STATEN ISLAND, N.Y. — Osteoporosis or porous bone is an illness in which the bones of the body become weakened. Such porous bones have less bone mass, which makes them more likely to break leading to various bone fractures.
It is an illness that used to remain undiagnosed until a person had a bone fracture. But with modern-day X-ray techniques we can diagnose it much earlier, especially when used on those more prone to develop a bone fracture. This can help prevent the progression of osteoporosis as well as its dreaded complication: Bone fractures and their associated disabilities.
Bones are made up of a special mineralized cell matrix that forms a honeycomb-like, three-dimensional structure, which gives it rigidity, and structure. But as you age and because of various other factors the matrix loosens and the bones become porous.
This makes them prone to fractures, especially at hip, spine and wrist joints even from the smallest of accidents or falls. These fractures can be very disabling, especially if the patient develops a dowager’s hump or hip fracture. They can either lead to chronic pain or a walking disability.
Osteoporosis is a very common disease. In fact, it is as common as diabetes or high blood pressure. It has been diagnosed in 4 to 6 million individuals in the United States and is accountable for a whopping 1.3 million fractures a year. It chiefly affects older people. Both men and women suffer from osteoporosis, but women are at the greatest risk of developing osteoporosis. Women are four times as likely as men to develop osteoporosis.
In women osteoporosis usually develops after menopause, making it postmenopausal osteoporosis. It is caused chiefly because of decreased estrogen levels in postmenopausal women. This occurs especially in women of small body structure or with personal or family history of fractures or osteoporosis.
Osteoporosis also develops in the presence of other medical conditions, in which case it’s called secondary osteoporosis. It occurs in conjunction with various hormonal imbalance diseases like hyperthyroidism or hypogonadism or with chronic diseases like chronic kidney disease or malabsorption disease.
Osteoporosis may also develop with the use of various medications like steroids, which are used for asthma or arthritis. Poor nutritional intake of vitamins and minerals, such as calcium and vitamin D, cigarette smoking, excessive caffeine or alcohol consumption and a sedentary lifestyle may all lead to osteoporosis.
Although there are many conditions that predispose an individual to get osteoporosis, your primary care physician would determine if you run the risk of developing osteoporosis. The physician would then order blood tests and X-rays to diagnose osteoporosis. It is therefore important to visit your primary care physician regularly so that the disease can be diagnosed early and prevented from progressing.
DIAGNOSIS & TREATMENT
The most widely used test for diagnosing osteoporosis is dual-energy X-ray absorptiometry also called DEXA. DEXA uses special X-rays to scan the bones especially the hip and spine bones to measure the bone mineral density. The DEXA gives an overall score of bone mineral density also called the BMD. This score called the T-score helps to determine the possibility of incurring a fracture in a given individual. There are other tests like special types of CT scan and ultrasound, which can also be used to determine the density of the bone but are not that popular.
Depending on the T-score and other risk factors, your physician will determine if you need treatment for osteoporosis. The condition can be prevented and treated by medicines called bisphosphonates along with clcium and vtamin D supplements.
Other therapies using estrogen agonists or hormone replacement therapy are also available. The type of therapy used depends on the individual patient’s risks as determined by the primary care doctor.
The other common non-pharmacologic approach to preventing osteoporosis and slowing its progression is eating a diet rich in calcium and vitamin D, exercising regularly and quitting smoking. Once osteoporosis develops, it becomes a lifelong condition. So changes in diet and exercise along with medication need to be continued throughout your life.
Prevention of osteoporosis should start in as early as childhood. Although it manifests itself usually late in one’s life the prevention should begin very early in life. And the same healthy lifestyle measures should be followed all through the latter years to keep your bones healthy and strong.
It is recommended that women should have a total dietary calcium intake between 1000 and 1500 mg of elemental calcium a day along with 400 to 800 international units (IU) of vitamin D. Regular weight-bearing and muscle-strengthening exercise such as walking is an excellent preventive therapy. One should avoid excessive caffeine, salt and alcohol intake and quit smoking.
This column is provided by the Richmond County Medical Society. The author, Dr. Sangita Parab, is an active member in the medical society. She specializes in internal medicine and maintains a practice in New Dorp.