OSTEOPOROSIS

Introduction

• Osteoporosis is characterised by a reduction in the mass of bone per unit volume (osteopenia) to a level below that required for adequate mechanical support function. There is no abnormality in the ratio of the mineral to organic phase of bone matrix.

• Osteoporosis is also defined operationally as a bone density that falls 2.5 standard deviation below the mean for a 30-year-old normal reference in that population (also known as T score of 2.5).

 

Common Disorders Associated with Osteoporosis

Nutritional and GI disorders

• Malnutrition

• Malabsorption syndromes

• Severe liver disease

Endocrine disorders

• Cushing's syndrome

• Thyrotoxicosis

• Hyperparathyroidism

• Acromegaly

• Hypogonadism

Rheumatological disorders

• Rheumatoid arthritis

• Ankylosing spondylitis

 

Inherited disorders

• Osteogenesis imperfecta

• Marfan syndrome

• Haemochromatosis

• Porphyria

Drugs

• Chronic steroid therapy

• Chronic phenytoin therapy

• Chronic heparin therapy

• Antiretroviral drugs

• Calcineurin inhibitors (tacrolimus, cyclosporine)

• Aromatase inhibitors (anastrozole, letrozole)

 

Miscellaneous

• Immobilisation

• Postmenopausal

• Pregnancy and lactation

• "Senile" osteoporosis

 

Clinical Features

• Fracture is the only cause of symptoms in osteoporosis that produces sudden pain. Common sites of fractures include spine, hip and wrist joints. Vertebral fractures can occur without any pain also.

• Vertebral and wrist fractures can occur much before hip fractures

Laboratory Investigations

• These include serum calcium, alkaline phosphatase, urinary calcium and other relevant investigations for the suspected underlying cause. Most often, serum calcium and alkaline phosphatase are normal.

• Urinary levels of cross-linked N-telopeptides of type I collagen (NTx) indicate the rate of bone breakdown or turnover. Urine NTx >40 nmol/L indicate excessive bone turnover, and is a feature of osteoporosis.

• Radiographs of spine and pelvis:

• Reduced cortical thickness of bones.

• Increased radiolucency of bones.

• Vertebrae show "codfish" appearance.

• Collapse of vertebral body with kyphosis.

• Measurement of bone density:

• CT scan.

• Ultrasound.

• DEXA scan.

 

Treatment

• Diet should include at least 1 g of calcium and 800-1000 IU of vitamin D daily. Additional supplementation may be done, if required to maintain bone and muscle strength.

• Ensure adequate weightbearing exercises.

• Smoking and alcohol should be stopped.

• Reduce falls by taking care of home safety and personal precautions.

• If steroids are required for chronic use, add calcium, vitamin D and bisphosphonates.

 

 

TREATMENT AT DR. SOHAN LAL CLINIC

The integrated POLYCLINIC facility offers patients to select their treatment either from the Department of Homeopathy or from the Department of Medicine.

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