Sorry, but copying text is forbidden on this website!
Today, I will be talking about osteoporosis, its types, symptoms, how it can be diagnosed, and its treatment options. I will also be discussing a study “Teriparatide or Alendronate in Glucocorticoid-Induced Osteoporosis,” which is a new treatment option for those who suffer from the disorder. Osteoporosis is one of the many bone diseases that affect not only the United States but the whole world as well. About 10 million Americans suffer from osteoporosis, and there are 18 million Americans who have decreased bone mass, also called osteopenia, which, if left untreated, may lead to osteoporosis.
People who suffer from osteoporosis have low bone mass. They also experience structural deterioration of their bone tissues. It is progressive but can be prevented and treated when detected. The spine, wrist, and hips are the areas where there are increased risk in fracture. Studies reveal that one out of five American women over 50 years old have osteoporosis. Moreover, approximately half of all women over 50 years old will suffer a hip, wrist, or vertebral fracture. It is responsible for more than 1. million fractures every year including hip, vertebral, and wrist fractures, as well as fractures at other sites.
These statistical values show how important it is to be aware of osteoporosis. Knowing the risk factors will lessen our chances of acquiring the disease. It is not enough to know what osteoporosis is, as well as the numbers associated with it. People have to realize how osteoporosis can affect their every day lives and that it can always happen to anyone. There are several risk factors involved in osteoporosis. These are divided in two categories, which are the control and non-control.
Control risk factors include smoking cigarettes, glucocorticoid-induced osteoporosis, rheumatic diseases, estrogen deficiency, low calcium intake, insufficient activity, alcohol use, and anorexia. Estrogen is a sex hormone found in women and its deficiency can lead to amenorrhea or the absence of menstrual period, a low estrogen level, or menopause. Men who have decreased testosterone level can increase their risk of developing osteoporosis. Anorexia nervosa, on the other hand, are those people who have an irrational fear of gaining weight, and can increase the risk for osteoporosis.
When a person’s diet contains little calcium and vitamin D, the person is more prone to bone loss because these are involved in bone development. Patients who have been taking glucocorticoids and some anti-convulsants for a long period of time are also prone to loss of bone density and fractures. An inactive lifestyle or extended bed rests tend to weaken bones because they are not properly used and exercised. It is also known that cigarette smoking has negative effect on bones, as well as the heart and lungs.
Excessive consumption of alcohol also increases the risk of bone loss and fractures. The risk factors that cannot be controlled because they involve genes and history include history of fracture, family history of osteoporosis, advanced age, female gender, and Caucasian race. Now that we have some kind of background, we can now discuss the different types of osteoporosis. The disorder can be classified in various ways, and the World Health Organization classifies osteoporosis as either primary osteoporosis or secondary.
Primary osteoporosis typically occurs in older people, as well as in women past menopause wherein bone loss is faster and increased. Secondary osteoporosis results from a different kinds of conditions. Aside from this classifications, there are two other kinds of osteoporosis: type I osteoporosis and type II osteoporosis. Of note, the amount of calcium left in the bones determines the existence of osteoporosis. This also determines whether it places a person at risk for fracture. An individual whose bones are already naturally dense might not lose that much calcium to reach the point where osteoporosis occurs.
On the contrary, an individual whose bones are relatively low in density will easily develop and be more prone to osteoporosis. Type I osteoporosis, also known as postmenopausal osteoporosis, is generally seen in women who had had menopause at which time the amount of estrogen in their body decreases greatly. When this happens, there is an increase in the resorption of bones. Approximately 5 to 20 percent of women experience this kind of osteoporosis with most cases seen between the ages of 50 and 75 due to a sudden decrease in their estrogen levels while postmenopausal.
This decrease in estrogen is related to the level of calcium, as it also decreases from the skeleton. This type is more frequently associated with fractures involving the vertebrae compressing together causing a collapse of the spine, as well as with hip, wrist, or forearm fractures caused by falls or minor accidents. It accounts for the greater risk in women than in men in terms of osteoporosis. On the other hand, type II osteoporosis, or senile osteoporosis, most commonly occurs after the age of 70. It also affects women two times more than men.
When the resorption and formation of bones are no longer coordinated, breakdown of bones exceeds the building of bones, at which time type II osteoporosis happens. It affects the trabecular and cortical bone that can lead to femoral neck, vertebrae, proximal humerus, proximal tibia, and pelvis fractures. It may also result from age-related reduction in vitamin D synthesis or resistance to vitamin D activity. In older women, types I and II often occur together. Another type of osteoporosis exists called Type III osteoporosis.
