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Osteoporosis

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nusrat-diu:
What are osteoporosis risk factors and causes?

The following are factors that will increase the risk of developing osteoporosis:

    Female gender


    Caucasian or Asian race


    Thin and small body frame


    Family history of osteoporosis (for example, having a mother with an osteoporotic hip fracture doubles your risk of hip fracture)


    Personal history of fracture as an adult


    Cigarette smoking


    Excessive alcohol consumption


    Lack of exercise


    Diet low in calcium


    Poor nutrition and poor general health


    Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from conditions such as celiac sprue


    Low estrogen levels in women (such as occur in menopause or with early surgical removal of both ovaries)


    Low testosterone levels in men (hypogonadism)


    Chemotherapy that can cause early menopause due to its toxic effects on the ovaries


    Amenorrhea (loss of the menstrual period) in young women associated with low estrogen and osteoporosis; amenorrhea can occur in women who undergo extremely vigorous exercise training and in women with very low body fat, for example, women with anorexia nervosa


    Chronic inflammation, due to chronic diseases such as rheumatoid arthritis or liver diseases


    Immobility, such as after a stroke, or from any condition that interferes with walking


    Hyperthyroidism, a condition wherein too much thyroid hormone is produced by the thyroid gland (as in Grave's disease) or is ingested as thyroid hormone medication


    Hyperparathyroidism is a disease wherein there is excessive parathyroid hormone production by the parathyroid gland, a small gland located near or within the thyroid gland. Normally, parathyroid hormone maintains blood calcium levels by, in part, removing calcium from the bone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis.


    When vitamin D is lacking, the body cannot absorb adequate amounts of calcium from the diet to prevent osteoporosis. Vitamin D deficiency can result from lack of intestinal absorption of the vitamin such as occurs in celiac sprue and primary biliary cirrhosis.

    Certain medications can cause osteoporosis. These include long-term use of heparin (a blood thinner), antiseizure medications such as phenytoin (Dilantin) and phenobarbital, and long-term use of oral corticosteroids (such as prednisone).

nusrat-diu:
Who should have bone density testing?

The National Osteoporosis Foundation guidelines state that there are several groups of people who should consider DXA testing:

    All postmenopausal women below age 65 who have risk factors for osteoporosis


    All women aged 65 and older


    Postmenopausal women with fractures, although this is not mandatory because treatment may well be started regardless of bone density


    Women with any of more than 50 medical conditions associated with osteoporosis; a primary-care physician can scan a patient's list of medical illnesses to determine if one of these conditions is present


    Women whose decision to begin treatment for osteoporosis might be aided by bone density testing to determine the presence or absence of osteoporosis or osteopenia

The National Osteoporosis Foundation guidelines state that bone density testing does not need to be performed if a person has a known osteoporotic fracture because the patient will be treated for osteoporosis with or without a bone density study. In addition, bone density testing is not appropriate if the person undergoing the test is not willing to take treatment based on the results. Therefore, if bone density testing is done, it should be performed on people willing to take some specific action based on the results.

nusrat-diu:
The goal of treatment of osteoporosis is the prevention of bone fractures by reducing bone loss or, preferably, by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fractures, none of the available treatments for osteoporosis are complete cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment. The following are osteoporosis treatment and prevention measures:

    Lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D

    Medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), zoledronate (Reclast), and denosumab (Prolia)

    Medications that increase bone formation such as teriparatide (Forteo)

Lifestyle changes

Exercise, quitting cigarettes, and curtailing alcohol

Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased. Research has not yet determined what type of exercise is best for osteoporosis or for how long it should be continued. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily.

A word of caution about exercise: It is important to avoid exercises that can injure already weakened bones. In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure, exercise should be prescribed and monitored by physicians. Extreme levels of exercise (such as marathon running) may not be healthy for the bones. Marathon running in young women that leads to weight loss and loss of menstrual periods can actually promote osteoporosis.

Smoking one pack of cigarettes per day throughout adult life can itself lead to loss of 5%-10% of bone mass. Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause. Smoking cigarettes also can lead to earlier menopause. In postmenopausal women, smoking is linked with increased risk of osteoporosis. Data on the effect of regular consumption of alcohol and caffeine on osteoporosis is not as clear as with exercise and cigarettes. In fact, research regarding alcohol and caffeine as risk factors for osteoporosis shows widely varying results and is controversial. Certainly, their effects are not as great as other factors. Nevertheless, moderation of both alcohol and caffeine is prudent.

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