High Fractures Risk If Missing Osteoporosis in RA patients
Osteoporosis, often called “the silent disease”, is a bone disease characterized by decrease in bone mass and density resulting in brittle, fragile bones that are more susceptible to fractures, even without injury. The condition most commonly develops in elderly women.
The exact cause of osteoporosis is not known, however the factors that increases the risk of developing osteoporosis include:
- Women are at a greater risk than men
- Poor nutrition
- Diet low in calcium
- Lack of exercise
- Asian people
- People with thin and small body frame
- Family history of osteoporosis
- Women who are postmenopausal
- Medical conditions, including hyperthyroidism, Cushing’s syndrome and hyperparathyroidism
- Some medications such as corticosteroids, endometriosis medications, thyroid replacement medications, and antacids containing aluminum may contribute to bone thinning
Osteoporosis may cause no symptoms in the early stage of the disease. Later as the condition progresses it may cause the following symptoms:
- Low back pain and neck pain due to fractures of the spinal bones
- Dull pain in the bones accompanied by tenderness
- Loss of the height of the spine giving a stooped posture (dowager hump)
- Fractures from minimal trauma. Thinning of the bone due to osteoporosis can cause the bone to break easily.
Your doctor will make the diagnosis of osteoporosis based on the medical history, physical examination and a bone density test. Bone mineral density test is a painless, non-invasive and safe method of measuring bone density.
The goal of the treatment is to control pain and to prevent bone fractures by reducing the bone loss. There are different treatment options for osteoporosis:
Diet: Consume a balanced diet rich in calcium and vitamin D.
Vitamin D helps in the absorption of calcium and phosphorus from food and is essential for maintenance of strong and healthy bones. It is also important for normal functioning of the muscles and an overall good health. Vitamin D deficiency is associated with an increased risk of fractures.
Skin can synthesize vitamin D from cholesterol, on exposure to UV B rays of the sun and this fulfills most of the body’s vitamin D requirements. Vitamin D is also present in a few natural foods that include:
- Oily fish such as North Sea salmon, herring, mackerel and sardines
- Liver and cod liver oil
- Egg yolk
Oily fish and cod liver oil are good dietary sources of vitamin D. Some foods such as milk and margarines are fortified with vitamin D.
Vitamin D supplementation is recommended, in the form of tablets, powders, liquids or injection. The dose and the appropriate treatment schedule depend on the age and severity of the deficiency. Usually a maintenance dose of vitamin D is recommended, even after the treatment, to prevent any further deficiency in the future.
Exercise: Regular exercises can decrease the risk of developing bone fractures in people with osteoporosis. Your doctor may recommend exercises such as weight bearing exercises, riding stationary bicycles, using rowing machines, walking, and jogging.
Medications: Medications such as alendronate, risedronate, raloxifene, ibandronate, and calcitonin are used to strengthen bones and to stop bone loss
The tips to prevent osteoporosis may include:
- Consume a healthy balanced diet rich in calcium and vitamin D
- Quit smoking and avoid excessive alcohol intake
- Exercise regularly
- Take medications to prevent osteoporosis
2017 ACR Guideline on Glucocorticoid-Induced Osteoporosis
The American College of Rheumatology has updated its 2010 guideline for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). The guideline provides recommendations on assessing fracture risk and treatment for adults and special patient populations including women of childbearing potential, adults treated with very high-dose glucocorticoids, adults with organ transplants, and children ages 4-17.
Higher Fracture Risks with Prolonged Bisphosphonate Use in Older Women
It is estimated that 50% of women over the age of 50 will experience a facture related to osteoporosis. And while there are many effective therapies to lower this risk, the optimal duration of treatment is the subject of current debate.