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![]() Osteoporosis |
Osteoporosis is one of the costliest diseases of aging. Osteoporosis implies diminution of quality and mineral density of bone. Bones become fragile and susceptible to fractures on minor trauma. The problem of osteoporosis is underestimated and grossly neglected in India. It is estimated that 36 million Indians would be osteoporotic by year 2013. It appears that osteoporotic fractures occur10-20 year earlier in Indian population as compared to West. Most fragility fractures are managed by orthopedic surgeons. Unfortunately, many of them do not subject these patients to osteoporosis tests. | ||||||
FeaturesOsteoporosis is rightly known as 'hidden enemy' in our body as it does not cause any symptoms (akin to many cases of blood pressure, diabetes and raised cholesterol). The problem is recognized only after a fracture following trivial trauma. A low trauma or stress fracture is defined as one that occurs after a fall from a height equivalent to height of the patient. Three common sites of osteoporotic fractures are - wrist, vertebra (spine) and thigh bone (femur). All fractures are costly and cause significant disability as well as loss of work days. Hip fractures are most dangerous as 15-20% of these cases die within one year due to one or the other causes and around 50% cannot walk without support. Vertebral fractures are usually painless but lead to spinal deformity (dowager's or widow's hump) and loss of height. They can cause pain that radiates to flanks. Each vertebral fracture reduces respiratory capacity by about 9%. | ||||||
Types
Secondary osteoporosis is due to an identifiable cause. Some of the causes are as follows:
Though rare, children can also develop primary as well as secondary osteoporosis. |
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Risk Factors
* Prolonged bedrest in situations such as pregnancy, fractures, chronic diseases and others is deleterious to bone health. |
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Investigations Standard X-ray is highly insensitive for diagnosis of osteoporosis as bone loss is apparent only after 30-50% decrease in bone mass. Measurement of bone density is an accepted method of diagnosis though it does not indicate the cause of osteoporosis. Ultrasound and Computed Tomography (CT) are not yet accepted to derive true bone density values. Dual Energy X-ray Absorptiometry (DEXA) is the only method endorsed by WHO at present. DEXA compares bone density of a patient with that of a standard individual. No Indian standards are available as yet. All women above 65 years age and those with risk factors need to be screened for bone mineral density (BMD) by DEXA. FRAX requires estimation of BMD at femoral neck only. Blood and urine examination for biochemical markers of bone turnover are not routinely used in clinical practice. |
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Treatment One would not get a fracture if there is no trauma. Prevention of falls is an important aspect of osteoporosis therapy. This needs proper ground surface with adequate illumination, use of hand rails, correction of vision and proper treatment of medical diseases that cause giddiness and imbalance. |