Postmenopausal Osteoporosis

Osteoporosis – What Is It

Osteoporosis or weakness/fragility of the bones is a common medical condition that normally occurs with advancing age. Bone strength is measured on the basis of a number of parameters, the principal of which is Bone Mineral Density (BMD). Measurements of the bone size, shape and thickness are used to determine the presence of osteoporosis. The condition is generally found in those over the age of 50 and is more common among women than men.

The Effects

Bone fractures are a common injury that can be painful and, in some cases, serious to the extent of being life-threatening. When osteoporosis is present the likelihood of bone fractures increases greatly. Minor injuries that would normally not require medical attention can cause fractures in those with osteoporosis. It is estimated that approximately 9 million fractures occur worldwide each year and a large percentage of these are due partly or in whole to osteoporosis. The complications resulting from osteoporosis include:

• An increase of 10 to 20% in the death rate from hip and spine fractures.
• The mortality rate even five years after a hip or spine fracture remains about 20% above the average.
• Fractures can result in loss of mobility, deformities, chronic pain, depression, loss of independence, other disabilities and even death.
• About 50% of osteoporosis related hip fracture patients will, for the rest of their lives, need assistance in walking and approximately 25% of them will require long term care.

Spine fractures are very common among those with osteoporosis and approximately 66% of those with this fracture do not show any early/immediate symptoms which could result in the problem becoming exacerbated. In many cases, the problem is diagnosed only incidental to a chest or abdominal x-ray being done for an unrelated reason.

Diagnosis

Diagnosis is done based on bone mass (BMD) measurement. The lower the density as compared to the average young adult density used as a reference point, the greater the risk of fractures. A computer-based program called the Fracture Risk Assessment Tool (FRAX) is used to evaluate the probability of major osteoporotic fractures in patients between 40 and 90 years of age with untreated osteoporosis.

Treatment

Treatment for osteoporosis consists of a combination of lifestyle changes and exercise and medication.

Lifestyle:

• Ensure that the daily intake of calcium is 1300 mg per day for women over 50. A doctor will be able to provide patient specific guidance.
• Ensure adequate absorption of Vitamin D by getting adequate exposure to sunlight. If this is not possible, Vitamin D supplements may be used. The doctor will able to provide patient specific doses based on requirements.
• Cessation of smoking and other tobacco use.
• Reduction in caffeine consumption, especially the amount of coffee consumed.
• Avoiding medications such as glucocorticoids that may cause bone loss.

Exercise:

• Regular exercise on an ongoing basis may reduce the risk of osteoporosis. Daily exercise of between 30 to 40 minutes is recommended
• Weight-bearing and resistance training exercises are the most beneficial. Weight-bearing exercises are those that are performed while standing up.

Medication:

Medications used to treat osteoporosis include Parathormone, Calcitonin, Bisphosphonates and selective estrogen receptor modulators. A doctor will prescribe the right medication after the patient’s condition is evaluated. In severe cases and those in which other medications are contraindicated, hormone therapy may be prescribed.

Prevention

Taking measures to prevent falling will reduce the chances of osteoporosis related fractures. These include:

• Correcting weak eyesight.
• Reduction of the use of medications that reduce alertness or affect balance.
• Making the home environment safer by fixing slippery floors, removing obstacles, ensuring lighting is sufficient and installing handrails and other safety features where required.
• The use of hip protectors, especially among the elderly, can reduce the risk of hip fractures.

Osteoporosis is a serious medical condition that can result in a variety of fractures and the resulting pain and mobility issues. Living with osteoporosis and the constant danger of fractures may also cause mental stress and depression which can affect the quality of life. Creating awareness about the condition, its prevention and safety measures for those who are suffering from it is vitally important in enabling those with osteoporosis, especially the elderly, to live full and independent lives.