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Dr. Noorali Bharwani
Osteoporosis is a condition in which there is a gradual softening
of the bones which makes them fragile. It is caused by the loss of
calcium. Our current understanding has been that osteoporosis
occurs most often in women after the age of menopause. Men can
suffer from osteoporosis as well when they experience low levels of
testosterone.
Bone fracture is a common complication of
osteoporosis. One in two women and one in five men over the age of
50 will have a fracture. A person may lose height if the vertebra
collapses due to osteoporosis. One may develop a hump if several
vertebrae collapse.
Other causes of osteoporosis for men and
women are: long-term use of corticosteroid medication, maternal
osteoporosis, smoking, heavy drinking, sedentary lifestyle, low
body weight and medical conditions that affect absorption, such as
celiac disease. Diagnosis of osteoporosis is made by measuring bone
mineral density.
A recent article in the CMAJ says that our
understanding of and approach to osteoporosis is in the middle of a
revolution. Research now shows the bone loss begins before
menopause and involves other hormones in addition to estrogen, and
that measuring bone mineral density alone is an inefficient way of
addressing the clinical burden of osteoporosis.
The ongoing Canadian Multicentre
Osteoporosis Study also shows that both men and women experienced
an additional phase of accelerated bone loss from age 70 onward.
Hormone replacement therapy with estrogen in women does protect
against bone loss over time.
The finding that bone loss began before
menopause indicates that estrogen loss alone cannot account for the
changes. Therefore, interest has focused on other hormones whose
levels change in early menopause such as follicle-stimulating
hormone and the activins and inhibins. The role of steroid produced
in the body and the size of the body composition is being
determined.
The current national guidelines recommend
that the test for osteoporosis (measuring bone mineral density)
should be done every two to three years. In one of the CMAJ
articles, Berger and colleagues suggest that densitometry for most
women can be repeated every five years because the average changes
in bone density over two to three years is small and comparable to
the measurement error in the scanning technique.
There is also a question whether women who
are already receiving treatment for osteoporosis should have
follow-up assessments of bone density at all, since changes in
density as a result of therapy account for only a small component
of the effectiveness of these medications, says the CMAJ
article.
There are four key points in the CMAJ
articles: bone loss in women begins before menopause and is
accelerated in old age, medications which reduce the loss of
calcium from the bone helps preserve bone density, the interval
between bone density assessments can safely be increased to five
years for many untreated women and finally, decisions about when to
test and treat will increasingly focus on estimates of absolute
fracture risk as indicated by the bone density test.
Osteoporosis is treated with calcium and
vitamin D supplements, a variety of hormone treatments (hormone
replacement therapy like estrogen) and Bisphosphonates, a group of
drugs that prevent bone breakdown and can be very effective in
osteoporosis. But prevention is better than cure. So, increase
calcium and vitamin D in your diet, increase the amount of
weight-bearing exercise you do, reduce your alcohol intake and quit
smoking.
So, have you had your glass of milk
today?
Dr. Bharwani is a general surgeon,
freelance columnist and author of A Doctor’s Journey. For his
video blogs and more information please visit: www.nbharwani.com.
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