Osteoporosis

Osteoporosis

DR. A. FAIZUL HUQ CHOWDHURY

Osteoporosis is a condition characterized by the loss of the normal density of bone, resulting in fragile bone. Osteoporosis leads to literally abnormally porous bone that is more compressible like a sponge, than dense like a brick. This disorder of the skeleton weakens the bone causing an increase in the risk for breaking bones.
Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone fracture. The fracture can be either in the form of cracking (as in a hip fracture), or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, and wrists are common areas of bone fractures from osteoporosis, although osteoporosis-related fractures can also occur in almost any skeletal bone.

Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone fracture.

Bone Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework.
This combination of collagen and calcium makes bone both flexible and strong, which in turn helps bone to withstand stress. More than 99 percent of the body's calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood.
Throughout one's lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation outpaces resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After that time, bone resorption slowly begins to exceed bone formation.
For women, bone loss is fastest in the first few years after menopause, and it continues into the postmenopausal years. Osteoporosis-which mainly affects women but may also affect men-will develop when bone resorption occurs too quickly or when replacement occurs too slowly. Osteoporosis is more likely to develop if you did not reach optimal peak bone mass during your bone-building years.
Symptoms
Osteoporosis is often called a silent disease because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse.
The osteoporosis condition can be present without any symptoms for decades, because osteoporosis doesn't cause symptoms unless bone fractures. Some osteoporosis fractures may escape detection until years later. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. Then the symptoms are related to the location of the fractures.
Fractures of the spine (vertebra) can cause severe "band-like" pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic lower back pain as well as loss of height or curving of the spine, which gives the individual a hunched-back appearance of the upper back, often called a "dowager hump."
A fracture that occurs during the course of normal activity is called a minimal trauma fracture or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.
Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial accidents. Hip fractures may also be difficult to heal after surgical repair because of poor bone quality.
Diagnosed
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. In addition, x-rays are not accurate indicators of bone density. The appearance of the bone on x-ray is often affected by variations in the degree of exposure of the x-ray film.
The National Osteoporosis Foundation, the American Medical Association, and other major medical organizations are recommending a dual energy x-ray absorptiometry scan (DXA, formerly known as DEXA) for diagnosing osteoporosis. DXA measures bone density in the hip and the spine. The test takes only 5 to 15 minutes to perform, uses very little radiation (less than one tenth to one hundredth the amount used on a standard chest x-ray), and is quite precise.
The bone density of the patient is then compared to the average peak bone density of young adults of same sex and race. This score is called the "T score," and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass.
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.
Bone density testing

Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and  calcium phosphate, a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone both flexible and strong, which in turn helps bone to withstand stress. More than 99 percent of the body's calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood.

