OSTEOPOROSIS . Causes of osteoporosis and its management

What is osteoporosis ?. Causes and its management

1. OSTEOPOROSIS A life style disease

2. OSTEOPOROSIS

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4. OSTEOPOROSIS Bone tissue is also called osseous tissue Bone remodeling ( bone turnover)- continual process of bone breakdown (resorption) and the formation (deposition) of a new bone The more bones are stressed the more they increase volume and mass, specifically at the site of mechanical loading .( Wolff’s law)

5. Skeletal system - functions Rigid support and protection for vital organs and allows for locomotion. Provides a site for blood cell formation (RBC) , plays a role in immune function(WBC) Serves as a dynamic storehouse for calcium and phosphate which are essential for nerve conduction, heart and muscle contraction ,blood clotting and energy formation

6. Development of peak bone mass Attained in mid 30’s in both sexes 95% achieved by age of 20 PBM is influenced by mechanical factors, nutrition, hormonal levels and genetics In girls peak velocity of BMC occurs at 12.5 – 13.5 years In boys peak velocity of BMC occurs at 14-15 years Specific exercise for bone development are required from approx. 9-16 years Adequate calcium and hormones are necessary for bone development For weight control avoiding dairy products is not a good habit( low fat dairy products may be used)

7. Bone cells Osteoclasts responsible for bone resorption Osteoblasts responsible for deposition of bone tissue or bone forming cells Osteocytes initiates the process of calcification

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9. Bone remodeling and BMD Bone remodeling may result in greater bone mass, the same bone mass, or a reduction in bone mass In young adulthood, more bone is formed than is resorbed ,increasing the bone mass. Thereby more strong bones and increased BMD. When bone remodeling is equilibrium, BMD constant In older adults and those with certain diseases the amount of bone resorbed is more than the amount of bone formed, decreasing BMD

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11. Hormones and bone Excess calcium in the blood leads to release of calcitonin ( from the thyroid gland), which causes deposition of calcium in the bone. This deposition decreases blood calcium level and increases BMD When blood calcium level drops below normal ,PTH stimulate osteoclasts activity , causing calcium to be released from its storage site, the bone. So blood calcium level increase and BMD decrease. Vitamin D is important for absorption of calcium from the intestine Estrogen , testosterone and growth hormones stimulate the protein formation necessary for the bone growth, closure of epiphyseal plate, which determines the persons height The loss of protective role of estrogen on skeletal system after menopause responsible for increased bone resorption in females

12. osteoporosis It means ‘porous’ bones is a condition characterized by compromised bone strength that increased the risk of fracture Osteoporosis results from an imbalance between bone resorption and bone formation Resorption occurs faster than formation leading to a loss in BMD The most common fracture sites related to osteoporosis are the hip, spine and wrist

13. Osteoporosis - causes Genetic factors Lack of appropriate exercise Sedentary life Lack of calcium and vitamin D Smoking Excessive alcohol Low body weight Increasing age Sex hormones

14. One or more symptoms can indicate a spinal fracture     Sudden, severe back pain (though many times the symptoms can come on gradually and worsen over time)       Worsening of pain when standing or walking       Some pain relief when lying down       Difficulty and pain when bending or twisting       Loss of height      Deformity of the spine - the curved, "hunchback" shape

15. Risk factors in osteoporosis Genetic risk factors (race sex family history and body size ) Nutritional risk factors (low calcium intake ,excessive alcohol consumption and consistently high protein intake) Life style factors( lack of physical activity and smoking) Physiological factors (inadequate levels of estrogen )

16. Prevention 1 . Building strong bones, especially before the age of 35, and maintaining a healthy lifestyle. 2. Getting calcium from foods (milk, cheese, yogurt, green leafy vegetables, and shell fish etc.) 3 .  Taking calcium supplements. 4.  Getting vitamin D (sunshine, 15-20 mins quick walk, having food such as liver, fish oil, vitamin-D fortified milk) 5.  Avoiding smoking and alcohol. 6.   Exercise.

17. Management Physical activity as per age and fitness ( Weight bearing activity more) More emphasis for strength and coordination exercises, thereby decreasing the risk of falling ( the risk of falling is affected by the individuals coordination, sight and muscular strength Environmental risk factors that increase the risk of falling are poor lighting uneven or slippery floor surfaces and inappropriate footwear Adequate nutrition Maintenance of normal hormonal level Medication Hormone replacement therapy