Obesity should be corrected
What is osteoporosis?
Osteoporosis is the most common metabolic disease of bone and is found most frequently in elderly women when it is known as post menopausal osteoporosis. It may occur in elderly men (senile osteoporosis) and rarely in younger people (Idiopathic osteoporosis). There is a wide variation in the geographical and racial incidence of generalized osteoporosis. For example, in the United States it is more prevalent in Caucasian than in Africans.
A physiological decrease in skeletal mass occurs in all persons from the age of 40 to 50 onwards; the process is more marked in women, and in some individuals it would appear to be accelerated by factors which are largely unknown. In post menopausal a failure of estrogen secretion and in men diminished androgen formation may contribute.
In women post menopausal osteoporosis Calcium absorption is reduced; serum1,25 (OH) 2D tends to be low. Calcitonin secretion is lower in women than in men and declines with age. A major function of this hormone appears to be prevention of unwanted bone resorption. Calcitonin levels our strikingly increased by estrogen in post menopausal women.
Inadequate physical activity promotes generalized osteoporosis and may, in part at least, account for high incidence of this condition in affluent societies. Immobilisation by splinting, inflammation or pain is the main cause of local osteoporosis.
Generalized osteoporosis may be secondary to prolong treatment with adrenal corticosteroids; it occurs in various endocrine disorders, notably Cushing's Syndrome and Hypogonadism, and also in severe malnutrition and chronic renal disease. Osteoporosis, like anemia may therefore be end result of a number of diverse process.
- The patient is usually an elderly woman who is otherwise healthy.
- There may be no disability despite obvious radiological abnormality.
- There are episodes of severe pain usually due to fracture of the brittle bones often occurring after minimal trauma.
- The lumber and thoracic vertebrae, neck of femur, the upper end of the humerus and the lower end of the radius are the commonest site of the fracture.
- More persistent back ache is a later feature of osteoporosis due to progressive compression or collapse of several vertebrae.
- This may result in loss of stature and in kyphosis.
- Healing is not impaired as it occurs pain usually subsides.
- Persistent elsewhere is not a feature of osteoporosis but is more characteristic of osteomalacia, paget's disease or skeletal metastasis.
- In contrast to these conditions there is also a tendency for spontaneous improvement to occur in osteoporosis.
- Ideopathic osteoporosis is occasionally found in younger person in whom it also tends to be self limiting.
- The radiological changes are more marked in axial skeleton than in the limbs.
- They consist of loss of bone density, reduction in the number and size of trabeculae and thinning of the cortex.
- The upper and lower surfaces of the lumbar and thoracic vertebral bodies become biconcave and later compression or collapse causes anterior wedging.
- In blood, the Calcium, Phosphorous and Alkaline Phosphotase levels are normal in contrast to OSTEOMALACIA
- Any primary factor such as excessive corticosteroid therapy or endocrine disease should be corrected if possible.
- The patient should know that the natural history of the disease is characterised by spontaneous improvement and that suitable regular exercise is beneficial.
- The patient should remain ambulant if symptoms permit.
- The use of spinal support is undesirable.
- Immobilisation following a fracture should be limited to the part involved and accompanied by graduated by remedial exercise.
- It should remain in mind that OSTEOMALACIA can coexist with fracture of the neck of the femur.
- Cyclical OESTROGEN therapy may be prescribed for otherwise healthy post menopausal women
- An adequate intake of VITAMIN D and CALCIUM should be ensured. Cow's MILK is the best source of Calcium, half a litre provides about 600 mg of Calcium.
- Obesity must be avoided and if present should be corrected.
- Floride and also 1Alpha OH-D, combined with Oestrogens are under investigation. There is evidence that Calcium supplements are beneficial.
- The use of Sodium Floride and also 1 Alpha OD-D, combined with Oestrogens are under investigation..