Medicine for Africa - Medical Information Service

STEOPOROSIS

Definition:
 
Loss of bone mass caused by an increased bone breakdown without a corresponding bone build-up / development. This leads to a bone structure that is similar to an old porous sponge which can result in an increased risk of bone fractures, predominantly of the hip bone ( also see Hip Fractures), the wrist and lower vertebral bodies (bones of the vertebral spinal column). Osteoporosis also causes pain. The highest (biggest, thickest) bone mass is reached at between age 15 and 30, with large individual variations; thereafter, every person shows declining bone mass over years to come. Risk factors for osteoporosis are multiple, stretching from chromosomal abnormalities (e.g. osteogenesis imperfecta, homocystinuria, Down's syndrome etc.) to a genetic predisposition, to chronic diseases such as liver cirrhosis, hyperthyroidism, vitamin D deficiency, tumors that infiltrate the bone marrow and many more. The most frequent cause, however, is the age-related osteoporosis due to hormonal imbalance in women around the time of their menopause with subsequent l owering of their estrogen levels. This drop in the estrogen level can also be the result of a hysterectomy with bilateral oophorectomy, i.e. the removal of both ovaries. Another very important cause, at least temporary, osteoporosis can be found in long-term immobility of the body or of individual bones. The former may be due to long lasting bed-rest because of a chronic disease process, and the latter may be the result of bone fractures with extended bed-rest requirements. Also, a sedentary life-style such as most office jobs in a predominantly sitting position, as well as smoking and excessive consumption of alcohol, can accelerate the development of osteoporosis. With the 'Baby Boomers' coming of age, osteoporosis is considered one of the biggest and fastest growing health problems for the upcoming decades.

 
Symptoms:
 
In advanced osteoporosis, general back pain, hip pain or associated muscle pain may arise, as well as problems with carrying or lifting heavy objects. Osteoporosis is clearly associated with an increased risk of bone fractures and it is often only at the time of a fracture that the degree of osteoporosis is first diagnosed.

 
Diagnosis:
 
Bone mass, or bone density, can be determined by special computer-associated x-ray machines (=densitometry) at the wrist, the hip bone or the lower vertebrae of the spinal column. This non-invasive examination can be performed within just a few minutes by specially trained and equipped physicians in their private practice, as well as in any major hospital. First measurements for women are recommended in their mid-thirties, after their bone peak mass has been achieved, and at the beginning of their menopause in order to establish a 'base-line' picture of their bone density, followed by regular examinations every 2 years or according to the suggestions of the physician who can best determine the individual needs.

 
Therapy:
 
Age-related, primary osteoporosis cannot yet be successfully reversed. It can only be stopped, or rather, slowed down, if preventive treatment is introduced before bone loss has occurred. Especially in women, estrogen replacement therapy at the time of menopause, is recommended. The addition of a progesteron derivative prevents the otherwise increased change of developing endometrial cancer. The somewhat increased risk of developing breast cancer on a long-term estrogen therapy is only significant if there is a family history of breast cancer. Otherwise, the benefits that accompany estrogen therapy in regard to delayed development of osteoporosis as well as the significant decrease in cardiac failures outweigh the risks. In severe cases, ingestion of fluorides produces new bone tissue which is, however, of lesser quality and therefore with less ability to withstand the daily stress that is put upon the skeleton. Regular, light exercise like daily walks, and vitamin D supplements (1,000 to 1,500 mg/day) are recommended.

 
Prevention:
 
Prevention is the most important and only way that osteoporosis can be delayed or slowed down. Bone is the only human tissue which can adjust to changing demands that are set upon it and which can actually actively grow and reshape itself in order to adapt to specific needs or predominant usage. Secondary osteoporosis due to other diseases, long-term immobility or sedentary life style can be prevented by treating the underlying disease or by daily physical activities such as walking, jogging or gymnastics / aerobics, respectively. In age-related osteoporosis, estrogen derivatives can slow down the development of osteoporosis remarkably, if taken from the time of menopause. Also, regular exercise like daily brisk walks and gymnastics / aerobics, as well as daily vitamin D supplements can be helpful. While smoking and alcohol in excess are clearly accelerating the development of osteoporosis at any age, new studies point to the benefits of one to two glasses of white wine daily, especially for postmenopausal women, as a way to slow osteoporosis.
 
Whatever treatment works best for you, can only be determined after you have had a thorough physical examination, resulting in establishing the cause of your osteoporosis. Therefore, you should consult a physician (orthopedist or specifically equipped internist, radiologist) who can create your personal 'bone structure profile' before recommending a treatment schedule that is most appropriate for you. In order to assure treatment response, regular bone density measurements (according to age, every 1-2 years) are also recommended. By abiding to such a schedule, the physician can identify changes in your bone density, and can subsequently prescribe certain changes in your life style in order to slow down further bone loss and to prevent bone fractures. Osteoporosis is a major health risk, especially in people of advanced age, associated with a high rate of hospitalization and chances of subsequently related death.

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