OSTEOPOROSIS-A BONE OF FRACTURE
SAIMA IBRAHIM (Saima_virgo1@hotmail.com)
Jan 25 - 31, 2010
Osteoporosis is a condition characterized by decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones.
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, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.
Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone micro architecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term 'established osteoporosis' includes the presence of a fragility fracture.
Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications.
Osteoporosis can be prevented with lifestyle changes and sometimes medication; in people with osteoporosis, treatment may involve both. Lifestyle change includes exercise and preventing falls; medication includes calcium, vitamin D, bisphosphonates and several others. Fall-prevention advice includes exercise to tone deambulatory muscles, proprioception-improvement exercises; equilibrium therapies may be included. Exercise with its anabolic effect, may at the same time stop or reverse osteoporosis. Osteoporosis is a component of the frailty syndrome.
SIGNS AND SYMPTOMS
Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip, and wrist. Fractures of the long bones acutely impair mobility and may require surgery. Hip fracture, in particular, usually requires prompt surgery, as there are serious risks associated with a hip fracture, such as deep vein thrombosis and a pulmonary embolism, and increased mortality.
Fracture Risk Calculators assess the risk of fracture based upon several criteria, including BMD, age, smoking, alcohol usage, weight, and gender.
Non-modifiable Risk factors - The most important risk factors for osteoporosis are advanced age (in both men and women) and female sex; estrogen deficiency following menopause is correlated with a rapid reduction in bone mineral density, while in men a decrease in testosterone levels has a comparable (but less pronounced) effect.
Potentially modifiable Risk factors - Small amounts of alcohol do not increase osteoporosis risk and may even be beneficial, but chronic heavy drinking (alcohol intake greater than 3 units/day), especially at a younger age, increases risk significantly. Low circulating Vitamin D is common among the elderly worldwide. Mild vitamin D insufficiency is associated with increased Parathyroid Hormone (PTH) production. PTH increases bone resorption leading to bone loss. Tobacco smoking inhibits the activity of osteoblasts, and is an independent risk factor for osteoporosis. Smoking also results in increased breakdown of exogenous estrogen, lower body weight, and earlier menopause, all of which contribute to lower bone mineral density. Nutrition has an important and complex role in maintenance of good bone. Identified risk factors include low dietary calcium and/or phosphorus, magnesium, zinc, boron, iron, fluoride, copper, vitamins A, K, E and C (and D where skin exposure to sunlight provides an inadequate supply). Excess sodium is a risk factor. High blood acidity may be diet-related, and is a known antagonist of bone. Some have identified low protein intake as associated with lower peak bone mass during adolescence and lower bone mineral density in elderly populations. Conversely, some have identified low protein intake as a positive factor, protein is among the causes of dietary acidity. Excessive exercise can lead to constant damages to the bones which can cause exhaustion of the structures as described above.
There are numerous examples of marathon runners who developed severe osteoporosis later in life. In women, heavy exercise can lead to decreased estrogen levels, which predisposes to osteoporosis. A strong association between cadmium, lead and bone disease has been established. Low-level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures. Some studies indicate that soft drinks (many of which contain phosphoric acid) may increase risk of osteoporosis; others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis. Contrary to popular belief, there is no evidence linking caffeine to osteoporosis.
Diseases and disorders: Many diseases and disorders have been associated with osteoporosis. In general, immobilization causes bone loss. Hypogonadal states can cause secondary osteoporosis. These include turner syndrome, klinefelter syndrome, kallmann syndrome, anorexia nervosa, andropause hypothalamic amenorrhea or hyperprolactinemia. In females, the effect of hypogonadism is mediated by estrogen deficiency. It can appear as early menopause or from prolonged premenopausal amenorrhea. A bilateral oophorectomy (surgical removal of the ovaries) or a premature ovarian failure cause deficient estrogen production. In males, testosterone deficiency is the cause (for example, andropause or after surgical removal of the testes).
Endocrine disorders that can induce bone loss include Cushing's syndrome, thyrotoxicosis, hypothyroidism, diabetes mellitus type 1 and 2, acromegaly and adrenal insufficiency. In pregnancy and lactation, there can be a reversible bone loss.
