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Author: DAVID P JOHNSON MB ChB FRCS FRCS. MD
Consultant Orthopaedic Surgeon
Introduction Osteoporosis is one of the commonest metabolic bone diseases characterised by low bone mass and structural deterioration of bone tissue. It affects all age groups, both sexes and all races. It occurs more frequently in the women over 50 years of age and often remains undetected. It is thought that 1 in 2 women will have an osteoporotic related fracture in their lifetime.
Anatomy/ Physiology Bone is complex living tissue providing support for muscles, protecting vital organs and storage of Calcium and other minerals. It consists of a thicker outer shell and a strong inner mesh resembling a honeycombed stricture with blood vessels and bone marrow. It is consistently being broken down by specialised cells and then rebuilt in a process known as remodelling. In the normal ageing process, bone breaks down quicker than it can be replaced. However, if the rate of bone destruction increases, this leads to increased fragility of the bone structure with an increased likelihood of sustaining a fracture.
Indications/ Symptoms Any bones can be affected, the more common ones affected being hips and vertebrae (spine). Frequently there are no visible symptoms until fracture occur, usually as a result of trauma. There are many recognised risk factors.
There is increased risk of having Osteoporosis if you:
Have a small, thin body frame
Have a family history of osteoporosis
Have an oestrogen deficiency
Have had an early induced menopause from surgery
Have a low Calcium intake
Have a Vitamin D deficiency
Have an inactive lifestyle, smoke or drink alcohol excessively
Are taking other medication for Chronic Medical conditions
Diagnosis The most accurate method of diagnosis is with bone density tests. These can detect bone mass and detect osteoporosis before a fracture occurs. The commonest is the dual energy x-ray absorption scan (DeXA scan) which can determine the rate of bone loss and monitor the progress of treatment, if done at regular intervals.
Treatment There are 4 main steps to take in decreasing the risks of osteoporosis
Maintain a balanced diet with Calcium and Vitamin D
Maintain a healthy lifestyle
Increase the amount of Weight-Bearing Exercise
Use medication to affect bone density.
Drugs Most of these have specific brand names and their use must be discussed with your General Practitioner. These are the most frequently used drug groups.
Biophosphonates- These are non-hormonal drugs that maintain bone density and therefore have the potential to decrease fracture rates.
Vitamin D- This is a fat-soluable vitamin used for controlling absorption of Calcium from the intestines. Only 10 % of the daily-recommended intake is needed from diet, the rest is produced by exposure of the skin to sunlight. Sources include butter, fatty fish, milk and orange juice.
Calcium supplements- It is advised to aim for 1200mg per day most of which is obtainable from an adequate diet. Good sources of Calcium include dairy products, sardines, green leafy vegetables and juices.
Parathyroid Hormone therapy- These drugs stimulate bone formation.
Calcitonin- this stops excessive reabsorption of calcium from the bones.
Complications Fractures are the most serious complications arising from osteoporosis. As a result of an osteoporotic fracture, patients may experience chronic pain and alteration of lifestyle. Research shows that 6 months after sustaining a hip fracture only 15% of the population can walk across a room unaided and 1 in 3 people who were ambulant pre-fracture require long term care afterwards.
Outcome Early prevention and treatment (including regular bone density testing) are essential in the appropriate management of osteoporosis. Patients are encouraged to take a greater responsibility for their own health by taking steps to decrease the rate of bone loss and the risk of falling. A good diet, assessment of household hazards, exercise and a healthy lifestyle is recommended.
www.Ortho500.co.uk – patient information – Osteoporosis
Disclaimer: The views expressed in this article are not necessarily those of Orthopaedic Opinion Online or the author. The information is provided for general background reading only and should not be relied upon for treatment. Advice should always be taken from a registered medical practitioner for individual circumstances and for treatment of any patient in any circumstances. No liability is accepted by Orthopaedic Opinion Online, or the author in respect to the information provided in respect of the content or omission or for any reason or as a result of treatment in individual circumstances. This information is not for use in the USA.