This type affects both genders and can occur at any age. It can be caused by other diseases or drugs and involves all types of fractures. However, this type happens rarely and can be seen in less than five percent of osteoporosis cases. After knowing what osteoporosis is and its types, we now focus on its symptoms and how we can prevent the disorder from progressing further. Osteoporosis is a disease that works silently because it would not be felt until a fracture occurs. People would also experience severe back pain, loss of height, and spinal deformities.
An example of spinal deformity is called kyphosis, which is the term for severely stooped posture. The disease would bring about impaired function, reduce appetite, decreased mobility, sleep disorder, shortened survival, and poor self esteem. As stated earlier, osteoporosis cannot be diagnosed until a fracture occurs. However, if it is diagnosed early on its course, a fracture can be prevented from occurring. Because the disease is affected by different factors, a patient suspected of having osteoporosis should have his or her personal and medical history recorded by a clinician who can assess the situation.
A person’s bone mineral density is also important in determining how likely he or she is to develop osteoporosis. A test that can measure the bone mineral density in different parts of a person’s body can aid in determining the existence of osteoporosis. Currently, the best way to measure bone mineral density is through the use of dual energy x-ray absorptiometry. Undergoing this test is similar to having an x-ray taken but dual energy x-ray absorptiometry uses less radiation. However, pregnant women still not undergo this procedure to avoid any risk of damaging the developing fetus.
Aside from these diagnostic means of determining the presence of osteoporosis, there are also treatments available for those who suffer from the disease. To maintain and increase a person’s bone mass, weight bearing exercise is recommended. Supplemental vitamins and minerals are also indicated for those who have osteoporosis to facilitate the increase of the lacking substances needed for proper bone development. Pharmacologically, people can be prescribed bisphosphanates (Fosamax), Calcitonin (Miacalcin), Raloxifene, and estrogen.
Another treatment available in the market is teriparatide, which was approved by the Food and Drug Administration in November 2002 to treat osteoporosis. It is also indicated for men who need to increase their bone mass due to primary or hypogonadal osteoporosis who are at high risk for fracture. Teriparatide is a recombinant form of parathyroid hormone, which regulates calcium and phosphate metabolism in bones. It stimulates new bone formation and can be injected 20 µg once a day.
This brings us to the study mentioned earlier called “Teriparatide or Alendronate in Glucocorticoid-Induced Osteoporosis. ” This was a random, double blind, placebo-controlled study, which incorporated both laboratory and classroom assessments. The participants consisted of 22 to 89 year-olds with a history of sustained glucocorticoid therapy. They should either have a T score of ? 2. 0 or less or ? 1. 0 or less. They should also have at least one fragility fracture during treatment with glucocorticoids. Prednisone 5 mg daily for three consecutive months is also a requirement for the participants.
Those who have fewer than three lumbar vertebrae that could be evaluated on dual energy x-ray absorptiometry, unresolved skeletal diseases other than glucocorticoid-induced osteoporosis, history of cancer in the last five years (with the exception of superficial basal-cell or squamous-cell carcinomas of the skin that had been definitively treated), increased risk of osteosarcoma, abnormal laboratory values, gastrointestinal disorders that would be likely to reduce tolerance of oral alendronate, and substantial renal impairment.
The method required the researchers to compare teriparatide with alendronate in 428 people suffering from osteoporosis and they must have taken glucocorticoids for at least three months prior to the study. A total of 214 patients received 20 ? g of teriparatide once daily, while 214 patients received 10 mg of alendronate once daily. Primarily, the outcome seen was at the lumbar spine where there was a change in bone mineral density.
Changes in bone mineral density at the total hip, changes in markers of bone turnover, the incidence of fractures, and safety were the secondary outcomes. The study was limited because it had insufficient power to determine if there was a reduction in the risk for vertebral fracture. It was unable to detect transient hypercalcemia after the study drugs were administered. Also, paired radiographs for the assessment of new vertebral fractures were missing for 92 patients.
The results showed that at the last measurement, the mean bone mineral density at the lumbar spine had increased more in the teriparatide group when compared to that of the alendronate group. After six months, significant differences between the two groups was seen. At 12 months, bone mineral density at the total hip had increased more in the teriparatide group. Fewer new vertebral fractures occurred in this group than in the alendronate group, while non-vertebral fractures were not a problem for both groups.
Significantly, more patients in the teriparatide group had at least one elevated level of serum calcium. Also noted were the adverse reactions that patients experienced including hypercalcemia, hyperuricemia, insomnia, and rash. The study concluded indicating that treating patients with teriparatide was efficacious and safe for the treatment of glucocorticoid-induced osteoporosis. With this being said and based on the data presented, I recommend the use of teriparatide over alendronate because it has been