Osteoporosis

a.    What is osteoporosis?

Osteoporosis is a condition characterized by a decrease in the density of bone, resulting in loss of bone strength. The term “Osteoporosis” literally means “less and porous bone” This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones. Osteopenia is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis.Individuals with osteopenia are also at a higher chance of bone fractures.

Normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone to fracture. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.

b.    How does Osteoporosis present?

Osteoporosis can be present without any symptoms for many years because osteoporosis doesn't cause symptoms until a fractureoccurs. Moreover, some osteoporotic fractures (especially those affecting the backbone) may escape detection for years when they do not cause symptoms. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. The symptom associated with osteoporotic fractures usually is bone pain. Fractures affecting the spine will cause back bone deformity, loss of height and back pain. Up to 30% of patients suffering a hip fracture will require long-term nursing-home care due to loss of mobility. Elderly patients can develop pneumonia and blood clotting in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after the hip fracture. Osteoporosis hip fractures are associated with an increased risk of death. About 20% of individuals with a hip fracture will die in the subsequent year as an indirect result of the fracture.

c.    How is osteoporosis diagnosed?

Osteoporosis can be diagnosed by measurement of bone mineral density by dual-energy X-ray absorptiometry scan (DXA, formerly known as DEXA). DXA typically measures bone density in the hip, the spine, and the forearm. The testtakes only five to 15 minutes to perform, exposes patients to very little radiation (less than one-tenth of the amount used on a standard chest X-ray), and is quite preciseand pain-free.

The bone density of the patient is compared to the average peak bone density of young adults of the same sex and race. This score is called the "T score", and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass.

d.    Who should receive BMD measurement?

The followings individuals are recommended to receive BMD testing:

• A previous history of fracture
• Post-menopausal women, especially age above 65
• Men above 65years
• A family history of fractureor osteoporosis
• Height loss of 1 inch (3cm) or more
• Use of corticosteroid for 3 months or more
• Cigarette smoking
• A history of alcoholism
• Gastrointestinal diseasesor surgery
• Rheumatoid Arthritis
• Endocrine diseases - such as thyroid disease, Cushing’s Syndrome
• Premature Menopause
• Hypogonadism in Men
• Eating Disorder
• Irregular menstruation
• Frequent falls