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ABC OSTEOPOROSIS
Definition and frequency of occurrence
The definition of Osteoporosis was formulated by the World Health Organisation and it states that this generalized skeleton disease is characterized by mineral bone density decrease and micro architectural deterioration of bone tissue, which lead to enhanced bone fragility and increase the risk of fracture.
Osteoporosis affects on average around 11% of population, including 30% of women aged above 50. It is estimated that 25 million people in the USA have been suffering from Osteoporosis, whilst in Poland around 3 million. Unfortunately, as a result of population aging, the frequency of occurrence of Osteoporosis will be inevitably increasing. Women develop Osteoporosis more often than men due to the loss of estrogen during the menopause. However, regardless of gender, people aged above 40 lose 1-2% of bone mass (in the period of menopause from 5 to 10 % per year), this disease attacks also men.
Causes of Osteoporosis
Bone remodeling takes place throughout the whole of human’s life due to the constant processes of bone deterioration and formation. From birth until the moment of gaining sexual maturity girls’ bones grow in length and width (boys, until around the age of 18). At the age of 14-18 we stop growing in height but the bones still increase their density until we reach the age of 30. Then, the amount of bone in skeleton is at its maximum (called a peak bone mass). After the age of 45 the bone mass starts to reduce as the bone deterioration process dominates the bone formation. Osteoporosis is called a “silent bone thief” as it proceeds throughout the years without any symptoms and not infrequently its first signal is a fracture caused by a small fall.
The main reason why women suffer from Osteoporosis is the menopause, which results in a rapid reduction of estrogen level. There are many, so called risk factors that are in favor of developing Osteoporosis. These are: early menopause (before the age of 45), advanced age, genetic disorders, white race, a diet low in calcium and vitamin D3, smoking, drinking alcohol and coffee, not very active lifestyle.
Among all the forms of this disease, 5% are the cases of so called secondary Osteoporosis, which are caused by many disorders associated with: hyperthyroidism, hyperparathyroidism, over active adrenal glands. Some of the medications can also increase the risk of Osteoporosis. These include: glucocorticosteroids, immunosuppressive drugs, antiepileptic drugs, heparine.
Osteoporosis fractures
Fractures are inevitably the after-effects of untreated Osteoporosis. Their occurrence is so frequent that we call them fracture epidemic. It is estimated that the fractures occur in 1.5 million people per year in the USA, including 700 thousand of vertebral fractures, 300 thousand of femoral neck, 250 thousand of distal radial and 300 thousand of other fractures. The risk of fracture for a 50 year old woman is as high as 39,7%. The risk of femoral neck fracture is higher than the occurrence of nipple, uterus and ovary cancer all together, and the risk to die because of the fracture is higher than the risk of death caused by a nipple cancer.
Progressing disappearance of bone mass in vertebra decreases its strength leading to the state where even a spontaneous fracture may occur. After the age of 50 this kind of fractures affect every fourth woman and after the age of 85 every second. The consequences of spine fractures can result in chronic back pains, loss of height (even 3cm in a year), advanced thoracic kyphosis - so called “widow’s hump”. Half of the fractures develop without any symptoms. Associated with the fracture, posture deformations lead to the reduction of lungs capacity, deterioration of cardio-pulmonary system’s performance and defect of intestinal passage. It is stated that the number of deaths caused by spine fractures has increased by 15-20% in a period of 5 years.
The most dangerous are femoral neck (hip) fractures that occur with a frequency of 2,5 fractures for 1000 ihabitants (30 fractures after the age of 80). It is estimated that in a year 1990 there were 1 600 000 fractures, and as a result of population aging this number can amount to 6 260 000 in a year 2050. Femoral neck fractures are normally treated surgically. However, independently of the applied way of treatment, 20% of women and 25% of men suffering from femoral neck fracture die within a year, and those who survive become disabled.
Osteoporosis diagnosis
Osteoporosis risk test.
Normally it is a doctor who is authorised to diagnose Osteoporosis, however, everyone can check whether he/she is at risk of developing Osteoporosis by answering the test questions recommended by IOF (International Osteoporosis Foundation).
Diagnostic investigation
The main step to diagnose Osteoporosis is the bone mineral density measurement (BMD), that is densitometry. Contemporary densitometers use the measurement of X-Ray absorption, but in a very small, completely harmless dose. The DXA method (Dual Energy X-ray Absorptiometry) is the “gold standard”. The measurement for a particular person is expressed both in absolute value in g/cm2 and equivalent scores. According to WHO the score of mineral bone mass measurement, that relates to peak bone mass – so called T-score, lower than -2,5 means occurrence of Osteoporosis.
