Jan/Feb 2011
Volume 7, Issue 1

How Osteoporosis Could Affect the Way You Practice

Osteoporosis is a condition that can strike even the most health-conscious and vibrant of your patients. Here is what you need to know about the condition.

Osteoporosis is a condition in which bones become thin and less dense over time; as bone mineral density is reduced, the amount and variety of proteins in bone changes and the bone micro-architecture is disrupted.1 In osteoporosis, the bone loss is severe, causing even the normal stress that occurs during sitting, standing, or even coughing to cause unexpected fractures. As a result, it is not uncommon for someone with osteoporosis to struggle with chronic pain, immobility, disability, loss of independence, and a lower quality of life.2,3

What Are the Symptoms?

Osteoporosis occurs stealthily over several years with no visible signs. Often, the first sign of osteoporosis is a painful fracture that needs medical care. The bones most susceptible to fracture are the spine, hip, rib, or wrist.4 About half of all broken bones due to osteoporosis are in the spine, and vertebral collapse—in which weakened vertebrae break and collapse on top of each other—is common. In addition to causing severe chronic back pain, it creates the very stooped-over posture we see in many elderly people, along with a reduction in height and mobility. In some people, this humped over posture applies enough pressure to the internal organs to make breathing difficult.5 Falling and stumbling more is another sign of the condition, since gait and balance become affected because of a weak skeletal system.4

How Is Osteoporosis Diagnosed?

A bone mineral density (BMD) test measures the density of minerals (such as calcium and magnesium) in bones and uses this information to calculate the estimated strength of bones. The most commonly used technique for measuring BMD is the dual-energy X-ray absorptiometry (DEXA). Considered the most accurate and least time-consuming way to measure BMD, it uses two different X-ray beams to estimate bone density in the spine and hip. Osteoporosis is defined as a bone mineral density 2.5 standard deviations below peak bone mass; the term “established osteoporosis” is given when it includes the presence of a fracture.6

How Is It Treated and Prevented?

If a patient’s bone density is low, it is possible that they can increase their bone strength and reduce the odds of fractures. The recommendations to achieve this will vary from patient to patient, but many of the more common ones for increasing bone density include engaging in more physical activity, doing more weight-bearing exercise, and increasing intake of bone-building nutrients, such as calcium, magnesium, and vitamin D (at doses typically recommended by a doctor on an individualized basis).4,7 Depending on the patient’s lifestyle, they may also need to limit intake of alcohol or soda or quit smoking to help stop bone loss.4,8-11

Medications may be prescribed to prevent or treat osteoporosis. These can include medications that affect hormone levels, such as estrogen replacement therapy in women or testosterone replacement therapy in men; bisphosphonates, which slow the rate of bone thinning, such as alendronate or ibandronate; or medications that regulate calcium levels in the , such as calcitonin.4,12,13 Bisphosphonates are of particular interest to oral healthcare practitioners because they have been linked with onset of osteonecrosis of the jaw (loss of blood supply in the jawbone). This can cause toothaches, loosening of teeth, and slowly healing gums.14,15 Many patients with osteoporosis also often use non-prescription and prescription painkillers to deal with pain resulting from fractures, because this can help to improve their quality of life.16

Taking steps to prevent falls and improve balance, such as wearing shoes with non-skid soles and taking a class in yoga or tai chi, are commonly recommended ways to prevent the falls that cause fractures.4,17,18

References

1. Fromgue O, Modrowski D, Marie PJ. Growth factors and bone formation in osteoporosis: roles for fibroblast growth factor and transforming growth factor beta. Curr Pharm De. 2004;10(2):2593-2603.

2. Baczyk G. Quality of life of women with osteoporosis – review of literature. Ortop Traumatol Rehabil. 299;11(4):291-303.

3. Adachi JD, Adami S, Gehlbach S, et al. Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women. Mayo Clinic Proceedings. 2010;85(9):806-813.