Malnutrition, parenteral nutrition and malabsorption can lead to osteoporosis. Nutritional and gastrointestinal disorders that can predispose to osteoporosis include coeliac disease, Crohn's disease, lactose intolerance, surgery (after gastrectomy, intestinal bypass surgery or bowel resection) and severe liver disease (especially primary biliary cirrhosis). Patients with bulimia can also develop osteoporosis. Those with an otherwise adequate calcium intake can develop osteoporosis due to the inability to absorb calcium and/or vitamin D. Other micronutrients such as vitamin K or vitamin B12 deficiency may also contribute.
RENAL INSUFFICIENCY CAN LEAD TO OSTEODYSTROPHY.
Hematologic disorders linked to osteoporosis are multiple myeloma and other monoclonal gammopathies, lymphoma and leukemia, mastocytosis, hemophilia, sickle-cell disease and thalassemia.
People with scoliosis of unknown cause also have a higher risk of osteoporosis. Bone loss can be a feature of complex regional pain syndrome. It is also more frequent in people with Parkinson's disease and chronic obstructive pulmonary disease.
Here are some exercises designed to prevent or treat osteoporosis by strengthening your muscles and bones and improving your posture and balance. Before you try any of these osteoporosis exercises, check with your doctor or physical therapist. He or she can help you determine which exercises are safe for you to do and tell you how many repetitions you should do.
- Stand with your head, shoulders, and buttocks against a wall, with your heels 2 to 3 inches from the wall.
- Relax your shoulders and pull in your chin. Tighten your abdomen and buttocks.
- Press your back against the wall, leaving room for your hand to fit flat behind the curve of your lower back.
Walking strengthens your legs and heart and improves your balance.
- Hold your head high and keep your back and neck as straight as possible.
- Keep your chin parallel to the ground.
- Gently tighten your abdominal muscles.
- Let your shoulders move freely and naturally.
- Stretch your chest and straighten your back.
- Sit with your feet flat on the floor. Keep your back erect and look straight ahead.
- Stretch your arms out to the side, keeping them level with your shoulders.
- Bend your arms at the elbows and bring your hands toward your chest.
Repeat five to 10 times, depending on your ability.
Pelvic tilt: To strengthen your lower back and abdominal muscles:
- Lie on your back with your knees bent and your feet flat on the floor
- Maintain a normal curve in your back; don't arch your back.
- Tighten your abdominal muscles.
- Roll your pelvis down to flatten your back against the floor.
- Avoid using your leg and buttock muscles.
- Hold the position for five seconds while breathing normally, and then relax. Repeat this exercise 10 times.
BACK AND SHOULDER STRETCH
- Lie on the floor. Bend your knees, tighten your abdominal muscles, and stretch your arms above your head.
- Keeping your arms straight, spread them out and lower them until they're level with your shoulders. Hold the position for a few seconds while breathing normally. Then return your arms to the starting position. Repeat this exercise five to 10 times, depending on your ability.
BACK POSTURE EXERCISE
- Flatten your upper back and stretch your chest.
- Sit in a chair as shown, with your hand behind your neck.
- Inhale while gently moving your elbows backward.
- Hold the position for a few seconds, breathing normally, before returning to your starting position. Repeat five to 10 times, depending on your ability.
SITTING KNEE EXTENSION
- Strengthen your thigh muscles: Sit with your back straight and your hands on your thighs. Tighten your abdominal muscles and look straight ahead.
- Slowly straighten one knee while lifting your heel a few inches from the floor. Don't slouch or round your back.
- Hold this position for a few seconds while breathing normally. Relax and return to the starting position. Repeat five to 10 times with each leg, depending on your ability.
- Stretch your calf muscle, your heel cord and the back of your thigh.
- Stand with your feet parallel, hip-width apart.
- Place your hands on the back of a chair for balance.
- Bend your knees, flatten your stomach, and straighten your back and shoulders.
- Slide one foot backward, keeping it flat on the floor, until your back leg is straight.
- Lean your weight forward onto your bent front knee.
- Hold this position for a few seconds while breathing normally. Repeat five times with each leg.
UPPER BACK LIFT
- Strengthen your back muscles: Lie facedown on the floor with a pillow under your abdomen and hips.
- Use a rolled towel to cushion your forehead, if you wish.
- Keep your arms at your sides as you tighten your abdominal muscles.
- Keep your head in line with your neck and torso.
- Focus on keeping your shoulders down - don't let them shrug up toward your ears.
- Inhale and raise your head and chest a few inches from the floor.
- Hold for five seconds, breathing normally, before returning to your starting position. Rest for a few seconds. Repeat five to 10 times, depending on your ability.