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Osteoporosis - A Complete Account

Updated on September 29, 2012

Osteoporosis is a disease which involves an imbalance between bone deposition and absorption which is apparent with aging and affects large number of people around the world.  Approximately 75 million are affected with the disease in UK, USA and Japan and now it has reached an epidemic proportion. It is a systemic skeletal disease characterized by low bone mass and micro architectural deterioration with a consequent increase in bone fragility and susceptibility to fracture. On medical grounds osteoporosis is defined as a bone mineral density (BMD) below 2.5 standard deviations (SD) from the mean peak value in young adults.

There are several risk factors for osteoporosis which include:

·         Female sex

·         Increasing age

·         Early menopause

·         Caucasians & Asian race

·         Lack of exercise

·         Immobility

·         Smoking

·         Family history

·         Excessive alcohol consumption

·         Nutritional causes like low calcium intake

·         Non or delayed child bearing

·         Stress

·         Steroid intake

·         Over treatment of hypothyroidism with thyroxine

Based on the aetiology osteoporosis is divided in to two categories they are,

1. Primary

a. Type I: Post menopausal (Oestrogen deficiency, mainly trabacular bone loss. Fractures of vertebral body and distal hand)

b. Type II: Senile (slower, age related, both sexes, both cortical and trabacular, hip fractures)

c. Idiopathic (at age <50yrs)

2. Secondary

a. Endocrine: thyrotoxicosis, primary hyperparathyroidism, Cushing’s syndrome, hypogonadism, diabetes mellitus

b. Malabsorption: Coeliac disease, partial gastrectomy, liver disease

c. Rheumatological : Rheumatoid arthritis, ankylosing spondylitis

d. Malignancy: Multiple myeloma , metastatic carcinoma

e. Drugs: Steroids, heparin, thyroxine, frusemide, cytotoxics

The most striking feature in this disease is that it remains unrecognized and untreated yet it is preventable and treatable. So it is important to keep high degree of clinical suspicion in managing patients with risk factors and clinical features like back pain which may present with fracture undiagnosed wedge fracture, deformities like kyphosis, abdominal protrution or loss of height. Importance of recognizing patients with osteoporosis is as for preventive measures since they have a higher risk of falling and getting fractures which are considered as low trauma fractures, and as these patients are old therefore if they get a fracture outcome is poorer than a young getting a fracture.

The investigations needed in such patients are;

·         To establish presence of low-trauma fracture- Spine radiograph

·         Evaluate degree of osteopenia- Bone densitometry

·         Exclude 2ry osteoporosis                                                                     

·         Evaluate bone turnover – Biochemical markers, bone histomorphometry

·         Quantitative CT

·         Quantitative ultrasound measurements

·         Bone biopsy

·         Biochemical bone markers

Spinal x-rays are important in identifying wedge fractures of the spine which is one of the commonest fractures in patients with osteoporosis, X-ray will show

·         Wedge deformity(Loss of anterior height)

·         End plate deformity(Loss of middle height)

·         Compression deformity(Loss of ant, post and middle height)                                                     

Here the Bone density measurements (BMD) are important in diagnosing the disease. But till the Dual Energy X-ray absortiometry(DEXA) remains an essential step in the diagnosis of Osteoporosis. BMD is useful in prevention, screening and in optimization of treatment.

Regarding management of patients with osteoporosis, there are several therapeutic goals to be achieved such as;

· Optimizing peak bone mass- Here encourage the patient to exercise, it must be regular and weight bearing (eg: walking, aerobics); excessive exercise may lead to bone loss. Uplifting of maximum mineral bone density in young should also be considered.

· Reducing rate of bone loss-Anti resorptive agents, Hormone replacement therapy, regular exercise, maintain Ca intake, stop smoking

Biphosphonates are important group of anti resorptive agent examples are Alendronate, Editronate. They should be taken 30 min before breakfast with a full glass of water. Patient should not lie down for 30min after ingestion of the drug. It is found that HRT increases BMD over 2 yrs of treatment. It is the most useful treatment, even in elderly females. But there are several risks involve in using HRT so the compliance is very poor, 50% drop out rate one year. It can be improved by using Tibolone which is used as continuous combined HRT. Raloxifene is a Selective Estrogen Receptor Modulator (SERM).With daily treatment it is found that it increases BMD and it’s a suitable alternative to HRT in those who do not want to use or cannot use. The advantage of Raloxifene is there is no risk of endometrial cancer which is there with HRT and can be taken without regard to meals but there are several adverse effects like hot flushes, deep vein thrombosis (DVT). Calcitonin is a hormone which involved in bone deposition it has an analgesic effect in acute vertebral fracture but it is not as effective as HRT and Bophosphonates. Calcitriol is the active form of vitamin D which stimulates ca absorption and stimulates osteoblasts directly.

Other aspects of treatment are proper pain relief, stabilization of fracture, treat secondary causes. Also it is important to take measures to prevent falls during old age like; treating postural hypotension preventing drugs causing drowsiness, physiotherapy to improve balance, provide appropriate walking aids.


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    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Thank you stayingalivemoma, spinal arthritis and osteoporosis has no direct association though immobility caused by any form of arthritis can lead to osteoporosis. Spinal arthritis usually occurs with sero negative arthritis such as ankylosing spondylitis and Reiter's syndrome.

      However, we hope that our hubs on rheumatoid arthritis, SLE and osteoarthritis may also be helpful to you.

