WHAT IS OSTEOPOROSIS?
First of all, the good news is thatOsteoporosisIt is a condition that can be prevented and treated if properly and timely diagnosed. However, we have bad news for you. Most people do not have enough awareness to prevent and treat it. Most people, especially women over the age of 50, suffer from disease and change in the shape of their bones, and in some cases die from such conditions.
Osteoarthritis alone does not cause back pain. However, such conditions can weaken the spine. In fact, bone fractures are the first warning sign of the disease. In advanced osteoporosis, a person develops pain and disability.
It is one of the most common problems among people. Approximately 8 million women and 2 million men in the United States have this condition. Other people are also at risk of developing it. Some key statistics include:
- Approximately 1.5 million people suffer from Osteoporosis and related fractures. It is estimated that 700,000 of these people suffer vertebral fractures.
- From the age of 50 onwards, one in two women and one in four men will develop some osteoporotic fracture.
- On average, 24% of pelvic fractures occur in people age 50 or older.
As stated by the World Health Organization, it is a general musculoskeletal disorder characterized by low bone mass. This leads to fracture. There are two types of it:
TYPE 1 :
This type usually occurs in postmenopausal women. Under such conditions, the amount of estrogen in the body decreases sharply. This process leads to the loss of the substance in the bones.
This type of is more common in women and develops between the ages of 50 and 70.
In this process, the amount of trabecular bone is usually reduced. A decrease in the overall strength of the bones leads to fractures of the wrist and spine.
Read also:What do we eat to strengthen the bones?
This type of is more common after age 70 and affects women twice as often as men.
There is often an overlap between these two types . Usually, type 1 can be diagnosed and prevented well in the early stages. It should be noted that osteoporosis can be a primary or secondary problem in some people.
About 20% of women and 40% of men with it have a secondary cause.
It is best to consult a doctor so that he can diagnose secondary causes. The doctor reviews your family and medical history and performs physical exams (in addition to diagnostic tests).
It is a disease originally caused by a significant loss of Bone mineral density (BMD) .
Early in life, more bone is stored in the body, and bone mass is high in the 30s. Bone size decreases after a person enters the aging process. This is why old age puts a person at risk of developing it and resulting fractures.
The process of bone loss usually begins between the early to late 30s of a person’s life. Women lose a certain amount of bone from this age until menopause:
- trabecular bone(Cancellous bone within the hard cortical bone) is lost at a rate of 1% per year.
- Cortical bone is lost(hard bone) at a rate of 0.5% per year.
Estrogen also plays an important role in maintaining bone strength. There are two lines of bone cells. one is Bone eroding cells (osteoclasts) and the other is bone-forming cells (osteoblasts) .
Without estrogen, osteoclasts become more active and more bone is lost. This causes osteoporosis. As a result, women who reach menopause with low estrogen levels increase the rate of bone loss by 2 to 3 percent per year.After 8 to 10 years, the rate of bone loss reaches the previous rate of 1 to 0.5 percent per year. This bone loss process, especially after menopause,A major cause of osteoporosis in women .
Type 1 can be affected by preventive measures. Most of these measurements are available individually and should be made as soon as possible. As mentioned earlier, high bone mass usually occurs around the age of 30. The amount of bone mass peaks and the amount of bone preserved thereafter depends on several factors.
These factors include:
People need to know their genetic predisposition to osteoporosis. Heredity plays an important role in this. It is estimated that about 75% of peak bone mass in individuals is genetically influenced. There are genes that encode vitamin D and estrogen receptors that affect bone mass.
If a person is genetically predisposed to osteoporosis, exercise, proper diet and regular bone mass testing will be even more important.
Weight training and muscle contraction can increase bone density in the spine.
It is recommended that people do about 20 to 30 minutes of aerobic exercise three to four times a week to increase their bone mass.
In one study, jogging, walking, and climbing stairs three times a week with 1,500 mg of calcium per day increased bone density. The effect of swimming in the pool on increasing bone density has not been determined.
People with osteoporosis or low bone mass should use caution when exercising.
Activities that require twisting the spine or bending forward through the waist can be dangerous for these people. People who already have osteoporosis should consult a doctor about their exercise programs.
3. DIET :
Eating Calcium properly is necessary to maintain strong bones. It is estimated that about 70% of people do not get enough calcium and vitamin D regularly. Vitamin D is also essential for the body as it helps absorb and store calcium in the bones. The recommended amount of calcium and vitamin D for adults is as follows:
- For premenopausal women aged 25-50 and postmenopausal women on estrogen replacement therapy, it would be 1,000 mg of calcium per day and 400 IU of Vitamin Dsuitable. Women who are breastfeeding or pregnant are advised to take 1,500 mg of calcium per day.
