Osteoporosisis a medical condition that deteriorates bones, making them prone tobreaking(Kanis, Delmas, Burckhardt, Cooper & Torgerson, 1997).The condition usually affects people who are above fifty years old.It develops gradually over time and is usually diagnosed when a bonefracture results due to a fall. The most regular injuries in peoplewith osteoporosis are vertebrae, wrist and hip fractures. However,other areas such as arms and pelvic can also be affected. A sneeze ora cough can cause a person to fracture a rib or partial collapse ofthe spine bones (kanis et al., 1997). This condition is not usuallypainful until the bone density becomes too low to a point offracture, which causes chronic pain. With aging, it is expected tolose some bone density, but to some people it usually happens at analarming rate, which increases their risk of fracture andosteoporosis. Of the two sexes, women are at a higher risk ofosteoporosis (kanis et al., 1997).
Otherfactors that have been known to increase the risk of osteoporosis area low body mass index, heavy drinking, and smoking, use of medicineswhich affect hormone levels, a family history of osteoporosis and thelong-term use of corticosteroids(Gueldner, 2008). Previously, attention was dedicated to curing and treatingosteoporosis, but recently the approach has shifted to trying toprevent the fragility of fractures and their consequences(Papaioannouet al., 2010).This has been necessitated by various medical issues that increasethe likelihood of fracture regardless of mineral density, toassimilate a holistic approach in the prevention treatment andmanagement of osteoporosis(Papaioannouet al., 2010).Studies have suggested that people suffering from osteoporosis do notreceive appropriate assessment and treatment. Thus, current clinicalguidelines have tried to close this gap by incorporating newapproaches for assessing the 10-year risk of osteoporosis(Gueldner, 2008).The utilization of such information will help in foreseeing fracturesthat are likely to occur and thus enable physicians to providepatients with the right therapies, which will aid in the preventionof the fractures.
Diagnosing,Treating and Managing Osteoporosis
Clinicalguidance of osteoporosis recommends that patients who have attainedthe age of 50 years and above should be assessed for risk factors topinpoint risk levels(Jeremiah,Unwin & Greenawald, 2015).It is recommended that clinicians do a detailed historical andphysical examination to ascertain possible risk factors for minimalbone mass, fall, and undiagnosed vertebral fractures(Jeremiahet al., 2015).This can be done by the utilization ofFracture Risk AssessmentTool (FRAX) or other relevant risk assessment tools. Furtherdiagnosis can be done by measuring the bone mineral density usingDual Energy X-Ray (DEXA)(Jeremiahet al., 2015).Also, the biochemical test should be carried out. The procedure ispainless and short, depending on the part being examined. The bonemineral density is taken and compared to a healthy adult of the samesex and age. The variation is calculated as standard deviation ifthe T score is above -1 the bone mineral density is normal, the rangebetween -1 and -2.5 is referred as decreased bone density while below-2.5 proves osteoporosis condition (Jeremiahet al., 2015).
Afterassessing and diagnosing a patient, the clinician can proceed to thetreatment process. This will depend on the risk of fracture for apatient, and then viable therapeutic options will be availed(Jeremiahet al., 2015).Patients that have been diagnosed with osteoporosis are encouraged todo regular exercises so as to minimize the possibility of risk forfracture. Also, it is recommended that they supplement their dietwith vitamin k and calcium rich foods. The reduction and stop ofsmoking and heavy drinking are also recommended (Jeremiahet al., 2015).Also, the patients are advised to take precautionary measures thatreduce the risk of falls such as having a regular hearing and sighttests, and removing obstacles in a patient`s environment thatincrease the risk for a fall (Papaioannouet al., 2010).There are also various pharmacologic therapies which can berecommended to patients who are above 50 years and have had multiplefractures and still express risk signs of additional fractures(Papaioannou et al., 2010).The grade of the therapies will usually be determined by thecondition of osteoporosis in a patient.
