Can They Target Osteoporosis Treatment to Specific Arts of Your Body

What is osteoporosis?

The word osteoporosis ways spongy (porous) bone.

Os is made up of minerals, mainly calcium salts, bound together by stiff collagen fibres. Our basic take a thick, hard outer shell (called cortical or compact os) which is easily seen on 10-rays. Inside this, there's a softer, spongy mesh of os (trabecular os) which has a honeycomb-like structure.

Bone is a living, active tissue that's constantly renewing itself. Quondam bone tissue is broken down past cells chosen osteoclasts and is replaced by new bone material produced by cells chosen osteoblasts.

The residual between the breakdown of old os and the formation of new bone changes at different stages of our lives.

• In childhood and adolescence, new bone is formed very rapidly. This allows our bones to grow bigger and stronger (denser). Bone density reaches its peak by our mid-to late-20s.
• After this, new bone is produced at about the same rate every bit older bone is cleaved downwards. This means that the adult skeleton is completely renewed over a period of vii–ten years.
• Eventually, from the age of about 40, bone starts to be broken downwards more apace than it'southward replaced, so our bones slowly brainstorm to lose their density.

We all have some caste of os loss as nosotros go older, but the term osteoporosis is used only when the bones become quite fragile. When bone is affected by osteoporosis, the holes in the honeycomb construction become larger and the overall density is lower, which is why the os is more than likely to fracture.

Who gets osteoporosis?

Osteoporosis is common in the UK, and the risk increases with historic period. Anyone can become osteoporosis just women are near iv times more likely than men to develop it. There are two main reasons for this:

• The process of bone loss speeds upwardly for several years after the menopause, when the ovaries stop producing the female person sex hormone oestrogen.
• Men generally reach a college level of bone density earlier the process of bone loss begins. Bone loss still occurs in men but it has to be more astringent before osteoporosis occurs.

A number of other take a chance factors tin can increase your chances of developing osteoporosis.

Symptoms

Osteoporosis oftentimes has no symptoms. The kickoff sign that you may have it is when you pause a os in a relatively pocket-sized fall or blow (known as a low-affect fracture). Fractures are most likely in the hip, spine or wrist.

Some people have dorsum issues if the basic of the spine (vertebrae) become weak and lose meridian. These are known as vertebral crush fractures. They usually happen around the mid or lower dorsum and tin can occur without whatsoever injury. If several vertebrae are affected, your spine will get-go to curve and yous may become shorter. Sometimes vertebral crush fractures can make breathing difficult simply because at that place's less space nether the ribs.

If you have a vertebral crush fracture you'll as well accept a greater chance of fracturing your hips or wrists.

Causes

Take a chance factors for developing osteoporosis include:

Steroids (especially if taken by mouth) – Steroids (corticosteroids) are used to care for a number of inflammatory weather condition including rheumatoid arthritis. They tin can affect the production of bone by reducing the amount of calcium absorbed from the gut and increasing calcium loss through the kidneys. If yous're likely to need steroids, such as prednisolone, for more than three months your doctor will probably suggest calcium and vitamin D tablets, and sometimes other medications, to help prevent osteoporosis.

Read more than about steroid tablets.

Lack of oestrogen in the body – If you take an early menopause (before the age of 45) or a hysterectomy where one or both ovaries are removed, this increases your run a risk of developing osteoporosis. This is because they cause your torso's oestrogen production to reduce dramatically, so the process of bone loss will speed up. Removal of the ovaries just (ovariectomy or oophorectomy) is quite rare but is also linked with an increased chance of osteoporosis.

Lack of weight-begetting do – Exercise encourages bone development, and lack of exercise means you'll be more than at risk of losing calcium from the bones and and so developing osteoporosis. Muscle and bone health are linked so it'southward also important to keep up your muscle strength, which will also reduce your risk of falling.

However, women who exercise so much that their periods stop are too at a higher risk because their oestrogen levels volition be reduced.

Poor diet – If your nutrition doesn't include enough calcium or vitamin D, or if you're very underweight, you'll exist at greater risk of osteoporosis.

Heavy smoking – Tobacco is direct toxic to bones. In women information technology lowers the oestrogen level and may crusade early menopause. In men, smoking lowers testosterone activity and this tin besides weaken the bones.

Heavy drinking – Drinking a lot of alcohol reduces the body'southward ability to make bone. It besides increases the chance of breaking a bone as a result of a fall.

Family history – Osteoporosis does run in families, probably because in that location are inherited factors that affect bone development. If a shut relative has suffered a fracture linked to osteoporosis then your own take chances of a fracture is likely to be greater than normal. Nosotros don't yet know if a particular genetic defect causes osteoporosis, although we do know that people with a very rare genetic disorder called osteogenesis imperfecta are more likely to suffer fractures.

