Osteoporosis - Are We a Victim?

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Osteoporosis is defined by WHO as a reduction in bone mineral density, more than two standard deviations below the corresponding age and sex matched control. It is usually defined as a disease involving elderly women who are post-menopausal. This is clearly one of the biggest subset of the patient spectrum. But, in addition, it may affect elderly men as well. And is some pathological conditions, it may affect much younger population. So, by far, nobody is immune to this disorder.

Among the many contributing factors that precipitate osteoporosis, the most important is prolonged immobility. Post-menopausal women (due to lack of estrogen), prolonged steroid therapy, anti-convulsive therapy, hypo- or hyperthyroidism, and alcoholism are among the common causes of osteoporosis.

A backache is the commonest complaint. In some patients, the diagnosis is first made when they present with a fracture of the vertebral body (most common), lower end radius (forearm) or fracture neck femur (hip). Such patients need treatment for the fracture and continued long-term prophylaxis to prevent subsequent similar events.

The golden rule to prevent osteoporosis is exercise.

This helps in adequate channelization of the Calcium and Vitamin D reserves of the body. Along with Calcium and Vitamin D supplementation in diet, and medication that block bone eating cell activity help restore the balance. Women in post-menopausal age group may need Hormone Replacement Therapy.

The medical treatment for osteoporosis includes the following categories:
1. Calcium and Vitamin D supplementation- Up to 1500 mg of Calcium in divided doses with 400 I.U. of vitamin D per day.
2. Estrogen supplementation- In post-menopausal women suffering with osteoporosis
3. Bisphosphonates- Osteophos in daily or weekly or even monthly depot injection may be administered.
4. Calcitonin- Nasal spray in the dose of 200 I.U. per day
5. Parathyroid Hormone- A novel drug with good result is low dose para-thyroid hormone; drawback is cost.

The usual duration of therapy is 18-24 months, and Dual Energy X-ray Absorption (DEXA) scan is a good guide to both diagnosis and following treatment efficacy. Osteoporosis of men is a well known entity now. Usually considered as a disorder of women, it may affect men as well in all age groups. In elderly, it is often labeled as senile osteoporosis.
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