Osteoporosis

Osteoporosis

OVERVIEW:

Osteoporosis is a skeletal disease characterized by severe bone loss sufficient to predispose to fractures of the vertebral column, leg, arm, pelvis, or ribs.

SIGNS AND SYMPTOMS:

• Back ache, pain
• Curvature of the spine
• Fractures in the absence of trauma
• Loss of height
• Depression
• Gastrointestinal symptoms

CAUSES:

Multiple factors; in many cases, the exact cause is unknown

SCOPE:

30-40% of women and 5-15% of men will develop osteoporosis.

MOST OFTEN AFFECTED:

Osteoporosis can be diagnosed in individuals from 8 years of age to the elderly. It is more common in females than males and in Caucasians and Asians than in African-Americans or Latinos.

RISK FACTORS:

• Dietary: inadequate calcium, excessive phosphate/protein; inadequate vitamin D
• Physical: immobilization, sedentary lifestyle
• Alcohol, smoking, caffeine
• Medical: chronic diseases, malabsorption, hormone disorders
• Drug therapy: corticosteroids, thyroid hormone replacement, heparin, chemotherapy, diuretics, anticonvulsants, radiation therapy
• Heredity

DIAGNOSIS

PHYSICAL EXAMINATION:

• The Physician will assess the presence and degree of osteoporosis.
• Numerous diseases can cause similar signs and symptoms, including cancers and other bone disorders.

TESTS AND PROCEDURES:

• Blood tests
• Urinalysis
• X-rays
• Specialized radiology procedures may be done, including bone mineral density (BMD) measurement.
• A sample of bone tissue may be obtained for laboratory analysis (rare).

TREATMENT

GENERAL MEASURES:

• Osteoporosis is usually managed in the outpatient setting.
• Acute back pain may require hospitalization, especially for vertebral fractures and upper leg and pelvic fractures.
• Nursing home or home care may be needed following fractures.
• Treatment is directed at relief of pain and disability, e.g., heat, pain relievers, physical therapy.

ACTIVITY:

• Walk 1 mile twice a day. If possible, try swimming and bicycling.
• Avoid exercises and maneuvers that increase compressive forces and mechanical stress on bone.
• Rehabilitation may be prescribed for back-muscle spasm and walking.

DIET:

• Reducing diet if overweight.
• Calcium intake 1500 milligrams per day (mg/day) from all sources, if not contraindicated.
• Avoid excess phosphate or protein intake, i.e., avoid phosphoric-acid-containing beverages and excess meat intake.
• 600-800 international units (IU) of vitamin D daily from all sources

MEDICATIONS

COMMONLY PRESCRIBED DRUGS:

• Hormone replacement therapy (HRT) [estrogen/progesterone]
• Synthetic salmon calcitonin nasal spray (Miacalcin)
• Oral synthetic salmon calcitonin (Osteocalcin, Calcimar, Miacalcin)
• Alendronate (Fosamax)

CONTRAINDICATIONS:

Numerous contraindications; read product information.

PRECAUTIONS:

Numerous precautions; read drug product information.

DRUG INTERACTIONS:

None

Other Drugs:

• Etidronate disodium
• Sodium fluoride
• Tamoxifen
• Raloxifene
• Hormones

FOLLOW UP

PATIENT MONITORING:

• The Physician should be seen monthly during start of therapy, every 2-4 months thereafter.
• Annual gynecological examination, breast examination, and mammography
• Repeat x-rays every 3 years, more often when indicated
• Annual or every other year bone mineral density test

PREVENTION/AVOIDANCE:

• Diet, exercise, and hormone replacement at menopause
• Increased calcium intake and adequate vitamin D intake
• Correction of treatable medical conditions and other risk factors

COMPLICATIONS:

WHAT TO EXPECT:

• In 70% patients, treatment will lead to stabilization.
• Small increases in bone mass occur in many cases.
• Reduced pain, increased mobility

MISCELLANEOUS

OTHER FACTORS:

N/A

PEDIATRIC:

A juvenile form of osteoporosis exists.

GERIATRIC:

N/A

OTHERS:

N/A

PREGNANCY:

Osteoporosis of pregnancy exists but is rare.

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Medical Diagnosis » O » Osteoporosis