Sunday, January 15, 2006

osteoporosis (brittle bones)

The most prevalent metabolic disease of bone is osteoporosis, a disorder characterized by a decreased volume of bone from reduced calcium levels, resulting in a thinning of the skeleton. Bones are easily fractured with little or no trauma.
Osteoporosis is found in increasing frequency in women over 45 and in men over 55 years of age and affects almost 11 million aged in the United States. It is four times more prevalent in women and very common among Caucasians and northern Europeans. Lack of estrogen and reduced intake of calcium are thought to be primary factors leading to osteoporosis. Reduced physical activity is now thought to be an equally important reason for bone loss. Drugs and toxins such as heparin, Dilantin, corticosteroids, and alcohol may contribute also to the loss of bone. Osteoporosis is also found in certain diseases such as hyperthyroidism, hyperparathyroidism, diabetes, sickle-cell disease, and multiple myeloma. Osteoporosis is often asymptomatic and is frequently discovered accidentally. Fractures and the collapse of vertebrae can occur insidiously.
The patient only becomes aware with the realization that his or her stature has shortened or perhaps when found on an unrelated X-ray. The most frequent symptom is a dull aching in the lower thoracic or lumbar region. The pain is exacerbated by sitting or standing for some time and is usually relieved by lying down.
The loss of height is due to vertebral compression with the resultant "dowager's hump. " This progressive deforming process leads to downward angulation of the ribs and a narrowing of the normal gap between the lower ribs and the iliac crest. Measurable reduction in height ceases when the coastal margins come to rest on the iliac crests.
By the time osteoporosis has become symptomatic, it is not possible to restore normal bone mass. Treatment of osteoporosis, therefore, centers around preventing further fractures and deformities and helping the person to continue daily activities. Calcium supplements, estrogen therapy, and fluoride therapy are used with varying degrees of success.
Loss of strength and muscle tone enhances osteoporosis. One of the best preventive and rehabilitative exercises is walking. If a patient is bed-ridden, isometric exercises should be employed until the patient is able to get out of bed and start walking again. Since many fractures occur as the result of a fall, the use of a cane or walker for support should be encouraged. If surgery is necessary, prolonged immobilization should be avoided, since osteoporosis invariable increases with the vicious cycle of pain, rest, and fractures. Intense remedial treatment is suggested utilizing heat applications, range of motion exercises, and whirlpool therapy.
Reichel, W. M. Clinical Aspects of Aging. Baltimore: The Williams & Wilkins Co., 1979. Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.

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