WHAT IS OSTEOPOROSIS?
Osteoporosis is a reduction of bone density, which weakens the bones to the point that they can fracture following minimal trauma (minor fall, stumbling or tripping). It is the most common bone disorder in developed countries. The wrists, hips and spinal column are the joints with the highest risk of osteoporotic fractures. Often, these fractures are the first sign of osteoporosis. Vertebral fractures cause pain in the back, stooped posture (kyphosis), and loss of height. The hip fracture is very painful and is associated with a significant loss of independency and quality of life. Unfortunately, by the time an osteoporotic fracture is produced there has already been a substantial loss of bone density, so it is strongly recommended to prevent osteoporosis at an earlier stage.
Stages of vertebral osteoporosis
WHO IS AFFECTED BY OSTEOPOROSIS?
Osteoporosis begins in women usually after menopause and progresses gradually over the years. In men, osteoporosis begins 10 years later than in women. Out of the patients with clinical osteoporosis, 80% are women, and 20% in men.
- Age: as you age there is an average loss of 0.5% bone density every year after the age of 50 in women and 60 in men.
- Genes: you have a 50-80% increased risk of developing osteoporosis if one of your family members has it.
- Gender: osteoporosis affects women much earlier and more severely. An osteoporotic fracture affects 1 in every 2 women and 1 in every 8 men. In women the loss in bone density is much greater after menopause, losing in the first 5-7 years the 3% bone density each year. This post-menopausal loss in bone density can be limited with regular physical exercise, medication and hormonal replacement therapy.
- Low body weight.
- Alcohol, tobacco, caffeine, theine.
- Low vitamin D and calcium intake in the diet.
- Sedentary lifestyle.
- Some chronic diseases (rheumatoid arthritis, hyperthyroidism, renal insufficiency…).
- Some medications, especially corticosteroids, anti-inflammatory agents and anti-aggregating drugs.
HOW IS OSTEOPOROSIS DIAGNOSED?
Clinical suspicion of osteoporosis arises when pain in the medium dorsal region (where ladies tie their bra) is suffered by the patient. X-ray scans will show any low bone density bones, as well as any osteoporotic fractures. To quantify how much bone density has been lost, a bone density scan must be performed. MRI will be used to see the fractures better and check for any are signs of oedema, which would indicate that the fracture is recent and that it is the cause of pain.
WHAT SHOULD I DO IF I SUFFER FROM OSTEOPOROSIS?
- Do not smoke, tobacco increases the osteoporosis, especially in women.
- If you drink alcohol do it moderately.
- Do moderate physical exercise every day within your capabilities: walk for at least an hour every day, do some swimming, etc.
- Make sure you have a varied diet and take dairy products every day.
- Take some sunlight at least 10 minutes in the sun and forearms, remembering that it is always better to do it early in the morning (10-12am).
- Remember to take the medication correctly and do not forget to attend the regular follow-ups.
HOW IS OSTEOPOROSIS TREATED?
The key point in treating osteoporosis lies in preventing or delaying the loss in bone density. For this purpose, the risk factors must first be corrected, e.g. ensuring an adequate calcium and vitamin D intake (either from your diet or with supplements) and regular physical exercise. The adequate calcium and vitamin D intake is achieved taking more skimmed dairy products (high cholesterol is not desirable either!), such as cheese, butter, milk and yoghurt. Some vegetables, such as broccoli, cauliflower, mustard, turnips and bok choy (Chinese cabbage), are also good sources of calcium, whereas vitamin D is found in fish, oysters, enriched cereals and especially in mushrooms.
Regular physical exercise is absolutely essential: walking every day for a while, swimming or going to the gym… Coffee and tea intake and smoking must be stopped, and alcohol ingestion must be minimised.
Available drugs include oestrogens, alendronate, resindronate, reloxifene and calcitonin. Your doctor will tell you if you need to take any of them and in what dose. The recommended dose of sodium resindronate is a 35mg tablet once a week, taken orally. It is important to follow the instructions of use:
- Choose the more convenient day of the week to take the medication; you will have to take it on the same day of the week always.
- Just after waking up and before eating or drinking anything, take the tablet of sodium resindronate with a glass of water from the tap (not mineral water) erect position, be it standing or sitting. Then start your daily activities, but do not go to bed, eat or drink anything, or take any medication for the next 30 minutes.
- If you forget to take the tablet in the morning, take it when you remember it and take the next tablet on the day due of the next week. NEVER take two tablets on the same week.
If there are any osteoporotic fractures, a percutaneous vertebroplasty, or a percutaneous kyphoplasty, depending on the case, will be needed.