Over time, men are apt to lose 25% and women 35% of their bone mass. As quoted by Gro Harlem Brundtland “osteoporosis, as the third threat, is particularly attributable to women’s physiology”. But we have to consider that men tend to have denser bones than women anyway, and their testosterone (male sex hormone) level generally does not begin to decline significantly until after age 65. In contrast, the estrogen (female sex hormone) level in women begins to decline at about age 45. Because sex hormones play an important role in maintaining bone strength, this difference means that women are more likely than men to suffer fractures, involving especially the hip, vertebrae, long bones, and pelvis. Although osteoporosis may at times be the result of various disease processes, it is essentially a disease of aging.

Categorization of Osteoporosis:

A. Primary :

1. Postmenopausal (Decreased serum estrogen)
2. Senile (Aging and reduced physical activity)

B. Secondary :
1. Endocrine Disorders:

• Hyperparathyroidism
• Hyper/hypothyroidism
• Hypogonadism
• Pitiutary tumor
• Diabetes Mellitus type 1
• Addisons disease

2. Neoplasia:

• Multiple myeloma
• Carcinomatosis

3. GIT disturbances:

• Malabsorption
• Malnutrition
• Hepatic insufficiency

4. Drugs :

• Anticoagulant
• Corticosteroids
• Chemotherapeutics
• Anticonvulasants

5. Miscellaneous :

• Osteogenesis imperfecta
• Immobilization

According to German Anatomist/Surgeon Julius Wolff a bone is only big and strong as it has to be. This indicates the role of physical inactivity and immobilization in development of osteoporosis.

Signs and Symptoms:
Patients may not be aware of their osteoporosis until they suffer a painful fracture.

• Joint pains
• Backache
• Change in posture
• Loss of height due to repeated fractures of spine
• Dowager/Widow’s hump due to curvature of the spine at the shoulders in older people
• Hip and wrist fractures during fall
• Stress fracture during normal activity

Prevention and Treatment:

Everyone can take measures to avoid having osteoporosis when they get older. Adequate dietary calcium throughout life is an important protection against osteoporosis. Males and females require 1,000 mg per day until age 65 and 1,500 mg per day after age 65, because the intestinal tract has fewer vitamin D receptors in the elderly. A small daily amount of vitamin D is also necessary to absorb calcium from the digestive tract. Exposure to sunlight is required to allow skin to synthesize vitamin D. Therefore, you should avail yourself of the vitamin D in fortified foods such as low-fat milk and cereal. Postmenopausal women should have an evaluation of their bone density. Presently, bone density is measured by a method called dual energy X-ray absorptiometry (DEXA). This test measures bone density based on the absorption of photons generated by an X-ray tube. Soon, a blood and urine test may be able to detect the biochemical markers of bone loss, making it possible for physicians to screen all older women and at-risk men for osteoporosis.

If the bones are thin, it is worthwhile to take measures to gain bone density because even a slight increase can significantly reduce fracture risk. Regular, moderate, weight-bearing exercise such as walking or jogging is a good way to maintain bone strength . A combination of exercise and drug treatment, as recommended by a physician, may yield the best results. A wide variety of prescribed drugs that have different modes of action are available. Hormone therapy includes black cohosh, which is a phytoestrogen (estrogen made by a plant as opposed to an animal). Calcitonin is a naturally occurring hormone whose main site of action is the skeleton where it inhibits the action of osteoclasts (the cells that break down bone).

Promising new drugs include slow-release fluoride therapy and certain growth hormones. These medications stimulate the formation of new bone. Examples include Biphosphonates and Selective Estrogen Receptor Modulator (SERM).

Q: When is World Osteoporosis Day celebrated?

Ans: Every year on 27th October

Dr Binit Vaidya,NMCTH

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a type of rheumatic disease with predominant effect on the joints. RA is a destructive disease which can cause damage and deformities of the affected joints. The major brunt of the disease falls in females of 25 to 50 years of age. However, people of both gender and all age groups may be affected. People with severe disease are known to have impaired lifestyle due to deformities, loss of function and pain. They are also known to have a shorter lifespan if untreated.

RA shows Iceberg phenomenon

What are the symptoms of Rheumatoid Arthritis?

Pain, swelling and morning stiffness of the joints of hands are the most common symptoms. People with this disease feel unwell, fatigued and feverish too. The severity of disease varies among individuals. It may also involve the joints of lower limbs. Patients with RA may also have symptoms of dry eye, red eye, skin ulcers, and difficulty in breathing in addition to joint symptoms.

Hand Deformity in Rheumatoid Arthritis

What causes of Rheumatoid arthritis?

In this disease, the body’s defence system designed to fight with the external elements attacks the persons own joints and tissues. This is thus a type of auto-immune disease. Many factors like genes, environment and smoking have been postulated in the development of this disease but what exactly triggers this disease is still unknown despite a lot of research going on.

How is Rheumatoid Arthritis diagnosed?

It is generally possible to diagnose RA based on the symptoms and the findings on examining the joints of the person. However, there are many diseases that mimic the symptoms of RA and they should be differentiated. Sometimes a few blood tests and x-rays are helpful in making the diagnosis. The diagnosis is either made by a physician or a rheumatologist. A rheumatologist is a person who helps and treats people with problems in joints, bones and muscles.

What are the treatment modalities of Rheumatoid Arthritis?

The various treatment modalities are:

• Lifestyle changes
• Drug treatment
• Physiotherapy and occupational therapy
• Surgery

Lifestyle changes: People with RA are required to maintain a proper balance between exercise, diet correct posture.

Drug treatment: Drug treatment for RA is most effective when started early and before any damage to the joints have already set in. Effective therapy at this stage can control the disease effectively and prevent deformity and hence the disability in these people. Because, the disease is actually a fight with the body’s own defence system, treatment has to be taken long-term or even lifelong. Most important drugs used in the treatment of RA are called disease modifying anti-rheumatic drugs (DMARDS).

The drugs include methotrexate, sulfasalazine, hydroxychloroquine and leflunamide. Another group of drugs known as biological agents are now being available in India and Nepal too. These drugs are highly effective but are very costly. All medications should be properly supervised and regularly monitored to avoid the potential toxic effects of these medications. Pain killers and corticosteroids should be used judiciously and their chronic intake for long term should be avoided as they can be harmful when taken regularly for a long time.

Physiotherapy and occupational therapy: This requires involvement of physiotherapist and occupational therapist and has a role is prevention and treatment of stiff joints. They can also help to make a deformed joint as functional as possible with the use of exercise and splints.

Surgery: Surgery may be required in a few cases with destroyed joints. It can help in pain relief as well as improvement in function. However, which patient needs surgery is a decision made by rheumatologist.

What are the goals of treatment of Rheumatoid Arthritis?

The main goals are control of pain and prevention of deformities with minimal use of drugs like steroids and pain killers. Also, the increased heart disease risk in these people has to be addressed.

Our Featured Author for the article:

Dr. Binit Vaidya, Nepal

MBBS ( BPKIHS),
MD( AIIMS,INDIA).
FACR.

Department of Medicine, NMCTH.

Global hospital, Alka Hospital,APOLLO Clinic.