Osteoporosis — NEXT STEP

Bone tissue is continuously lost by resorption and rebuilt by formation; bone loss occurs if the resorption rate is more than the formation rate. Menopause and advancing age cause an imbalance between resorption and formation rates (resorption becomes higher than absorption. Certain factors that increase resorption include aging, smoking, alcohol and estrogen deficiency, as well as specific risk factors such as use steroids or certain other medications.

Osteoporosis is a disease characterized by low bone mass, deterioration of bone tissue, and disruption of bone microarchitecture. It can lead to compromised bone strength and an increase in the risk of fracture. It is more common in Caucasians, women, and older people. It was reported that in both Europe and the United States, 30% women are osteoporotic, and it was estimated that 40% post-menopausal women and 30% men will experience an osteoporotic fracture in the rest of their lives. This can be improved.

Osteoporosis is a silent disease until the patient experiences a fracture. A recent fracture at any major skeletal site, such as vertebrae (spine), proximal femur (hip), distal forearm (wrist), or shoulder in an adult older than 50 years with or without trauma, should suggest that the diagnosis of Osteoporiosis.

Bone strength can be defined using a bone mineral denisity scan - dual X-ray absorptiometry (DXA); it is the actual expression of the bone in absolute terms of grams of mineral (primarily, as g/cm2 of calcium) per square centimeter of the scanned bone. BMD measurements of the hip and spine are used to establish or confirm the diagnosis of osteoporosis to predict future fracture risk and monitor patients. The difference between the patient’s BMD and mean BMD of young females aged in the range of 20–29 years creates a statistical Z-score. As defined by the World Health Organization (WHO), osteoporosis is present when BMD is 2.5 SD or more below the average value for young healthy women (a T-score of <−2.5 SD). A second, higher threshold describes “low bone mass” or osteopenia as a T-score that lies between −1 and −2.5 SD.

Several interventions, including an adequate intake of calcium and V-D, are fundamental aspects for any osteoporosis prevention or treatment program, including lifelong regular weight-bearing and muscle-strengthening exercises, cessation of tobacco use and excess alcohol intake, and treatment of risk factors for falling.

In order to maintain serum calcium at a constant level, an external supply of adequate calcium is necessary; otherwise, low serum calcium levels promote bone resorption to bring the calcium levels to normal. Calcium requirements increase among older persons; thus, the older population is particularly susceptible to calcium deficiency. The Institute of Medicine (IOM) recommends a daily intake of 1000 mg/day for men aged 50–70 years and 1200 mg of calcium for women aged over 50 years and men aged over 70 years. All calcium preparations are better absorbed when taken with food, particularly in the absence of the secretion of gastric acid. For optimal absorption, the amount of calcium should not exceed 500–600 mg per dose. This can be added to the diet as a supplement.

Vitamin D is necessary for calcium absorption, bone health, muscle performance, and balance. The IOM recommends a dose of 600 IU/day until the age of 70 years in adults and 800 IU/day. This is usually found in Calcium supplements.

Excessive intake of alcohol has detrimental effects on bones, so it should be avoided. Persons predisposed toward osteoporosis should be advised against consuming more than 7 alcoholic drinks/week. Patients should be advised to limit their caffeine intake to less than 1 to 2 servings (8 to 12 ounces in each serving) of caffeinated drinks per day.

A regular weight-bearing exercise regimen (for example, walking 30–40 min per session) along with back and posture exercises for a few minutes on most days of the week should be advocated throughout life. Among older patients, these exercises help slow bone loss attributable to disuse, improve balance, and increase muscle strength, ultimately reducing the risk of falls.

All osteoporotic patients should be evaluated for secondary causes of osteoporosis before starting treatment and subjected to BMD measurements using central DXAby their physician. Medications include estrogen; bisphosphonates (BPs) such as alendronate, risedronate, ibandronate, and zoledronic acid

Osteoporosis is a common and silent disease until it is complicated by fractures that become common. It was estimated that 50% women and 20% of men over the age of 50 years will have an osteoporosis-related fracture in their remaining life. These fractures are responsible for lasting disability, impaired quality of life, and increased mortality, with enormous medical and heavy personnel burden on both the patient’s and nation’s economy. Osteoporosis can be diagnosed and prevented with effective treatments, before fractures occur. Therefore, the prevention, detection, and treatment of osteoporosis should be a mandate of primary healthcare providers.