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Description: Osteoporosis Definition

Osteoporosis is a disease in which bones become weak and brittle. If left unchecked, osteoporosis can progress painlessly until a bone breaks (fracture). Any bone can be affected, but of special concern are fractures of the hip, spine, and wrist.

Causes

Throughout life, old bone is removed and new bone is added to the skeleton. During... More

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Osteoporosis Definition

Osteoporosis is a disease in which bones become weak and brittle. If left unchecked, osteoporosis can progress painlessly until a bone breaks (fracture). Any bone can be affected, but of special concern are fractures of the hip, spine, and wrist.

Causes

Throughout life, old bone is removed and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger and denser. Peak bone mass is reached around age 30. From that point on, more bone is lost than is replaced. If not treated, bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if optimal bone mass was not achieved during the bone-building years.

Bone density also plays a role in bone health. Bone density is determined in part by the amount of calcium, phosphorus and other minerals contained within the framework of the bone. As the mineral content of a bone (especially calcium) decreases, the bone becomes weaker. Getting enough calcium and vitamin D and exercising regularly can help ensure that bones stay strong throughout life. Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

* Abnormal cessation of menstrual periods (amenorrhea) due to anorexia nervosa, rigorous exercise, or an endocrinological problem
* Age: risk increases with age
* Anorexia
* Body size: small, underweight women
* Cigarette smoking
* Depression
* Diseases including:
      o Alcoholism
      o Cancer, including lymphoma
      o Cushing's syndrome
      o Gastrointestinal disorders
      o Hyperparathyroidism
      o Hyperthyroidism
      o Liver disease, including cirrhosis
      o Marfan's and Ehler-Danlos syndromes
      o Scurvy
* Excessive use of alcohol, coffee and tea
* Family members with osteoporosis
* Inactive lifestyle
* Low estrogen levels in women
* Low testosterone levels in men
* Low-calcium diet
* Medications:
      o Aluminum-containing antacids
      o Anticonvulsants
      o Cholesterol-lowering drugs
      o Immunosuppressants, such as prednisone and other steroids, methotrexate, cyclosporine
      o Long-term heparin therapy
      o Thyroid drugs
* Post-menopausal status
* Race: Caucasian and Asian women
* Sex: female
* Too little sunlight

Symptoms

Osteoporosis does not usually cause symptoms. Pain is the only symptom, and generally occurs when the bones have broken or collapsed.

Symptoms include:

* Loss of height, with stooped posture (kyphosis)
* Severe back pain with fracture of the vertebrae, wrists, hips, or other bones

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Early signs of osteoporosis can be detected with bone density testing.

Bone density testing techniques include:

* Dental x-rays of bone
* Dual-energy x-ray absorptiometry - measures bone density in the entire body
* Single-energy x-ray absorptiometry - measures bone density in the arm or heel
* Ultrasound bone density measurement - measures bone density in fingers, heels, leg bones

Other tests may include:

* Blood and urine tests - to test for calcium levels or substances created when bone is broken down

Treatment

Treatment includes:

Nutrition

Eat a balanced diet rich in calcium and vitamin D. Consider decreasing your intake of caffeinated beverages and alcohol. Calcium is abundant in:

* Calcium-fortified products
* Canned fish with bones
* Dairy products
* Green leafy vegetables

Smoking

Do not smoke. If you smoke, quit.

Exercise

Exercise improves bone health and increases muscle strength, coordination, and balance. Maximum benefits are gained from doing weight-bearing exercises, including strength-training exercises. Balance training may help prevent falls and fractures. Dietary Supplements

People who cannot consume enough calcium from food might want to consider calcium supplements. Other vitamins and minerals may be recommended, including vitamin D, magnesium, vitamin K, and potassium. Talk to your doctor or dietitian before you begin taking dietary supplements. Medications

These include medications to prevent bone loss, increase bone density, and reduce the risk of spine and hip fractures.

Raloxifene (Evista) - one of a class of drugs known as selective estrogen receptor modulators (SERMS) that appears to prevent bone loss of the hip, spine, and total body. It is approved for both prevention and treatment of osteoporosis.

Bisphosphonates (alendronate [Fosamax]; risedronate [Actonel]) - reduce bone loss, increase bone density, and reduce the risk of spine and hip fractures

Calcitonin - slows bone loss, increases spinal bone density, and may relieve pain from bone fractures

Fluoride – low doses of monofluorophosphate to decrease pain and fractures in the spine

Hormone Replacement Therapy (HRT) – Although HRT (including estrogen replacement therapy, or ERT) may cut the risk of osteoporosis in half, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.

HRT therapy may include:

* Estrogen alone (also referred to as Estrogen Replacement Therapy or ERT)
* Estrogen and Progestin - estrogen combined with progestin (frequently preferred for women with an intact uterus because ERT slightly increases the risk of uterine cancer)
* Foods containing soy - may improve bone mass because they contain plant estrogens

HRT can:

* Increase bone density
* Reduce bone loss
* Reduce the risk of hip and spinal fractures in postmenopausal women

Safety Measures

Because falls can increase the likelihood of fracture in someone with osteoporosis, the following measures are recommended:

* Install grab bars in bathrooms.
* Keep rooms free of clutter.
* Use a cane or walker for added stability.
* Use plastic or carpet runners when possible.
* Wear rubber soled shoes for traction.

Prevention

Building strong bones throughout the early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis, none of which is likely to be effective by itself.

* A balanced diet rich in calcium and vitamin D
* Bone density testing and medications where appropriate:
      o Actonel
      o Evista
      o Fosamax
* Healthful lifestyle (no smoking and moderate alcohol)
* Weight-bearing exercise

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