- For postmenopausal women under 65 years of age who do not have estrogen replacement therapy, the recommended amount of calcium is 1,500 mg per day of calcium and 400 to 800 unitsof Vitamin D.
- For women between the ages of 25 and 65, about 1,000 milligrams of calcium per day is recommended.
- for all persons over 65 years of age; It is recommended to use 1500 mg of calcium daily.
VITAMIN D AND CALCIUM
Calcium can be found is in most foods.For example, dairy products such as milk, yogurt, cheese and green leafy vegetables such as spinach Cereals, legumes and some fish contain calcium. Additionally, calcium supplements are available and people can take them without consulting a doctor.
Each of these supplements contains varying amounts of calcium, so you should consult your doctor before taking them to make sure you are taking the right amount.
Vitamin D can be obtained from sunlight, fatty fish, liver, and fortified foods such as milk, orange juice, and breakfast cereals.
Supplements are also available. In addition to properly taking calcium and vitamin D, studies have shown that a healthy, balanced diet plays an important role in preventing osteoporosis.For example, a diet rich in protein and sodium can increase the loss of calcium through the urine, which in turn reduces the availability of calcium in the body.
You should realize that More than 2,000 mg of calcium per day can be dangerous for kidney and kidney stones. Kidney stone formation cannot be increased when taken in the recommended amount. People who already have kidney disease should consult a doctor.
BONE DENSITY TESTING AND MEDICATIONS TO REDUCE BONE LOSS:
A bone mineral density (BMD) test can measure a person’s bone density and comparing it to normal density.
This test not only determines whether the bones are normal, but also whether a person is at risk of fracture.
Some experts recommend testing every one or two years for women over age 65 and postmenopausal women under age 65.
Depending on the bone density test and other diagnostic tests your doctor performs, the specialist may prescribe medications to reduce the rate of bone loss and reduce fractures caused by osteoporosis. It is best to consult a specialist before you can use approved medications.
A method called a DEXA scan can be the best way to diagnose osteoporosis. This test is done by passing a low-energy X-ray through the bones. This test may take 10 minutes and be painless. The values generated by this test can be compared with the following two values:
- Young adult population:It is also called a T-score. This test measures the variance between a patient and a young person. If the score is higher than -1, the person is normal. If the score is between -1 and -2.5, the person has osteoporosis, and if the score is more than -2.5, the person has it too.
- Age and sex control group:The Z-score measures the variability between the patient and the amount of bone in the control group. The control group includes other subjects in the patient’s age group and gender. An abnormally high or low score indicates the need for further testing.
With the help of statistical analysis, a DEXA scan can determine the risk of fractures due to osteoporosis. Based on the available recommendations, BMD testing is recommended in the following situations:
- All women over 65 years old.
- Postmenopausal women under the age of 65 have many risk factors for osteoporosis.
- During menopause, no decision has been made regarding hormone replacement therapy.
- Abnormal X-ray test of the spine
- Long-term use of oral steroid medication
- Busy thyroid
It is usually diagnosed to determine if it is a primary disease or a secondary sign of another problem. Therefore, a doctor can make a good diagnosis by reviewing the history and physical examination, and in some cases will need other tests to make the diagnosis.
COMMON CAUSES OF SECONDARY OSTEOPOROSIS INCLUDE:
- Endocrine disorders (hypogonadism, hyperthyroidism, hyperparathyroidism, diabetes)
- bone marrow disorders
- Collagen disorders
- Gastrointestinal disorders (malabsorption, malnutrition)
- Medications (aluminum antacids, anticonvulsants, chemotherapy, glucocorticoid therapy, thyroid hormone replacement)
Women over the age of 45 or 50 are more likely to develop type 1 . People at risk of developing osteoporosis should have preventive testing and identification of early signs.
RISK FACTORS :
There are usually many risk factors that are involved in the development of the disease. These factors include:
old age:People over the age of 65 are more likely to develop it.
Gender:Women are usually more likely than men to lose their bones. However, men are also at risk. 20% of patients with osteoporosis are men.
Family and personal history:This includes a history of osteoporosis, a history of fractures to a part of the body in the mother’s family, and a personal history of any type of bone fracture as an adult.
Sweat:Asian women are more likely to develop osteoporosis.
body type:Women who have small bones and weigh less than 127 pounds are more likely to develop it.
History of menstruation and menopause:Even natural menopause alone can increase the risk. Early menopause or premature menopause can increase your risk of developing the disease.
Lifestyle: IncludeLifestyle behaviors that can increase the risk of osteoporosis include Calcium or vitamin D deficiency, lack or lack of exercise, excessive alcohol use, and smoking.
