Osteoporosis is a condition where there is decreased bone strength. Due to decreased strength the bone fractures easily with minor or no trauma.
Predominant majority of osteoporosis results due to genetically mediated bone fragility. 70 to 80% of bone strength is determined by genetics. The most common presentation of genetically mediated osteoporosis is in the form of osteoporosis that occurs in women shortly after menopause and continues to worsen from that age till the age of 75 to 80 years. In these three decades of life women who have genetic predisposition to bone fragility tend to lose bone mass very rapidly and suffer multiple fractures over a period of this time. The other causes of osteoporosis include glucocorticoid therapy, rheumatoid arthritis, endocrine disorders such as hyperthyroidism, and hypogonadism both in men and women.
Osteoporosis usually does not have any symptoms until there has been a fracture. Fall from height less than one standing height resulting in a fracture is considered a fragility fracture and it is the way osteoporosis will clinically manifest. In elderly women with long-standing osteoporosis multiple fractures of the vertebral spine can result in an abnormal posture due to which there can be backache and also there can be pain due to the rubbing of the rib cage against the iliac crest (hip bone). But these symptoms occur very late and when they do occur, they cause severe disability for the patient. The ideal way to recognise osteoporosis is through screening, when the patient is not yet symptomatic using bone mineral density.
Osteoporosis is a disease of abnormal genetics and aging. One cannot cure osteoporosis but it can be slowed down to an extent that the risk of fractures is substantially reduced. We now have several therapies which are highly effective in preventing fractures in individuals who have osteoporosis. Just like other diseases like type2 diabetes, hypertension, cardiovascular disease osteoporosis requires lifelong treatment with usage of various agents at various time points to reduce the overall risk of fractures.
If osteoporosis is left untreated it will result in a higher risk of fractures. Some of these fractures can be life-threatening. For example, a hip fracture has a high mortality over the next 30 days for a person who has it.
The best doctor to meet for treating osteoporosis is an Endocrinologist. This is because Endocrinologist can easily tell the difference between osteomalacia and osteoporosis. They can also tell the difference between primary osteoporosis and secondary osteoporosis. These two distinctions are very important in order to form a very good therapeutic strategy for osteoporosis. They are also experts in the latest therapies in line for osteoporosis treatment, and they can also supervise treatment very effectively. And more importantly Endocrinologists are specifically trained to treat osteoporosis. Surgeons treat osteoporosis once a fracture has occurred. There are spine surgeons who will treat spine fractures after it has occurred to relieve pain and improve mobility.
At Magna, the doctor will take a detailed history and examine the patient to find out whether there are risk factors for osteomalacia or secondary osteoporosis. A blood work is ordered to look for any calcium or phosphorus abnormalities. A bone mineral density of lumbar spine and hip is then asked.
Osteoporosis can be treated through various drug therapies. The most elementary drug therapy for osteoporosis is weekly intake of alendronate. The tablet is to be taken on an empty stomach with water and the person taking it must make sure that they do not lie down immediately after taking it. This is to make sure that the pill goes through the food pipe into the stomach and does not get stuck in the food pipe.
Another form of treatment of osteoporosis is an injection called Denosumab which is to be taken every six months. In the most severe case of osteoporosis the Endocrinologist may recommend teriparatide. Recombinant Teriparatide is an injection which is given like an insulin shot every day at night for one and a half to two years. Among all therapies for osteoporosis this is the most effective in improving bone mineral mineral density.