The osteoporosis

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Information about The osteoporosis

Published on June 13, 2016

Author: edwinsencar

Source: slideshare.net

1. Medical Author: Catherine Burt Driver, MD Medical Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor WHAT CAUSES OSTEOPOROSIS? Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. The body may fail to form enough new bone, or too much old bone may be reabsorbed, or both. Two essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones. Calcium is essential for proper functioning of the heart, brain, and other organs. To keep those critical organs functioning, the body reabsorbs calcium that is stored in the bones tomaintain blood calcium levels. If calcium intake is not sufficient or if the body does not absorb enough calcium from thediet, bone production and bone tissue may suffer. Thus, the bones may become weaker, resulting in fragile and brittle bones that can break easily. Usually, the loss of bone occurs over an extended period of years. Often, a person will sustain a fracture before becoming aware that the disease is present. By then, the disease may be in its advanced stages and damage may be serious. The leading cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men. Women, especially those older than 60 years of age, are frequently diagnosed with the disease. Menopause is accompanied by lower estrogen levels and increases a woman's risk for osteoporosis. Other factors that may contribute to bone loss in this age group include inadequate intake of calcium and vitamin D, lack of weight-bearing exercise,and other age-related changes in endocrine functions (in addition to lack of estrogen). Other conditions that may lead to osteoporosis include overuse of corticosteroids (Cushing syndrome), thyroid problems, lack of muscle use,bone cancer, certain genetic disorders, use of certain medications, and problems such as low calcium in the diet. The following are risk factors for osteoporosis: Women are at a greater risk than men, especially women who are thin or have a small frame, as are those of advanced age. Women who are white or Asian, especially those with a family member with osteoporosis, have a greater risk of developing osteoporosis than other women. Women who are postmenopausal, including those who have had early or surgically induced menopause, or abnormal or absence of menstrual periods, are at greater risk. Cigarette smoking, eating disorders such as anorexia nervosa orbulimia, low amounts of calcium in the diet, heavy alcoholconsumption, inactive lifestyle, and use of certain medications, such as corticosteroids and anticonvulsants, are also risk factors. Rheumatoid arthritis itself is a risk factor for osteoporosis. Having a parent who has/had osteoporosis is a risk factor for the offspring. What Is the Medical Treatment for Osteoporosis? Treatment for osteoporosis focuses on slowing down or stopping the mineral loss, increasing bone density, preventing bone fractures, and controlling the pain associated with the disease. Some 40% of women will experience a broken bone (fracture) due to osteoporosis during their lifetime. In those who have a vertebral fracture (in their back), one in five will suffer another vertebral fracture within one year. This condition potentially leads to more fractures. This is called a "fracture cascade."The goal of treatment is to prevent fractures. Diet: Young adults should be encouraged to achieve normalpeak bone mass bygetting enough calcium (1,000 mg daily) in their diet (drinking milk or calcium-fortified orange juice and eating foods high in calcium such as salmon), performing weight-bearingexercise such as walking or aerobics (swimming is aerobic but not weight-bearing), and maintaining normal body weight. Specialists: People who have spinal, hip, or wrist fractures should be referred to a bone specialist (called an orthopedic surgeon) for further management. In addition to fracture management, these people should also be referred to a physical and occupational therapist to learn ways to exercise safely. For example, someone

2. with spinal fractures would avoid touching their toes, doing sit-ups, or lifting heavy weights. Many types of doctors treat osteoporosis, including internists, generalists, family physicians, rheumatologists, endocrinologists, and others. Exercise: Lifestyle modification should also be incorporated into your treatment. Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Studies show that exercises requiring muscle to pull on bones causes the bones toretain, and perhaps even gain, density. Researchers found that women who walk a mile a day have four to seven more years of bone in reserve than women who don't. Some of the recommended exercises include weight- bearingexercise,ridingstationarybicycles,usingrowing machines, walking, and jogging. Before beginning any exercise program, make sure to review your plan with your doctor. Are There Home Remedies for Osteoporosis? If you suspect that you have signs or symptoms of osteoporosis or have risk factors for osteoporosis, see your doctor for further evaluation and treatment. WHAT IS THE DIAGNOSIS? Osteoporosis is the most common bone disease in humans and affects both men and women. The clinical and public health implications of the disease are substantial because of the mortality, morbidity, and cost of medical care associated with osteoporotic fractures. Osteoporosis is diagnosed on the basis of a low-impact or fragility fracture or low bone mineral density, which was best assessed by central dual-energy x-ray absorptiometry. Both nonpharmacological therapy (calcium and vitamin D supplementation, weight-bearing exercise, and fall prevention) and pharmacological treatments (antiresorptive and anabolic agents) may be helpful in the prevention and treatment of osteoporosis. Therefore, clinicians need to be vigilant in instituting primary prevention measures for those at high risk for osteoporosis and in instituting treatment for patients diagnosed as having the disease either byscreening or a history of fracture. This article provides an overview of the diagnosis, screening, prevention, and treatment of osteoporosis. What exams and tests do health-care professionals use to diagnose osteoporosis? The doctor will usually begin with a careful history to determine if you have osteoporosis or if you may be at risk for the disease. You will be asked a variety of questions regarding lifestyle and other conditions that you mayhave. The doctor willalsoaskif you have a family history of osteoporosis or a history of previous broken bones. Often blood tests are used to measure calcium, phosphorus, vitaminD, testosterone, and thyroid and kidney function. Based on a medical examination, the doctor may recommend a specialized test called a bone mineral density test that can measure bone density in various sites of the body. The diagnosis of osteoporosis or osteopenia can be made based on the results of these tests. Osteopenia is lower-than-normal bone density not severe enough to be classified as osteoporosis and is considered by many experts to be a precursor to osteoporosis. A bone mineral density test can detect osteoporosis before a fracture occurs and can predict future fractures. A bone mineral density test can also monitor the effects of treatment if the tests are performed a year or more apart and mayhelp determine the rate of bone loss. Severaldifferentmachines measure bonedensity.Allare painless, noninvasive, and safe. They are becoming more readily available. In many testing centers, you don't even have to change into an examination robe. Central machines may measure density in the hip, spine, and total body. Peripheral machines may measure density in the finger, wrist, kneecap, shinbone, and heel. The DXA (dual-energy X-ray absorptiometry) measures the bone densityof the spine, hip, or total body. With your clothes on, you simply lie on your back with your legs on a large block. The X-raymachinemoves quicklyover your lower spine and hip area. SXA (single-energy X-ray absorptiometry) is performed with a smaller X-ray machine that measure bone density at the heel, shinbone, and kneecap. Some machines use ultrasound waves pulsing through water to measure the bone density in your heel. You place your bare foot in a water bath, and your heel fits into a footrest as sound waves pass through your ankle. This is a simple way to

