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What is osteoporosis?
Osteoporosis is a progressive disease of multifactorial etiology resulting in thin and brittle bones with time, making them more vulnerable to breakdown with a minor fall.
Why concern:
This condition is a social burden for its impact and outcome, hence raising concern of the health care workers as there is a vast care gap. Fractures due to osteoporosis have a devastating impact on millions of people worldwide and result in enormous socio-economic costs to society and healthcare systems. Fractures caused by osteoporosis can be life-threatening and a major cause of pain and long-term disability.
Yet, despite effective medical advances to reduce fractures, a minority of men and women actually receive treatment. This is surprising to know that only 10% of elderly women presented with fractures receive the actual therapy for osteoporosis. In Europe, approximately 12.3 million high-risk people (considered to be at a high-risk for osteoporotic fractures), left untreated in 2010. Worldwide, one in three women and one in five men aged 50 years and over will suffer an osteoporotic fracture.
The Mystery of development of Osteoporosis:
Bone is uniquely a dynamic tissue. This tissue is continually changing its shape and composition in response to physical exercise, diet, and other factors. This is controlled by three major cell types within the bone tissue – osteoblasts (that form bone), osteocytes (a network of cells that provide a signal to osteoblasts and osteoclasts regarding balance for old bone destruction and new bone formation), and osteoclasts (that destroy bone). Osteocytes may survive for up to 25 years, making them one of the longest living cells in the body. They also make up 90% of all the cells of the bone. Osteocyte activity has the key roleplayer to osteoporosis development.
Low Bone density is a concern to common people as to have more prone to sustain a fracture. But surprisingly 60% of fractures occur in people found having normal bone density scans. Hence, there obviously should be some other issues in the bone composition that makes a bone vulnerable to sustain a fracture.
Risk Factors of Osteoporosis:
Non-Modifiable Risk Factors
►Thin built (bodyweight below 127lb / 57Kg)
►History of fragility fracture
►Family history of osteoporosis
►Post-Menopausal women, 65 or older of age, regardless of risk factors
►Reduced level of Oestrogen in women
Having some pre-existing medical conditions
►Rheumatoid arthritis
►Endocrinopathies( Hypercalcuira, Hyperparathyroidism, Hyperthyroidism, Cushing’s syndrome)
►Malabsorption (Gastrectomy, IBS, Celiac disease, Intestinal bypass, Pancreatic insufficiency, Primary biliary cirrhosis)
►Marrow-based and neoplastic disorders (Multiple Myeloma, hemoglobinopathies, hemolytic anemia, skeletal metastases)
►Inherited disorders (Osteogenesis imperfecta, Marfan’s syndrome, Homocystinuria)
►Osteomalacia
►Organ Transplants
Having some certain medications
► Corticosteroids for a period of 6 months or longer
► Antacids that contain aluminum, if they are overused.
► Heparin, Phenytoin, Phenobarbital, Cyclosporin
► Tetracycline, Rifampin
► Exchange resins
► Some hormonal treatments for endometriosis
► Aromatase inhibitors (used to treat breast cancer)
► Thyroid hormone replacement, when the dose is more than the body’s need.
► Depo-Provera if used more than 2 years
Modifiable Risk Factors Lifestyle Factors Include:
► Smoking
► Alcohol abuse
► Getting little or no exercise
► A diet low in foods containing calcium, phosphorus, and vitamin D
► Cola soft drinks
► Anorexia
Symptoms:
Usually less seen in the elderly. Some may suffer from –
► Back Pain due to fracture or collapsed vertebral body.
► Loss of body height over time.
► Stooped Posture
► A Fracture that occurs much more easily in minor fall.
Investigation of Osteoporosis
DEXA scan measures the bone density in the spine, total hip, and femoral neck. It compares the bone density at their peak bone mass (ages 25-30) and develops a bell curve comparison.
Treatment for Osteoporosis: The treatment should be under the guidance of the concerned doctor and individualized therapy is based on the history, pre-existing diseases, present body conditions, and medications. In summary, the common medication and measures used are –
► Calcium 1200-1500 mg/d and Vitamin D 800 -1000 IU/d
► Weight-bearing exercise (ie. Walking, jogging, small hand weights, and aerobics)
► Discontinuation of smoking and alcohol abuse
► Possible Oestrogen replacement therapy
► Possible Bisphosphonate therapy
History of World Osteoporosis Day:
On 20 October 1996, World Osteoporosis Day was launched by the United Kingdom’s National Osteoporosis Society and supported by the European Commission. The day has been organized by the International Osteoporosis Foundation (IOF) since 1997. In 1998 and 1999, the World Health Organization acted as co-sponsor of World Osteoporosis Day.
IOF was established in 1998 with the merger of the European Foundation for Osteoporosis (EFFO) and the International Federation of Societies on Skeletal Diseases (IFSSD).
In 2020, the Global Campaign theme of world Osteoporosis day (WOD) is “THAT’S OSTEOPOROSIS”, highlighting the emotionally impactful visuals and stories of real people living with osteoporosis in all regions of the world. WOD aims to make osteoporosis and fracture prevention a global health priority by reaching out to health-care workers, different media, policymakers, patients, and the public at large.
Prevention of Osteoporosis: Steps to healthy bones and a fracture-free future is summarized below.
1. Doing regular physical exercise is the best as it’s a non-drug therapy. Weight-bearing, muscle-strengthening and balance-training exercises are suggested as the best.
2. A diet chart should be followed to be rich in bone-healthy nutrients.
Calcium, vitamin D and protein are the most important elements for bone and joint health. Safe exposure to sunlight will help one to get enough vitamin D.
3. Avoid negative lifestyle habits (smoking and excessive drinking) to maintain a healthy body weight.
4. Early assessment of risk factors and raise concern to family doctor as attention for early prevention.
5. This is better to get tested and treated if needed or suffered chronic pain in back or fracture with a minor fall.
Best practice Concern:
The Capture the Fracture® (CTF) program was created by IOF in 2012 to promote secondary fracture prevention through best practice framework guidance and recognition of Fracture Liaisons Services (FLS) around the World. 224 Fracture Liaisons Services (FLS) have been established in 35 countries as part of the CTF program. The Map of Best Practice established as part of the CTF program, gives recognition to FLS by grading their level of service. The excellence obtained by the FLS is graded as gold, silver or bronze. Many other countries are also now raising concerns and level of care to be part of this.