The National Osteoporosis Foundation guidelines state that there are several groups of people who should consider DXA testing:
All postmenopausal women below age 65 who have risk factors for osteoporosis; All women aged 65 and older;
Postmenopausal women with fractures, although this is not mandatory because treatment may well be started regardless of bone density;
Women with medical conditions associated with osteoporosis. These diseases number more than 50. A primary care physician can scan a patient's list of medical illnesses to verify that one of these conditions is not present;
Women whose decision to use medication might be aided by bone density testing.
The National Osteoporosis Foundation guidelines state that bone density testing does not need to be performed if a person has a known osteoporotic fracture because the condition will be treated with or without bone density results. In addition, bone density testing is not appropriate if the person undergoing the test is not willing to take any treatment based on the results. Therefore, if bone density testing is done, it should be performed on people willing to take some specific action based on the results.
Risk for osteoporosis
During menopause, the level of estrogen produced by the ovaries greatly decreases causing the risk of bone loss to increase significantly.
Surgical menopause with the removal of the ovaries accelerates the process of bone loss to a rapid level unless estrogen replacement therapy is begun.
An inadequate intake of calcium throughout life increases the chance of bone loss since calcium is one of the main components in bone.
White women and Asian women face the greatest risk of osteoporosis.
An inactive lifestyle puts women at a higher risk for developing osteoporosis.
Women with a slender build experience more bone loss than other women.
A history of eating disorders increases the risk of osteoporosis.
Women whose family history includes osteoporosis have a higher risk of developing this condition.
Some medications such as diuretics, steroids, and anticonvulsants increase the risk.
Women who smoke or drink alcohol experience a higher incidence of osteoporosis.
If you feel that you are at risk for osteoporosis, talk with you physician. You physician may order a bone density scan which is a simple and painless tool that measures bone density. Women who do not take estrogen after menopause have other options for preventing osteoporosis including drugs which slows bone loss. Your physician can help you determine what is best for you.
Osteoporosis and nutrition
Nutrition is one of many factors that influence bone mass. Dietary intake can also impact the tendency to fall and plays a significant role in maintaining a softCalcium and Calcium Balance
Bone serves as the reservoir for 99% of the body's total calcium. Calcium is an essential nutrient for bone health. It is also needed for the heart, muscles and nerves to function properly and for blood to clot normally. The body loses calcium every day through:
Urine, Feces, Sweat, The skin, The hair, The nails.
The lost calcium is normally replaced by calcium in the diet. When the diet does not contain enough calcium to offset such losses, the body breaks down bone to release calcium needed to accommodate these physiologic demands.
The role of calcium
Calcium is important throughout a woman's life, although the amount necessary varies with age.
Children from ages 1 to 10 require 800 mg of calcium daily.
Teenagers need 1200 to 1500 mg of calcium per day.
Women between 25 and 50 need 1000 mg of daily calcium before menopause and 1500 mg after surgical or premature menopause.
Women over 50 require 1500 mg of calcium if they are not
taking estrogen and 1000 mg if taking estrogen.
Pregnant or nursing women
need an additional 400 mg of calcium daily.
Younger women who experience the symptoms of premenstrual syndrome (PMS) may be pleasantly surprised to find their symptoms are reduced by employing these osteoporosis preventing techniques. Studies show that calcium supplementation may reduce or prevent up to 50% of all PMS symptoms, and exercise is often effective for reducing PMS symptoms.
The role of vitamin D
Vitamin D is needed for the body to absorb calcium. Without enough vitamin D, we can't form enough of the hormone calcitriol (known as the "active vitamin D"), causing insufficient calcium absorption from the diet.
In this situation, the body must take its calcium from its stores in the skeleton, which weakens existing bone and prevents the formation of strong, new bone.
You can get vitamin D safely in two ways: through the skin and from the diet.
Vitamin D is formed naturally in the body after exposure to sunlight. Fifteen minutes in the sun is plenty of time to manufacture and store all of the vitamin D you need.
Experts recommend a daily intake of between 400 and 800 International Units (IU) of vitamin D, which also can be obtained from supplements or vitamin D-rich foods such as egg yolks, saltwater fish and liver. Do not take more than 800 IU per day unless prescribed by your doctor since massive doses up to and over 5,000 IU of vitamin D may be harmful.
Protein and Bone Health
It is known that high protein intake increases the calcium requirement. However, the association between protein and osteoporotic bone fractures in individuals has not been fully explored.
Reduced protein intake has been linked to low femoral neck bone density in elderly hospitalized patients. In these individuals,
clinical outcomes following hip fracture were significantly enhanced when protein intake was normalized through nutritional supplementation.
Treatment  and prevention
The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment.
Life style changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D;
Beginning a lifelong commitment to exercise and healthy nutrition while you are still young will reduce your risk of developing this condition later in life. Remember, you are never too young to think about preventing osteoporosis.
Exercise increases bone mass before menopause and helps to reduce bone loss after menopause. Bone strength increases with regular exercise-to help prevent bone loss weight-bearing exercise such as walking, low-impact aerobics, or tennis work best.
An adequate calcium intake is essential in the prevention of osteoporosis. Good sources of calcium include dairy products, leafy green vegetables, nuts, and seafood. Most women get only about half of the calcium they need everyday so taking a calcium supplement is often advisable. The best form of calcium for preventing bone loss is calcium carbonate. If you choose to use supplements, it's important that you understand that the body can only absorb up to 750 mg of calcium at one time, so you will need to divide your dose if the amount of calcium supplement you take exceeds that amount.
Vitamin D is necessary for the body to absorb calcium-milk that is fortified with vitamin D is one of the best sources. Sunlight also is an excellent source of vitamin D-being in the sun for just 15 minutes a day helps the body produce and activate vitamin D. (Reprint)

