What is Osteoporosis?
Osteoporosis is essential that the stability of the skeleton and the bones that form it be maintained. If these weaken, then the entire system may gradually lose its strength, and the basic foundation of the body is in jeopardy.
Other disorders of the bony system may occur. Fractures resulting from direct trauma are common. Almost any accident may result in a bony fracture. The bones are frequently the site for secondary cancerous deposits that have been carried there from other parts of the body. These are termed metastases, and may lead to premature fractures of the bones. These will not be dealt with either.
The main disorders that will be covered will include osteoporosis, osteomalacia, osteitis deformans (Paget’s disease). osteomyelitis, with brief mention of some less common ones.
With advancing years, the bones of the body tend to lose their calcium, which makes them weaker and more liable to ready fracture. This may occur with minimum trauma, and under normal circumstances, in younger persons, would never produce a break. just when normal calcium loss merges into abnormal loss is a debatable point. It is usually demonstrated by X-ray, but by the time this is noticeable, a large amount of calcium has already left the bony substance.
There are many causes, but advancing years and senility hold first place. Second, postmenopausal osteoporosis in older women comes in strongly. These far outweigh all other causes combined. However, a certain number are due to disorders of the internal (endocrine) gland system. Patients with excessive thyroid function and with the fairly rare condition called acromegaly (gigantism) arc claimed to have a higher rate than normal.
Nutritional disturbances from an inadequate diet can theoretically cause osteoporosis, but in practice, this is probably very rare.
If a person has been immobilised for any reason and is confined to bed for a prolonged period of time, then the bones tend to lose calcium rapidly on this score alone. In most cases, the heavy bones comprising the vertebral column arc usually affected first.
The bones lose their calcium, so tend to become spongy and brittle. This means they lose their strength and fracture (break) far more readily. The bones are not tender, except when a recent fracture has taken place, for example in the vertebral column where the bones may simply collapse. In the early stages, there are often no signs at all.
As the bones weaken, they tend to fracture readily. As each fresh fracture takes place (commonly in the back), it is accompanied by local pain at the site. But this soon heals. The person may find relief from going to bed for a while, and in four to eight weeks the fracture heals. Or the patient may elect to use a wheelchair during the acute period of discomfort. Stress on the back may initiate these fractures. Stooping and lifting a heavy weight is a common predisposing cause. But in others the fracture merely takes place for no obvious reason.
Each time a fracture occurs, there is a shortening of the total vertebral column. At first it may be unrecognised, and only when it causes symptoms in itself will the patient be aware of it.
As this condition progresses, chronic and constant backache tends to result, but this is usually a late symptom. It is often aggravated by a forward tilting of the back.
Apart from the back bones, others may be involved. The hip is a favourite site, and the neck of the femur notorious, as evidenced by the large number of fractures in this region in older people seems that nature endeavours to protect the brain, for the skull is rarely the site for spontaneous fracture.
These changes tend to occur most commonly in women usually in the sixth and seventh decades. They are irreversible. However, the period of the recurrent fractures and height loss is usually limited to about 10-1.5 years. Diagnosis made these days with a special examination called the mineral bone density test. There are various forms of this, one being the dual photon densitornetry Tests are usually carried out in special units attached to the major public hospitals in Australia and New Zealand.
As osteoporosis is largely irreversible efforts are chiefly concerned at reducing the rate at which calcium is being removed from the bones, so halting the process. Many treatments have been tried over the past several years, and there have been all manner of claims made. At present, the most successful treatment seems to be a highly nutritious diet, plus hormonal therapy in conjunction with a high daily calcium intake. Fat reduced milk is also good.
Calcium is given at the rate of 100 grams daily. The use of relatively pleasant effervescing tablets has greatly facilitated the intake of this clement.
Female hormone: It is now universal accepted that if women past the menopause regularly took “HRT”—short for Hormonal Replacement Therapy—the risk of osteoporosis would be greatly reduced. This is now considered to be perfectly safe, provided it is taken according to an exact routine. Generally, the conjugated oestrogens are recommended, and taken in conjunction with another female hormone, a progestogen.
The recommended routine is as follows for women who still have their womb (uterus) intact (ie have not undergone hysterectomy): Take one oestrogen tablet daily from Day 1 to Day 24 of calendar month, then stop until the first day of the following month, when an identical course is taken. Then, from Day 14 to Day 24 of each calendar month, one orogestogen tablet is taken each day, then stopped until the same day of the following month.
For women who have lost their womb,having undergone hysterectomy, there is no need to take progestogen. This is needed when the womb is present and estrogen may cause the womb lining to break down and there may also be a small risk of uterine cancer developing. But this is virtually negated when progestogen is taken. This may cause some vaginal bleeding (like a period) three to four days after the cessation of medication, but this is usually considered a small price to pay the beneficial effects.
This routine, carried out under medical supervision, will almost entirely remove the risks of osteoporosis. Women are the main sufferers—it is uncommon males. The use of the anabolic steroids i:e. taken by injection has had its advocates. Fluoride is claimed to be necessary to put calcium back into the bones, and is often used. Calcium is at present under investigation.
A diet high in protein, and high in calcium and vitamins C and D is necessary. Activity should be encouraged, and frequent bouts in bed are unwise, as this will aggravate the situation. Avoid all unnecessary stresses that may produce ulcers.