World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 865
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
CME SERIES
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 66-68  

Osteoporosis - an emerging disease of the 21 st century, part 1: An overview


1 Department of Trauma and Orthopaedics, Charing Cross Hospital, Imperial College NHS Trust, Fulham Palace Road, London, United Kingdom
2 Department of Trauma and Orthopaedics, Borras Park Surgery, Wrexham, United Kingdom

Date of Web Publication30-Mar-2012

Correspondence Address:
K H Sunil Kumar
Charing Cross Hospital, Imperial College NHS Trust, Fulham Palace Road, London
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.94457

Rights and Permissions
  Abstract 

Osteoporosis is a condition where bones are fragile with a poor bone mineral density. This increases the risk of fracture especially of the hip, vertebrae, and wrist. These fractures are usually termed "fragility fractures." In this article, we aim to provide a broad overview of osteoporosis-investigation, management, and prevention.

Keywords: Bone mineral density, dual-energy X-ray absorptiometry scan, fragility fractures, osteoporosis


How to cite this article:
Sunil Kumar K H, Bhaskar P. Osteoporosis - an emerging disease of the 21 st century, part 1: An overview. J Family Med Prim Care 2012;1:66-8

How to cite this URL:
Sunil Kumar K H, Bhaskar P. Osteoporosis - an emerging disease of the 21 st century, part 1: An overview. J Family Med Prim Care [serial online] 2012 [cited 2019 May 27];1:66-8. Available from: http://www.jfmpc.com/text.asp?2012/1/1/66/94457


  Introduction Top


Osteoporosis means "porous bones" and results from a decrease in bone density leading to poor quality of bones. This occurs when there is a mismatch between the bone formation and bone resorption. The bones become fragile and are susceptible to fracture very easily. [1] It is important to diagnose the condition early and to take preventative measures so as to prevent fractures.


  Epidemiology Top


Osteoporosis is estimated to affect about 20 million women worldwide. An osteoporotic fracture is estimated to occur every 3 s. [2] One in three women and one in five men will sustain an osteoporotic fracture. [2] About 80% of people who were in the high risk category and had sustained at least one fracture were never diagnosed or treated for osteoporosis. As estimated, about 50% of hip fracture would be occurring in Asia by 2050. The problem accentuates and mainly lies in the diagnosis and treatment of this condition especially in India where a majority of the population lives in rural areas with limited resources. About 26 million were estimated to suffer from osteoporosis in India in 2003, which is projected to rise to 36 million by 2013. [3] A major cause of osteoporosis and osteopenia in Indian women was noted to be due to inadequate nutrition. [4]


  Pathophysiology Top


Bone undergoes remodeling constantly replacing the old bone content with new content. About 10% of the bones are undergoing remodeling at a given point of time. Osteoclasts resorb the bone. This is followed by the synthesis and mineralization of new bone matrix by the osteoblasts in the cavity created. The amount of bone resorption and new bone formation is closely balanced with complex control mechanisms. Bone remodeling is dependent on (1) mechanical stresses, (2) systemic biochemicals like parathyroid hormone, calcitonin, vitamin D metabolites, growth hormones and estrogen, and (3) locally produced cytokines, prostaglandins, and growth factors. Bone loss begins at around 35-40 years with an increase following menopause in women. [5] Some of the factors influencing bone loss are shown in [Table 1].
Table 1: Factors influencing bone loss

Click here to view


Bone remodeling is essential to replace the bone after micro-damage which occurs following normal activity thus keeping the bone healthy and strong. An imbalance between the two processes leads to osteoporosis. Osteoporosis is dependent on the peak adult bone mass which is around the age of 30 years. If the peak bone mass (PBM) is low then the bones may become fragile quickly with the onset of osteoporosis. [5]


  Fracture Risk Top


The most common sites which are susceptible to fractures are vertebrae, hip and wrist. Fractures occurring at these places secondary to osteoporosis are termed "fragility fractures." Fragility hip fractures result in significant morbidity and mortality in the elderly population. [6] Even though hip fractures are currently a major concern in the West, soon they would be a growing problem in Asia. [4] By 2050, about 50% of all hip fractures are predicted to occur in Asian patients. A significant proportion of these fractures would be occurring in India with a growing segment of the aging population.

To tackle this global problem of public health relevance, various organizations are involved like the International Osteoporosis Foundation, National Osteoporosis Foundation, Bone and Joint decade (BJD), etc. The BJD was launched in 2000 to reduce the impact of musculoskeletal diseases across the world. The BJD is endorsed by the United Nations, the World Health Organization, the World Bank, and health officials in 63 countries. "Keep People Moving" is the vision of BJD which is now in the second decade: 2010-2020. [7] Bone health and Osteoporosis is one of the five priorities of the BJD [Table 2]. The BJD brings together various professional, scientific, and patient organizations to reduce the burden of musculoskeletal diseases.
Table 2: Priorities of the bone and joint decade 2010- 2020

Click here to view



  Bone Mineral Density Top


Bone mineral density (BMD) is a measure of calcium and other minerals in the bone giving it strength. [1] A BMD test is a test to calculate the amount of minerals in a given section of the bone. There are various tests to calculate BMD as given below:

  1. Dual energy X-ray absorptiometry (DEXA)
  2. Peripheral dual-energy X-ray absorptiometry (P-DEXA)
  3. Dual photon absorptiometry (DPA)
  4. Quantitative computed tomography (QCT).
  5. Quantitative ultrasound


Ultrasound is a cost-effective method used as a screening tool to identify osteoporosis but needs confirmation by a DEXA scan.


