MBBS, MS (Ortho), MRCS (Eng), MRCS (Ire), MRCPS (Glasgow)
February 28, 2016
Osteoporosis is a condition where there is an abnormal weakening of the bone due to lack of mineralthus increasing the chance of fractures following a 'trivial' injury. It is the one of the most common medical conditions affecting people around the world. Almost 70-80% of the people above 70 years suffer from this condition. It is a major health and economic problem. Osteoporosis related costs approached $17 billion in 2005 in a study conducted in the United States of America. Medical intervention can reduce the risk of an osteoporotic fracture and is cost effective; however it is often under diagnosed and untreated.
Primary osteoporosis: There are no underlying causes
Senile osteoporosis: Old age
Post menopausal osteoporosis: Accounts 80% of the osteoporosis in women
Secondary osteoporosis: 40-60% of osteoporosis in men is secondary
Drugs used in seizures (fits), steroids
Disuse: Prolonged immobilisation
Inflammatory conditions: Rheumatoid arthritis
Liver problems, digestion issues, diabetes, thyroid problems
Bone pain: Generalised body ache and easy fatiguability maybe seen.
Fragility fractures: Fractures that occur following a very trivial or minor force. Common sites are around the wrist, spine fractures and fracture around the hip joint.
Unfortunately, many patients with osteoporosis are identified only after they have sustained a fracture.
Dexa: This is the most accurate way as of now to diagnose osteoporosis. It gives scores known as the t score and the z score with the help of which osteoporosis can be diagnosed. Though accurate this test is associated with a risk of radiation exposure.
QUS (quantitative ultrasound): this is the scan that is most commonly used in the bone camps. Though not very accurate it does give a certain idea about the condition of the bone. It also does not involve any radiation exposure
X-Rays: the weakened bone can be diagnosed by a trained doctor. Usually the hip or the spine x rays are used
Apart from this blood tests may be needed including a calcium profile and other tests to rule out conditions that do cause osteoporosis as mentioned earlier.
Studies have shown that the peak bone mass that is attained in the third decade of life is a significant determinant In deciding if a person would get osteoporosis. Hence it is important to cultivate good habits at a young age to attain this goal.
Diet being a predominant factor in attaining good bone quality it is important that the right food habits are inculcated right from a very young age. Diet rich in calcium, protein and Vitamin d is important. Food rich in these ingredients include sea food, cod liver oil, green leafy vegetables, ragi, milk etc. Junk food needs to be avoided. Aerated drinks which result in the weakening of the bones should be discouraged. Smoking and alcohol also should be avoided
Exercises also help in attaining good bone mass. Sports, swimming and other physical activities should be encouraged at a very young age.
Once osteoporosis is diagnosed it needs to be attended to as soon as possible to avoid catastrophic complication like fragility fractures which would result in significant morbidly and mortality.
Calcium supplements: This forms the baseline of the treatment. 1000-1500 mg might be required to treat osteoporosis. One should also drink plenty of fluids to avoid formation of kidney stones.
Vitamin D supplements: This should be taken as it goes hand in hand with calcium supplementation. Usually 2000 iu per day or 60000 iu per week is prescribed.
Calcitonin nasal spray: It helps to improve the quality of the bone especially the spine. It has an added advantage of reducing back pain in case of fragility fractures of the back bone.
Bisphosphonates: These medications help to improve the bone strength as well. There are various preparations available which can be taken orally on a weekly or a monthly basis. One should follow the instructions given by their doctor as it can cause gastric and oesophageal irritation. It isalso available in an injectable for given on a yearly basis.
Paratharmone: It’s a self administered subcutaneous injection( like insulin) which helps to avoid fragility fractures. It is expensive but quite effective.
Hormone replacement therapy: Usually prescribed by gynecologist for post menopausal symptoms. Also helps in osteoporosis. Side effects include rare occurrence of breast and endometrial ( uterus) cancer.
Treatment of fragility fractures
Spine: Usually nonsurgical with analgesics and lumbar support belts with rest.. Takes 3 months for symptom relief. Latest treatment include vertebroplasty.
Wrist: Requires reduction and pop cast application
Hip fractures: Might need surgical intervention.
Osteoporosis is an under diagnosed problem
It can be prevented by good diet, exercise and appropriate supplements
If not dealt with can cause fragility fractures which cause significant mortality and morbidity
Better to be safe than sorry.
Dr Vivian Roshan D'Almeida
MBBS, MS (Ortho), MRCS (Eng), MRCS (Ire), MRCPS (Glasgow),
Fellow in Knee Surgery, Arthroscopy & Sports Medicine (USA, South Korea)
Consultant Orthopaedic, Knee & Arthroscopy Surgeon,
Ortho 1 Speciality Clinic.