4. Poole KE, Compston JE. Osteoporosis and its management. BMJ. 2006;333(7581):1251-1256.

5. Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine: current options and considerations for treatment. Spine J. 2006;6(5):479-487.

6. World Health Organization. Assessment of fracture risk and its application to screening for postemenopausal osteoporosis. Report of a WHO Study Group. World Health Organization technical report series. 1994;843:1-129.

7. Tucker KL. Osteoporosis prevention and nutrition. Curr Osteoporos Rep. 2009;7(4):111-117.

8. Berg KM, Kunnis HV, Jackson JL, et al. Association between alcohol consumption and both osteoporotic bone fracture and bone density. Am J Med. 2008;121(5):406-418.

9. Tucker KL, Morita K, Qiao N, et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr. 84(4):936-942.

10. Wong PK, Christie JJ, Wark JD. The effects of smoking on bone health. Clin Sci. 2007;113(5):233-241.

11. World Health Organization Scientific Group on the Prevention and Management of Osteoporosis http://whqlibdoc.who.int/trs/WHO_TRS_921.pdf. Accessed Oct 4, 2010.

12. Ebeling PR. Clinical practice: Osteoporosis in men. N Eng J Med. 2008;358(14):1474-1482.

13 Davis S, Sachdeva A, Goeckeritz B, Oliver A. Approved treatments for osteoporosis and what’s in the pipeline. Drug Benefit Trends. 2010;22(4):121-124.

14 Purcell P, Boyd I. Bisphosphonates and osteonecrosis of the jaw. Medical Journal of Australia. 2005;182(8):417-418.

15. Fantasia JE. Bisphosphonates—what the dentist needs to know: practical considerations. J Oral Maxillofac Surg. 2009;67(5 Suppl):53-60.

16 Lukert BP. Vertebral compression fractures: how to manage pain, avoid disability. Geriatrics. 1994;49(2):22-26.

17. Lui PP, Qin L, Chan KM. Tai Chi Chuam exercises in enhancing bone mineral density in active seniors. Clin Sports Med. 2008;27(1):75-86.

18. Tuzun S, Aktas I, Akarirmak U, et al. Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis. Eur J Phys Rehabil Med. 2010;46(1):69-72.

19. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Fracture/. Accessed Oct 4, 2010.

20. Centers for Disease Control. Osteoporosis among estrogen-deficient women—United States, 1988-1994. Morbidity and Mortality Weekly Reports. 1998;47(45):969-973.

21. Luckey MM, Wallenstein S, Lapinksi R, Meier DE. A prospective study of bone loss in African American and White women—a clinical research center study. J Clin Endocrinol Metab. 1996;81(8):2948-2956.

22. Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest. 2005;115(12):3318-3325.

23. Ch’ng CL, Jones MK, Kingham JG. Celiac disease and autoimmune thyroid disease. Clin Med Res. 2007;5(3):184-192.

24. Merlotti D, Gennari L, Dotta F, et al. Mechanisms of impaired bone strength in type I and type II diabetes. Nutr Metab Cardiovasc Dis. 2010 Oct 8. [Epub ahead of print].

25. Terpos E, Voskaridou E. Treatment options for thalassemia patients with osteoporosis. Ann N Y Acad Sci. 2010;1202:237-243.

26. Kamen DL, Alele JD. Skeletal manifestations of systemic autoimmune disease. Curr Opin Endocrinol Diabetes Obes. 2010 Oct 18. [Epub ahead of print].

27. Mitchell JE, Crow S. Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2006;19(4):438-443.

28. Gourlay M, Franceschini N, Sheyn Y. Prevention and treatment strategies for glucocorticoid-induced osteoporotic fractures. Clin Rheumatol. 2007;26(2):144-153.

29. Bab I, Yirmiya R. Depression, selective serotonin reuptake inhibitors, and osteoporosis. Curr Osteoporos Rep. 2010;8(4):185-191.

30. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton inhibitor therapy and risk of hip fracture. JAMA. 2006;296(24):2947-2452.

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