What is Osteoporosis

Osteoporosis is a bone disease that occurs when the body

loses too much bone, makes too little bone, or both.
Osteoporosis means porous bone. Viewed under a
microscope, healthy bone looks like a honeycomb. When
osteoporosis occurs, the holes and spaces in the honeycomb
are much larger than in healthy bone. Osteoporotic bones have
lost density or mass and contain abnormal tissue structure.
Osteoporosis causes bones to become weak and brittle so
brittle that a fall or even mild stresses like bending over or
coughing can cause a fracture. Osteoporosis-related fractures
most commonly occur in the hip, wrist or spine.
Bone is living tissue that is constantly being broken down and
replaced. Osteoporosis occurs when the creation of new bone
doesn't keep up with the removal of old bone.
Breaking a bone is a serious complication of osteoporosis,
especially with older patients. Osteoporotic bone breaks are
most likely to occur in the hip, spine or wrist, but other bones
can break too. In addition to causing permanent pain,
osteoporosis causes some patients to lose height. When
osteoporosis affects vertebrae, or the bones of the spine, it
often leads to a stooped or hunched posture.
Osteoporosis may limit mobility, which often leads to feelings of
isolation or depression. Additionally, twenty percent of seniors
who break a hip die within one year from either complications
related to the broken bone itself or the surgery to repair it. Many
patients require long-term nursing home care.
Osteoporosis affects men and women of all races. But white
and Asian women especially older women who are past

menopause are at highest risk. Medications, healthy diet and

weight-bearing exercise can help prevent bone loss or
strengthen already weak bones.

RISK FACTORS/CAUSES
Some risk factors for osteoporosis are out of your control,
including:

Gender. Women are much more likely to develop

osteoporosis than are men.

Age. The older you get, the greater your risk of

osteoporosis.

Race. You're at greatest risk of osteoporosis if you're white

or of Asian descent.

Family history. Having a parent or sibling with

osteoporosis puts you at greater risk, especially if your
mother or father experienced a hip fracture.

Body frame size. Men and women who have small body
frames tend to have a higher risk because they may have
less bone mass to draw from as they age.

Hormone levels
Osteoporosis is more common in people who have too much or
too little of certain hormones in their bodies. Examples include:

Sex hormones. Lowered sex hormone levels tend to

weaken bone. The reduction of oestrogen levels at
menopause is one of the strongest risk factors for developing
osteoporosis. Women may also experience a drop in
oestrogen during certain cancer treatments. Men experience
a gradual reduction in testosterone levels as they age. And
some treatments for prostate cancer reduce testosterone
levels in men.

Thyroid problems. Too much thyroid hormone can cause

bone loss. This can occur if your thyroid is overactive or if
you take too much thyroid hormone medication to treat an
underactive thyroid.

Other glands. Osteoporosis has also been associated

with overactive parathyroid and adrenal glands.

Dietary factors
Osteoporosis is more likely to occur in people who have:

Low calcium intake. A lifelong lack of calcium plays a

major role in the development of osteoporosis. Low calcium
intake contributes to diminished bone density, early bone
loss and an increased risk of fractures.

Eating disorders. People who have anorexia are at

higher risk of osteoporosis. Low food intake can reduce the
number of calories and amount of protein and calcium
ingested. In women, anorexia can stop menstruation, leading
to weaker bones. In men, anorexia lowers the amount of sex
hormones in the body and can weaken bone.

Gastrointestinal surgery. A reduction in the size of your

stomach or a bypass or removal of part of the intestine limits
the amount of surface area available to absorb nutrients,
including calcium.
Steroids and other medications

Long-term use of oral or injected corticosteroid medications,

such as prednisone and cortisone, interferes with the bonerebuilding process. Osteoporosis has also been associated with
medications used to combat or prevent:

Seizures

Gastric reflux

Cancer

Transplant rejection

Lifestyle choices
Some bad habits can increase your risk of osteoporosis.
Examples include:

Sedentary lifestyle. People who spend a lot of time sitting

have a higher risk of osteoporosis than do those who are
more active. Any weight-bearing exercise and activities that
promote balance and good posture are beneficial for your
bones, but walking, running, jumping, dancing and
weightlifting seem particularly helpful.

Excessive alcohol consumption. Regular consumption

of more than two alcoholic drinks a day increases your risk of
osteoporosis.

Tobacco use. The exact role tobacco plays in

osteoporosis isn't clearly understood, but it has been shown
that tobacco use contributes to weak bones.

SYMPTOMPS

Unlike other diseases, osteoporosis has no visible symptoms of

pre-effects. A person is often not aware that he or she has
osteoporosis until a fracture occurs. Once bones have been
weakened by osteoporosis, you may have signs and symptoms
that include:

Back pain, caused by a fractured or collapsed vertebra

Loss of height over time

A stooped posture

A bone fracture that occurs much more easily than

expected

DIAGONASIS AND TREATMENT

TESTS:
Almost 80% of bone density is determined by heredity and 20% by lifestyle. Bone mineral
density tests (BMD) shows how dense bones are and whether you have osteoporosis. This
information helps determine which prevention or treatment steps are needed.

