Osteoporosis is progressive loosening of the density of bone , thinning and fragile which lead to fracture easily.
Symptoms of osteoporosis include Severe back pain, Loss of height over time, stooped posture and fracture of bones with mild stress. Most of the time the patient does not know until they get fracture as they do not have significant symptoms.
The diagnosis can be done by X ray films of the hand, wrist, arm, elbow, shoulder, foot, ankle, leg (shin), knee, thigh, hip, pelvis or spine.Unfortunately, by the time X-rays can detect osteoporosis, at least 30% of the bone has already been lost. In addition, X-rays are not accurate indicators of bone density.
Bone density scan or dual-energy x-ray absorptiometry (DXA or DEXA) Scan is helpful in confirmation of diagnosis as well as quantitative assessment. The amount of x-rays absorbed by tissues and bone is measured by the DXA machine and correlates with bone mineral density. Osteoporosis is defined as a bone density T score of -2.5 or below. Osteopenia (between normal and osteoporosis) is defined as bone density T score between -1 and -2.5.Osteopenia is significant when it is associated with other risk factor.
CT scan of the spines are done to assess alignment and fracture.It can be used to measure bone density and determine whether vertebral fractures are likely to occur.
Risk factors are Female gender, Caucasian or Asian race, Thin and small body frame, Family history of osteoporosis, history of fracture ,Smoking , Low calcium diet , lack of exercise, Excessive alcohol,Low estrogen level , low testosterone level, drugs, chronic illnesses, Hyperthyroidism and hyperparathyroidism.
The goal of treatment of osteoporosis is the prevention of bone fractures by reducing bone loss or, preferably, by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fractures, none of the available treatments for osteoporosis are complete cures.It is not considered as a curable disease.
Management of osteoporosis include
- Lifestyle changes – quitting cigarette smoking, curtailing excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D
- Medications that stop bone loss and increase bone strength- Compounds called bisphosphonates are the standard of care for the treatment of osteoporosis. eg; Alendronate, Residronate, Raloxifene, Ibrandronate , Zoledronate and Calcitonine
- Calcium supplement and vitamin D
- Hormone replacement therapy where appropriate
- Excercise – Weight bearing excercise such as walking , Muscle strenghening excercise such as weight lifting
Non-impact activities such as balance, functional, and posture exercises also may benefit people with osteoporosis. Although these exercises don’t build or maintain bone density, they may increase muscle strength and decrease the risk of falls and fractures.
Review medications and treat for other cor morbidity factors and risk factors.
- Fall risk assessment by a occupational therapist to improve home safety.
- Patient education and referring to supportive and self help groups