEDICAL MANAGEMENT:
• Calcium supplementation.
• Vitamin D.
• Androgens.
• Estrogens.
• High protein in the diet.
• Alandronate.
• Calcitonin.
• Teriparatide.
• Strontium ranelate.
• Biphosphonates.
• Hormone replacement therapy.
• Pharmacological treatment is indicated in patients: T-score- below -2.5.
• ORTHOPEDIC TREATMENT
• Exercise.
• Bracing.
• Limitation of alcohol intake.
• Cessation of smoking.

Hope you all find this helpful for you, if you have any query related to this topic or any other topic then you all are free to contact me via contact us or you can also ask your doubts on the comment box. Thank you! 

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