Osteoporosis means weak bones. In this common disease, bones loose minerals like calcium and the amount and variety of bone propeins is altered. They become fragile and break easily. The compact woven structure of the bone becomes loosely woven. It is a skeletal systemic disease characterised by low bone mass and microarchitectural deterioration of bone tissue with consequent increase in bone fragility and susceptibility to fracture.

As per WHO, it is defined as . . .0 bone mineral density that is 2.5 strandard deviations or more below the mean peak bone mass (average of young, healthy adult) as measured by DXA.

The term" Established Osteoporosis" includes the presence of a fragility fracture. It is classified as:

Primarylype 1, (post menopausal osteoporosis)

Primarylype 2.(Senile Osteoporosis occurring after 75 yrs in both males and females.) Secondary Osteoporosis.(Due to some disease or drugs).

Osteoporosis can lead to Kyphosis, Pain, Height loss or fractures. Commonest fracture sites being Spine, hip and wrist.

It is also called The" Silent Disease" as the bone loss occurs without symptoms.

Bones are living organs and Calcium is deposited and withdrawn from bones daily. Bones build to about age 30. We need to build up a healthy bone account while young and continue to make deposits with age. After mid-30's, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too. Bonescan weaken early in life without a healthy diet and the right kinds of physical activity.

Risk factors:

Age, Prior fragility # after 50 yrs age, Underweight for height., Smokers, Female gender, Low BMI, Heredity, Early menopause, More than 2 drinks several times a week, Diet poor in calcium, Less activity, Medications like : Oral glucocorticoids (steroids),Cancer treatments (radiation, chemotherapy), Thyroid medicine, Antiepileptic medications, Gonadal hormone suppression, Immunosuppressive agents, Medical Conditions- like: Hyperthyroidism, Chronic lung disease, Cancer, Inflammatory bowel disease, Chronic liver or kidney disease, Hyperparathyroidism, Vitamin D deficiency, Cushing's disease, Multiple sclerosis, Rheumatoid arthritis.

Clinical Features

In itself, there are not much clinical symptoms. Generralised bone pains, feeling of loss of height, development of kyphosis in old age can be suggestive. Fracture with a trivial injury catches the diagnosis and the features will depend upon the site of fracture.

Investigations

·       Plain X-ray of the spine will show Photo frame appearance.

·       X-ray of the pelvis with both hip joints can help us grade the osteoporosis as per Singh's Index.

·       DXA scan for BMD when T-score is less than 2.5

·       Renal function tests

·       Serum calcium, Albumen and phosphorus levels.

·       Serum Vit-D level.

·       Biochemiocal markers of bone resorption

Prevention

The National Osteoporosis Foundation (NOF) recommends FIVE simple steps to bone health and osteoporosis prevention

·                 Get your daily recommended amounts of calcium and vitamin D.

·                 Engage in regular weight- bearing exercise

·                 Avoid smoking and excessive alcohol

•                          Talk to your doctor about bone health

•                          Have a bone density test and take medication when appropriate.

How to get enough Calcium everyday'

Dietary Calcium Sources

•                          Dairy- low fat yogurt, skim milk, cheese, chocolate pudding, ice milk, ice cream or frozen yogurt.

•                          Protein- tofu, sardines, salmon

•                          Vegetables- turnip greens, Spinach, Broccoli, collard greens

•                          Other foods: cheese pizza, calcium fortified orange juice, vegetable lasagnia.

•                          An easy way to meet calcium needs is consuming 3 cups (8 oz.) each day of fat-free or low-fat milk or equivalent milk products in combination with a healthy diet.

Vitamin D

Main dietary sources of vitamin D are: Fortified milk (400 IU per quart) Some fortified cereals, Cold saltwater fish (Example: salmon, halibut, herring, tuna, oysters and shrimp) Some calcium and vitamin/mineral supplements

From sunlight exposure

Vitamin D is manufactured in your skin following direct exposure to sun. Amount varies with time of day, season, latitude and skin pigmentation. 10-15 minutes exposure of hands, arms and face 2-3 times/week may be sufficient (depending on skin sensitivity) Clothing, sunscreen, window glass and pollution reduce amount produced.

Drugs used for Post-menopausal Osteoporosis Bisphosphonates

Alendronate                                     70 mg/wk

Risendronate                                   35 mg/wk

Ibandronate                                     150mg/mo

Calcitoni n                                        100 U/d by inj. Or 1 Nasal spray/d

Raloxifene (non-hormonal)            60 mg/d

PTH (Teriparatide)                         20 ugld byinl.