  Diagnosis Top


DEXA remains a gold standard for the assessment of BMD and the diagnosis of osteoporosis. [1] World Health Organisation (WHO) and International Osteoporosis Foundation (IOF) have devised an assessment tool called FRAX tool for the assessment of fracture risk, categorizing patients into low, medium, and high risk. [8]

WHO classification of BMD values are shown in [Table 3].
Table 3: WHO classification of BMD values

Click here to view



  Treatment Top


There are several drugs for the treatment of osteoporosis that is essential to prevent fractures in the future. These can be broadly classified into those which (1) prevent bone resorption and (2) promote bone formation. The list of drugs is given in [Table 4]. In addition, calcium and vitamin D supplements are essential to ensure that drug therapy is effective.
Table 4: Pharmacological agents for treatment of osteoporosis

Click here to view



  Prevention Top


Although there are various factors which play an important role in the development of osteoporosis, lifestyle factors can influence bone development in youth and also the rate of bone loss in adulthood. During childhood and adolescence there should be an emphasis on providing adequate calcium intake avoiding malnutrition. Regular physical activity and an adequate supply of vitamin D are also essential. The PBM determines the risk of osteoporosis, the higher the PBM the lower the risk of osteoporosis. Regular exercise and adequate calcium and vitamin D intake keep the bones strong. Avoidance of alcohol and smoking also help prevent osteoporosis.It is vital for the general practitioners to have a low threshold for diagnosis of osteoporosis in the vulnerable group. Any new onset of back pain should raise the suspicion of a possible vertebral compression fracture needing appropriate management. The average cost of a DEXA scan is around Rs 2500-3000 and that of an ultrasound is around Rs 1000. [3] With a per capita income of about Rs 10,000, these investigations can be expensive for the patients. Nevertheless, prompt diagnosis of the condition and adequate treatment could prevent fracture and long-term morbidity and mortality that could help save additional costs in the long run.


  Conclusion Top


Osteoporosis is a serious public health problem which can lead to significant morbidity and mortality. It is essential to diagnose and treat this condition to prevent fragility fractures that can cause severe disability and changes after the event. There is an urgent need to increase awareness among the public and professionals to identify the seriousness of this condition and adopt preventative measures.

In this article, we have tried to provide an overview of osteoporosis. In the next issue, we aim to discuss more about osteoporosis in detail.

 
  References Top

1.International Osteoporosis Foundation. About Osteoporosis. Available from: http://www.iofbonehealth.org/health-professionals/about-osteoporosis.html. [Last accessed on 2011].  Back to cited text no. 1
    
2.International Osteoporosis Foundation. Facts and statistics about osteoporosis and its impact. Available from:http://www.iofbonehealth.org/facts-and-statistics.html#factsheet-category-25 [Last accessed on 2011].  Back to cited text no. 2
    
3.International Osteoporosis Foundation. Osteoposoris Asian audit - India. Available from: http://www.iofbonehealth.org/download/osteofound/filemanager/publications/pdf/Asian-audit-09/4-2009-Asian_Audit-India.pdf [Last accessed on 2009].  Back to cited text no. 3
    
4.Bone and Joint Decade. Bone and Joint Decade: The next ten years - Keep people moving. Available from: http://www.boneandjointdecade.org/default.aspx?contId=223. [Last accessed on 2010].  Back to cited text no. 4
    
5.Sutcliffe A. Pathogenesis of osteoporosis. In: Sutcliffe A, editor. Osteoporosis: A Guide for Health-care Professionals. 1 st ed. United States: Wiley-Blackwell; 2006.  Back to cited text no. 5
    
6.Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop2011;45:15-22.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.International Osteoporosis Foundation. The Asian Audit Epidemiology, costs and burden of osteoporosis in Asia 2009. Available from: http://www.iofbonehealth.org/download/osteofound/filemanager/publications/pdf/Asian-audit-09/4-2009-Asian_Audit-India.pdf. [Last accessed on 2009].  Back to cited text no. 7
    
8.International Osteoporosis Foundation. FRAX® - Information and Resources. Available from: http://www.iofbonehealth.org/health-professionals/frax.html. [Last accessed on 2011].  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Osteoporosis strategic plan for the Middle East and North Africa region
Patricia Khashayar,Eghbal Taheri,Gemma Adib,Leith Zakraoui,Bagher Larijani
Archives of Osteoporosis. 2019; 14(1)
[Pubmed] | [DOI]
2 Longan fruit increase bone mineral density in zebrafish and ovariectomized rat by suppressing RANKL-induced osteoclast differentiation
Younglim Son,Eun Mi Lee,Do Yup Lee,Jong Hun Lee,Sangtaek Oh
Phytomedicine. 2019; 59: 152910
[Pubmed] | [DOI]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Epidemiology
Pathophysiology
Fracture Risk
Bone Mineral Density
Diagnosis
Treatment
Prevention
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed3239    
    Printed246    
    Emailed0    
    PDF Downloaded620    
    Comments [Add]    
    Cited by others 2    

Recommend this journal