He has been working as a physical medicine and rehabilitation specialist at Anadolu Medical Center since 2005.
Osteoporosis is a systemic disease in which bone density is reduced and bones become more porous and fragile due to reduction of bone quality and which affects the entire skeletal system. Osteoporosis has now become one of the most prevalent diseases due to the increase in life expectancy and increase in elderly population. While studies show the fact that 1 out of every 3 women and 1 out of every 5 men over 50 experience a fracture in any period of their lives, specialists underline the fact that the best treatment is protection.
The most important indication of osteoporosis is fracture. People mistakenly think that osteoporosis may cause pain. Pain associated with osteoporosis is rarely seen unless fracture occurs. Due to a spinal fracture, height is reduced, postural disorders and lordosis occur. Due to lordosis, bones cause pressure on the abdominal cavity and the chest. Organs are negatively affected, and the patient's body appearance deteriorates. This in return triggers psychological problems and isolation of the patient with osteoporosis from the society.
Although osteoporosis is known as a disease which mostly women suffer, it is an important health issue also affecting men. The most important known risk factor of osteoporosis is ageing. Positive developments in the diagnosis and treatment of diseases in the current century prolong life expectancy, however, several diseases that increase with age, including osteoporosis, occupy the first ranks of the medical agenda. With the increase of the aged population in the world, the prevalence of osteoporosis and osteoporosis-related fractures significantly increase. Today, death due to hip fractures occupies the third place after death subject to coronary diseases and cancer.
While studies show the fact that one out of every three women and one out of every five men over 50 experience a fracture in any period of their lives, specialists underline the fact that the best treatment is “protection”. Specialists recommend that all women over 65 should undergo osteoporosis screening, and bone density measurements should be performed generally between 40 and 50 years of age. Also, postmenopausal women over 65 who have additional osteoporosis risk factors or have recently suffered a fracture should undergo osteoporosis screening.
On the other hand, there is no official information that shows when men should undergo osteoporosis screening. Specialists recommend that some elderly men should have routine osteoporosis screening. According to a new research published by the Journal of the American Medical Association, routine testing and treatment of osteoporosis is essential for men of certain age. In the research, a computer program was used to estimate hip fracture risk in men over 65, which represents the group of men having the highest risk of osteoporosis. In the research, indirect and direct medical costs such as low efficiency accompanied by osteoporotic fracture in this group of men were also calculated. As a result of the research, it was determined that men over 65 should undergo routine bone mineral density test if they have fracture in the early period, and men over 80 should undergo routine test, irrespective of history of fracture.
Bones are in fact live tissues which are continuously regenerated through production and destruction activities. This production and destruction process follows a balanced course until the age of 30 in women, however, the balance changes in favor of destruction after that age. After the age of 30 when bone mass reaches the climax, an irrevocable bone loss of 0.5 percent a year starts. This loss speeds up especially after menopause, and the amount of bone tissue lost becomes one of the most important factors that determine whether a woman will experience bone fracture in the future or not.
Osteoporosis mostly affects the vertebral bones that bear the body weight. Of all osteoporosis cases, 47 percent occurs in vertebral bones, 20 percent in the hip, 13 percent in the wrists and 20 percent in other bones. Subject to compression fractures in the vertebral bones, height reduction may occur especially at advanced ages. Fatal fractures may also develop in other bones including the hip in particular, due to mild falls or spontaneously.
The most important consequences of osteoporosis are fracture and disability caused by fracture. Risk of fracture in hip, vertebra and wrist particularly after the age of 50 is considered to be 40 percent in women and 13 percent in men. These statistical data show that 4 out of every 10 patients over 50 face the risk of hip, vertebra or wrist fracture. When the cost and social aspects of fracture is reviewed, major problems occur. Today, 1.5 million fractures occur a year in US, including 300 thousand hip fractures, 700 thousand vertebral fracture, 250 thousand wrist fractures and 300 thousand other fractures. Unfortunately, 20 percent of the patients who suffer a hip fracture die in the first 1 year, and more than 30 percent become disabled. The number of hip fractures which was 1.7 million in early 1990s is expected to rise to 6.5 million by 2050.
