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Osteoporosis ( Bone Weakness)                 

What is osteoporosis?
What are the symptoms of osteoporosis?
What causes osteoporosis?

How is osteoporosis diagnosed?
How to diagnose the cause of osteoporosis
How is osteoporosis treated and prevented?

What is osteoporosis?

Osteoporosis is a condition in which bones become weak due to decrease in the amount of mineral & bony material in a particular bone characterized by low bone mineral density (BMD). It is one of the most common bone diseases in human being and, while traditionally thought of as a problem primarily of post-menopausal women, it is also significant problem for men. In osteoporosis bone becomes porous from inside & it has less calcium & other minerals, less strength & thus more prone to fracture & deformity .Thus osteoporotic bones are weak bones. Normally bones are made up of inner honeycomb like lamellar bone surrounded by a thick outer shell called cortical bone. In osteoporosis there is decrease density of bone and bone becomes fragile. The osteoporosis of bone weakens the bone leading to an increase in the risk of bone fracture. Bones that are affected by osteoporosis can fracture with only a minor fall or injury that normally would not cause a bone fracture.


Normal Bone Physiology: In every bone continuous cycle of old bone removal & new bone laying occurs i.e. some part of bone is removed & then immediately replaced by new bone so that after every year all most whole Skelton is replaced with new bone.

From childhood till the age of 35 years, more bone is laid down than is removed thus bone density keeps on increasing and an individual’s peak bone mass is typically achieved by around age 35. After peak bone mass is reached, the remodeling process (the process of laying down new bone and removing old bone) takes away more bone than is replaced. Hence making the bones more prone to osteoporosis (and consequently to fracture).

Thus, the process of bone loss typically begins after 35 years. Starting from about that age to the onset of menopause, women lose a certain amount of bone steadily every year. Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production may suffer.

As you age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury.

Usually, the loss occurs gradually over years. Many times, a person will have a fracture before becoming aware that the disease is present. Osteoporosis occurs when the body fails to form enough new bone or too much old bone is reabsorbed by the body, or both. Fractures may occur as a result of osteoporosis.

For your knowledge we’ll like to explain you that there are two types of cells which are constantly at work in our bones. One set builds up new bone (called osteoblastic i.e. bone forming activity) whereas another set break down old bone (called osteoclastic i.e. bone resorption activity). Up to our 35 year the construction cells work harder building strength into our skeleton. Thus in initial years of life there is more construction of bone than breakdown of old bone so that bone density as well as bone strength keeps on increasing. Our bones achieve maximum strength by the age of 35 years. From the age of 35 onwards, the demolition cells overtake and our bones gradually lose their density as a natural part of ageing. After the age of 35 year bone resorption i.e. destruction supercedes the new bone formation so bone strength & bone mineral content including amount of bone material in a particular bone starts gradually decreasing. This gradual decline in bone content occurs in every body. But in some people the bone loss is very fast compared to other people so that in few years there bone becomes very weak & becomes prone to easy fracture even on minor trauma.

The osteoporosis which occurs due to aging or not due to well defined cause is called primary osteoporosis. There are many diseases which lead too rapid degradation of bone leading to significant osteoporosis more than what is expected at that age due to aging. Osteoporosis due to these diseases is called secondary osteoporosis.

 

What are the symptoms of osteoporosis?

There are no symptoms in the early stages of the disease & the patient with osteoporosis may remain silent for decades. Many people have decreased bone mineral i.e. osteoporosis from lone time but they are not aware of it because it does not causes any symptoms in the beginning. Symptoms occurring late in the disease are Bone pain, back pain or pain on compression of the bone, Fracture with little or no trauma as fall on ground, Loss of height of spine due to forward bending because of vertebral fractures over time leading to decrease in height of vertebra,  Low back pain due to fractures of the spinal bones, Neck pain due to fractures of the spinal bones or forward bending Stooped posture

In many osteoporsis doesn't cause symptoms unless some acute bone fracture occurs. Once fracture occurs this causes severe acute pain in the affected areas. In most cases it often remains undetected until the time of this first broken bone. The most common fractures are of wrists, hips and spinal bones in people with osteoporosis.