Osteoporosis

Osteoporosis DR. A. FAIZUL HUQ CHOWDHURY Osteoporosis is a condition characterized by the loss of the normal density of bone, resulting in fragile bone. Osteoporosis leads to literally abnormally porous bone that is more compressible like a sponge, than dense like a brick. This disorder of the skeleton weakens the bone causing an increase in the risk for breaking bones. Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone fracture. The fracture can be either in the form of cracking (as in a hip fracture), or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, and wrists are common areas of bone fractures from osteoporosis, although osteoporosis-related fractures can also occur in almost any skeletal bone. Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone fracture. Bone Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone both flexible and strong, which in turn helps bone to withstand stress. More than 99 percent of the bodys calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood. Throughout ones lifetime, old bone is removed (resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation outpaces resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After that time, bone resorption slowly begins to exceed bone formation. For women, bone loss is fastest in the first few years after menopause, and it continues into the postmenopausal years. Osteoporosis-which mainly affects women but may also affect men-will develop when bone resorption occurs too quickly or when replacement occurs too slowly. Osteoporosis is more likely to develop if you did not reach optimal peak bone mass during your bone-building years. Symptoms Osteoporosis is often called a silent disease because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse. The osteoporosis condition can be present without any symptoms for decades, because osteoporosis doesnt cause symptoms unless bone fractures. Some osteoporosis fractures may escape detection until years later. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. Then the symptoms are related to the location of the fractures. Fractures of the spine (vertebra) can cause severe band-like pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic lower back pain as well as loss of height or curving of the spine, which gives the individual a hunched-back appearance of the upper back, often called a dowager hump. A fracture that occurs during the course of normal activity is called a minimal trauma fracture or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb. Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial accidents. Hip fractures may also be difficult to heal after surgical repair because of poor bone quality. Diagnosed 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. In addition, x-rays are not accurate indicators of bone density. The appearance of the bone on x-ray is often affected by variations in the degree of exposure of the x-ray film. The National Osteoporosis Foundation, the American Medical Association, and other major medical organizations are recommending a dual energy x-ray absorptiometry scan (DXA, formerly known as DEXA) for diagnosing osteoporosis. DXA measures bone density in the hip and the spine. The test takes only 5 to 15 minutes to perform, uses very little radiation (less than one tenth to one hundredth the amount used on a standard chest x-ray), and is quite precise. The bone density of the patient is then compared to the average peak bone density of young adults of same sex and race. This score is called the T score, and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass. 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. Bone density testing Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone both flexible and strong, which in turn helps bone to withstand stress. More than 99 percent of the bodys calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood. The National Osteoporosis Foundation guidelines state that there are several groups of people who should consider DXA testing: All postmenopausal women below age 65 who have risk factors for osteoporosis; All women aged 65 and older; Postmenopausal women with fractures, although this is not mandatory because treatment may well be started regardless of bone density; Women with medical conditions associated with osteoporosis. These diseases number more than 50. A primary care physician can scan a patients list of medical illnesses to verify that one of these conditions is not present; Women whose decision to use medication might be aided by bone density testing. The National Osteoporosis Foundation guidelines state that bone density testing does not need to be performed if a person has a known osteoporotic fracture because the condition will be treated with or without bone density results. In addition, bone density testing is not appropriate if the person undergoing the test is not willing to take any treatment based on the results. Therefore, if bone density testing is done, it should be performed on people willing to take some specific action based on the results. Risk for osteoporosis During menopause, the level of estrogen produced by the ovaries greatly decreases causing the risk of bone loss to increase significantly. Surgical menopause with the removal of the ovaries accelerates the process of bone loss to a rapid level unless estrogen replacement therapy is begun. An inadequate intake of calcium throughout life increases the chance of bone loss since calcium is one of the main