Other factors that may touch your risk include:

• ethnicity
• low body weight
• previous fractures
• medical conditions, such every bit coeliac disease (or sometimes treatments) that affect the absorption of food.

How will osteoporosis touch me?

There's a great deal you can practice at different stages in your life to help protect yourself against osteoporosis.

Practice

Any exercise where the basic are made to acquit the weight of the torso, such as walking, can speed upward the process of new os growing.

The more than weight-bearing exercise you lot do from a young historic period, the more this will reduce the take a chance of getting osteoporosis.

If you exercise have osteoporosis, doing weight-bearing do volition minimise bone loss and strengthen muscles.

However, all forms of practice will assist to improve co-ordination and keep up muscle strength. This is important because muscles can also get weaker as we get older, and this is a gamble gene for falling and therefore for fractures.

T'ai Chi tin exist very effective in reducing the chance of falls. Doing T'ai Chi regularly volition strengthen muscles in the upper torso, lower body and the core. Information technology as well improves remainder.

Walking is a adept exercise to improve bone force and it is also expert for keeping thigh and hip muscles stiff, which is important to help people have skillful balance and forestall falls.

Loftier-bear upon exercise such as skipping, aerobics, weight-training, running, jogging and tennis are idea to be useful for the prevention of osteoporosis. These exercises might not all be suitable if you have osteoporosis.

For more support, motivation and advice talk to your doc, a physiotherapist or a personal trainer at a gym about your status and the best exercise for y'all.

Diet and diet

Calcium

The best sources of calcium are:

• dairy products such as milk, cheese and yogurt (low-fat ones are all-time)
• calcium-enriched types of milk made from soya, rice or oats
• fish that are eaten with the bones, such equally tinned sardines.

Other sources of calcium include:

• leafy light-green vegetables such as cabbage, kale, broccoli, watercress
• beans and chick peas
• some nuts, seeds and dried fruits.

If y'all don't eat many dairy products or calcium-enriched substitutes, then you may need a calcium supplement. We recommend you discuss this with your dr. or a dietitian.

The table beneath lists the approximate calcium content of some common foods.

Food	Calcium content (mg)
115 g (iv oz) whitebait (fried in flour)	980
60 m (two oz) sardines (including bones)	260
0.2 litre (⅓ pint) semi-skimmed milk	230
0.2 litre (⅓ pint) whole milk	220
3 big slices brown or white staff of life	215
125 m (iv½ oz) low-fat yogurt	205
xxx m (1 oz) difficult cheese	190
0.2 litre (⅓ pint) calcium-enriched soya milk	180
125 grand (4½ oz) calcium-enriched soya yogurt	150
115 grand (4 oz) cottage cheese	145
3 large slices wholemeal breadstuff	125
115 grand (4 oz) baked beans	60
115 g (4 oz) boiled cabbage	xl

Note: measures shown in ounces or pints are gauge conversions only.

Vitamin D

Vitamin D is needed for the body to absorb and process calcium and there's some evidence that arthritis progresses more quickly in people who don't accept enough vitamin D.

Vitamin D is sometimes called the 'sunshine vitamin' because it's produced by the body when the pare is exposed to sunlight. A slight lack (deficiency) of vitamin D is quite mutual in the United kingdom of great britain and northern ireland in winter.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance on safety sunlight exposure which aims to residuum the benefits of vitamin D confronting the risks of pare cancer from too much exposure to sunlight.

Vitamin D tin can also be obtained from some foods, particularly from oily fish, or from supplements such as fish liver oil. However, information technology's important not to take too much fish liver oil.

Because we don't go enough sunshine all year round in the Uk, and because it'due south hard to guarantee getting plenty vitamin D from what we eat, Public Wellness England recommends that anybody should take a 10 microgram supplement of vitamin D every day during the autumn and winter.

People in certain groups at risk of not having enough exposure to sunlight, or whose skin is not able to absorb plenty vitamin D from the level of sunshine in the UK, are encouraged to take a daily supplement of 10 micrograms all year round.

For many people, calcium and vitamin D supplements are prescribed together with other osteoporosis treatments.

What else might help?

It's important to effort to foreclose falls. Simple things you tin exercise at dwelling include:

• mopping upwards spills direct abroad
• making sure walkways are complimentary from clutter or trailing wires.

Some hospitals likewise offer falls prevention clinics or support groups – enquire your doctor if there'due south one in your area.

Smoking tin affect your hormones and so may increase your take a chance of osteoporosis. We strongly recommend you terminate smoking. Support is available if you wish to stop.

Drinking a lot of booze can affect the product of new bone, and so we recommend keeping within the maximum amounts (14 units per week) suggested past the regime.