Blood Test Markers

Whether you're being screened or treated for osteoporosis, your doctor may order a blood or
urine test to see the metabolism of bone. This provides clues to the progression of your
disease.

Bone Densitometry
Bone densitometry is a test like an X-ray that quickly and accurately measures the density of
bone. Bone density can be measured by a machine that uses low levels of X-

rays to determine the proportion of mineral in bones. In most cases, only a few
bones are checked usually in the hip, wrist and spine.

CURE:

There is no cure for osteoporosis. The goal of treatment is to protect and

strengthen the bones. Treatment usually includes a combination of drugs and
lifestyle changes to help slow the rate of bone re-absorption by the body.

Bisphosphonates
These are the most common osteoporosis drug
treatments. They include the following

Alendronate (Fosamax) is an oral medication

people typically take once per week.

Ibandronate (Boniva) is available as a monthly oral

tablet or as an intravenous injection that you get four
times per year.

Risedronate (Actonel) is available in daily, weekly,

bimonthly, or monthly doses.

Zoledronic acid (Reclast) is available as an

intravenous infusion that you get once every one or two
years.
The side effects of these drugs can include acid reflux,
nausea, and stomach pain. In some cases, they can
cause bone damage in the jaw, or jaw osteonecrosis.
This side effect is rare and occurs more often in people
who take high doses of bisphosphonates. Using
bisphosphonate therapy for more than five years has been linked to a rare
problem in which the middle of the thighbone cracks and might even break
completely. Bisphosphonates also have the potential to affect the jawbone.

Antibodies
Denosumab is an antibody. It links to a protein
involved in your bodys process of bone re-absorption.
This antibody slows bone re-absorption. It also
maintains bone density. Its available as an injection
that you get every six months. The side effects can
include:

skin irritation
muscle stiffness
pain
spasms
fatigue

excessive sweating
bone fractures in rare cases

Hormone therapy
Postmenopausal women are at a high risk for
osteoporosis. Oestrogen helps protect bones, and
oestrogen production drops during menopause. For
women in menopause, hormone therapy, or hormone
replacement therapy, is a treatment option. Typically,
doctors dont use it as a first line of defence because it
increases your risk of:

a stroke
a heart attack
breast cancer
blood clots

Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in

postmenopausal women, without some of the risks associated with estrogen.
Taking this drug may also reduce the risk of some types of breast cancer. Hot
flashes are a common side effect. Raloxifene also may increase your risk of
blood clots.
In men, osteoporosis may be linked with a gradual age-related decline in
testosterone levels. Testosterone replacement therapy can help increase bone
density, but osteoporosis medications have been better studied in men with
osteoporosis and are recommended alone or in addition to testosterone.

Thyrocalcitonin

This is a hormone the thyroid gland makes. It helps

regulate calcium levels in the body. Doctors use
synthetic thyrocalcitonin, or calcitonin (Fortical,
Miacalcin), to treat spinal osteoporosis in people who
cant take bisphosphonates. It can also ease the pain in
some people who have spinal compression fractures.
The drug is available by nasal spray or injection. Side
effects from nose sprays may include a runny nose or
nosebleeds.

Parathyroid hormone (PTH)

This hormone controls calcium and phosphate levels in
bone. Treatments with a synthetic PTH (Forteo) can
promote new bone growth. This drug is available as a
daily injection in combination with calcium and vitamin
D supplements. This drug is expensive and generally
reserved for people with severe osteoporosis who have
poor tolerance for other treatments.

Lifestyle changes
Calcium and vitamin D
Getting plenty of calcium and vitamin D in your diet can
help slow bone loss. Calcium-rich foods include:

dairy products
dark green vegetables
enriched grains and breads
soy products

Most cereals and orange juices are now available with

added calcium as well. Vitamin D helps your body
absorb the calcium it needs.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) recommends that women
aged 19-50 and men aged 19-70 should take 1,000
milligrams (mg) of calcium per day. They recommend
that women aged 51-70 and everyone over 70 should
take 1,200 mg of calcium per day.
The NIAMS recommends adults under age 70 should
take 600 international units (IU) of vitamin D per day
and adults over age 70 should take 800 IU of vitamin D
per day.

Physical activity
Exercise helps strengthen your bones. Whatever the
form, physical activity helps slow age-related bone loss
and can slightly improve bone density in some cases.
Exercise can also help improve your posture and
balance, lowering your risk of falls. Fewer falls can
mean fewer fractures.
Strength training benefits the bones in your arms and
upper spine. This can mean free weights, weight
machines, or resistance bands. Weight-bearing exercise
like walking or jogging, and low-impact aerobics such
as elliptical training or biking can also be beneficial.

Both can help strengthen the bones in your legs, hips,

and lower spine.