OSTEOPOROSIS (BONE RESORPTION)
WHAT ARE THE OSTEOPOROSIS RISK FACTORS?
Osteoporosis and therefore the risk of fractures increases with age. Age is not the only risk factor for osteoporosis. Those with a family history of fractures, especially in the mother, are at risk due to genetic characteristics. Other risk factors include early menopause, being thin, having a thin build, smoking, drinking alcohol, excessive caffeine intake, low calcium intake in the diet, excessive salt intake, vitamin D deficiency, long-term use of cortisone, thyroid or parathyroid diseases, diabetes, rheumatic diseases, insufficient physical activity and a tendency to fall. Genetic factors are thought to affect bone mineral density by 50–80%.
DOES OSTEOPOROSIS GIVE SYMPTOMS?
In osteoporosis, a long silent period is observed before the development of clinical symptoms or complications. Osteoporosis can be detected during this process by chance or if bone densitometry is performed during screening. Clinical complaints and findings are back pain, shortening, spinal deformities and fractures. Pain often becomes apparent with movement and lifting weights. Bones are sensitive to pressure. Pain usually occurs due to posture disorder, ligament tension or chronic spinal fractures. Fractures are most commonly seen at the junction of the back and waist. Compression fractures cause shortening. Forearm fractures usually occur when the arms are extended forward as a protective mechanism during a fall. Arm fractures are more common between the ages of 40-65, while the frequency of hip fractures increases after the age of 65.
WHAT SHOULD WE PAY ATTENTION TO TO PROTECT AGAINST FALLS?
Individual factors that increase the likelihood of falling include general debility, decreased muscle strength, abnormal walking pattern, visual impairment, decreased reaction time, use of multiple medications, and alcohol consumption. Environmental factors include slippery and wet surfaces, poor weather conditions, inadequate lighting, unfamiliar stairs, flooring, tripping cords, carpets, etc.
HOW IS OSTEOPOROSIS DIAGNOSED?
It is recommended that all postmenopausal women and elderly men be evaluated for osteoporosis risk factors. If the patient is over 65 years of age, has a spinal depressed fracture, has a family history of osteoporotic fractures (especially a hip fracture in the mother), has received cortisone treatment for more than 3 months, has a tendency to fall, has radiological bone loss, has entered menopause before the age of 45, has intestinal malabsorption, has hormonal problems, has increased alcohol consumption, or has been smoking, the patient should be examined for osteoporosis. Blood tests are usually within normal limits. Direct X-ray is not sufficient for the diagnosis of osteoporosis; however, it is a good method for determining the presence of a spinal depressed fracture. Bone mineral density should be measured in those with more than one risk factor. This is an extremely simple and fast method; it provides important information about fracture risk. Dual energy X-ray absorptiometry (DXA) is the most commonly used technique and is applied in a short time (2–5 minutes). The lumbar region, femur, forearm or the entire body can be measured. The radiation dose is low.
HOW TO PREVENT OSTEOPOROSIS?
The first step in treatment should be prevention. Adequate and balanced nutrition, adequate calcium and vitamin D intake, regular exercise and prevention of falls are components of the prevention program. Dairy products and green vegetables are foods rich in calcium. Calcium is necessary for normal development of the skeleton in childhood and adolescence, reaching a high level of peak bone mass and preserving bone mass in adulthood. When sufficient calcium cannot be obtained through the diet, calcium supplementation should be given. Its administration together with vitamin D increases its effectiveness. Sunlight is needed for the synthesis of vitamin D through the skin. Walking in the sunlight for 10–15 minutes a day is sufficient for this. When vitamin D supplementation is applied together with exercise, it increases muscle strength, walking speed and balance and reduces the risk of falling. Magnesium, zinc and copper, as well as ascorbic acid, from the trace elements, play important roles in bone formation and deficiency of these substances has been detected in osteoporotic patients. The importance of a well-rounded, conscious, balanced and sufficient diet should not be forgotten.
DOES EXERCISE HAVE A PLACE IN PREVENTION AND TREATMENT OF OSTEOPOROSIS?
Exercises recommended for osteoporosis treatment are aerobic exercises that put weight on the body. Walking for 45 minutes 3 days a week is usually sufficient. Running or tennis are also recommended sports. Stretching, balance and strengthening exercises are also recommended. Stretching exercises protect the patient from falling and injury by providing flexibility of the joints. Balance exercises prevent falls in the elderly. Strengthening exercises are performed with handheld weights and standing cuffs. Relaxation, breathing and posture training should be planned. Swimming has no significant effect on bones. In those with osteoporosis, the exercise program should be applied under supervision and especially exercises performed by bending forward should be avoided.
HOW IS OSTEOPOROSIS TREATED?
The main goal in the presence of osteoporosis is to prevent fractures. In the presence of fractures, treatment goals should be to reduce the patient’s pain and discomfort, improve their functions, and increase their quality of life. The reason for the development of osteoporosis is the disruption of the balance between bone formation and destruction. Destruction has overtaken construction. The drugs used in treatment are either drugs aimed at reducing destruction or increasing construction. Although bone mineral density is often taken as the basis in the diagnosis and treatment of osteoporosis, factors such as the patient’s age, the presence of risk factors, and the risk/benefit profile of the treatment should be taken into consideration when deciding on treatment for a patient.
Treatment is not necessary in women with normal bone mineral density. In women with low bone mineral density, the causes of bone loss should be evaluated and a prevention program should be planned. In women with a history of fractures, treatment is needed regardless of the scores. If the bone mineral density is below the osteoporosis limit, treatment is decided according to age and other risk factors.
Osteoporosis is a disease that can be diagnosed before fractures occur, and the health problems that fractures will create can be prevented with the necessary precautions and treatments. Therefore, if you are over 65 years of age or have one of the risk factors for osteoporosis mentioned above, you can apply to our clinic to be evaluated for osteoporosis.