·
Osteoporosis weakens
bone and increases risk of bones breaking.
·
Bone mass (bone
density) decreases after 35 years of age, and bone loss occurs more rapidly in
women after menopause.
·
Key risk factors for
osteoporosis include genetics, lack of exercise, lack of calcium and vitamin D,
personal history of fracture as an adult, cigarette smoking, excessive alcohol
consumption, history of rheumatoid arthritis, low body weight, and family
history of osteoporosis.
·
Patients with
osteoporosis have no symptoms until bone fractures occur.
·
The diagnosis of
osteoporosis can be suggested by X-rays and confirmed by tests to measure bone
density.
·
Treatments for
osteoporosis, in addition to prescription osteoporosis medications, include
stopping use of alcohol and cigarettes, and assuring adequate exercise, calcium, and vitamin D
What is osteoporosis?
·
Osteoporosis is a
condition characterized by a decrease in the density of bone, decreasing its
strength and resulting in fragile bones. Osteoporosis literally leads to
abnormally porous bone that is compressible, like a sponge. This disorder of
the skeleton weakens the bone and results in frequent fractures (breaks) in the
bones. Osteopenia is
a condition of bone that is slightly less dense than normal bone but not to the
degree of bone in osteoporosis.
·
Normal bone is
composed of protein, collagen, and calcium, all of which give bone its
strength. Bones that are affected by osteoporosis can break (fracture) with
relatively minor injury that normally would not cause a bone to fracture. The
fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a
compression fracture of the vertebrae of the spine). The spine, hips, ribs, and
wrists are common areas of bone fractures from osteoporosis although
osteoporosis-related fractures can occur in almost any skeletal bone.
What are osteoporosis symptoms and signs?
·
Osteoporosis can be
present without any symptoms for decades because osteoporosis doesn't cause
symptoms until bone fractures. Moreover, some osteoporotic fractures may escape
detection for years when they do not cause symptoms. Therefore, patients may
not be aware of their osteoporosis until they suffer a painful fracture. The
symptom associated with osteoporotic fractures usually is pain; the location of the pain depends on the location of the
fracture. The symptoms of osteoporosis in men are similar to the symptoms of
osteoporosis in women.
·
Fractures of the spine
(vertebra) can cause severe "band-like" pain that radiates from the
back to the sides of the body. Over the years, repeated spinal fractures can
lead to chronic lower back pain as
well as loss of height and/or curving of the spine due to collapse of the
vertebrae. The collapse gives individuals a hunched-back appearance of the
upper back, often called a "dowager hump" because it commonly is seen
in elderly women.
·
A fracture that occurs
during the course of normal activity is called a minimal trauma, or stress fracture.
For example, some patients with osteoporosis develop stress fractures of
the feet while walking or stepping off a
curb.
·
Hip fractures
typically occur as a result of a fall. With osteoporosis, hip fractures can
occur as a result of trivial slip-and-fall accidents. Hip fractures also may
heal slowly or poorly after surgical repair because of poor healing of the
bone.
·
Osteoporotic bone
fractures are responsible for considerable pain, decreased quality of life,
lost workdays, and disability. Up to 30% of patients suffering a hip fracture
will require long-term nursing-home
care. Elderly patients can develop pneumonia and
blood clots in
the leg veins that can travel to the lungs (pulmonary
embolism) due to prolonged bed rest after the hip fracture.
Osteoporosis has even been linked with an increased risk of death. Some 20% of
women with a hip fracture will die in the subsequent year as an indirect result
of the fracture. In addition, once a person has experienced a spine fracture
due to osteoporosis, he or she is at very high risk of suffering another such
fracture in the near future (next few years). About 20% of postmenopausal women
who experience a vertebral fracture will suffer a new vertebral fracture of
bone in the following year.
What factors determine bone strength?
·
Bone mass (bone
density) is determined by the amount of bone present in the skeletal structure.
Generally, the higher the bone density, the stronger the bones. Bone density is
greatly influenced by genetic factors, which in turn are sometimes modified by
environmental factors and medications. For example, men have a higher bone
density than women, and African Americans have a higher bone density than
Caucasian or Asian Americans.
·
Normally, bone density
accumulates during childhood and reaches a peak by around age 25. Bone density
then is maintained for about 10 years. After age 35, both men and women will
normally lose 0.3%-0.5% of their bone density per year as part of theaging process.
·
Estrogen is important in
maintaining bone density in women. When estrogen levels drop after menopause,
loss of bone density accelerates. During the first five to 10 years after menopause, women can suffer up to 2%-4%
loss of bone density per year! This can result in the loss of up to 25%-30% of
their bone density during that time period. The accelerated bone loss after
menopause is a major cause of osteoporosis in women, referred to as
postmenopausal osteoporosis.
What are osteoporosis risk factors and causes?
The following are
factors that will increase the risk of developing osteoporosis:
·
Female gender
·
Caucasian or Asian
race
·
Thin and small body
frame
·
Family history of
osteoporosis (for example, having a mother with an osteoporotic hip fracture
doubles your risk of hip fracture)
·
Personal history of
fracture as an adult
·
Cigarette smoking
·
Excessive alcohol
consumption
·
Lack of exercise
·
Diet low
in calcium
·
Poor nutrition and
poor general health
·
Malabsorption
(nutrients are not properly absorbed from the gastrointestinal system) from
conditions such as celiac sprue
·
Low estrogen levels in
women (such as occur in menopause or with early surgical removal of both
ovaries)
·
Low testosterone levels
in men (hypogonadism)
·
Chemotherapy that
can cause early menopause due to its toxic effects on the ovaries
·
Amenorrhea (loss
of the menstrual period)
in young women is associated with low estrogen and osteoporosis; amenorrhea can
occur in women who undergo extremely vigorous exercise training and in women
with very low body fat (for example, women withanorexia nervosa)
·
Chronic inflammation,
due to chronic diseases such as rheumatoid
arthritisor liver diseases
·
Immobility, such as
after a stroke,
or from any condition that interferes with walking
·
Hyperthyroidism,
a condition wherein too much thyroid hormone is
produced by the thyroid gland (as in
Grave's disease) or is ingested as thyroid hormone medication
·
Hyperparathyroidism is
a disease wherein there is excessive parathyroid hormone production by the
parathyroid gland, a small gland located near or within the thyroid gland.
Normally, parathyroid hormone maintains blood calcium levels by, in part,
removing calcium from the bone. In untreated hyperparathyroidism, excessive
parathyroid hormone causes too much calcium to be removed from the bone, which
can lead to osteoporosis.
·
When vitamin D is lacking, the body cannot
absorb adequate amounts of calcium from the diet to prevent osteoporosis. Vitamin D
deficiency can result from lack of intestinal absorption of the
vitamin such as occurs in celiac sprue and primary biliary
cirrhosis.
·
Certain medications
can cause osteoporosis. These include long-term use of heparin (a
blood thinner), antiseizure medications such asphenytoin (Dilantin) and
phenobarbital, and long-term use of oralcorticosteroids (such
as prednisone).
·
Inherited disorders of
connective tissue, including osteogenesis imperfecta, Marfan syndrome, Ehlers-Danlos
syndrome,homocystinuria,
and osteoporosis-pseudoglioma syndrome.
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