Introduction

Osteoporosis is defined as a systemic skeletal disease characterised by weak and brittle bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Sometimes the bones can become so brittle that activities like bending over, lifting a vacuum cleaner or coughing can cause a fracture.

Osteoporosis related fractures have been recognised as a major health problem, particularly in the elderly. The common sites of fracture are the spine, wrist and hip. Hip fractures are associated with high morbidity and a mortality rate of up to 20% in the first year. Majority of those who survive are disabled and only 25% will resume normal activities.

In 1997, the incidence of hip fracture in Malaysia among individuals above 50 years of age was 90 per 100,000. There was a marked increase in the incidence among the older age group. The incidence of hip fracture is consistently higher in women .

Causes

In most cases, the brittle and weak bones are caused by low levels of calcium, phosphorous and other minerals in your bones. Osteoporosis can also accompany endocrine disorders or result from excessive use of drugs such as corticosteroids.

The strength of your bones depends on their mass and density. Bone density partially depends on the amount of calcium, phosphorus and other minerals. When your bones contain less mineral, their strength is decreased. Activities like hiking, swimming, pilates, and running help improve bone density and lowers your risk of developing osteoporosis.

At menopause, when estrogen levels drop, bone loss in women accelerates to about 1 percent to 3 percent a year. Around age 60, a woman’s bone loss slows but doesn’t stop. At the same time, bone loss in men accelerates so that by age 65, men lose bone at the same rate as do women. As women age, they may have lost between 35 percent and 50 percent of their bone mass. Men may have lost 20 percent to 35 percent.

Risk factors

Osteoporosis is a silent disease without any symptoms in most patients until fractures occur. While screening is not cost effective, identification of risk factors will help in case finding.

Non modifiable risks :

• Advancing age
• Ethnic group (Oriental & Caucasian)
• Female gender
• Premature menopause (< 45 years) including surgical menopause
• Slender build
• Family history of osteoporosis

Modifiable risks :

• Low calcium intake
• Sedentary lifestyle
• Cigarette smoking
• Excessive alcohol intake
• Excessive caffeine intake

Signs and symptoms

In the early stages of bone loss, you usually have no pain or symptoms. But once bones have been weakened by osteoporosis, you may have signs and symptoms that include :

• Back pain
• Loss of height over time, with an accompanying stooped posture
• Fracture of the vertebrae, wrists, hips or other bones with minor injury

Diagnosis

Doctors can detect early signs of osteoporosis using a variety of devices to measure bone density. The best screening test for osteoporosis is dual energy X-ray absorptiometry (DEXA). This procedure is quick, simple, and gives accurate results. It allows your doctor to measure the density of bones in your spine, hip and wrist – the areas most likely to be affected by osteoporosis. Other tests that can measure bone density include ultrasound and quantitative CT scanning.

When to seek medical advice?

Early detection is important in osteoporosis. You may be able to slow the disease if you are aware that you have it or prevent it if you discover you’re likely to develop it. Consider your risk factors, then discuss your risk with your doctor and plan your prevention strategy. If you are a woman, it’s best to do this well before menopause.

Treatments

Selective Estrogen Receptor Modulators (SERMs) :

Selective estrogen receptor modulators (SERMs, e.g. raloxifene at 60 mg daily) improves and preserves bone density at both the spine and hip with a reduction in the risk of breast cancer.

Bisphosphonates :

Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass and even increase bone density in your spine and hip. In general, bisphosphonates may reduce your risk of hip and spine fractures by about 50 percent. Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They’re also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis. Side effects can include nausea, abdominal pain and irritation of the esophagus. Bisphosphonates include alendronate and risedronate, which are taken orally.

Calcitonin:

Calcitonin is an anti-resorptive agent. Calcitonin has also been shown to have an analgesic effect for acute pain relief in osteoporosis related fractures.

Calsium:

In established osteoporosis, calcium supplementation alone is not adequate. However, calcium supplementation has been shown to potentiate other treatment modalities.

Vitamin D

Vitamin D supplementation at 800 IU/day in combination with calcium has been shown to reduce fracture in elderly populations with vitamin D deficiency.

Prevention

Get adequate calcium and vitamin D.

Exercise –exercise can help you build strong bones and slow bone loss.

Don’t smoke

Avoid excessive alcohol

Limit caffeine