Crucial in diagnosis of Osteoporosis are the measurements of mineral density of femoral neck and vertebral. Measurements in different parts e.g forearm give rough values and should be verified.
Ultrasound indicates bone’s acoustic parameters and it is not a densitometry examination and cannot be used to diagnose Osteoporosis. The final stages in diagnosis of Osteoporosis include the interview between the patient and the doctor, physical examination, densitometry and analytical examinations.
Osteoporosis treatment
The main aim in treatment of Osteoporosis is the prevention from the first fracture, and if the first fracture occurs, then prevention from the next fractures. Currently there are many drugs with very high clinical effectiveness. These drugs increase bone mineral density and lower the risk of fracture. Independently of active medicine, every patient should receive calcium specimens (about 800mg – 1200 mg) and vitamin D3 (about 1000IU).
Nowadays in the treatment of Osteoporosis the following group of drugs is most frequently used:
Bisosphonians
Calcitonin
Estrogens and derivatives
SERMs (selective estrogen receptor modulators)
The doctor decides about the treatment and the choice of specimen.
Falls prevention
Independently of pharmacological treatment the prevention of falls is necessary, because they normally cause braking limbs. Physical condition, coexisting illnesses and taken medicine play the important role. Exercising can be a substitute for many drugs but none of the drugs can be a substitute for exercising.
Whom to ask for help?
Osteoporosis treatment is a job for specialists, such as: Rheumatologist, Orthopaedist, Gynecologist and Endocrinologist, who hold diplomas of completion of courses organized by Polish Osteoporosis Foundation. There are specialist centers assigned to Osteoporosis treatment in many places.
In the current system of Health Care in Poland free of charge diagnosis are available to patients referred from the NHS doctor, otherwise the diagnosis is charged.
The definition of Osteoporosis was formulated by the World Health Organisation and it states that this generalized skeleton disease is characterized by mineral bone density decrease and micro architectural deterioration of bone tissue, which lead to enhanced bone fragility and increase the risk of fracture.
Osteoporosis affects on average around 11% of population, including 30% of women aged above 50. It is estimated that 25 million people in the USA have been suffering from Osteoporosis, whilst in Poland around 3 million. Unfortunately, as a result of population aging, the frequency of occurrence of Osteoporosis will be inevitably increasing. Women develop Osteoporosis more often than men due to the loss of estrogen during the menopause. However, regardless of gender, people aged above 40 lose 1-2% of bone mass (in the period of menopause from 5 to 10 % per year), this disease attacks also men.
Causes of Osteoporosis
Bone remodeling takes place throughout the whole of human’s life due to the constant processes of bone deterioration and formation. From birth until the moment of gaining sexual maturity girls’ bones grow in length and width (boys, until around the age of 18). At the age of 14-18 we stop growing in height but the bones still increase their density until we reach the age of 30. Then, the amount of bone in skeleton is at its maximum (called a peak bone mass). After the age of 45 the bone mass starts to reduce as the bone deterioration process dominates the bone formation. Osteoporosis is called a “silent bone thief” as it proceeds throughout the years without any symptoms and not infrequently its first signal is a fracture caused by a small fall.
The main reason why women suffer from Osteoporosis is the menopause, which results in a rapid reduction of estrogen level. There are many, so called risk factors that are in favor of developing Osteoporosis. These are: early menopause (before the age of 45), advanced age, genetic disorders, white race, a diet low in calcium and vitamin D3, smoking, drinking alcohol and coffee, not very active lifestyle.
Among all the forms of this disease, 5% are the cases of so called secondary Osteoporosis, which are caused by many disorders associated with: hyperthyroidism, hyperparathyroidism, over active adrenal glands. Some of the medications can also increase the risk of Osteoporosis. These include: glucocorticosteroids, immunosuppressive drugs, antiepileptic drugs, heparine.
Osteoporosis fractures
Fractures are inevitably the after-effects of untreated Osteoporosis. Their occurrence is so frequent that we call them fracture epidemic. It is estimated that the fractures occur in 1.5 million people per year in the USA, including 700 thousand of vertebral fractures, 300 thousand of femoral neck, 250 thousand of distal radial and 300 thousand of other fractures. The risk of fracture for a 50 year old woman is as high as 39,7%. The risk of femoral neck fracture is higher than the occurrence of nipple, uterus and ovary cancer all together, and the risk to die because of the fracture is higher than the risk of death caused by a nipple cancer.