Forinstance, patients that can be termed to have a moderate risk, it isrecommended that various medical assessments be administered to themto pinpoint further potential risks, which might have been missed inthe assessment process(Gueldner, 2008).Also, because this stage is associated with many cases ofosteoporotic fractures, it is wise to consider the adoption ofpharmacologic therapy. These measures are necessary to preventfurther fracture. On the other hand, if a patient shows minimalprobabilities of fractures it is not necessary to considerpharmacologic therapy (Gueldner,2008).What a physician can do in this stage is to advise a patient to adopta lifestyle that reduces the risk of fracture and osteoporosiscondition. This can be through the cessation of heavy drinking andsmoking habits, intake of calcium and vitamin supplements, andprevention of fall risks (Gueldner,2008).
Inmoderate stage, it is also recommended that bone mineral densitymeasure is done within a period of one to three years to monitor thechanges in patients undergoing fracture and osteoporosis treatment(Gueldner,2008).If the patient results show positive reaction towards treatment, thetesting interval can be adjusted upwards, and this reflects apositive reaction to therapy. Thus, patients whose bone mineraldensity is stable or stabilizing will not be subjected to frequentmonitoring. On the other hand, if patients’ results show continualfracture and drop of bone mass density, it is vital that thesepatients are recommended to a specialist (Gueldner,2008).Also, patients that exhibit these attributes, unsuccessful subsequenttherapy responses, very low levels of bone mineral density despitetreatment and other issues causing osteoporosis that is outside thephysician knowledge should also be recommended to a specialist(Gueldner,2008).
Accordingto data collected by National Health and Nutrition ExaminationSurvey, 2005-2008, 9% of the USA adults aged 50 years and above hadosteoporosis at lumber spine or femur neck while 49% had a low bonemass in lumbar spine or femur neck (Looke, Borrud, Hughes, Shepherd &Wright, 2012).
Figure1: Percentage of people above 50 years with osteoporosis.
Figure2: Comparison between men and women
Menand women who had low bone mass were 38% and 61% while those who hadosteoporosis were 4% and 16% respectively (Looke et al., 2012).
Figure3: Data for men with a low bone mass and osteoporosis according torace.
Thestatistics also differed in race and ethnicity. The occurrence ofosteoporosis in men of another ethnicity was higher than the MexicanAmerican, Non-Hispanic Black and Non-Hispanic White (Looke et al.,2012). Also, the prevalence of low bone mass was higher in other racethan Non-Hispanic black and Non- Hispanic white (Looke et al., 2012).
Osteoporosiswas highly prevalent in Mexican American women while it was least inNon-Hispanic black compared to other races. All races showed a highprevalence of low bone mass with the highest percentage beingreflected in the “other” race (Looke et al., 2012).
Thus,from the above information, we can deduce that osteoporosis and lowbone mass greatly affect people who have attained the age of 50 yearsand above. Of these people, women are highly affected. According tothe literature in this field, clinical guidance concentrates onprevention and management than curing, which is seen as onealternative to an end. The condition can be prevented throughlifestyle changes and elimination of risk that increase theoccurrence of the condition. Pharmacological therapy options are alsoavailable to help patients live with the condition.
Gueldner, S. H.(2008). Osteoporosis:Clinical guidelines for prevention, diagnosis, and management.New York, NY: Springer Pub. Co.
Jeremiah, M. P.,Unwin, B. K., & Greenawald, M. H. (2015).Diagnosis and management of osteoporosis. Americanfamily physician, 92(4),261-268..
Kanis, J. A.,Delmas, P., Burckhardt, P., Cooper, C., &Torgerson, D. (1997). Guidelines for diagnosis and management ofosteoporosis. OsteoporosisInternational, 7(4),390-406.
Looker, A. C.,Borrud, L. G., Hughes, B. D., Shepherd, J. S.,& Wright, N. C. (2012).Osteoporosisor low bone mass at the femur neck or lumbar spine in older adults:United States, 2005–2008 (93).Retrieved from Center for Disease Ciontrol and Prevention website:http://www.cdc.gov/nchs/data/databriefs/db93.htm
Papaioannou, A.,Morin, S., Cheung, A. M., Atkinson, S.,Brown, J. P., Feldman, S., … Leslie, W. D.(2010). 2010 clinical practice guidelines for the diagnosis andmanagement of osteoporosis in Canada: summary. CanadianMedical Association Journal,182(17),1864-1873. doi:10.1503/cmaj.100771