Osteoporosis

Medicines prescribed for prevention of osteoporosis

Hormonal therapy :-

• Raloxifen – selective estrogen receptor modulator.
• Estrogen Replacement Therapy – Remains a good treatment for prevention of osteoporosis, but is not recommended yet unless other indications for its use are present, as well. There is uncertainty and controversy about whether estrogen should be recommended in women in the first decade after the menopause.
• Testosterone -In hypogonadal men, testosterone has been shown to give improvement in bone quantity and quality.

Bisphonates:- Are effective in preventing fractures of the vertebrae, non vertebral bones and hips when taken for three to four years.

Teriparatide(a recombinant parathyroid hormone)has been shown to be effective in treatment of women with postmenopausal osteoporosis.

Calcium and vitamin Ddecrease the risk of non vertebral fractures in those with postmenopausal osteoporosis by about 18%. High intake of vitamin D reduces fractures in the elderly.

A sedentary lifestyle, poor posture, poor balance and weak muscles increase the risk of fractures. A person with osteoporosis can improve their health with exercise in valuable ways, including :

• Reduction of bone loss
• Conservation of remaining bone tissue
• Improved physical fitness
• Improved muscle strength
• Improved reaction time
• Increased mobility
• Better sense of balance and coordination
• Reduced risk of bone fractures caused by falls
• Reduced pain
• Better mood and vitality.

Always consult with your doctor, physiotherapist or health care professional before you decide on an exercise program. Factors that need to be considered include :

• Your age
• The severity of your osteoporosis
• Current medications
• Your fitness and ability
• Other medical conditions such as cardiovascular or pulmonary disease, arthritis, or neurological problems
• Whether bone density or falls prevention are the main aims of your exercise program
• A combination of weight-bearing aerobic and muscle-building (resistance) exercises is best, together with specific balance exercises.

Others :- Eat brown rice, Oats, Fruits and vegetables etc.

There are only a few foods that are good sources of vitamin D, so vitamin D supplements are often recommended unless you are exposed to sunlight on your skin regularly

Suggested dietary sources of vitamin D are listed below.

*DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for vitamin D is 400 IU for adults.

Daily Adequate Intake of Vitamin D

Follow your Doctors advice on calcium and Vitamin.-D supplements.

Frequently Osteoporosis is diagnosed for the first time, when an old age-geriatric patients presents with acute unexplained debilitating localized bone pain or chronic generalized bone pain.

Very often, these pains on investigation are diagnosed as fracture of vertebra (compression fractures), hip forearm or any other bone fractures with or without minor trauma such as bending forward, lifting, jumping or falling from standing position etc.

Pain, disfigurement, and debilitation are common in the latter stages of the disease. Early spinal compression fractures may go undetected for a long time, but after a large percentage of calcium has been lost, the vertebrae in the spine start to collapse, gradually causing a stooped posture called kyphosis, although this is usually painless.

In old age, the increase risk of falling, along with impaired eyesight, collapse due to transient loss of postural tone with or without loss of consciousness lead to often multiple fractures .Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with gait or balance disorders, are most at risk.

(A)DEXA (Dual-energy X-ray absorptiometry)

DEXA is considered the gold standard for the diagnosis of osteoporosis. 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. This is translated as a T-score. But because bone density decreases with age, more people become osteoporotic with increasing age. The World Health Organization has established the following diagnostic guidelines:

The International Society for Clinical Densitometry takes the position that a diagnosis of osteoporosis in men under 50 years of age should not be made on the basis of densitometric criteria alone. It also states, for premenopausal women, Z-scores (comparison with age group rather than peak bone mass) rather than T-scores should be used, and the diagnosis of osteoporosis in such women also should not be made on the basis of densitometric criteria alone.

Biomarkers

• Chemical biomarkers are a useful tool in detecting bone degradation. The enzyme cathepsin K breaks down type-I collagen protein, an important constituent in bones. Prepared antibodies can recognize the resulting fragment, called a neoepitope, as a way to diagnose osteoporosis.Increased urinary excretion of C-telopeptides, a type-I collagen breakdown product, also serves as a biomarker for osteoporosis.
• CTX markers
• P1NP markers etc

Quantitative CTdiffers from DEXA in that it gives separate estimates of BMD for trabecular and cortical bone and reports precise volumetric mineral density in mg/cm3 rather than BMD’s relative Z score.

QCT’s advantages: it can be performed at axial and peripheral sites, can be calculated from existing CT scans without a separate radiation dose, is sensitive to change over time, can analyze a region of any size or shape, excludes irrelevant tissue such as fat, muscle, and air, and does not require knowledge of the patient’s subpopulation in order to create a clinical score (e.g. the Z-score of all females of a certain age).

QCT’s disadvantages: it requires a high radiation dose compared to DXA, CT scanners are large and expensive, and because its practice has been less standardized than BMD, its results are more operator-dependent. Peripheral QCT has been introduced to improve upon the limitations of DXA and QCT.

Quantitative Ultrasound has many advantages in assessing osteoporosis. The modality is small, no ionizing radiation is involved, measurements can be made quickly and easily, and the cost of the device is low compared with DXA and QCT devices. The calcaneus is the most common skeletal site for quantitative ultrasound assessment. The method can be applied to children, neonates, and preterm infants, it is expected that quantitative ultrasound will be increasingly used in clinical practice but this can give mor of fals high readings. It cannot replace DEXA.