OSTEOPOROSIS

 

INTRODUCTION:  Osteoporosis is characterized by reduced bone mass, deterioration of bone matrix, and diminished bone architectural strength. The rate of bone resorption is greater than the rate of bone formation. The bones become progressively porous, brittle, and fragile, and they fracture easily. Multiple compression fractures of the vertebrae result in skeletal deformity (kyphosis).  This kyphosis is associated with loss of height.

RISK FACTORS:  Patients at risk include postmenopausal women and small framed, nonobese Caucasian women. Other risk factors include inadequate nutrition, inadequate vitamin D and calcium, and lifestyle choices including but not limited to; smoking, caffeine intake, and alcohol consumption; genetics; and lack of physical activity.  Age-related bone loss begins soon after peak bone mass is achieved (in the fourth decade).  Withdrawal of estrogens at menopause or oophorectomy causes decreased calcitonin and accelerated bone resorption, which continues during menopausal years. Immobility contributes to the development of osteoporosis. Secondary osteoporosis is the result of medications or other conditions and diseases that affect bone metabolism. Specific disease states such as, celiac disease, hypogonadism and medications such as, corticosteroids, antiseizure medications that place patients at risk need to be identified and therapies instituted to reverse the development of osteoporosis.

ASSESSMENT AND DIAGNOSTIC FINDINGS: Osteoporosis is identified on routine x-ray films when there has been 25% to 40% demineralization.  Dual-energy x-ray absorptiometry (DEXA; DXA) provides information about spine and hip bone mass and bone mineral density (BMD).  Laboratory studies (eg, serum calcium, serum phosphate, serum alkaline phosphatase, urine calcium excretion, urinary hydroxyproline excretion, hematocrit, erythrocyte sedimentation rate [ESR]) and x-ray studies are used to exclude other diagnoses.

GERONTOLOGIC CONSIDERATIONS:  Elderly people fall frequently as a result of environmental hazards, neuromuscular disorders, diminished senses and cardiovascular responses, and responses to medications. The patient and family need to be included in planning for care and preventive management regimens. For example, the home environment should be assessed for safety and elimination of potential hazards (eg, scatter rugs, cluttered rooms and stairwells, toys on the floor, pets underfoot). A safe environment can then be created (eg, well-lighted staircases with secure hand rails, grab bars in the bathroom, properly fitting footwear).

MEDICAL MANAGEMENT:  Adequate, balanced diet rich in calcium and vitamin D.  Increased calcium intake during adolescence, young adulthood, and the middle years, or prescribe a calcium supplement with meals or beverages high in vitamin C.  Regular weight-bearing exercise to promote bone formation (20 to 30 minutes aerobic exercise 3 days/week).  Other medications: the bisphosphonates alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast); calcitonin (Miacalcin); selective estrogen receptor modulators (SERMs) such as raloxifene (Evista); teriparatide (Forteo).  Osteoporotic compression fractures of the vertebrae are managed conservatively. Patients who have not responded to first-line approaches to the treatment of vertebral compression fracture can be considered for percutaneous vertebroplasty or kyphoplasty (injection of polymethylmethacrylate bone cement into the fractured vertebra, followed by inflation of a pressurized balloon to restore the shape of the affected vertebra).

 

RELATED;

1.  CALCITONIN  

2.  BACK PAIN

3.  GOUT

4.  MEDICINE AND SURGERY

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