Risk factors are classified under two headings, including major and minor risk factors. Major risk factors include, inter alia, very low bone density. For this reason, bone density measurement should be performed between the ages of 45 - 50, which are regarded as osteoporosis ages. After evaluating risk factors, the doctor should decide at what intervals these measurements have to be repeated.
Another risk factor is age. The possibility of fracture risk is different a patient aged 50 and a patient 80 even if they have the same bone density. It is because bone quality deteriorates with age. The reduction in quality increases the risk of fracture irrespective of density. Contrary to what we knew in the past, fracture risk is now evaluated by reviewing not only bone density but also micro-architectural structure and quality of bone.
Fractures suffered in the past also increase fracture risk. If the patient has a vertebral fracture in his/her past, it is possible to say that he/she is 5 times more likely to experience a new vertebral fracture in 1 year, and 2 times more likely to experience a new hip fracture in 3 years. If the mother, any sibling or aunt has history of fracture, the risk to have a new fracture in 1 year is increased by 1.5 to 2 times.
Gender is the primary minor risk factor in osteoporosis. 4 out of every 5 fractures are observed in women. The fracture risk of white women is higher than that of African women. Today it is believed that genetic characteristics have a 70 to 80 percent effect on bone structure. Excessive alcohol and caffeine consumption, long-term use of corticosteroids and drugs used in thyroid treatment are causes that elevate the risk of osteoporosis. Estrogen deficiency is another trigger of osteoporosis.
Early menopause or menopause caused by surgical intervention break bone production and destruction balance in favor of production. For this reason, women who go through menopause at or before the age of 38 for any reason should be examined in terms of osteoporosis. Also, diseases of the thyroid gland, severe lung and renal diseases, some rheumatic diseases are among the minor factors.
The golden standard in the diagnosis and treatment of osteoporosis is bone mineral density measurement. In addition, spinal and lower back x-rays of patients are required on a routine basis in order to understand whether there is fracture or not. Also, to review other diseases likely to cause osteoporosis, blood and urine tests are important.
In the past, one would first recall hormone therapy when osteoporosis treatment was concerned. However, this method is not recommended much in the recent years. Hormone therapy should only be used when other symptoms of menopause such as sweating, hot flush, sleeplessness, irritability, are intensively experienced. Hormone therapy has no other role in osteoporosis treatment. The aim in osteoporosis treatment should be to prevent fractures, to protect and even increase bone mineral density, struggle with complaints due to fracture and postural dysfunction, to maximize daily activities and improve life quality. Instead, elements such as bisphosphonates, strontium, selective estrogen receptor modulators, i.e. SERMs, calcitonin, parathormone, and drugs containing estrogen of herbal origin are preferred. The treatment should include calcium which is the building block of bone and vitamin D to increase calcium absorption.
With age, postural impairment (scoliosis), reduced strength (weakness of muscles surrounding the hip and the knee), gait disorders (walking with small and frequent steps), weakened reflexes (insufficiency of reaction shown against an unexpected obstacle), activities such as extension, bending, sitting and standing frequently cause falls.
1) Has your mother or father experienced a hip fracture after a simple strain or a mild fall?
- Yes – No
2) Have you ever experienced a hip fracture after a simple strain or a mild fall?
- Yes – No
3) Have you taken any cortisone-containing drugs for longer than 3 months?
- Yes – No
4) Has there been a reduction more than 3 centimeters in your height?
- Yes – No
5) Do you consume excessive alcohol?
- Yes – No
6) Do you smoke more than 20 cigarettes a day?
- Yes – No
7) Do you frequently experience diarrhea? (Do you have Celiac or Crohn’s disease?)
- Yes – No
8) Have you gone through menopause before the age of 45?
- Yes – No
9) Has your menstruation period been delayed or interrupted for 12 months?
- Yes – No
10) Have you ever experienced loss of impotency or libido due to reduction in your testosterone level?
- Yes – No
If you have given the answer yes to one or more of these questions, you should consult a doctor.
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