21/8-2017 
 
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Bone tissue diseases

Osteoporosis (Osteroporose)

Definition and causes of Osteoporosis

Osteoporosis, or brittle bones, is a condition in which bones become depleted of bone protein and minerals. It makes the bones become fragile, and they have a greater tendency to break.

Bone density can be measured with a special scanner, and at a sufficiently low density the state is defined as osteoporosis.

Osteoporosis causes minimal symptoms and is often discovered only when there is a fracture. The body's bone mass decreases with age, and osteoporosis are predominantly seen in the elderly. The condition is much more common in women and predominantly after menopause. The body's production of female hormones (estrogen and progesterone) has a protective effect against bone degeneration, and after menopause, this production is sharply reduced, and bone mass depleted.
 

Certain predisposing factors for osteoporosis:

  • Heredíty - increased incidence of osteoporosis in the family.
  • Early menopause.
  • Low production of sex hormones, which can be seen in both sexes.
  • Inactivity, immobilitet or paralysis.
  • Low body weight.
  • Excessive alcohol consumption.
  • Smoking.
  • Treatment with relatively large doses of adrenal cortical hormones or Cushing's syndrome.
  • Lack of intake of calcium and vitamin D (see soft bones).
  • Thyrotoxicosis (high metabolism).
  • Diabetes.
It is believed that 30% of women between 60-70 years and 40% of women between 70-80 years have osteoporosis, but are not necessarily predisposed for the disease.
 

Symptoms of osteoporosis

As previously stated, osteoporosis, in itself causes no symptoms. It is only when the bones fracture as a result of even small traumas or falls, which would not normally result in breakage, that the disease becomes evident. The typical places for osteoporosis related fractures are:
  • The wrist. A broken wrist, typically after a fall, is often the first fracture to appear and may be the first sign of osteoporosis, especially among women after menopause.
     
  • The back. The vertebrae may be so depleted of bone mass that one or more vertebrae spontaneously collapses. It is estimated that one in every three women will experience a fracture in the back. However, it is only approximately 50%, which will cause symptoms. The is often a curvature of the spine, which in severe cases may cause compression of inner organs in the chest and abdominal cavity.
     
  • The Hip. Fractures in the hip region are very common. They often seen later in life than the wrist fractures (but may be seen simultaneously). About one in three women after menopause will experience a fracture near the hip. The treatment is surgery, and many will find that they do not regain their former functionality fully.

Diagnosis of Osteoporosis.

The diagnosis of osteoporosis is official made by a so called DEXA scan, which can measure the density of the bones and compare it with a normal value. If you come to hospital with a so called low energy fracture (e.g. a wrist, back or hip fracture), and you are at risk for osteoporosis (e.g. a post menopausal woman), this will often be enough to obtain diagnosis with osteoporosis, and treatment initiated.

In patients with an underlying disease, it is important to get this diagnosed and treated, which in many cases will improve the osteoporosis significantly.
 

Precautions and prevention of osteoporosis

After menopause, it is important to get sufficient calcium, magnesium and vitamin D for example through milk or fatty fish. This strengthens the building of bones. Sunlight of the skin also makes the body produce vitamin D, and especially older Muslim women who will be covered outside, may benefit from taking calcium and vitamin D supplements all year round.

Physical activity, alcohol and smoke cessasion reduce the risk of osteoporosis.

Obesity seems to reduce the risk of osteoporosis, but at the same time increases the risk significantly for a number of other diseases e.g. cardiovascular diseases.

It is also important to minimize the risk of falls. If you are a little uncertain on your feet, a stick or cane may be a good idea. You should avoid having loose carpets, slippery floors and other things you may fall over, lying on the floor. If you have a tendency to dizziness when you stand up quickly, it is important to rise slowly and possibly have installed support in the toilet, for when you have been to the toilet.
 

Treatment of osteoporosis

An important part of treatment is the change of lifestyle. A proper diet, smoking cessasion, limited alcohol intake and proper exercise habits, as well as elimination of risk factors for falling, can improve the prognosis for osteoporosis significantly.

Supplement with a vitamin D and calcium magnesium supplements, which strengthens bones is recommended.

Medical treatment with so-called biphosphonates, reduces turnover of bone, which in turn will make them stronger. The same effect has been seen from treatment with estrogen (female sex hormone). It is however important to be careful not to use estrogen for a longer period of years, because it may give an increased risk of developing breast cancer and blood clots.

It is also very important to treat any fracture with surgery or fixation.
 

Prognosis and complications

The course depends entirely on the degree of osteoporosis, and the number of bone fractures, the individual experiences. It is possible to live a completely normal life with a mild degree of osteoporosis, particularly if one takes adequate precautions.

Many, however, will experience some form of disability after e.g. a fracture close to the hip or fractures in the back. After a fracture, it can be very difficult to re-train bones and muscles to function as well as before the incident.

Pain, especially in the spine, can cause major nuisance in everyday life.

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