Osteoporosis

Osteoporosis  - General Information

Osteoporosis is a systemic disease of the skeleton, which leads to bone fragility and causes fractures. The disease is a consequence of the loss of bone density and strength, generating an alteration of the bones architecture, these becoming thinner and thinner with the inside soft and porous .Usually, bones weaken when the levels of calcium, phosphorus and other minerals in the bones are low. The disease can also accompany endocrine disorders or can be the result of an excessive use of drugs such as corticosteroids. Even if it's often thought of as a women's disease, it also affects a large number of men.
Osteoporosis can appear at any age, but usually older persons get it, especially women past menopause. Normally, there is loss of bone mass with aging, perhaps 0.7% per year in adults. The process of bone remodeling normally takes about 8 months--a slow but constant process. Bone in older people just isn't as efficient as bone in younger people at maintaining itself--there is a slow activity of osteoblasts and a slow production of growth factors and bone matrix. Bones that are ill of Osteoporosis can break with only a minor fall or injury that normally would not lead to a bone fracture. The fracture can be either in the form of cracking (as in a hip fracture), or collapsing (as in a compression fracture of the vertebrae of the spine). The spines, hips, and wrists are usual areas of bone fractures, although fractures can also occur in almost any skeletal bone region.

Osteoporosis -Symptoms

Osteoporosis means `porous bone` and it’s known to be a silent disease because the bone loss takes place without symptoms. People don’t realize they’ve got it until a sudden fall or minor accident causes a fracture. Some of the fractures may slip detection until years later. Therefore, patients may not be conscious of their illness until they get a painful fracture. Then the symptoms are related to the region of the fractures. Fractures of the spine can cause major "band-like" pain that goes around from the back to the side of the body. In time, many spine fractures can lead to chronic lower back pain as well as loss of height or curving of the spine, which gives the patients a hunched-back look often called a "dowager hump.” A fracture that takes place during the course of usual activity is called a minimal trauma fracture. For example, some people with this disease get stress fractures of the feet by just walking or stepping off a curb. Hip fractures usually occur as a result of a fall. With Osteoporosis, hip fractures can happen as a result of trivial events. Hip breaks may also be difficult to recover after surgical repair because of poor bone feature. Patients who have had a fracture are at high risk of getting another one. A simple test that measures bone mineral density (BMD) at distinct parts of your body, like your spine and your hip, can help determine if you have the disease. Dual energy x-ray absorptiometry (DEXA) is the best test to determine BMD.

Osteoporosis- Treatment

Even if there is no cure for Osteoporosis, it can be treated. Many family doctors have been learning about this disease and can treat people who got it. Endocrinologists, rheumatologists, geriatricians, and internists are just some of the specialists who can take care of people with this disease. The aim of the treatment is to prevent fractures. A diet rich in calcium and vitamin D, a regular exercise program, and fall prevention are basic for maintaining bone health.

Several drugs are approved by the Food and Drug Administration for the treatment of Osteoporosis. Since all medications have side effects, it is important to consult your doctor about which medication is the best for you. Alendronate, risedronate, and ibandronate are from a class of drugs named bisphosphonates that inhibit bone loss, fracture risk, and in some cases increase bone density. These drugs diminish the activity of bone-dissolving cells. Alendronate and risedronate can be used in daily and weekly doses for treating both sexes; ibandronate can only be used in a monthly dose for women. They can decrease the chance of fractures. Side effects may include qualmishness, heartburn, and stomach ache. Bisphosphonates can cause many digestive problems if they are not taken correctly.  

Estrogen is approved for treating the menopausal symptoms and Osteoporosis, but considering the latest evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who get estrogen, it is recommended to take the lowest effective dose for the shortest period possible. Estrogen should only be given to women with a significant risk for this Osteoporosis. Raloxifene is used for postmenopausal women. It is from a class of drugs called SERMs (Selective Estrogen Receptor Modulators), it is a non-hormonal medicine that has estrogen-like effects on the bones, but blocks estrogen side-effects in the breast and uterus. Raloxifene has effects at the level of the spine and wrists, but no effect on the hip.      

Calcitonin is used for the treatment of Osteoporosis in women who are at least 5 years past menopause. It is a hormone produced by the thyroid gland and it has no serious side-effects. Teriparatide, a form of parathyroid hormone, increases the activity of bone-forming cells. It is given as a daily injection and has been shown to reduce the risk of spine and other fractures. Teriparatide is approved for the treatment of postmenopausal women and men who are at high risk of fracture. Some patients experience leg cramps and dizziness while using this drug. Tamoxifen is a synthetic hormone used in the treatment of breast cancer and is given to certain high-risk women to help prevent their chances of making a breast cancer. Even if tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on bone cells. As a result, tamoxifen appears to diminish the risk of fractures, especially in women over age 50. Some of the side effects of this drug can be hot flashes, stomach upset and vaginal dryness or discharge.