Home | What's New | Our Services | Events & Activities | Career Opportunities | 4all.my | About Us | Contact Us
Encyclopaedia ->
Health Topics
Herbs
Nutrition
Drug
therapies
Tests
Symptoms
First letter
Body System
Dictionary The Skeletal System

Osteoporosis

Clinical features, Diagnosis, Management, Prognosis,

Osteoporosis is defined as a decrease in the absolute amount of bone that can lead to fractures following minimal trauma. The bone that remains is histologically and biochemically normal, but there is not enough of it to maintain normal skeletal integrity and sufficient mechanical support. Osteoporosis develops when the net rate of bone resorption exceeds the rate of bone formation, resulting in a decrease in bone mass without a defect in bone mineralisation. The end result is brittle, light but firm bones. 

It is by far the commonest form of metabolic bone disease and a major public health problem. Bone mass is determined by genetic and environmental factors and reaches a peak around the age of 35 and remains largely unchanged for next 10 years. After that there is net bone loss of about 0.3-0.5% per year. Age-related bone loss is greatly accelerated in women after the menopause due to loss of oestrogen production. It has been estimated that the rate of bone loss after the menopause can be as high as 3-5% per year. Decreased physical activity in older persons may also be very important because preservation of bone mass depends on skeletal stress through muscle contraction and weight bearing. Radius fractures, femoral neck fractures and vertebral fractures are all related to osteoporosis, although not everyone with low bone mass will experience them. 

Several risk factors for osteoporosis have been identified:

1.      Endogenous:

         Female sex

         Small stature and thin physical constitution (obesity is associated with higher bone mass because of physical stress on bones)

         Family history

         Nullparity (childlessness)

         Early menopause

         Advanced age

2.      Exogenous:

         Low calcium and phosphate intake

         Reduced physical activity

         Cigarette smoking

         Alcohol abuse

         Abuse of aluminium antacids (they bind calcium in the gut preventing its absorption)

         Corticosteroid therapy

         Excessive protein intake in form of red meat 

Osteoporosis can be classified into primary (95% of all cases) and secondary (5% of cases). Primary is further divided into the following two types although there is a significant overlap between them:

         Type I (postmenopausal) osteoporosis that starts to develop after the age of 50 and is six times more common in women but can occur in men after castration or with low levels of testosterone. This type is associated with fractures such as distal radius (so called Colles?fracture) and vertebral crush fractures.

         Type II (involutional or senile) osteoporosis is associated with ageing process when there is progressive but gradual loss of osteoblastic activity in the bone. This type occurs in individuals older than 60 years and it is twice as common in women as in men (in older women type I and II frequently coexist). The most common type of fractures are those of the femoral neck (hip), wedge vertebrae, proximal humerus, proximal tibia and pelvis. 

Secondary osteoporosis is associated with certain endocrine disorders such as glucocorticoid excess in Cushing’s syndrome (glucocorticoids stimulate catabolism of proteins in the bone, reduce activity of osteoblasts and promote activity of osteoclasts), hyperparathyroidism (PTH mobilises calcium from bones), long term treatment with heparin (anticoagulant) or barbiturates (in combined antiepileptic preparations), prolonged immobilisation, chronic liver and kidney failure (due to impaired activation of vitamin D in these organs) and various malabsorption syndromes (impaired absorption of calcium and vitamin D).

Clinical features:  < BACK TO TOP >

           Patients with uncomplicated osteoporosis may remain asymptomatic or may have aching pain in the bones, particularly the back.

           Vertebral fractures develop with minimal or no trauma, usually in weight-bearing vertebrae (Th-8 and below).

           The pain is acute, usually does not radiate, is aggravated by weight-bearing, may be associated with local tenderness, and generally subsides in a few days or weeks.

           Multiple compression fractures may cause marked height reduction and thoracic kyphosis (hunchback) with exaggerated cervical lordosis and chronic, dull, aching pain (because of excessive stress on the back muscles and ligaments caused by abnormal body posture), particularly prominent in the lower thoracic and lumbar area.

           Fractures at other sites (e.g., hip or distal radius) usually result from an accidental fall.

Diagnosis:  < BACK TO TOP >

             Plasma biochemical measurements are usually normal but the alkaline phosphatase (produced by osteoblasts) may be raised following a recent fracture, reflecting repair process in progress.

             Levels of parathyroid hormone (PTH) may be elevated in primary hyperparathyroidism (due to benign autonomously functioning tumour of the parathyroid gland) or secondary (hypocalcaemia caused by decreased activation of vitamin D, impaired absorption of calcium and vitamin D) hyperparathyroidism.

             X-ray shows decrease in bone density as well as the characteristic wedge and crush fractures in the spine but it has been calculated that at least 40% of bone mineral must be lost before the changes are detectable on plain X-ray films.