components in bone. White women and Asian women face the greatest risk of osteoporosis. An inactive lifestyle puts women at a higher risk for developing osteoporosis. Women with a slender build experience more bone loss than other women. A history of eating disorders increases the risk of osteoporosis. Women whose family history includes osteoporosis have a higher risk of developing this condition. Some medications such as diuretics, steroids, and anticonvulsants increase the risk. Women who smoke or drink alcohol experience a higher incidence of osteoporosis. If you feel that you are at risk for osteoporosis, talk with you physician. You physician may order a bone density scan which is a simple and painless tool that measures bone density. Women who do not take estrogen after menopause have other options for preventing osteoporosis including drugs which slows bone loss. Your physician can help you determine what is best for you. Osteoporosis and nutrition Nutrition is one of many factors that influence bone mass. Dietary intake can also impact the tendency to fall and plays a significant role in maintaining a softCalcium and Calcium Balance Bone serves as the reservoir for 99% of the bodys total calcium. Calcium is an essential nutrient for bone health. It is also needed for the heart, muscles and nerves to function properly and for blood to clot normally. The body loses calcium every day through: Urine, Feces, Sweat, The skin, The hair, The nails. The lost calcium is normally replaced by calcium in the diet. When the diet does not contain enough calcium to offset such losses, the body breaks down bone to release calcium needed to accommodate these physiologic demands. The role of calcium Calcium is important throughout a womans life, although the amount necessary varies with age. Children from ages 1 to 10 require 800 mg of calcium daily. Teenagers need 1200 to 1500 mg of calcium per day. Women between 25 and 50 need 1000 mg of daily calcium before menopause and 1500 mg after surgical or premature menopause. Women over 50 require 1500 mg of calcium if they are not taking estrogen and 1000 mg if taking estrogen. Pregnant or nursing women need an additional 400 mg of calcium daily. Younger women who experience the symptoms of premenstrual syndrome (PMS) may be pleasantly surprised to find their symptoms are reduced by employing these osteoporosis preventing techniques. Studies show that calcium supplementation may reduce or prevent up to 50% of all PMS symptoms, and exercise is often effective for reducing PMS symptoms. The role of vitamin D Vitamin D is needed for the body to absorb calcium. Without enough vitamin D, we cant form enough of the hormone calcitriol (known as the active vitamin D), causing insufficient calcium absorption from the diet. In this situation, the body must take its calcium from its stores in the skeleton, which weakens existing bone and prevents the formation of strong, new bone. You can get vitamin D safely in two ways: through the skin and from the diet. Vitamin D is formed naturally in the body after exposure to sunlight. Fifteen minutes in the sun is plenty of time to manufacture and store all of the vitamin D you need. Experts recommend a daily intake of between 400 and 800 International Units (IU) of vitamin D, which also can be obtained from supplements or vitamin D-rich foods such as egg yolks, saltwater fish and liver. Do not take more than 800 IU per day unless prescribed by your doctor since massive doses up to and over 5,000 IU of vitamin D may be harmful. Protein and Bone Health It is known that high protein intake increases the calcium requirement. However, the association between protein and osteoporotic bone fractures in individuals has not been fully explored. Reduced protein intake has been linked to low femoral neck bone density in elderly hospitalized patients. In these individuals, clinical outcomes following hip fracture were significantly enhanced when protein intake was normalized through nutritional supplementation. Treatment and prevention The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment. Life style changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D; Beginning a lifelong commitment to exercise and healthy nutrition while you are still young will reduce your risk of developing this condition later in life. Remember, you are never too young to think about preventing osteoporosis. Exercise increases bone mass before menopause and helps to reduce bone loss after menopause. Bone strength increases with regular exercise-to help prevent bone loss weight-bearing exercise such as walking, low-impact aerobics, or tennis work best. An adequate calcium intake is essential in the prevention of osteoporosis. Good sources of calcium include dairy products, leafy green vegetables, nuts, and seafood. Most women get only about half of the calcium they need everyday so taking a calcium supplement is often advisable. The best form of calcium for preventing bone loss is calcium carbonate. If you choose to use supplements, its important that you understand that the body can only absorb up to 750 mg of calcium at one time, so you will need to divide your dose if the amount of calcium supplement you take exceeds that amount. Vitamin D is necessary for the body to absorb calcium-milk that is fortified with vitamin D is one of the best sources. Sunlight also is an excellent source of vitamin D-being in the sun for just 15 minutes a day helps the body produce and activate vitamin D. (Reprint)