Hello everyone today I'm sharing about osteoporosis, causes of osteoporosis and treatments of osteoporosis
What is osteoporosis?
Osteoporosis is thinning of the bones it's actually a metabolic process which occurs after menopause and when testosterone is declining so it's an important thing that needs to be screened for in people who are high risk otherwise people can end up with bone fractures.
Who is normally affected by osteoporosis?
Men and women can be affected by osteoporosis so one in three women is affected by osteoporosis and around one in five men. we also see it in pre-menopausal women and men people have had history of intake of steroids people have had abrupt onset of menopause surgical menopause and people have malabsorption and eating disorders so these patients need to be thought of quite carefully in the screening programs
What are the causes of osteoporosis?
The causes of osteoporosis are over activity of the cells called the osteoclasts. the osteoclasts are overactive so this is the metabolic process that gets switched on in osteoporosis they're overactive and break down too much bone the osteoblasts are the bone cells which build up new bone and these are less active than they should be and they don't keep up with the breakdown which is caused by the osteoclasts the whole process is a dynamic process of breakdown and build up which happens anyway but it's overactive in the osteoclast terms of breakdown in in postmenopausal women and people with osteoporosis.
What are early signs and symptoms of osteoporosis?
Often it's completely asymptomatic which is why we need to think early about screening so family history very important did my mother or grandmother somebody have a stoop of their back did they have fractures so even fractures in the elderly such as a hip fracture it's still and it's a fragility fracture they fell on the carpet it still counts as a risk factor for osteoporosis in the offspring of that person so the the genetics are very strongly predictive that somebody's had osteoporosis will have offspring with osteoporosis so that should be a red flag a warning. so often people just noticed the first time they have a fracture.
So fragility fracture of the wrist i fell over it wasn't very much but i fractured my wrist second fractures are in the spine so people can get a curved spine stooped forward and not even know that they've actually had some silent wedge fractures so it's about looking at the spine taking a history have they had a history of pain have they lost height that's the other thing so people lose height and think oh why have i lost height that is one of the things that everyone should look at whether they've got reduced bone density on a bone density scan if they've lost height or have have a fracture.
What treatment options are available? Is it curable?
Not curable but treatable and what doctor's aim to do with the medications is to prevent fractures is number one and improve bone density is number two. so they can actually visualize this on repeat bone density scans which incidentally are very safe to repeat because it's low dose x-ray so you can do it every year if you want to every two years recommended to see what the improvement in bone density is and that's what they use to measure whether patients a taking medixations having a good result but the medications are incredibly powerful and good so we have oral medications which are bisphosphonates allendronic acid you take once a week on an empty stomach first thing in the morning with tap water and then we move on to in.
So there's a whole group of bisphosphonates by mouth there's also injectable bisphosphonates which are given by infusion once a year so that means that you know patient visits and compliance is always excellent because that's controlled by the doctor of the patient and they know how much has gone into the body.
Then the third option which is used now and can be used by gps is injectable prolia or denatumab. this is like a flu jab subcutaneous injection every six months under the skin provides those being that patients have normal vitamin D, calcium and renal function test before they have the injection but it really is virtually painless and it's once every six months and it's called prolia or denatumab as it's a generic name.
What lifestyle can changes?
First go-to about a patient's lifestyle are they having enough vitamin D do they have enough vitamin D so i was measuring vitamin d levels and they find that most of the population now is deficient so it used to be thought that 50 nanomoles per liter was perfectly adequate it isn't not for osteoporosis not for preventing fractures. Doctors have patients who are above 75 nanomoles per liter on the blood test and if it's not there they replace the vitamin D with quite high dose vitamin D.
Some of the commercial products which are readily prescribed by GPS don't have adequate vitamin D they also talk in depth about the diet so are they milk avoidant, cheese, yogurt avoidant if so then they might need to add some calcium supplements but in general it's the vitamin D that's the most important supplement for people.
Otherwise the medications don't work and they'll still carry on to get fragility fractures so these are really important exercise is very very important so 30 minutes of brisk walking every day important if somebody's disabled if they can't walk then obviously some movements really important do as much walking as they can but doing resistance exercises with say physiotherapists personal trainer to strengthen the muscles in the spine so that's very important.
Remember it's all about muscle strengthening as well to support the bones and to stimulate new bone growth but the walking for those that can do it that's very helpful it improves the bone density by activating the osteoblasts so it actually the percussive movement of the feet on the pavement let's say transmits energy up to the femoral neck the femur where the hip is and and this can actually stimulate new bone growth but generally this won't if somebody's got established osteoporosis this won't work on its own it can work in addition to the medications that they give if someone's got modest or severe osteoporosis they have to have the medications to fix that really.
Don't forget to share this information to your friends and families.
Thank you
Post a Comment