Osteoporosis is a chronic asymptomatic disease characterized by accelerated loss of bone mineral mass, loss of structural bone strength and bone fractures to disproportionately mild trauma-prone.

The problem

Bone is formed by an organic matrix-based proteins and other substances that give architecture and elasticity to bone and an inorganic matrix formed by minerals that you damage the structural strength. The most important of these minerals is calcium; When the calcium from the bones lose their resistance is lost.

From childhood and up to 35 years of age bone mass increases progressively, then stays about the same until the onset of menopause, moment in which begins a substantial and accelerated loss that can vary from 1 to 5% of the total bone mass po r each year that passes without treatment. Osteoporosis can affect both older men and women, but in the first, the effect is much more rapid and severe and that is due to the sharp fall of hormone levels in menopausal women absolutely necessary factors to maintain the balance of bone turnover in normal levels

Although all the bones of the body are susceptible to weakened by loss mineral are those who have the greatest work which have a greater tendency to fracture and cause problems, these are: the bones of the forearm (RADIUS and ulna), vertebrae (spine vertebral) and bones (femur). For many people, a hip fracture has meant the beginning of the end of his life because of the complications of the fracture, the immobility and surgery; in a nutshell, it is better to not have osteoporosis!

Risk factors associated with osteoporosis

• Advanced age (> 65 years), fragility syndrome (organic reserve decreased, health precarious way)
• (Caused by illness or too much thyroid hormone) hyperthyroidism, hyperparathyroidism, renal disease or chronic hepatic
• Chronic use of corticosteroids, rheumatoid arthritis and other autoimmune diseases with arthritis and similar treatments
• Deficiency of estrogen, menopause before age 45, drug-induced menopause (GNRH agonists)
• Intestinal Malabsorption Syndromes: Celiac disease, syndrome of short bowel, Bariatric Surgery (gastric bypass)
• Alcohol: more than 3 units of Alcohol per day (1 unit is equivalent to a: 150 cc of red wine, 355 cc of beer or spirituous beverages 45 cc – Scotch, rum, Vodka-)
• Tobacco use, present or past
• Coffee: more than 4 cups a day
• Lack of exposure to the Sun, prolonged immobility

What are the symptoms of osteoporosis?

Osteoporosis is an asymptomatic disease, is a silent problem that is ending the resistance of the bones without producing pain or any discomfort until a fracture occurs, or begin to have discomfort by compression of the nerves in the spine vertebral. It is remarkable to see that the “old ladies” are made more tiny and bow without manifetar any pain, that is a totally asymptomatic striking sign product of a severe osteoporosis (fracture compression fractures)

How is it diagnosed?

Since the beginning of the 90’s used a very effective radiological method which is known as bone Densimetry, DO, DXA (ABSORPTIOMETRY of RAYS X of power DUAL). The DO is a study of the regions most important body in which Osteoporosis is concerned (spine and hip) and emits graphical results easily understandable and comparable between studies every year.

The results of the bone densimetry are issued in the form of values and graphs of colors by comparing the values of the patient with the normal women under it (T index) with bone mass optima:

Normal: Bone density > – 1.0 DS

Osteopenia: Bone density of – 1.0 to – 2.4 SD

Osteoporosis: Bone density < – 2.5 SD

Treatment and measures are indicated?

In women it is recommended a diet rich or supplemented in calcium (1200 mg of elemental calcium / day) and vitamin D (2000-6000 IU/day). Note: I am considering the use of vitamin D in doses above according to the Vitamin D Council, this will initiate the measurement of levels of this vitamin (25-hydroxy-vitamin D). The optimal value suggested in blood is 40-60 ng/ml. In case of low serum levels of vitamin shall be 1000 IU for each 10 ng/mL of deficiency.

Regular physical exercise: aerobics and with loads of weight, 3-4 times a week. It has been shown that exercise strengthens bones in men as in women.

Menopausal women may receive hormone replacement therapy (estrogen, estrogen-progestogen) to prevent the loss of bone mass. Ask for gynecological vocational guidance regarding the use of hormonal and non-hormonal measures for the treatment and prevention of osteoporosis and deleterious effects of menopause.

Fasteners bone calcium (bisphosphonates): are non-hormonal drugs designed specifically to fix calcium in bones in the absence of substitutive hormonal intake in menopause). Treatment and prevention of osteoporosis is very related to the comprehensive management of female menopause. Bisphosphonates should be used for 5 years according to the ACP (American College of physicians) to prevent fractures in patients with Osteoporosis. In women older than 65 years with Osteopenia should be discussed the therapeutic decision individually. The ACP does not recommend the use of estrogen or progestogen estrogen and raloxifene (Evista) for the exclusive treatment of Osteoporosis.

Sun exposure: 15-20 minutes a day. If your skin is dark will need up to six times the exposure time.

Duration of treatment

The problem of compliance with the treatment and prevention of osteoporosis is that as this silent disease patients tend to abandon the measures indicated not feeling any difference using the prescribed treatment or not. The treatment is multidisciplinary, indefinite (not necessarily drug) and requires follow-up.

Once it appears osteoporosis becomes a chronic disease. Changes in diet and exercise must be maintained throughout life. Modern therapeutic measures have eliminated the paradigm established that osteoporosis not could be cured, only stop: that is false, you can cure or at least improve, but is a long and disciplined treatment

Osteoporosis is a sword of Damocles, once we suspend the treatment begin to lose bone mass, if we have a good mass will take us to get to osteoporosis and vice versa. While we can continue the treatment we should do it.

Calcium clips

Because calcium, bisphosphonates, clips are absorbed poorly by digestive tract and are very irritating to the esophagus the patient should:

1. Take the dose recommended once per week or per month (depends on the brand, I prefer the monthly scheme) according to the chosen day: suggest Saturday or Sunday so that it can fulfil the treatment steps.
2. Take the Tablet immediately rising from the bed with water, it cannot be another liquid, some suggest that it take before brushing your teeth.
3. Keep standing for 30-45 minutes to avoid the tablet to come in contact with the esophagus and their anger. During this time you cannot take or eat anything other than water.
4. Do not take other medications until the end of the 30-45 minutes.
5. You can you have breakfast and continue with your normal day at the end of the period of 30-45 minutes.
6. The calcium is taken daily without any kind of previous Protocol, but never together with the fastener of the calcium. If you do not take calcium daily calcium post is useless.

Efficacy of bisphosphonates in reducing the risk of fractures in postmenopausal osteoporosis. Bilezikian. AJM 122 (2 Suppl.), s14-21, Feb 2009

Compared with placebo, 4 agents (alendronate, Risedronate, ibandronate and zoledronate) showed a decrease in the risk of new vertebral fractures in patients with postmenopausal osteoporosis. They also reduce the relative risk of new fractures in the hip and non-vertebral zones. Studies on long-term (10 years) Alendronate and risedronate (7 years) have shown that efficacy is maintained long term.