OSTEOPOROSIS

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. Osteoporosis means “porous bone.”

Osteon is bone and porous is a hole in Greek. Osteoporosis is a “ Systemic skeletal disorder “ characterized by “ Low bone mass “, microarchitectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It leads to the abnormally porous bone that is compressible, like a sponge. The spine, hips, and wrists are common areas of bone fractures from osteoporosis. 

Prevalence:-  Osteoporosis is the most prevalent bone disease in the world. According to the International Osteoporosis Foundation, 1 in 3 women over 50 will experience osteoporotic fractures, as will 1 in 5 men. 
Female to male ratio 1: 6

Types of bone cells:- 
Two types:- 1) Osteoclasts 2) Osteoblasts
Bone Remodeling:- Five phases – 1) Activation 2) Resorption 3) Reversal 4) Formation 5) Quiescence (Resting phase) 

Types of osteoporosis:- 
 2 types:- a) Primary osteoporosis:
Type-1: Postmenopausal osteoporosis 
Type-2: Age-associated osteoporosis 
                b) Secondary osteoporosis Loss of bone is caused by an identifiable agent or disease process such as inflammatory disorder, bone marrow cellularity disorder, and corticosteroid use.

CAUSES:

SIGN & SYMPTOMS:

• Fractures caused by osteoporosis are often painful. Osteoporosis is often called the ‘Silent disease’ or ‘Silent thief’ as many people don’t recognize they have it until a fracture occurs. 
• Back pain: Episodic, acute, low thoracic/high lumbar pain 
• Compression fracture of the spine 
• Bone fractures 
• Decrease in height 
• Kyphosis 
• Dowager’s hump 
• Decreased activity tolerance 
•  Early satiety

RISK FACTORS:

1. Current cigarette smoking 
2. Low body weight (<127 pounds) 
3. Alcoholism 
4. Estrogen deficiency 
5. Prolonged amenorrhea (>1 year) 
6. Early menopause (<45 years) or bilateral ovariectomy 
7. Lifelong low calcium intake 
8. Recurrent falls 
9. Poor health/fragility 
10. Inadequate physical activity 
11. Family history of osteoporosis

INVESTIGATION:

Physical examination:- 

1. Osteoporosis 
2. Height loss 
3. Bodyweight 
4. Kyphosis 
5. Humped back 
6. Tooth loss 
7. Skinfold thickness 
8. Grip strength Vertebral fracture 
9.  Arm span-height difference 
10. Wall- occiput distance 
11. Rib-pelvis distance

Diagnosis:- 

1. Bone Mineral Density (BMD) test:- The most common test. Results are reported using T-scores.T-scores are relative to how much higher or lower your bone density is compared to that of a healthy adult.T-score:- It is the number of standard deviation (SD) above or below a reference value

Category T-score:
 Normal -1.0 or Above Osteopenia(Low bone mass) 
-1.0 to -2.5 Osteoporosis
 -2.5 or Less Severe osteoporosis 
-2.5 or Less with one or more fragility fracture 

Laboratory Tests:- 

1. Blood Calcium levels 
2. 24-hour urine calcium measurement 
3. Thyroid function tests 
4. Parathyroid hormone levels 
5. Testosterone levels in men 
6. 25-hydroxyvitamin D test to determine whether the body has enough vitamin D 
7. Biochemical marker tests 

TREATMENT:

Pharmacological option in osteoporosis:- 
Antiresorptive:- Act on osteoclasts and stabilize the bone 
Calcium 
Estrogen 
Calcitonin 
Bisphosphonates 
Selective estrogen receptor modulators 
Thiazide diuretics Formation:- Act on osteoblasts and increase bone formation 
 Vitamin D 
Anabolic steroids 
Parathyroid hormone 
Growth factors (investigation) 
Fluoride (investigation) 

Goals:- 

1) To educate proper posture. 

2) Teach safe ways of moving and lifting. 

3) To prevent a decline in bone mass and prevent fractures. 

4) To increase the strength in bones. 

5) To maintain or improve balance. 

6) To improve flexibility. 

7) To help decrease the stress placed on the bones by tight muscles. 

8) To improve overall mobility. 

9) To control pain and gradually returning back to regular activities. 

Physical therapy:-

1. Physical therapy intervention for individuals with osteoporosis, or even osteopenia, 
2. should include: Maintain posture, Strengthening exercise, Weight-bearing exercise, Balance exercise, Flexibility exercise.

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                                                                                     RAIN HEALTH CARE

                                                                                                 H.C. INDRAJIT BISWAS