What is Osteoporosis?
Osteoporosis is a disease characterised by a decrease in
bone mass and deterioration of the bone micro-architecture which results in
bone fragility and susceptibility to fractures, it currently affects over two
million Australians. Osteoporosis most commonly occurs in females usually
postmenopausal (over 60years), but can still occur in males. It is more common
in females partly because the peak bone mass in males occurs during the third
decade of life and then slowly declines at 4% per decade. Whereas females
maintain their peak bone mass until menopause, then it declines at 15% per
decade.
The onset of osteoporosis is governed by a combination of
genetic and environmental factors. Some of those being, advanced age, prior
fracture, history of a femur fracture, family history, low bone mass,
rheumatoid arthritis, premature menopause, smoking and alcohol abuse.
Types of Osteoporosis + Symptoms
There are three types of osteoporosis, type 1
(postmenopausal) which is thought to be due to a deficiency in estrogen which
leads to accelerated bone loss. Type 2 (senile) which is due to decreased bone
formation. Type 3 which is bought on by medication such as glucocorticoids.
Diagnosis of Osteoporosis is made via a bone density scan and a T Score
<-2.5 indicates Osteoporosis.
Osteoporosis maybe asymptomatic, it have a mild generalized
ache or there maybe a sharp sudden onset of pain as a result of a fracture. The
most common locations fractures occur include, the hips, spine and wrists.
Treatment
The key to Osteoporosis is not in the treatment but in the
early detection as it can substantially improve the overall outcome. The
current treatment options available according to the research literature
include:
- Biphosphonates (alendronate and risedronate)-are first line
pharmacological drugs both which can substantially reduce the risk of hip and
vertebral fractures but are contraindicated in patients with upper
gastronintesinal disease.
- Selective Estrogen-Receptor Modulaters (Raloxifene)-are an
alternative first line pharmacological drug that provides considerable
protection against vertebral fractures through inhibiting bone resorption and
increasing bone mineral density. It also reduces the risk of breast cancer, the
major side effect though are hot flushes.
- Strontium Ranelate-is a relatively new drug which appears to
increase bone mineral density within the spine and hips and reduce the risk of
fracture, but its side effects include nausea, diarrhea and an increased risk
of venous thromboembolism.
- Diet-has only been proven to have a moderate relationship
with Osteoporosis, but increasing fruit and vegetable intake as well as soy
products and reducing salt levels, may reduce the risk of Osteoporosis
fractures.
- Calcuim and Vitamin D-calcium is required for bone formation
and remodeling, an intake of 1500mg/day is recommended, sources include dairy,
fish with bones, green vegetables, legumes. Vitamin D is required for the
absorption of calcium, without it calcium can't be absorbed, an intake of
400-800IU/day is recommended, sources include fatty fish (Salmon, Mackerel),
20mins of UV sunlight. Both calcium and Vitamin D are important nutritional
requirements in the older population.
- Physical Activity-there is convincing evidence suggesting
exercise especially that which maintains or increases muscle strength,
co-ordination and balance is beneficial in reducing the risk of falls and
preventing Osteoporosis fractures. Furthermore regular lifetime weight bearing
activity (especially vigorous impact exercise) increases peak bone mass in
youth which helps maintain those levels later in life.
Sources
Orthopedia, Traumatologia, Rehabilitacja, World
Health Organisation, Osteoporosis International, Geriatrics, Pharmacotherapy,
Drugs and Aging, Cochrane Database Systems Review, Physical Medicine and
Rehabilitation Clinics of North America, Clinical
Rehabilitation, The Medical Journal of Australia,
New England Journal of Medicine
Click here to download this file
Level 2, 343 Little Collins Street Melbourne, 3000 P: 03 9670 9950
