| Punarnava Ayurveda Hospital - Suresh 2004-10-28, 11:09 am |
| Osteoporosis
It is estimated that 10 million Americans have established
osteoporosis and another 34 million have osteopenia, or low bone
mass, which leads to osteoporosis. It is responsible for 1.5 millions
fractures annually, mostly involving the lumbar vertebrae, hip, and
wrist. About 50% of women and 25% of men are expected to have
osteoporosis in their lifetime
Osteoporosis is a disease of bone in which the amount of bone is
decreased ,becomes thin and are susceptible to fracture. It is
defined according to the bone mineral density (BMD) as measured by
Dual Energy X-ray Absorptiometry. A BMD of 2.5 standard deviations
below the 20 year old person standard is considered osteoporosis.
Etiology
Estrogen deficiency following menopause causes a rapid reduction in
BMD. This, plus the increased risk of falling associated with aging,
leads to fractures of the wrist, spine and hip. Other hormone
deficiency states can lead to osteoporosis, such as testosterone
deficiency. Glucocorticoid or thyroxine excess states also lead to
osteoporosis. Lastly, calcium and/or vitamin D deficiency from
malnutrition increases the risk of osteoporosis.
Risk Factors
Current cigarette smoking Intake of soft drinks containing
phosphoric acid at any age
Low body weight <58 kg (127 lb)
Estrogen deficiency
Early menopause (<45 years) or bilateral oophorectomy
Prolonged premenstrual amenorrhea (>1 year)
Low calcium intake
Alcoholism
Impaired eyesight despite adequate correction
Recurrent falls
Inadequate physical activity
Poor health/frailty
In the absence of treatment, overt osteoporosis is heralded by a
fracture. Some fractures, like vertebral compression fractures or
sacral insufficiency fractures, may not be apparent at first,
appearing to patient and physician as a very bad back ache or
completely without symptoms. Hip fractures and wrist fractures are
more obvious.
Hip fractures are responsible for the most serious consequences of
osteoporosis. In the United States, osteoporosis causes a
predisposition to more than 250,000 hip fractures yearly. It is
estimated that a 50-year-old white woman has a 17.5% lifetime risk of
fracture of the proximal femur. The incidence of hip fractures
increases each decade from the sixth through the ninth for both women
and men for all populations. The highest incidence is found among
those men and women ages 80 or older.
An estimated 700,000 women have a first vertebral fracture each year.
The lifetime risk of a clinically detected symptomatic vertebral
fracture is about 15% in a 50-year-old white woman.Distal radius
fractures, usually of the Colles' type, are the third most common
type of osteoporotic fractures. In the United States, the total
annual number of Colles' fractures is about 250,000. The lifetime
risk of sustaining a Colles' fracture is about 16% for white women.
By the time women reach age 70, about 20% have had at least one wrist
fracture.
Prognosis
Patients with osteoporosis are at a high risk for additional
fractures (the best predictor of fracture is a previous fracture).
Treatment can improve fracture risk considerably.
Fractures can lead to decreased mobility and an additional risk of
deep venous thrombosis and/or pulmonary embolism. Vertebral fractures
can lead to severe chronic pain of neurogenic origin, which can be
hard to control.
Although osteoporosis patients have an increased mortality rate due
to the complications of fracture, most patients die with the disease
rather than of it.
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