In some patient may even have fracture of spine but because it is gradual onset patient may not have any symptom thus may escape detection until years later which is then detected during a routine x-ray of spine. 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 as back pain when crush fracture of vertebra occurs. Sometimes fractures of the spinal vertebrae can cause severe "band-like" pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic back pain as well as loss of height or curving of the spine leading to stooping forward posture which is typically seen in many older women, which gives the individual a hunched-back appearance. A fracture that occurs during the course of normal activity is called a minimal trauma 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 accidents. Hip fractures may also be difficult to heal after surgical repair because of poor bone quality.

Some persons with osteoporosis become severely disabled as a result of weakened bones. Hip fractures leave about half of patients unable to walk independently. This is one of the major reasons people are admitted to nursing homes.

Although osteoporosis is debilitating, it does not affect life expectancy.

Common complications of osteoporosis are:

Fracture of various bones: The fracture can be either in the form of hip or wrist fracture or collapse of the vertebra of the spine. The spine, hips, and wrists are common areas of osteoporosis-related bone fractures, although osteoporosis-related fractures can also occur in almost any skeletal bone area.

·                               compression fractures of the spine

·                               Disability caused by severely weakened bones

·                               Hip and wrist fractures

·                               Loss of ability to walk due to hip fractures

 

What causes osteoporosis?

  1. Deficiency of Estrogen in women hypogonadism: The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women, especially those over age 50, get osteoporosis more often than men. Estrogen plays an important part in maintaining bone strength in women. When women reach menopause their estrogen levels decreases, the rate of bone loss increases. Thus absence of menstrual periods i.e. amenorrhea for long time or  Early menopause may lead to osteoporosis.

  2. Deficiency of Testosterone in men hypogonadism: Similarly in men testosterone is very essential for maintain normal bone strength & testosterone deficiency is an important cause of osteoporosis in men.

  3. Cushing syndrome & Cushing disease i.e. cortisol excess

  4. Excess corticosteroid levels due to ongoing use of medicines for asthma or for certain forms of arthritis or skin diseases, and COPD

  5. Hyperthyroidism/ thyrotoxicosis i.e. thyroid hormone excess

  6. Hyperparathyroidism

  7. Hyperprolactinemia

  8. Idiopathic  Growth hormone deficiency

  9. vitamin D deficiency & Calcium deficiency chronic hypophosphatemia 

  10. Uncontrolled Diabetes for long time

  11. Rheumatoid Arthritis and other inflammatory conditions, SLE

  12. Drinking large amount of alcohol

  13. Anorexia Nervosa

  14. Low body weight for long time

  15. chronic heavy Smoking

  16. Too little calcium in the diet

  17. Use of certain medications, including steroids and antiseizure drugs

  18. Being confined to bed for prolong periods

  19. Bone Marrow disorders (multiple myeloma, disseminated cancer, chronic alcohol use, lymphoma)

  20. Collagen disorders (osteogenesis imperfecta, Marfans syndrome)

  21. Gastrointestinal disorders (Malabsorption, malnutrition)

  22. Medications (Aluminum antacids, anti-convulsants, chemotherapy, glucocorticoid therapy, thyroid hormone replacement)

  23. juvenile osteoporosis

  24. multiple myeloma

  25. Cancers

  26. Chronic Liver disease

  27. Chemotherapeutic (especially alklylating agents, Ionizing radiation,

  28. Chronic debilitating disease

  29. Chromosomal defect (as Downs's Syndrome, Turner Syndrome)

  30. Chronic Systemic diseases

  31. Chronic Renal disease : CRF, RTA

  32. Hematologic disease :Anemia d/t Thallasemia major sickel cell anemia

  33. Cardiac disease: Cynotic heart disease, CHF d/t any cause

  34. Malnutrition, anemia, Under nutrition of calorie, protein, & Zinc)

  35. Malabsorption: Celiac diseases, chron’s disease & Chronic Giardiasis

  36. Inborn errors of Metabolism (Mucopolysacharidosis, Galactosemia) 

 

 

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