             The gold standard for diagnosis of osteoporosis is dual energy X-ray absorption scan (DEXA scan). The test is performed by passing low energy X-rays through a bone (e.g. spine, hip or wrist). The test takes about ten minutes and is associated with very limited radiation exposure (less than during one plain X-ray). The results are expressed in units referred to as standard deviations (SD). These SD units tell how much a result differs (or deviate) from what is considered normal. If one is 2.5 SD units below normal (-2.5), this is considered to be osteoporosis.

             Heel ultrasound is an interesting new technology for testing bone density. The test usually involves immersing a foot in a bath of warm water, allowing high frequency sound waves to pass through the heel. The test measures the density and quality of the bone in the heel. It has not yet become a standard testing procedure but since the equipment is portable it may nicely supplement DEXA as a screening procedure.

Management  < BACK TO TOP >

             Non pharmaceutical measures such as regular physical exercise in any form, adequate calcium intake (more than 1g per day), avoidance of smoking and alcohol are intended to minimise bone loss.

             A small daily supplement of vitamin D [Rocaltrol, Caltrate or similar] (400 IU) is recommended.

             Hormone replacement therapy (HRT) with oestrogens, with or without progestogen component, should be considered in postmenopausal women with low bone mass especially with family history of bone fractures. However, HRT is not a substitute for healthy life style and may increase risk for endometrial and breast cancer.

             Alendronate [Fosamax] and etidronate [Didronel, Didrocal] inhibit osteoclast-mediated bone resorption and may be an alternative for postmenopausal women in who they can significantly decrease the risk of fracture. These drugs must be taken with a lot of water due to their ability to cause irritation and damage of the oesophagus if the tablet lodges there. Because of this and possible gastric irritation this treatment is usually reserved for individuals who already developed osteoporosis-related bone fracture or are in great risk to have it (e.g., strong family history, low bone density).

             Treatment of fractures often proves difficult because brittle bones mend very slowly. Prolonged hospitalisation and immobility increase the risk for deep leg vein thrombosis, pulmonary embolism and/or pneumonia, which are very serious, sometimes life threatening complications.

Prognosis  < BACK TO TOP >

  • - - 

(source : Dr Zoran Pletikosa)

search this site the web

search engine by freefind

Disclaimer

Powered by visit montaine home page

Thank You visiting MONTAINE

Welcome To Montaine
action activity adventure aerobic aerobics after age air alternative medicine amateur areas arthritis athletes backpack backpacking backpacks bad bag barbeque basecamp based bay before beginners being benefit best bike biking blonde bmi body bodybuilder bodybuilding brand building BUY calculate calculated calculation calculator calculators calories camp camping camps cardiorespiratory cardiovascular center centers centre centres certification chat chi circuit climb climbing club clubs college competition competitor components conservation consumed consumption count courses day http://www.montaine.com.my/dictionary.htm definition download education environmental equipment erotica excercise exercise exercises exercising explore euro 2004 event famous fat female figure find fires fit fitness fittness for force franchise free gallery gay get getfit given glutes green greatest group groups guide guides gym gyms health height hikers hiking home homepage how human ideal idealweight in increasing index injures injuries instructions intermediates iron is kl knowing layout link locations loosing male man map maps mass massage masseur maximuscle me measure metabolism miss model models morning mount mountain mountaineering mountains mt multiple multistage muscle muscular music naked natural therapy national near new night noon nutrition occupational of online olympics or out outdoor outdoors page pages Pain park parks people per personal phisical photo photos physical picture pictures pilates porn program programs rafting rainbows reaction real recommendations recreation recreational rehab rehabilitation rentals requirements results rock rooms running school schools sclerosis scoliosis sex sexy should site sites source spinal sport sports stars state statistics studio studios student swedish swim swimsuit team techniques test testing tests the therapeutic therapist therapy time tips to top trail trails trainer trainers training trip trips ultimate university visitor watching water web weekend weekends weigh weight what white whitewater women womens workout world your yout
Tsunami online Donations and Information Tsumani online Donations and Infomation We are closed from Feb 9 to Feb 13, 2005 and will resume business on Feb 14, 2005

Donation Drive:The New Straits Times, Berita Harian, TV3, 8TV Malaysian Tsunami Disaster Fund The Star Earthquake/Tsunami Relief Fund Subang/USJ Disaster Fund theSun Tsunami Emergency Supplies Fund Asian Tsunami Disaster Fund - by the Foreign Ministry Yayasan Sultanah Bahiyah Buddhist Maha Vihara - 123 Jalan Berhala, Brickfields 50470 KL -Tel: 03 2274 1141, Fax: 03 2273 2570
¡¡