3. screen large numbers of people quickly. You might find this type of screening device at a health fair. Bone loss at the heel may mean bone loss in the spine, hip, or elsewhere in the body. If bone loss is found in this test, you might be asked to have the DXA to confirm the results and get a better measurement of your bone density. The resultofthe bonemineraldensityis comparedtotwo standards, or norms, known as "age matched" and "young normal." The age-matched reading compares your bone mineral density to what is expected of someone of your age, sex, and size. The young normal reading compares your density to the optimal peak bone density of a healthy young adult of the same sex. The information from a bone mineral densitytest enables the doctor to identify where you stand in relation to others your age and to young adults (which is presumed to be your maximum bone density). Scores significantly lower than "young normal" indicate you have osteoporosis and are at risk for bone fractures. The results will also help the doctor to decide the best way to manage your bone health. For patients who have borderline results, an especiallyhelpful new method of determining the 10-year probability of fracturing bone can be determined using a program called FRAX. This computation method is available onlineandtakes into accountallriskfactors for a given individual to determine their personal risk for fracture and, therefore, need for treatment. WHAT IS THE MEDICAL TREATMENT FOR OSTEOPOROSIS? Treatment for osteoporosis focuses on slowing down or stopping the mineral loss, increasing bone density, preventing bone fractures, and controlling the pain associated with the disease. Some 40% of women will experience a broken bone (fracture) due to osteoporosis during their lifetime. In those who have a vertebral fracture (in their back), one in five will suffer another vertebral fracture within one year. This condition potentially leads to more fractures. This is called a "fracture cascade."The goal of treatment is to prevent fractures. Diet: Young adults should be encouraged to achieve normalpeak bone mass bygetting enough calcium (1,000 mg daily) in their diet (drinking milk or calcium-fortified orange juice and eating foods high in calcium such as salmon), performing weight-bearingexercise such as walking or aerobics (swimming is aerobic but not weight-bearing), and maintaining normal body weight. Specialists: People who have spinal, hip, or wrist fractures should be referred to a bone specialist (called an orthopedic surgeon) for further management. In addition to fracture management, these people should also be referred to a physical and occupational therapist to learn ways to exercise safely. For example, someone with spinal fractures would avoid touching their toes, doing sit-ups, or lifting heavy weights. Many types of doctors treat osteoporosis, including internists, generalists, family physicians, rheumatologists, endocrinologists, and others. Exercise: Lifestyle modification should also be incorporated into your treatment. Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Studies show that exercises requiring muscle to pull on bones causes the bones toretain, and perhaps even gain, density. Researchers found that women who walk a mile a day have four to seven more years of bone in reserve than women who don't. Some of the recommended exercises include weight- bearingexercise,ridingstationarybicycles,usingrowing machines, walking, and jogging. Before beginning any exercise program, make sure to review your plan with your doctor. Are There Home Remedies for Osteoporosis? If you suspect that you have signs or symptoms of osteoporosis or have risk factors for osteoporosis, see your doctor for further evaluation and treatment. IS IT POSSIBLE TO PREVENT OSTEOPOROSIS? Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. The average woman has acquired 98% of her skeletal mass by 30 years of age. There are four steps to prevent osteoporosis. No one step alone is enough to prevent osteoporosis. Eat a balanced diet rich in calcium and vitamin D and high in fruits and vegetables. Engage in weight-bearing physical exercise.

4. Adopt a healthy lifestyle with nosmoking or excessive alcohol intake. Take medication to improve bone density when appropriate. WHAT IS THE PROGNOSIS FOR OSTEOPOROSIS? With adequate treatment, the progression of osteoporosis can be slowed, stopped, or reversed. Nevertheless, some people become severely disabled as a result of weakened bones. Some patients will fracture their hip, pelvis, vertebrae, wrist, humerus, or leg in the year following an osteoporotic vertebral fracture. Hip fractures are a frequent fracture and leave about half of those who break a hip unable to walk independently. Women who have a hip fracture are at fourfold greater risk for a second hip fracture. There is a significant overall increase in mortality (death rate) in the year after a hip fracture. By 80 years of age, 15% of women and 5% of men have hip fractures. Thus, osteoporosis is a serious disease that requires better efforts at prevention, detection, and treatment. © 2016 WebMD, Inc. Todos los derechos reservados. EMedicineHealth no proporciona consejo médico, diagnóstico o tratamiento. Ver información adicional. Medical Author: Catherine Burt Driver, MD Medical Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor

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