Progressing disappearance of bone mass in vertebra decreases its strength leading to the state where even a spontaneous fracture may occur. After the age of 50 this kind of fractures affect every fourth woman and after the age of 85 every second. The consequences of spine fractures can result in chronic back pains, loss of height (even 3cm in a year), advanced thoracic kyphosis - so called “widow’s hump”. Half of the fractures develop without any symptoms. Associated with the fracture, posture deformations lead to the reduction of lungs capacity, deterioration of cardio-pulmonary system’s performance and defect of intestinal passage. It is stated that the number of deaths caused by spine fractures has increased by 15-20% in a period of 5 years.
The most dangerous are femoral neck (hip) fractures that occur with a frequency of 2,5 fractures for 1000 ihabitants (30 fractures after the age of 80). It is estimated that in a year 1990 there were 1 600 000 fractures, and as a result of population aging this number can amount to 6 260 000 in a year 2050. Femoral neck fractures are normally treated surgically. However, independently of the applied way of treatment, 20% of women and 25% of men suffering from femoral neck fracture die within a year, and those who survive become disabled.
Osteoporosis diagnosis
Osteoporosis risk test.
Normally it is a doctor who is authorised to diagnose Osteoporosis, however, everyone can check whether he/she is at risk of developing Osteoporosis by answering the test questions recommended by IOF (International Osteoporosis Foundation).
- Did any of your parents suffer from a hip fracture caused by a small fall?
- Have you ever suffered from a bone fracture caused by a small fall?
- Have you ever used glucocorticosteroids (e.g Encorton) for longer than 3 months?
- Have you noticed a loss in your height, more than 3cm?
- Do you regularly consume alcohol (above the norm)?
- Do you smoke more than 20 cigarettes per day?
- Do you frequently suffer from diarrhea (caused by Celiac or Crohn diseases)?
- Did you go through the menopause before the age of 45?
- Did you stop menstruating 12 months ago or earlier (for other reasons than pregnancy)?
Diagnostic investigation
The main step to diagnose Osteoporosis is the bone mineral density measurement (BMD), that is densitometry. Contemporary densitometers use the measurement of X-Ray absorption, but in a very small, completely harmless dose. The DXA method (Dual Energy X-ray Absorptiometry) is the “gold standard”. The measurement for a particular person is expressed both in absolute value in g/cm2 and equivalent scores. According to WHO the score of mineral bone mass measurement, that relates to peak bone mass – so called T-score, lower than -2,5 means occurrence of Osteoporosis.
Crucial in diagnosis of Osteoporosis are the measurements of mineral density of femoral neck and vertebral. Measurements in different parts e.g forearm give rough values and should be verified.
Ultrasound indicates bone’s acoustic parameters and it is not a densitometry examination and cannot be used to diagnose Osteoporosis. The final stages in diagnosis of Osteoporosis include the interview between the patient and the doctor, physical examination, densitometry and analytical examinations.
Osteoporosis treatment
The main aim in treatment of Osteoporosis is the prevention from the first fracture, and if the first fracture occurs, then prevention from the next fractures. Currently there are many drugs with very high clinical effectiveness. These drugs increase bone mineral density and lower the risk of fracture. Independently of active medicine, every patient should receive calcium specimens (about 800mg – 1200 mg) and vitamin D3 (about 1000IU).
Nowadays in the treatment of Osteoporosis the following group of drugs is most frequently used:
Bisosphonians
Calcitonin
Estrogens and derivatives
SERMs (selective estrogen receptor modulators)
The doctor decides about the treatment and the choice of specimen.
Falls prevention
Independently of pharmacological treatment the prevention of falls is necessary, because they normally cause braking limbs. Physical condition, coexisting illnesses and taken medicine play the important role. Exercising can be a substitute for many drugs but none of the drugs can be a substitute for exercising.
Whom to ask for help?
Osteoporosis treatment is a job for specialists, such as: Rheumatologist, Orthopaedist, Gynecologist and Endocrinologist, who hold diplomas of completion of courses organized by Polish Osteoporosis Foundation. There are specialist centers assigned to Osteoporosis treatment in many places.
In the current system of Health Care in Poland free of charge diagnosis are available to patients referred from the NHS doctor, otherwise the diagnosis is charged.
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