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Thursday, January 18, 2018

Osteoporosis: A hidden enemy

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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. Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined. Due to its prevalence worldwide, osteoporosis is considered a serious public health concern. Currently it is estimated that over 200 million people worldwide suffer from this disease.



Approximately 30% of all postmenopausal women have osteoporosis in the United States and in Europe. At least 40% of these women2 and 15-30% of men will sustain one or more fragility fractures in their remaining lifetime. Ageing of populations worldwide will be responsible for a major increase in the incidence of osteoporosis in postmenopausal women.

By 2050, the worldwide incidence of hip fracture in men is projected to increase by 240% in women and 310% in men. The estimated number of hip fractures worldwide will rise from 1.66 million in 1990 to 6.26 million in 2050, even if age-adjusted incidence rates remain stable. Osteoporosis itself has no symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.

Risk factors: The most important risk factors for osteoporosis are advanced age (in both men and women) and female sex; estrogen deficiency following menopause or surgical removal of the ovaries is correlated with a rapid reduction in bone mineral density, while in men, a decrease in testosterone levels has a comparable (but less pronounced) effect. Vitamin D deficiency, Tobacco smoking, Malnutrition, Underweight/inactive, Endurance training, Heavy metals, Soft drinks, Proton pump inhibitors, Excess consumption of alcohol etc are Potentially modifiable risk factors.

Medication: Certain medications have been associated with an increase in osteoporosis risk:
*    Steroid-induced osteoporosis
*    Barbiturates, phenytoin and some other enzyme-inducing antiepileptics
*    Anticoagulants
*    Proton pump inhibitors
*    Thiazolidinediones

Diagnosis: The diagnosis of osteoporosis can be made using conventional radiography and by measuring the bone mineral density (BMD).The most popular method of measuring BMD is dual-energy X-ray absorptiometry.

Prevention: Lifestyle prevention of osteoporosis is in many aspects the inverse of the potentially modifiable risk factors. As tobacco smoking and high alcohol intake have been linked with osteoporosis, smoking cessation and moderation of alcohol intake are commonly recommended as ways to help prevent it. Proper nutrition and physical exercise are very much protective to bone loss.

Management: Weight-bearing endurance exercise and/or exercises to strengthen muscles improve bone strength in those with osteoporosis. Medications: Bisphosphonates are useful in decreasing the risk of future fractures in those who have already sustained a fracture due to osteoporosis.

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