      Once again thank you for your comments and you are always welcome for comments and questions on our hubs!

    • stayingalivemoma profile image

      Valerie Washington 6 years ago from Tempe, Arizona

      useful information as I was recently diagnosed with spinal arthritis. I am reading up all I can on conditions that affect the bones and joints. Thank you!

    • VENZKHVAM profile image

      VENZKHVAM 6 years ago from Milk way galaxy, trying to find a more adventurous place in another galaxy with my great followers

      Osteo means bones, porosis means pores formation. So osteoporosis means pores formation in bones. generally this happanes aminly with people whjo are less exposed to sunlight. So majorly women whlo works indoor.



      As this dialogue is common for everything,"Prevention is better than cure" it is better to eat lot of calcium rich vegetable and food and also have an active life with outdoor activities and some sun bathing for people living in cold areas.


    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear writer20, the arthritis you are having may be rheumatoid arthritis or nodal generalized osteoarthritis. You will get more information on these diseases in our hubs

      Thank you for your comment and you are most welcome for future comments and questions!

    • writer20 profile image

      Joyce Haragsim 6 years ago from Southern Nevada

      My eldest sister and I both athritus in our hands with swollen joints. Now my big right thumb joint is giving me pain.

    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear Melissatwin1,

      thank you for your comments! We are so glad that this was helpful to you!

    • Melissatwin1 profile image

      Melissatwin1 6 years ago from Philippines

      This is such a helpful hub. Thanks for reminding me again about my health.

    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear The Blagsmith,

      The symptoms your sister is having are not directly related to osteoporosis. Since she had been diagnosed with osteoporosis, there is a possibility of her acquiring a fracture of her right wrist (Colle's fracture). The symptoms fit quite well with the carpal tunnel syndrome. So, I encourage her to read my article on carpal tunnel syndrome as well and take medical advice.

      Thank you for the comments and you are always welcome for future comments and questions!!

    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear Les Trois Chenes,

      Thank you for the comment and wish you a long life free from disease like osteoporosis!!

    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear coffeesnob,

      Bonviva is a drug preparation containing ibandronic acid a bisphosphonate. This is one of the best drugs used in the current day practice to treat diagnosed osteoporosis. However, the drug places you at a higher risk to develop oesophagial ulcers and gastritis. This could be prevented by taking the drug in the morning before taking anything with a large amount of water and staying in erect position (standing or seated - not lying down) for atleast half an hour. There after better to take a good meal containing less fat and more carbohydrates and proteins. Other side effects of the drug include mild fever like illness, headache, vomiting,diarrhoea and hypocalcaemia.

      Anyway best wishes for a healthy life free from illness and thank you for the comments. You are always welcome for comments and questions.

    • The Blagsmith profile image

      The Blagsmith 6 years ago from Britain

      My sister has recently been diagnosed with this. Her whole right arm is incapable of holding anything and gives her acute pain from time to time. It is drastically changing her life. I will get her to read this hub.

      And thanks for the follow too.

    • Les Trois Chenes profile image

      Les Trois Chenes 6 years ago from Videix, Limousin, South West France

      I'm impressed by the readability and clarity of this article. I fall into several of the risk factors and clearly must stop drinking and take a nice, long walk every evening instead. Many thanks.

    • profile image

      coffeesnob 6 years ago

      I have been taking Boniva now for two months. Is there any major concerns/risk factors with it. I take the once-per-month dose.

    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear carlop,

      Thank you for the comment. Glad that this was useful!

      As I have stated in my other comments on this hub, mild to moderate weight bearing exercises have proven to be beneficial than supplements alone after 35 years. So, it would be better to be engaged in some exercise program while taking the supplements. Wish you a life free of health problems!!

    • carolp profile image

      Carolina 6 years ago from Switzerland

      Thanks for this helpful information. I am now of my 50's and i am starting taking Vit.D, Calcium, Magnesium with Vit. C combination. I hope it will help me get rid of this health problems.

    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear acnelight,

      Osteopaenia means that your bone mineral density is between 1-2 standard deviations from the mean of the normal population. It is true that you are at risk of developing osteoporosis and the vitamin D, calcium and magnesium regieme is the right combination. However, it would be better if you also can get involved in some weight bearing exercises so that the age related loss of bone mass may be slowed down.

      Thank you for the comments and as always you are most welcome for your comments and questions.

    • acnelight profile image

      acnelight 6 years ago from Texas

      I was was told that I was osteopean which means I was maybe going to get osteoporosis so I started the calcium, vitamin D and magnesium regime. I have not had a new bone density test. I will not take Fosamax anyway. Lately I have heard about new side effects from it. Vitamins, minerals and herbs are needed to keep us healthy.

    • Nadeeshan301 profile image

      Chathurika Dhanasekara 6 years ago from Kandy - Sri Lanka

      Dear kat11,

      It is good to here that you are keen about the disease and taking measures to prevent the disease early. However, it has been shown that regular exercise helps more than supplements for the maintenance of the bone mass. So, it would be even better if you to follow a regular workout in addition to taking the supplements.

      Thank you for your comments and your are always welcome.

    • kat11 profile image

      kat11 6 years ago from Illinois

      I have a family history of this disease and have started in taking preventative measures. I take a calcium, Vitamin D and magnesium supplement in my late forties so that I will not have this disease like my aunt.