OSTEOPOROSIS occurs when bones become porous and weak due to the reduction of bone density (mass and strength), making the bones fragile. About 200 million persons worldwide are estimated to have osteoporosis where the ratio of women to men affected is four to one. There are no signs or symptoms to alert you of a fracture. So, learn all you can to make your bones healthy very early.

The theme on World Osteoporosis Day, to be celebrated on October 20, is “Step up for bone health.” Strong bones before age 30 enhance the durability of the skeletal system which means better mobility and fracture-free incidents for persons later on in life. Generally, bone mass peaks during the early 30s.

However, the combination of endocrine changes due to age, along with nutrition and sedentary lifestyles, will affect bone mass as you get older. So menopausal women who have lower levels of estrogen or younger women who removed their ovaries, will sooner experience changes in their bone health.

Johns Hopkins Arthritis Center stated that 30 per cent of Caucasian women in the post-menopausal stage suffer from osteoporosis, which can increase as high as 70 per cent over age 80.
There is an ethnic risk also for osteoporosis where Caucasians, Chinese, Japanese and Koreans are statistically more affected.

Whilst men’s reproductive hormones are not as severely diminished as women’s, bone loss is still accelerated since the levels of growth hormone and androgen gradually decrease. The abrupt loss of testosterone production in men on prostate cancer treatment and all cancer patients (both men and women) on treatment with chemotherapy, radiation and hormonal therapy can contribute to bone loss.

Older persons may notice that they are getting shorter with age due to worn cartilage and spinal osteoporosis. Women can lose two inches whilst men one inch after age 30. Note that after age 80 both genders can lose another inch.

Additionally, small frame or petite, thinner women are at highest risk for osteoporosis later in life.
Also, those persons with a genetic factor for osteoporosis or a history of parental fractures are inevitably at a higher risk. It is key to know that the first fracture sustained increases the likelihood of future fractures if appropriate treatment is not immediately given. Assessing and building bone density as soon as a fracture occurs is highly recommended.

World Health Organization (WHO) criteria for diagnosing osteoporosis is connected to measurement of bone mineral density (BMD), after ascertaining a T-score measured by a dual X-ray absorptiometry scan.
Another assessment tool for fracture risk called FRAX, recently developed by the University of Sheffield may soon become a universal protocol to decide on the way forward with respect to treatment. Clinical risk factors used in FRAX calculations are age, gender, an earlier fracture, bone-mineral density, low BMI (less than 21kg/m2), using prednisolone tablets 5mg per day for greater than three months, history of parental hip fracture, type one diabetes mellitus, early menopause(before age 40), smoker history and alcohol consumption (more than three drinks per day).

The National Osteoporosis Foundation of the United States estimated a cost of approximately US$19 billion annually on direct and indirect cost from fractures, which could have been prevented if proactive measures had been put in place.

For example, all female patients should be informed that after a total hysterectomy, or the removal of their ovaries, that they will have to be referred to the orthopaedic clinic for continuous assessment of their bone density and the need to build up their bones because of future risk for fractures.

The American Society for Bone and Mineral Research formed a coalition of experts from 42 professional organizations including physicians, nurses, pharmacists, members from the Geriatric Society and the International Osteoporosis Foundation to develop clinical recommendations for the optimal prevention of secondary fractures in persons aged 65 and older.
Greater use of pharmaceuticals to prevent fractures is key in the 13 evidence-based recommendations they made. The coalition recommended:
* bisphosphonates as first line, in oral form but if not well tolerated then in intravenous form
* anabolic agents but very selective for high-risk patients who don’t have a cost barrier
* adequate daily intake of calcium and vitamin D either from dietary or supplement source
* routine fracture-risk assessment and monitoring patient-adverse events
* prompt post-fracture treatment initiated and optimal duration for treatment follow-up monitored
Pharmacists play a vital role in monitoring patient-adverse events and educating patients on fracture-reduction risks and the benefits of medications versus side-effect profiles. Pharmacists further enhance treatment compliance by discussing morbidity and mortality outcomes due to non-compliance.
It is advisable that only highly selective persons, those not at risk for blood clots or breast cancer, should be considered for estrogen therapy. And if you have been exposed to radiation you should not take teriparatide or abaloparatide.
In summary, the three pillars of ensuring bone health are:
> Regular weight-bearing and muscle-strengthening exercise
> Bone nutrition, consuming the adequate daily amount of calcium (1200mg) from foods and supplements and the required daily dose vitamin D
> Smoke-free and alcohol-free lifestyles
Whilst the risks factors for osteoporosis are:
> Advancing in age
> Bone density
> History of fracture
There is a projection that by 2050 there will be 21.3 million hip fractures annually and osteoporosis will become the second global health crisis after cardiovascular diseases. Currently, 80 to 90 per cent of patients worldwide with osteoporotic fractures are not assessed routinely for bone health and not monitored for medication usage.
For further discussion, contact the pharmacist of Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.