Unfortunately this is process is too common. In fact this is so common that it may even be a natural process our bodies go through with aging. It is most pronounced in women and leads to decreased height and produces a hump in their back. The underlying problem is the loss of bone minerals from our bones. The major mineral is Calcium and is a major national concern since this condition leads to major disability and patient grief. Since bone becomes very fragile with the loss of Calcium the patient is disposed to fractures in many different bones. Most common is hip, wrist, and spine. The older the patient, the higher the likelihood of these fractures since bone loss is more severe.
Up to the age of 30 our bodies absorb calcium and store it in our bones. After the age of 35 our bodies slowly begin to loss calcium. However the effects of bone loss are not seen until the condition is sever enough to cause fractures. The hormone Estrogen also has a major role in bone loss. Estrogen slows down the process of bone loss and has a protective effect on these osteoporotic fractures. It is for this reason that women after menopause have higher risk for this disease. It is not only the fracture that cause the problems, but the fact that it is very hard to treat these fractures, and that some patients become bedridden from disability. If a patient becomes bedridden from a fracture, there is much higher likelihood of complications like lung infections (pneumonia), blood clots in the legs (Deep Venous Thrombosis or DVT’s), or bed sores. Each one of these entities could lead to tragic results. In sever cases very simple movement could lead to a fracture in the spine. These movements may be as simple as removing clothes from a laundry machine.
Although there are some treatment options, still the best chance to fight this disease is its prevention. Since up to the age of 25 our body stores Calcium, the prevention of this disease must begin in the teenage years. The avoidance of carbonated drinks is another factor which can strengthen bone. Calcium supplements exist like OsCal that include Calcium and Vit D. This combination maximized Calcium absorption from the gastrointestinal tract.
There are more less common causes for osteoporosis like tumors in the parathyroid, or an over active parathyroid. Also steroid use decreases bone density and may lead to osteoporosis if used for a long time. Certain other cancers may lead to the same effect. Some women are more predisposed to have osteoporosis. Since Estrogen has a protective effect, early menopause can be a predisposing factor. Patients that drink alcohol and smoke are at higher risk also. It is hard to believe but being fat actually has a protective effect. Fat people will place more stress on their bones which stimulates more bone production to support the weight and so are somewhat protected from osteoporosis. On the other hand patients with white skin that is thin and has small frames have a higher risk. Coffee intake, low activity, tobacco use, low intake of Calcium, and low intake of Vit D all have a negative impact and increase risk.
We know that muscle and bone both increase in mass when used more. This is the concept of weight training to increase muscle mass. The same concept applies to bone. People that have high physical activity have higher bone density. In the treatment of osteoporosis exercise is also recommended. People who want to prevent getting this disease and choose to exercise must participate in vigorous high impact exercise to benefit. This will provide the right stimulus for bone mass increase.
If a patient sustains a vertebral (spine) fracture, these are usually compression fractures due to the weak architecture. Fortunately, these fractures have a tendency to stabilize themselves and the rib cage provides further architectural support. The problem with these fractures is the initiation of pain which usually resolves in a few weeks to months. However, if the fracture is sever enough it looses stability and could lead to chronic instability and pain without healing. Another danger is the propagation to other areas and fracture of other levels. With more fractures the patient develops a hump in their back also referred to as kyphosis. These fractures may also lead to an obvious decrease in height.
The diagnosis is begun with an X-ray. X-rays are easy tests to perform and are widely available. However, they will not detect this disease until 30-50% of bone is lost. So it is not a very good test. Other more precise tests are available and all have their own benefits and disadvantages. The most commonly used test is the DEXA scan which is widely available. It has low radiation and is relatively fast. It gives very accurate information regarding the risk for future fractures and the need for prevention and treatment.
There are several options to treat osteoporosis and its complications. Prevention begins in the early years of life with Calcium/Vit D supplementation. Vigorous exercising is another method to prevent further bone loss and should be performed for at least 30 minutes 3-5 days a week. Medications used to treat this condition include Estrogen hormone therapy, Fosomax, and Calcitonin. Another drug which was recently approved by the FDA is Raloxifene which works similar to the mechanism of estrogen but is not as powerful. This last drug has a very similar counterpart which is Tomoxifen and is used to treat breast cancer.
