OSTEOPOROSIS

Osteoporosis ("porous bones)is a disease of bones that leads to an increased risk of fracture

Bone is living tissue, which is constantly being absorbed and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the removal of old bone

CAUSES
Your bones are in a constant state of renewal new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Most people reach their peak bone mass by their early 20s. As people age, bone mass is lost faster than it's created.

 HOW LIKELY YOU ARE TO DEVELOP OSTEOPOROSIS DEPENDS PARTLY ON HOW MUCH BONE MASS YOU ATTAINED IN YOUR YOUTH. THE HIGHER YOUR PEAK BONE MASS, THE MORE BONE YOU HAVE "IN THE BANK" AND THE LESS LIKELY YOU ARE TO DEVELOP OSTEOPOROSIS AS YOU AGE.

RISK FACTORS
A number of factors can increase the likelihood that you'll develop osteoporosis including your age, race, lifestyle choices, and medical conditions and treatments Unchangeable risks Some risk factors for osteoporosis are out of your control, including: Your sex. Women are much more likely to develop osteoporosis than are men.

 Age. The older you get, the greater your risk of osteoporosis. Race. You're at greatest risk of osteoporosis if you're white or of Asian descent. Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures. Frame size. Men and women who have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age. A low body mass index (BMI of 19kg/m2 or less)

HORMONE LEVELS
Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include: Sex hormones. The reduction of estrogen levels at menopause is one of the strongest risk factors for developing osteoporosis. Women may also experience a drop in estrogen during certain cancer treatments. Men experience a gradual reduction in testosterone levels as they age. And some treatments for prostate cancer reduce testosterone levels in men. Lowered sex hormone levels tend to weaken bone.

 Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medication to treat an underactive thyroid.

Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.

DIETARY FACTORS
Osteoporosis is more likely to occur in people who have: Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures. Eating disorders. People who have anorexia are at higher risk of osteoporosis. Low food intake can reduce the amount of calcium ingested. In women, anorexia can stop menstruation, which also weakens bone.

Weight-loss surgery. A reduction in the size of your stomach or a bypass of part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. Lack of Vitamin D Too little vitamin D can lead to weak bones and increased bone loss. Active vitamin D, also called calcitriol , helps your body to absorb and use calcium.

STEROIDS AND OTHER MEDICATIONS

Long-term use of corticosteroid medications, such as prednisone and cortisone, interferes with the bonerebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:
Seizures Depression Gastric reflux Cancer Transplant rejection

LIFESTYLE CHOICES
Some bad habits can increase your risk of osteoporosis. Examples include: Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than do their more-active counterparts. Any weight-bearing exercise is beneficial for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful for creating healthy bones. Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis, possibly because alcohol can interfere with the body's ability to absorb calcium.

 Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones. Too much caffeine consumption - the association between high caffeine consumption and bone loss is highly suspected, but not completely proven. As caffeine is a diuretic it may increase mineral (calcium) loss. Many experts say that the phosphoric acid in sodas (fizzy drinks) may contribute to bone loss

SYMPTOMS
In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have been weakened by osteoporosis, you may have osteoporosis signs and symptoms Back pain, caused by a fractured or collapsed vertebra Loss of height over time Stooped posture or kyphosis, also called a "dowager's hump A bone fracture that occurs much more easily than expected

DIAGNOSIS
DEXA scan - this scan measures bone density. DEXA stands for Dual Energy X-ray Absorptiometry. The DEXA scan measures bone densities and compares them to a normal range. The patient is then given a 'T' score. This score describes the person's bone density compared to the average. T scores are set out in the following way:
0 or minus 1 - normal range bone density Minus 1 to minus 2.5 is a lower bone density. The patient has osteopenia (not osteoporosis) Below minus 2.5 - the patient has osteoporosis.

Ultrasound An ultrasound scan can also provide a doctor with a reliable indication of bone density. CT (computerized tomography) This can also provide a doctor with a reliable indication of bone density.
You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age

TREATMENT
The goals of osteoporosis treatment are to:
Control pain from the disease Slow down or stop bone loss Prevent bone fractures with medicines that strengthen bone Minimize the risk of falls that might cause fractures

BISPHOSPHONATES
Bisphosphonates are the primary drugs used to both prevent and treat osteoporosis in postmenopausal women. Bisphosphonates taken by mouth include alendronate (Fosamax), ibandronate (Boniv a), and risedronate(Actonel). Most are taken by mouth, usually once a week or once a month. Bisphosphonates given through a vein (intravenously) are taken less often.

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. Calcitonin appears to be less effective than bisphosphonates

HORMONE REPLACEMENT THERAPY

Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis and are not approved to treat a woman who has already been diagnosed with the condition.

PARATHYROID HORMONE
Teriparatide (Forteo) is approved 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. You can give yourself the shots at home

EXERCISE
Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include:
Weight-bearing exercises -- walking, jogging, playing tennis, dancing Resistance exercises -- free weights, weight machines, stretch bands Balance exercises -- tai chi, yoga Riding a stationary bicycle Using rowing machines Avoid any exercise that presents a risk of falling, or highimpact exercises that may cause fractures

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. Follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include: Cheese Ice cream Leafy green vegetables, such as spinach and collard greens Low-fat milk Salmon Sardines (with the bones) STOP UNHEALTHY HABITS Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone

PREVENT FALLS
It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include: Using bars in the bathtub, when needed Wearing well-fitting shoes

MONITORING
Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1 - 2 years. Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

RELATED SURGERIES
There are no surgeries for treating osteoporosis itself.

vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebrae from becoming fractured by strengthening the bones in your spinal column.
kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

COMPLICATION
Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often result from a fall and can result in disability and even death from postoperative complications, especially in older adults. In some cases, spinal fractures can occur even if you haven't fallen. The bones that make up your spine (vertebrae) can weaken to the point that they may crumple, which can result in back pain, lost height and a hunched forward posture.

PREVENTION
Calcium is essential for building and maintaining healthy bone. Vitamin D is also needed because it helps your body absorb calcium. Following a healthy, well-balanced diet can help you get these and other important nutrients throughout life. Other tips for prevention: Avoid drinking excess alcohol Don't smoke Get regular exercise