Osteoporosis

Osteoporosis is a disease of bone in which bone mineral density is reduced and bone microarchitecture is disrupted. Osteoporotic bones are susceptible to fracture. It is defined according to the bone mineral density (BMD) as measured by DEXA: a BMD of 2.5 standard deviations below the peak bone mass (20-year-old person standard) is considered osteoporosis. While treatment modalities are becoming available, prevention is still the most important way to reduce fracture. Due to its hormonal component, more women suffer from osteoporosis than men.

Treatment

Patients at risk for osteoporosis (e.g. steroid use) are generally treated with vitamin D and calcium supplements. In renal disease, a different form of Vitamin D (D3) is used, as the kidney cannot adequately synthesise D3 from precursors.

Related Topics:
Steroid - Vitamin D - Calcium - Renal

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In osteoporosis (or a very high risk), bisphosphonate drugs are prescribed. The most often prescribed bisphosphonate is presently sodium alendronate (Fosamax®) 10 mg a day or 70 mg once a week. Other commonly used treatments include risedronate (Actonel®), another bisphosphonate, and raloxifene (Evista®), a selective estrogen receptor modulator (SERM).

Related Topics:
Bisphosphonate - Presently - Sodium alendronate - Risedronate - Raloxifene - Selective estrogen receptor modulator

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Recently, teriparatide (Forsteo®, recombinant parathyroid hormone) has been shown to be effective in osteoporosis, either alone or together with alendronate. Oral Strontium ranelate has also become available; this agent may also increase bone, rather than simply halting its breakdown. Both teriparatide and strontium are registered only for treatment if bisphosphonates have failed or are contraindicated.

Related Topics:
Teriparatide - Recombinant - Parathyroid hormone - Strontium ranelate

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Changes to lifestyle factors and diet are also recommended; the "at-risk" patient should include up to 1000mg of calcium in their diet (1500mg for a post-menopausal woman), which is roughly 3 servings of foodstuffs high in calcium daily. However, the benefit of supplementation of calcium alone remains to a degree controversial, since several nations with high calcium intakes through milk-products (e.g. the USA, Sweden) have some of the highest rates of osteoporosis worldwide. A few studies even suggested an adverse affect of calcium excess on bone density and blamed the milk-industry for misleading customers. Some nutrionalists assert that excess consumption of dairy products causes acification, which leaches calcium from the system, and argue that vegetables and nuts are a better source of calcium and that in fact milk products should be avoided. In any case, thirty minutes of weight-bearing exercise such as walking or jogging, three times a week, has been shown to increase bone mineral density, and reduce the risk of falls by strengthening the major muscle groups in the legs and back.

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Increasing vitamin D intake has been shown to reduce fractures up to twenty-five percent in older people, according to recent studies. The current RDA is 600-700 IU, but it may have to be raised to 700-800 IU based on new information. Information on this research is available at Daily News Central.

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