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Osteoporosis (OP) is defined as the condition in which
bone density is decreased. Hence, fractures may occur easier after trauma than it would
for normal bone. Hip fracture is the most serious consequence of OP. Other common
consequences include forearm, foot, and vertebral fractures.
Risk Factors
Potentially modifiable factors are sexual hormone deficiency states, menopause, decrease
in the number of menstrual periods, low calcium intake, inactive lifestyle, tobacco use,
alcoholism, bone-thinning drugs (steroids, anticonvulsants, heparin) and low weight. Other
risk factors include age, heredity (blacks have the lowest incidence), and being female.
Diagnosis
Bone density can be assessed by single photon absorptiometry or dual energy x-ray
absorptiometry. These techniques are far superior to plain radiographic studies.
Treatment and Prevention
Although OP is clinically manifest in the elderly, prevention efforts should include all
age groups.
A. Calcium is not sufficient to prevent OP, but it is an important factor for its
prevention.
B. Hormonal replacement therapy (HRT) is the most effective preventive modality for women,
resulting in about a 50% reduction in fractures. As mentioned in our section on menopause, a new medication by the name of
Raloxifene has estrogen-like benefits in the bone but doesn't effect breast or uterine
tissue. Thus, it does not increase the occurrance of breast or uterine cancer.
C. Exercise (walking, running, dancing, aerobic exercise, sports, weight lifting) has
has skeletal as well as cardiovascular, muscular, and emotional benefits for all
age groups.
D. Calcitonin. This medication is also useful for the treatment of osteoporosis.
E. Bisphosphonates.
F. Vitamin D. Homebound, elderly people, and others who do not receive adequate sun
exposure should receive vitamin D daily.
G. Physical therapy. Gait and balance training may prevent falls and thus fractures.
Spinal extension exercises and instruction in lifting technique may prevent vertebral
crush fractures. Brief bed rest and local heat complement analgesics in managing
compression fractures. Protective padding may prevent hip fractures in elderly people who
fall.
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