Osteoporosis

by James O'Sullivan

 

Osteoporosis is a disorder of the bones characterized by decreased bone mass (leading to thin and fragile bones), which also decreases bone strength. Osteoporosis can cause a great deal of suffering, including loss of independence or even death, particularly when the fracture involves the hip. It is much more common in women than in men. It is not a form of arthritis, although it can cause fractures that, in turn, lead to arthritis.

 

Symptoms and Signs

Most people with osteoporosis have no symptoms. Osteoporosis usually does not cause pain unless there has been a fracture. Because weakened bones are more fragile and more likely to break, people with osteoporosis are at increased risk of fractures, especially fragility fractures (broken bones that happen with little or no trauma). The most common first fracture is a wrist fracture, which typically occurs between ages 50 and 70 in women. Hip fractures and fractures of the spine (compression fractures) are also common, especially among people who are in their 70s.

 

One early sign can be a loss of height caused by curvature or compression of the spine.

 

Risk Factors

These risk factors include:

  • Being female

  • Being age 40 or older

  • Being a postmenopausal woman

  • Having a diet low in calcium or an intestinal problem that prevents absorption of calcium and vitamins

  • Having an overactive parathyroid (hyperparathyroidism) parathormone (hypercalcemic)

  • Leading a sedentary lifestyle, with little or no routine exercise

  • Being thin

  • Taking certain medications, such as prednisone. (corticosteroids)

  • Ethnicity: Caucasian or of Asian descent are more at risk, than African origins.

  • Smoking

  • Excessive alcohol consumption

  • Having a family history of osteoporosis

  • Having a history of at least one fragility fracture

 

Diagnosis

Physical examination, you are shorter than you thought you were or that you have a "dowager's hump," a curve of the spine in the upper back that produces a prominence.

X-rays, your bones may be less dense than expected, a sign of osteopenia (diminished bone on an X-ray). Although most cases of osteopenia are caused by osteoporosis, there are other causes such as too little mineral in bone (called osteomalacia) as a result of inadequate intake or absorption of vitamin D.

Bone-density test. There are several techniques available to measure bone density.

Blood and urine tests (Once osteoporosis is identified), may be recommended to identify a cause of osteoporosis. However, for most women, no clear cause (other than age and being postmenopausal) is found.

 

Treatment

  • Dietary alteration: Adequate intake of calcium and vitamin D,

  • A program of routine weight-bearing exercise

  • Modifying other risk factors.

  • A number of Medications are available for both women and men.

  • When an osteoporotic hip fracture occurs, surgery may be necessary. A wrist fracture may do well with casting alone, or surgery may be needed. Other treatments for fracture include pain medication and rest for a short time. Calcitonin injections may reduce spine pain from a new compression fracture.

 

Prognosis

The prognosis for osteoporosis is good, especially when it is detected and treated early. Bone density, even in severe osteoporosis, generally can be stabilized or improved, and the risk of fracture can be reduced by 50 percent or more after several years of treatment. People with mild osteoporosis have an excellent prognosis. Those who have already experienced osteoporotic fractures generally can expect their bones to heal normally and pain to generally resolve within a week or two. The prognosis is improved when a reversible cause, such as prednisone use, is identified and stopped under your doctor's supervision. If proper treatment is begun and tolerated, most patients can effectively prevent osteoporosis from developing or improve it once it has started.

 

Prevention (You can help prevent osteoporosis)

  • Take adequate calcium and vitamin D,

  • Follow a routine program of weight-bearing exercise,

  • Do not smoke and avoid excess alcohol consumption.

  • If you are a woman who has entered menopause, you should speak with your doctor about evaluation and treatment for osteoporosis.

  • A bone-density test for osteoporosis may make the decision easier if it shows signs of a problem.

 

Another measure to help prevent osteoporosis is regular monitoring of thyroid medication if you take it, because too much of this medication may lead to osteoporosis and other medical problems. If you take prednisone for any reason, work with your doctor to reduce the dose to its lowest possible amount or even to discontinue the medication.

 

Note: You should seek medical advice for any medical condition that you are interested in. These notes are intended for information purposes only and should not be used as a substitute for face to face medical advice......

 

 


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