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Osteoporosis ( Bone Weakness)
What is osteoporosis?
Diagnostic Tests in Osteoporosis:
1) X-ray Spine: A routine X-ray can reveal osteoporosis of the bone, which appears much thinner and lighter than normal bones. Unfortunately, by the time x-rays can detect osteoporosis, at least 30% of the bone has already been lost.
2) Bone Densitometry (Dexa Bone Scan): Bone mineral density testing (specifically a densitometry or DEXA scan (i.e. dual energy x-ray absorptiometry scan) measures how much bone patient have. This is the best test the diagnosing osteoporosis. This test measures bone density in the hip and the spine.
BMD of patient compared to Young adult population is called "T score". Normal bone density is defined as bone density expressed as T score with in – 1SD (standard deviation) from the normal peak bone density as in adult. A score above -1 is considered normal; a score between -1 and -2.5 is considered osteopenia; and a score below -2.5 is considered osteoporosis. For each -1 standard deviation in T score there is a 3 times increased risk of hip fracture and a 2.5 times risk of spine fracture. Osteoporosis is defined as bone density T score of –2.5 SD or below. Osteopenia (between normal and osteoporosis) is defined as bone density T score between –1 and –2.5 SD. DEXA scan results can indicate if someone is at increased risk of sustaining a fracture.
BMD of patient compared to same age normal population called "Z score"
INVESTIGATIONS TO FIND OUT CAUSE OF
1. Complete hormone profile tests as sex hormone as total testosterone in male & estradiol in female , thyroid tests (Free T4, Free T3, TSH), prolactin, FSH, LH, & other hormone tests
2 Calcitropic Hormone & Factor tests:
a) Parathyroid hormone (intact)
b) 25 hydroxy vitamin D
c) 1,25 Hydroxy Vitamin –d
e) Urinary calcium
3. Bio-chemical test: (Hemoglobin, ESR, GBP, Alkaline Phosphatase, Calcium, Ionized Calcium, Phosphorus, Urea, Creatinine, Urine Protein, M/E ,Fasting urinary ph , Serum bicarbonate, Serum Potassium ,Serum protein, SGPT Stool
4. Tests to diagnose other systemic diseases.
Now there are lot many newer drugs are available for
osteoporosis as treatment of cause, calcium, Vitamin D, female
hormone, raloxifene, Tibolon & Biphosphonates & synthetic PTH given
with good results.
Medications that stop bone loss and
increase bone strength, such as alendronate, risedronate, raloxifene,
ibandronate, calcitonin ;
1. Bisphosphonates: Bisphosphonates are a type of drug used for both the prevention and treatment of osteoporosis. Several bisphosphonates are approved for the treatment of osteoporosis. Most are taken by mouth, usually once a week or once a month. In severe cases bisphosphonates can be given through a vein (intravenously). This class of medications includes Alendronate, Ibandronate and Risedronate is used to prevent and treat osteoporosis in both women and men. Bisphosphonates slows the rate of bone destruction by osteocalsts thus prevents the development of osteoporosis. Thus it leads to gradual strengthening of bone denisity & mineral content leading to gradual normalization of bone denisity. It also reduces the risk of bone fracture in osteoporotic patients. They are mostly taken orally.
These drug shifts bone balance toward bone formation by inhibiting bone resorption i.e. bone destruction and has been shown to increase bone mass. These drugs have ability to prevent fractures. Alendronate is taken daily or weekly. Ibandronate is taken once per month. Risendronate ( actonel or risofos) is given once a week.
2. CALCITONIN : Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection. The main side effects are nasal irritation from the spray form and nausea from the injectable form.While calcitonin slows bone loss and reduces the risk of fractures, it appears to be less effective than bisphosphonates.
3. PARATHYROID HORMONE( Forteo) : Teriparatide (Forteo) is approved in the United States for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. The course of forteo is very effective & bone strength normalizes in most patients.
4. RALOXIFENE : Raloxifene is used for
the prevention and treatment of osteoporosis. Raloxifene is similar
to the breast cancer drug tamoxifen. Raloxifene can reduce the risk
of spinal fractures by almost 50%. However, it does not appear to
prevent other fractures, including those in the hip. It may have
protective effects against heart disease and breast cancer, though
more studies are needed.
5. HORMONE REPLACEMENT THERAPY: for women female hormone estrogen replacement is given & in men male hormone testosterone replacement is given.
a) In Women: Estrogens are still used to prevent osteoporosis but are not approved to treat a woman who has already been diagnosed with the condition.
· A woman's age
· The age menopause started
· The dose of hormone therapy being considered
· Prior hormone replacement therapy taken in the past
· Quality of life issues
b) In Men: Testosterone therapy is given
6. SURGERIES : There are no surgeries
for treating osteoporosis itself. However, a procedure called
vertebroplasty can be used to treat any small fractures in your
spinal column due to osteoporosis. It can also help prevent weak
vertebra from becoming fractured by strengthening the bones in your
7. EXERCISE : Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Some of the recommended exercises include-
· Weight-bearing exercises -- walking, jogging, playing tennis, dancing
· Resistance exercises -- free weights, weight machines, stretch bands
8. DIET : Get at least 1,200 milligrams per day of calcium, and 800 - 1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium.Your doctor may recommend a supplement to give you the calcium and vitamin D you need.
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