Diagnosis

There are no clear physical signs of osteoporosis and it may non crusade any problems for some time. If your doc thinks y'all may have osteoporosis, they may suggest you lot have a DEXA (dual energy x-ray absorptiometry) browse to measure the density of your basic.

The browse is readily available and involves lying on a burrow, fully clothed, for near xv minutes while your basic are x-rayed. The dose of ten-rays is very minor – well-nigh the same as spending a twenty-four hours out in the sun. The possible results are:

Normal – Your take chances of a low-affect fracture is likely to be depression.

Osteopenia – Your os is becoming weaker but your risk of a low-impact fracture is relatively small-scale. You may or may non need treatment depending on what other risk factors y'all take. You should discuss with your doctor how you tin can reduce your risk factors.

Osteoporosis – You accept a greater gamble of low-bear on fractures and you may need handling. You lot should discuss this with your doctor.

Who should have a scan?

At that place'due south no good show that screening everybody for osteoporosis would be helpful. Even so, y'all should talk to your doctor about having a scan if whatsoever of the following apply to you:

• you lot've already had a low-impact fracture
• y'all need steroid treatments for 3 months or more
• you lot had an early menopause (before the age of 45)
• either of your parents has had a hip fracture
• you have another condition which can affect the bones – for example, coeliac illness, inflammatory bowel affliction (Crohn's disease or ulcerative colitis), rheumatoid arthritis, diabetes and hyperthyroidism (overactive thyroid)
• you have a body mass alphabetize (BMI) of less than xix.

How to work out your body mass index:

• Multiply your height in metres by itself – e.thou. 1.7 (thou) x 1.7 = two.89
• Divide your weight in kilograms (kg) by the number yous got in phase 1 – e.grand. 53 (kg) ÷ 2.89 = 18.three
• The result is your BMI e.g. 18.3

For most people a healthy BMI is between nineteen and 25.

Your doctor may use an online scoring tool chosen FRAX®, adult by the World Wellness Organization (WHO), to help assess your hazard of fracture and to help decide whether you should have a DEXA scan or handling for osteoporosis.

Treatment

If yous're diagnosed with osteoporosis following a low-touch fracture, then the fracture will need to exist treated first. The next step is to begin treatment to reduce your risk of further fractures.

Handling of fractures

Most fractures are kickoff treated in A&Eastward, and you lot'll usually have a follow-upward appointment at a fracture dispensary to see how things are going.

Unless you have a vertebral compression fracture, you'll probably have a cast on the affected area to stop it moving and let the fracture to heal. In some cases the fracture may demand to be manipulated by a specialist before the cast is put on. This may exist done in A&Due east or you may be admitted to infirmary. You lot're also probable to be admitted to infirmary if the fracture needs surgical fixing.

Information technology'due south likely that you'll need pain relief medications, for case:

• painkillers (analgesics), such every bit paracetamol, codeine and occasionally morphine
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.

Prevention of fractures

Self-aid measures such every bit diet and weight-bearing practice can assist to reduce your risk of fractures, only a number of specific treatments are also available.

Y'all're probable to take a bone density scan before yous outset treatment, although this may not be needed, for instance if you're 75 or over. Once you've started treatment your bone density may be monitored in one of the following means:

• bone density scans, ordinarily of the spine and/or hips, every 2–5 years depending on your individual circumstances.
• blood and urine tests to bear witness how well your os is renewing itself – these aren't so widely available equally bone density scans.

If yous're taking hormone replacement therapy (HRT), you'll also take regular blood force per unit area checks and breast scans (mammograms).

Your os density should start to better after 6–12 months, although you lot may need longer-term handling to further reduce your fracture take a chance.

Bone renewal is a ho-hum procedure so it's important to continue treatment as your doctor advises – even though you won't be able to feel whether it's working.

Because longer-term handling can sometimes accept side-effects your doctor may propose a break from your handling later 3–5 years. The benefits of osteoporosis handling last a long fourth dimension so these won't be lost if your dr. does suggest a 'handling vacation'.

Your handling will depend on your private circumstances, and you lot should discuss this with your doctor. Types of treatment include:

• calcium and vitamin D
• bisphosphonates (alendronate, risedronate, ibandronate, etidronate, zoledronate)
• teriparatide and parathyroid hormone
• raloxifene
• calcitonin
• denosumab
• strontium ranelate
• hormone replacement therapy (HRT).

Strontium ranelate

This drug, which was produced under the brand name Protelos, was discontinued in 2017 merely is at present existence produced once more under the brand name Aristo. We will have further data on this drug presently.

If yous were previously taking Protelos, you may want to speak to your physician about Aristo.

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Source: https://www.versusarthritis.org/about-arthritis/conditions/osteoporosis/

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