OSTEOPOROSIS (BONE REMOVAL):
Definition: The condition that results in increased fragility as a result of changes in bone microarchitecture and decrease in bone mass due to various reasons is called Osteoporosis. Osteoporosis is generally divided into two groups as Primary and Secondary.
Primary Osteoporosis is a condition that occurs due to menopause in women, andropause in men, and advanced age (senile) in both sexes. It is the most common cause of osteoporosis in the population.
Secondary Osteoporosis is osteoporosis that occurs at any age due to diseases and drugs affecting the bones. There are many different diseases that cause secondary osteoporosis.
Causes of Secondary Osteoporosis:
Endocrinological Causes: 1- Cushing’s Syndrome
2- Acromegaly
3- Hyperthyroidism
4- Hypogonadism
5-Hyperprolactinemia
6- Hyperparathyroidism
7- Type 1 Diabetes
8- Anorexia
9- Porphyria
10- Hypocalcemia
11- Vitamin D deficiency
Genetic Causes
Gastrointestinal Causes
Hematological Causes
Rheumatologic Causes
Nephrological Causes
Drugs: Many different drugs used in the treatment of various diseases can cause osteoporosis as a side effect. (Cortisone, Heparin, Thyroid Hormone, Chemotherapy drugs, etc.)
Conditions Increasing the Risk of Osteoporosis:
Female Gender
Caucasian Race
Advanced Age
Low Body Weight
Sedentary Life
Smoking
Alcohol Use
Excessive Coffee Consumption
Early Menopause
Insufficient Calcium and Vitamin D intake in the diet
Pregnancy
Diagnostic Tests: As long as osteoporosis does not cause a fracture, it often does not cause any serious symptoms that patients will feel. For this reason, various screening methods have been developed so that people at risk (menopause, Andropause, Secondary Causes) can be diagnosed before fracture. These methods are:
DEXA (Dual Energy X-Ray Absorptiometry)
CT (Quantitative Computed Tomography)
Peripheral Ultrasonography
The most commonly used of these tests It is the DEXA method. As a result of DEXA test, Osteoporosis diagnosis is made according to T score values
Normal : T score > -1
Osteopenic : -2.5< T Score < -1
Osteoporotic : T Sk score < -2.5
Severe Osteoporosis: T Score < -2.5 and Fracture
Secondary causes should definitely be considered in patients with low Z score together with T score in DEXA. Further tests should be planned for the reasons listed above in people who are thought to have secondary osteoporosis.
Treatment: It is very important to do regular (30-60 minutes at least 3 days a week) exercise to prevent the development of osteoporosis and slow the progression of the disease in people who already have Osteoporosis. Particularly active-passive types of exercises that lift weights (brisk walking, racquet sports, jogging, weight lifting, etc.) are beneficial in the prevention of osteoporosis. Exercises that only work the muscles, such as swimming, have less effect on osteoporosis. Along with exercise, nutrition is extremely important. Adequate calcium (especially milk and its products) and vitamin D must be taken in the diet. Smoking, alcohol and excessive coffee consumption should be avoided. In addition to these measures, drug (Pharmacological) treatment should be considered in people with a T Score < -2.5 in DEXA measurements. The drugs used in the treatment of osteoporosis can be listed as follows.
Calcium and Vitamin D
Bisphosphonates (Alendronate, Risedronate, Ibandronate, Zolendronic acid )
Rankl inhibitors (Denosumab)
Selective Estrogen Receptor Modulators
Calcitonin
Teriparetide (Parathormone Analogue )
Strontium Ranelate
Classical Hormone Replacement Therapy
Bioidentical Hormone Replacement Therapy
In the treatment, the drug suitable for the degree of osteoporosis and other health problems of the person is selected from the drugs classified above. These drugs are available in forms suitable for daily, weekly, monthly, quarterly and annual use. There are also forms of drugs administered orally, nasally and intravenously as injections.
