Osteoporosis

Osteoporosis

Osteoporosis or "Porous/Soft Bones" is a progressive disease involving the bones which makes them more prone to fractures even with minor injuries in addition to increasing generalized "bony Pains". It is an ongoing process and is rarely noticed before it leads to a fracture. It affects all bones of our body but most commonly the spine, ribs, hip and wrist. Studies have shown that around 35 to 50% women over the age of 50 are at risk of developing an osteoporotic vertebral fracture.

Symptoms

Osteoporosis by itself does not have any specific symptoms. Common early symptoms are often vague such as generalized bone-pains, tiredness, decreased stamina and stiffness. These symptoms are often ignored and assumed to be simply a result of ageing. Medical help is usually sought when osteoporosis causes a fracture in one of the bones involved. Osteoporotic fractures can occur in situations when an otherwise normal individual would not have fractured a bone. This is because in osteoporosis the problem lies in the structure of the bones which become soft and porous, hence these fractures are also called as "fragility fractures".

People who have had an osteoporotic fracture are twice more likely to have another such fracture.

Risk Factors

Factors which cannot be modified :

• Age : Advanced age is the most common risk factor associated with osteoporosis in both men and women.
• Sex : Females are more prone to develop osteoporosis. After reaching menopause due to estrogen hormone deficiency, there occurs a rapid reduction in bone mass leading to osteoporosis.
• Race : Certain ethnic groups are more prone to osteoporosis like Asians
• Heredity : Studies have shown that there are certain genes linked to osteoporosis

Factors that can be modified :

• Malnutrition/ Underweight
• Vitamin D deficiency
• Excess consumption of alcohol/smoking
• Heavy metal content in diet
• Soft drinks : Some studies have shown that the phosphoric acid content of certain soft drinks can lead to osteoporosis.
• Medicines : Some drugs when taken for a longer duration can lead to osteoporosis. Eg. Steroids
• Medical Conditions: Eg. Kidney, blood, liver and endocrine(hormonal) disorders.

Management

Early diagnosis and limiting further worsening is the most important aspect of Osteoporosis management

Diagnosis

Investigations that can help in diagnosing Osteoporosis early before it has lead to a fracture thereby reducing the debility include :

• DEXA (Dual energy X-ray absorptiometry) – It's a method of measuring bone density and quantifying it with certain values. Based on the results treatment can be started.
  If your T-Score is -2.5 or lower then you have osteoporosis and have a higher chance of a fracture.
• Quantitative Computed Tomography
• Routine X-rays can give us some idea about the status of osteoporosis.

Before osteoporosis has lead to a fracture treatment is aimed to prevent its further worsening and in severe cases improvement in bone density with certain medicines/injections.

Basic treatment measures include :

• Lifestyle changes – smoking cessation, moderation of alcohol intake, fall prevention, endurance exercises, resistance exercises
• Nutrition – healthy diet, calcium and Vitamin D supplements
• Medicines – Biphosphonates like Fosavance, Fosamax, Actonel; Calcitonin Nasal Spray; Strontium derivatives; injections like synthetic PTH or teriparatide (Forteo).
  
  Specific treatment for reducing pain invertebral compression fracture:
  
  Two types of procedures are presently advocated for certain vertebral compression fractures which fail to heal on its own over a reasonable period of time causing ongoing back pain.
• Vertebroplasty
• Kyphoplasty

What is Vertebroplasty and Kyphoplasty?

Vertebroplasty is a procedure for certain type of osteoporotic vertebral compression fractures in which fast hardening paste (bone cement) is injected into the weak or fractured part of the bone to provide stability to the overall structure of the vertebra.

Kyphoplasty is a similar procedure in which before injecting that paste first the bone is expanded with a balloon. It has a relative advantage of restoring some of the lost structure of the vertebra.