Osteoporosis
The term osteoporosis means porous bones. Osteoporosis is a metabolic disorder characterized by progressive loss of bone mass making the bones increasingly weak and prone to fractures. In the initial stages it is undetected till the development of a fracture. Fractures of the hip, spine, leg, arm and wrist are more common in these patients, usually secondary to a fall. With the progression of the disease, the patient may experience low back and neck pain due to a fracture of the spinal vertebrae. In severe cases, osteoporosis may lead to a vertebral compression fracture resulting in a loss in overall height (around 6 inches) and a stooped back which is also known as dowager’s hump.
Causes and risk factors
The exact cause of osteoporosis is not clear. The major risk factors associated with an increase in the incidence of osteoporosis include:
Age and gender: After the age of 35 years, the body gradually loses bone mass. Hence, the greater the age, the higher the risk for osteoporosis. Moreover, women are four times more prone to osteoporosis when compared to men. Thus, older women over 50 are at a high risk for osteoporosis.
Family history and ethnicity: Caucasians, Hispanics and Asians are at an increased risk to develop osteoporosis. This risk is further increased by a small, thin body frame and a family history of fractures. Hence heredity plays an important role in the development of osteoporosis.
Endocrine disorders: Endocrine disorders such as hyperparathyroidism and thyroid problems increase the risk of osteoporosis by adversely affecting the process of bone formation.
Medications: Hormone replacement therapy for prostate cancer or breast cancer, long term corticosteroid therapy (more than 3 months) and some anti-epileptic drugs increase the risk for osteoporosis.
Nutrition and lifestyle: A sedentary lifestyle, smoking, excessive alcohol intake and poor nutrition with a calcium deficient diet make an individual highly prone to develop osteoporosis.
Eating disorders: These may lead to a deficiency of essential nutrients required for healthy bone and thereby increase the risk for osteoporosis.
Rheumatoid arthritis: Rheumatoid arthritis is an auto immune disease associated with bone loss at the affected joints. This increases the risk for joint fractures.
Diagnosis
The diagnosis of osteoporosis includes medical and family history, physical examination and radiological examination (X-ray). If these examinations detect a low bone mass, additional lab tests may be ordered to rule out other conditions associated with bone loss. A bone scan using Dual Energy X-ray Absorptiometry (DEXA) may be performed to measure bone density or bone strength. It is a safe and simple test with a high accuracy and sensitivity which can detect osteopenia, a condition with weak bones, suggesting an early sub-clinical stage of osteoporosis. The results of DEXA are represented in terms of T-score, which is a comparison of the individual’s bone mineral density to that of a young Caucasian female.
T score of +1 to -1 indicates normal bone density
T score of -1 to -2.5 indicates low bone density (osteopenia)
T score of less than -2.5 indicates osteoporosis
Treatment
Treatment of osteoporosis aims at strengthening the existing bones and stopping the disease progression. Medication such as calcium and vitamin D supplements, estrogen for post-menopausal women and testosterone for men, parathyroid hormone shots and bisphosphonates can be prescribed to patients. Pain medication and non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed for the resolution of pain. Back braces may also be recommended to support the back and minimize movement to reduce mechanical pain.
Simple lifestyle changes such as healthy, well balanced diet rich in protein, calcium and vitamin D, regular exercises such as walking and jogging, along with abstinence from smoking and alcohol improve overall bone health and prevent the development of osteoporosis. In patients with osteoporosis these lifestyle changes may delay the progression of the disease.
Consult your doctor for clarification of any of your queries on osteoporosis.
Vitamin D Deficiency
Vitamin D helps in the absorption of calcium and phosphorus from food and is essential for maintenance of strong and healthy bones. It is also important for normal functioning of the muscles and overall good health. Vitamin D deficiency is associated with an increased risk of diseases such as cardiovascular disease, cancer, diabetes, autoimmune disease, cognitive impairment in elderly and severe asthma in children.
Skin can synthesize vitamin D from cholesterol on exposure to UVB rays of the sun and this fulfils most of the body’s vitamin D requirements. Vitamin D is also present in a few natural foods that include:
- Oily fish such as North Sea salmon, herring, mackerel and sardines
- Liver and cod liver oil
- Egg yolk
Oily fish and cod liver oil are good dietary sources of vitamin D. Some foods such as milk and margarines are fortified with vitamin D.
Cause
Vitamin D deficiency may occur due to various reasons including:
- Insufficient synthesis of Vitamin D: This may occur if exposure of the skin to the sun is limited. Thus, people who spend most of their time indoors, always wear long sleeves and pants, and those who always use sunscreen with SPF factor higher than 15 are at an increased risk of vitamin D deficiency. The risk is higher in people with dark skin and elderly people because of the inherent inability of their skin to synthesize sufficient vitamin D.
- Pure vegetarian diet
- Problem in absorption and metabolism of vitamin D: Certain medical conditions such as crohn’s disease, cystic fibrosis, celiac disease or liver disease affect the ability of the intestine to absorb vitamin D from food and may lead to vitamin D deficiency. Kidneys convert vitamin D to its active form. Thus, any kidney problem can increase the risk of vitamin D deficiency.
- Obesity: Vitamin D is a fat-soluble vitamin. People with a body mass index ≥ 30 are at a higher risk of vitamin D deficiency as all the vitamin D in the blood is taken up by the fat cells and its availability for other bodily functions is significantly reduced.
Symptoms of vitamin D deficiency
In children, vitamin D deficiency may lead to late teething and dental deformities, reluctance to start walking, irritability, susceptibility to infections, impaired growth, short stature, bone pain and muscle pain. Severe vitamin D deficiency in children is called rickets and may cause muscle cramps, breathing difficulties, seizures and skeletal deformities such as bow legs, pigeon chest, pelvic and spinal deformities (scoliosis and kyphosis).
In adults the symptoms are very subtle and may include general aches and pains and tiredness. Severe deficiency in adults is called osteomalacia and results in severe pain in lower back, hips, pelvis, thighs and feet along with muscle weakness. Affected individuals experience difficulty in climbing stairs and getting up from the floor or low chairs due to muscle weakness.
Diagnosis
The simplest and most accurate method to diagnose vitamin D deficiency is estimation of 25-hydroxy vitamin D levels in blood. Value <12 ng/ml indicates vitamin D deficiency.
Treatment
Treatment involves vitamin D supplementation in the form of tablets, powders, liquids or injection. The dose and the appropriate treatment schedule depend on the age and severity of the deficiency. Usually a maintenance dose of vitamin D is recommended, even after the treatment, to prevent any further deficiency in the future.
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