Written By: Abier Hamami. RPH. CPHQ What is Osteoporosis?
Osteoporosis means porous bones. It is characterized by increase tendency of fractures due to progressive bone loss.

Who is affected by Osteoporosis?
Osteoporosis usually occurs at old ages and in women more than men (One in two women and one in five men over age 65).

What are the causes of Osteoporosis?
Many elements could contribute and increase the incidence of osteoporosis as:
Aging: with age the body builds less new bones to replace losses of old bones.

Heredity: Small, slim body build; fair skin; and a Caucasian or Asian background can increase the risk for osteoporosis.

Nutrition and lifestyle: Low calcium diet, poor nutrition, smoking, excessive alcohol use, lack of sports, and deskbound work.

Medications and Diseases: some medications could cause osteoporosis as steroids or chemotherapy, and diseases such as the thyroid gland abnormality, and malabsorption.

What are the symptoms of osteoporosis?
Osteoporosis is a silent disease that doesn’t cause symptoms unless bone fractures. Some osteoporosis fractures may escape detection until years later. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. Then the symptoms are related to the location of the fractures.

How is Osteoporosis diagnosed?
It is diagnosed by complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests.

What is a bone densitometry and who should do it?
Bone densitometry is an X-ray technique that compares the patient bone density to the peak bone density that someone of a same sex and ethnicity should have reached at about age 20 to 25, when it is at it's highest.

The American Osteoporosis Foundation guidelines state that there are several groups of people who should consider DXA testing:

All postmenopausal women below age 65 who have risk factors for osteoporosis;All women aged 65 and older;Postmenopausal women with fractures, although this is not mandatory because treatment may well be started regardless of bone density;Women with medical conditions associated with osteoporosis. These diseases number more than 50. A primary care physician can scan a patient’s list of medical illnesses to verify that one of these conditions is not present;Women whose decision to use medication might be aided by bone density testing.

What should be done to prevent osteoporosis?

· Include adequate amounts of calcium in your diet:
Dairy products, including yogurt and cheese, are excellent sources of calcium. An eight-ounce (240 ml) glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones and green leafy vegetables, including broccoli and collard greens. If your diet doesn't contain enough calcium, dietary supplements can help. The National Academy of Sciences makes the following recommendations regarding daily intake of calcium:

o Males and females 9 to 18 years: 1,300 mg per day

o Women and men 19 to 50 years: 1,000 mg per day

o Pregnant or nursing women up to age 18: 1,300 mg per day

o Pregnant or nursing women 19 to 50 years: 1,000 mg per day

o Women and men over 50: 1,200 mg per day

Talk to your doctor before taking a calcium supplement.

· Include adequate amounts of vitamin D in your diet:
Also dairy products are an excellent source of vitamin D. (A cup of milk contains 100 iu).The recommendation for vitamin D is 200-600 iu daily. Vitamin supplements can be taken if your diet doesn't contain enough of this nutrient. (A multivitamin contains 400 iu of vitamin D), again consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic.

· Exercise regularly 3-4 times a week
This include weight bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting.

What medications are used for treatment?

All current treatment methods can reduce bone loss, but there are no proven methods of restoring lost bone. The following are the most common used treatments:

· Estrogen Replacement Therapy (ERT) is recommended for women at high risk for osteoporosis to prevent bone loss and reduce fracture risk. It is known to prevent also some heart diseases, but could increase the risk of breast cancer.

· Selective Estrogen Receptor Modulators (SERMs) as Raloxifene (Evista) They increase bone mass, decrease the risk of spine fractures and lower the risk of breast cancer.

· Calcitonin, a hormone given either as a shot under the skin (subcutaneously) or into the muscle (intramuscularly), or inhaled nasally (intranasally). Intranasal calcitonin is the most convenient of the three methods. It increases bone mass, limits spine fractures and may offer some pain relief.

· Bisphosphonates, including Alendronate(Fosamax), Risedronate (Actonel), Ibandronate(Boniva) markedly increase bone mass and prevent both spine and hip fractures.

· Teriparatide (Forteo) is a synthetic version of the human parathyroid hormone, which helps to regulate calcium metabolism. It promotes the growth of new bone, while the other osteoporosis medications improve bone density by inhibiting bone resorption.

References:

· http://www.medicinenet.com/osteoporosis/page5.ht

· American Academy of Orthopedic Surgeonshttp://orthoinfo.aaos.org/brochure/thr_report.cfm&topcategory=Osteoporosis&Thread_ID=13

· National Osteoporosis Foundation http://www.nof.org/osteoporosis/diseasefacts.htm