What is osteoporosis?
Osteoporosis is a disorder of the bones in which the bones become fragile, weak and easily damaged or broken. A decrease in mineralization and bone strength over time causes osteoporosis.
Does osteoporosis only affect the elderly?
While the effects of osteoporosis are often seen in the elderly, the disorder usually begins to progress from middle age. Bones are the strongest in the middle of a person's 20s, so it's important to have a good foundation from the start to keep bones healthy later in life.
Why is osteoporosis an important public health problem?
In the United States, 10 million people have osteoporosis (80% of them are women) and 34 million are at risk of developing the disease due to low bone density. Osteoporosis is a public health problem because the disease contributes to 1.5 million fractures (broken bones), including 350,000 hip fractures per year. The cost of medical care for these injuries was approximately $ 17 billion in 2005. These injuries can also cause permanent disability or the inability to return to work or perform daily activities.
What are the symptoms of osteoporosis?
Osteoporosis may not cause any apparent symptoms. Patients may not know they have osteoporosis until they break (fracture) a bone.
Symptoms of osteoporosis: Fractures of the spine
Spinal (spinal) compression fractures are broken bones in the back that are due to weak bones caused by osteoporosis. The vertebrae (spine) collapse as a result of even minor injuries related to falls, push-ups, sprains or sneezes. As the bones of the spine lose their mineralization and strength, they can collapse, causing a stooped appearance, often referred to as a "widow's hump".
Symptoms of osteoporosis: stress fracture
Stress fractures occur in bones due to repetitive injuries, usually with minimal trauma. Patients with osteoporosis are more likely to suffer stress fractures due to weak bones.
Symptoms of osteoporosis: Hip fracture
Patients with osteoporosis have a higher risk of suffering hip fractures. Even a simple fall can cause a hip fracture in a person with osteoporosis. Due to the weakness in the bones, these injuries can take a long time or be difficult to heal completely.
What are the consequences of osteoporosis?
Fractures related to osteoporosis can cause significant pain and disability. Hip fractures are common among patients with osteoporosis. Twenty percent of patients with a hip fracture die within a year after their injury, and a third will remain in a nursing home for at least a year.
Patients who have a vertebral compression (spinal) fracture have a high risk of developing other similar fractures.
What factors determine bone strength?
Bone strength is related to bone mass (density), which refers to the amount of mineralization that remains in bones as people get older. The denser the bones, the stronger they are.
The factors that determine bone strength include:
Genetics Environment Drugs Ethnicity (African-Americans have higher bone density than Caucasians or Asians) Gender (men have higher bone density than women) Aging (Bone density reaches its peak around 25 years and decreases after age 35)
Menopause, estrogen and osteoporosis
Women tend to be diagnosed with osteoporosis more often than men because once they reach menopause The levels of estrogen decrease. Estrogen helps maintain bone density in women. Postmenopausal women can lose up to 4% of bone mass annually in the first 10 years after menopause.
What are the risk factors for developing osteoporosis?
Risk factors for the development of osteoporosis that can not be controlled include:
Female gender Ethnicity: Caucasian or Asian Family history
The risk factors for the development of osteoporosis that can be controlled include:
What are the risk factors for developing osteoporosis? (continued)
Additional risk factors for the development of osteoporosis include medical conditions such as:
Chronically low levels of estrogen vitamin D deficiency Hyperthyroidism Inability to exercise Medications, such as chemotherapy, corticosteroids or medications for seizures Hyperparathyroidism Loss of menstrual periods (amenorrhea) Inability to absorb nutrients properly in the digestive tract
How is osteoporosis diagnosed?
Osteoporosis is often diagnosed on an x-ray when the patient has a fracture. However, when osteoporosis is visible on the x-ray, there can be significant bone loss.
A dual-energy X-ray absorptiometry scan (DEXA or DXA) may be used as a screening test for osteopenia (bone loss that precedes osteoporosis). This test measures bone density in the hip and spine and is more accurate than an x-ray.
Who should have bone density tests?
The National Osteoporosis Foundation recommends that the following groups of people should undergo dual-energy X-ray absorptiometry (DEXA or DXA) scans to detect osteoporosis:
All women over 65 All postmenopausal women under 65 who have risk factors for osteoporosis Postmenopausal women with fractures Women with a medical condition associated with osteoporosis
How are bone density results measured?
The DXA scan lists the results as a "T-score." This measurement is a statistical comparison (SD or standard deviation) of the patient's bone density compared to the average maximum bone density of a young adult of the same sex and ethnicity.
A T score of -1 to -2.5 SD is characteristic of osteopenia, which is a precursor to osteoporosis. A T T score of -2.5 SD or less indicates osteoporosis
How is osteoporosis treated and prevented?
There is no current cure for osteoporosis. The treatment of osteoporosis involves stopping additional bone loss and strengthening bones that show signs of weakness. The prevention of osteoporosis is key.
Prevention and Treatment: Exercise
Exercise is important to help improve muscle strength and balance, which can decrease falls and other accidents. Exercise with weights also has the benefit of helping to strengthen the bones. Consult your doctor about the type and duration of exercise that is right for you.
A word of caution about exercise
In patients with osteoporosis, exercise can damage weakened bones. It is important to discuss with a health professional the exercises that are appropriate for patients with osteoporosis. It is also important to consider other medical problems that may also be present (heart disease, diabetes, high blood pressure) Before starting any exercise program. It is possible that some types of extreme exercise, such as running a marathon, are not recommended for patients with osteoporosis.
Prevention and treatment: stop smoking and reduce alcohol
Smoking can result in bone loss. In patients with osteoporosis, this can accelerate the progression of the disease. It also lowers estrogen levels in women, which can lead to earlier menopause and greater bone loss.
The effect of alcohol and caffeine on osteoporosis is unclear. To maintain optimal health, consume alcohol and caffeine in moderation.
Prevention and treatment: calcium supplements
Calcium intake is important for strong, healthy bones. Adequate calcium intake should occur earlier in life to help prevent osteopenia and osteoporosis.
The recommended calcium intake for all adult and adolescent women is 1,000-1,300 mg per day. Good sources of calcium in the diet include dairy products, vegetables (kale, cabbage, broccoli, spinach) and fortified foods (fruit juices, non-dairy milks, cereals). Postmenopausal women may need more calcium.
Prevention and treatment: foods fortified with calcium
Most Americans do not consume the daily amount of calcium recommended by the US. UU (USRDA, for its acronym in English). Some examples of dietary sources of calcium include milk, yogurt, cheese and fortified orange juice.
Prevention and Treatment: Vitamin D
In order to properly absorb calcium in the diet and maintain good bone health, the body also needs vitamin D for the next:
Calcium absorption in the intestines Prevents osteomalacia, which can further weaken bones Increase bone density and decrease fractures in postmenopausal women
The USRDA for vitamin D is 600 IU (international units) per day for children from 1 year to adults of 70 years. Babies under 1 year old need 400 IU, while adults age 71 and older require 800 IU.
Good sources of vitamin D include sunlight, fatty fish such as salmon or mackerel, beef liver, egg yolk, milk or orange juice enriched with vitamin D, fortified cereals and formulas for babies.
Prevention and treatment: menopausal hormone therapy
Because estrogen may play a role in maintaining strength and bone density in women, many menopausal women with osteoporosis are prescribed hormone therapy (menopausal hormone therapy, formerly called hormone replacement therapy or HRT). to prevent bone loss and fractures.
Estrogen can only be prescribed orally (Premarin, Estrace, Estratest) or as a skin patch (Estraderm, Vivelle) or together with progesterone. The combination of the two hormones can help prevent the uterus.
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