Chronic diseases and medications:Some medications can damage the bones and cause a condition called secondary osteoporosis. This type occurs in 20% of women and 40% of men with osteoporosis.Certain medications used to treat endocrine disorders such as hyperthyroidism, bone marrow disorders, collagen disorders, gastrointestinal problems, and seizure disorders are categorized in this list.Long-term use of oral corticosteroids (oral corticoids) to treat conditions such as asthma and arthritis can particularly damage bones. These diseases in and of themselves are dangerous, so you cannot stop or replace medications to prevent it without consulting your doctor.
Treatment begins after the medical history, physical examination and diagnostic tests are performed and the person diagnosed with primary osteoporosis.
Treatment usually includes changes in diet, nutrients, exercise (if there is no fracture), and medication. The goal of osteoporosis treatment is to prevent further fractures.
First, your doctor will try to prescribeThe right amount of calcium and vitamin D and other nutrients. If necessary, exercises and fitness are used to help maintain bone density and reduce the risk of falls.
There are many medications used to treat osteoporosis and they can reduce the risk of fractures. In general, these medications can maintain bone strength and prevent bone fractures. Medications approved to treat or prevent it include:
Osteoporosis medications that can stop or slow bone loss:
- Selective estrogen receptor modulator such as raloxifene
- Estrogen/hormone therapy
Osteoporosis-related medications that increase bone formation:
- Triparathyroid, parathyroid hormone
These medications, which include alendronate (for example, Fosamax), ibandronate (for example, Boniva), and risedronate (for example, Actonel), are used to prevent and treat it in men and women.
Bisphosphonates reduce the rate of osteoporosis, which prevents its development and reduces the risk of fractures in people who already have it. These medications are taken orally
The use of alendronate (eg, Fozamax) alters the bone equilibrium towards bone formation by inhibiting bone resorption. This drug has been shown to increase bone mass. Alendronate is much more expensive than estrogen, but its ability to prevent fractures is very similar to estrogen.
There are two studies on alendronate:
- Taking 10 mg of alendronate daily over three years increased bone mass in 96% of patients. This amount was able to significantly reduce the risk of bone fractures.
- With alendronate, there was a 47% reduction in vertebral fractures, a 50% reduction in pelvic fractures, a 48% reduction in wrist fractures, and a 28% reduction in clinical fractures.
It’s approved for postmenopausal cases and taken by mouth once a month. Use of this drug reduces bone loss and increases bone density. Its use can reduce the risk of vertebral fractures.
It is also used in postmenopausal and glucocorticoid-induced osteoporosis (eg, long-term use of prednisone or corticosteroids).
This medication is taken by mouth and taken daily or weekly. Its use can reduce the risk of bone loss, increase bone density, reduce the risk of spinal cord injury, etc.
Calcitonin is a hormone that is naturally produced in the body and is available to people today as a prescription drug. It can be used as an injection or nasal spray. This drug increases bone density mainly in the spine.
Calcitonin is used for patients about 5 years after menopause who have low bone density. Or it is used in patients who clearly have it and have not chosen or could not use estrogen. Calcitonin will also be helpful in managing pain.
In one study, a comparison was made between placebo and estrogen, calcitonin, and alendronate. The increase in bone density by all factors was as follows:
- Estrogen -5%
- Alendronate -8%
- Calcitonin -2%
No increased support for bone loss was observed after discontinuation of estrogen and calcitonin. However, a positive bone equilibrium has been reported after discontinuation of alendronate.
RALOXIFENE IS A SELECTIVE ESTROGEN RECEPTOR MODULATOR:
Raloxifene is part of a class of selective estrogen receptor modulators that was developed to provide estrogen-related benefits without its drawbacks. Taken by mouth once daily, this medication has been able to increase bone mass and reduce the risk of spinal fractures.
ESTROGEN THERAPY / HORMONE THERAPY:
Estrogen therapy is widely used to treat menopausal symptoms in women after this period. To reduce the risk of endometrial cancer, doctors often prescribe a progesterone combination with estrogen for women with a healthy uterus. This combination is called ET/HT.
Due to the ability of this method to reduce the risk of pelvic and spinal fractures in postmenopausal women; Estrogen replacement therapy and ET/HT have also been used to treat osteoporosis.
However, recent studies show that certain types of hormone substitutes have been associated with an increased incidence of breast cancer, stroke, and heart attacks. That’s why the Food and Drug Administration advises its patients to consider other medications for osteoporosis.
Triparatide is the only approved treatment that can increase bone formation and eventually lead to increased bone density.
It can be used as an injectable medication for 24 months in men at risk of fractures and in postmenopausal women.
Studies show that taking this medication reduces the number of spinal fractures in men and the number of fractures to the spine, pelvis, and other bones in postmenopausal women.