Montaine
Chinese New Year 2005
3 days post Chinese New Year detox programme
Local News & Info: Missing Persons E-mail Appeals Tsunami Penang Blog iPenang Screenshots The Star Bernama Project Petaling Street TV Smith's Tsunami InTech: Bloggers fill the void

12 August 20096December 2005


25 November 2004 International Day for the Elimination of Violence against WomenInternational Day of Innocent Children Victims of AggressionHuman Rights Day
International Youth Day

 sWorkshop探 访 各 类 癌 症 的 真 相10 June 2004 7:30am-8:30pmCall (603) 2713 9288 to reserve a seat
 
Charting Your Way to Success workshop Organised by JCI

Venue : Montaine Menara Weld Level 4 |

 Date  : 30th July 2004 Friday (6:30pm -8:00pm)

Organizer : JCI Kuala Lumpur |

 Contact    : Kelly 012-320 3350 & Ang 012-296 5138

 speaker Mr NgThian Watt the Principal Trainer from Napoleon Hill Associates MalaysiaDetails www.kljuniorchamber.org
Montaine's Health and Weight Management Programme
Call 012 201 8020 or 03 5636 6788 NOW
 

January, February, March, April, May, June, July, August, September, October, November, December
April Promotion
(Gift Voucher Available)
 - Spa Gateway - Beauty Gateway
Usual RM293 Now RM138

Queen of The Day  RM138 (2 hours)

          Full Body Exfoliation worth RM68 (30 minutes)

          Full Aromatherapy Massage worth RM128 (60 minutes)

          Full Body Detox Treatment worth RM128 (30 minutes)

   All For RM138Additional RM68 – Make Over (Evening Make Up)ecretary's Day Gift, Secretarie

Call 012 201 8020 or +603 5636 6788

 

Massage or Reflexology Package Buy 7 get 3 Free  (First 50 Customers or till 31 October 2004 Only, Hurry call 03 7710 5593 now!!)

Jobs vacancy
Customer Service Exec at Montaine centre

Salary RM1000 - RM4000 Female is preferable call KC at 012 201 8020

MONTAINE Centre of Health and Wellness
kl, jb, jp, au, Africa Antarctica Arctic Asia Caribbean Europe North America Oceania South America Afghanistan Kabul Albania Tirana Algeria Algiers Andorra Andorra la Vella Angola Luanda Antigua and Barbuda St. John's Argentina Buenos Aires Armenia Yerevan Australia Canberra Austria Vienna Azerbaijan Baku a port on the Caspian Sea Bahamas Nassau Bahrain Al-Manámah Bangladesh Dhaka Barbados Bridgetown Belarus Mensk (Minsk) Belgium Brussels Belize Belmopan Benin Porto-Novo Bhutan Thimphu Bolivia Sucre ; Administrative capital: La Paz Bosnia and Herzegovina Sarajevo(unofficial) Botswana Gaborone Brazil Brasília Brunei Darussalam Bandar Seri Begawan Bulgaria Sofia Burkina Faso Ouagadougou Burundi Bujumbura Cambodia Phnom Penh Cameroon Yaoundé Canada Ottawa Ontario Cape Verde Praia Central African Republic Bangui Chad N'Djamena Chile Santiago China Beijing Colombia Santafé de Bogotá Comoros Moroni Congo, Republic of Brazzaville Congo, Democratic Republic of the Kinshasa Costa Rica San José Côte d'Ivoire Yamoussoukro (official) Croatia Zagreb Cuba Havana Cyprus Lefkosia (Nicosia) (in government-controlled area) Czech Republic Prague Denmark Copenhagen Djibouti Djibouti Dominica Roseau Dominican Republic Santo Domingo East Timor Dili Ecuador Quito Egypt Cairo El Salvador San Salvador Equatorial Guinea Malabo Eritrea Asmara Estonia Tallinn Ethiopia Addis Ababa Fiji Suva (on Viti Levu) Finland Helsinki France Paris Gabon Libreville Gambia, The Banjul Georgia Tbilisi Germany Berlin (capital since Oct.) Ghana Accra Greece Athens Athens Grenada St. George's Guatemala Guatemala City Guinea Conakry Guinea-Bissau Bissau Guyana Georgetown Haiti Port-au-Prince Honduras Tegucigalpa Hungary Budapest Iceland Reykjavik India New Delhi Indonesia Jakarta Iran Teheran Iraq Baghdad Ireland Dublin Israel Jerusalem Italy Rome Jamaica Kingston Japan Tokyo Jordan Amman Kazakhstan Astana(formerly Aqmola; capital since ) Kenya Nairobi Kiribati Tarawa Korea, North Pyongyang Korea, South Seoul Kuwait Kuwait Kyrgyzstan Bishkek (formerly Frunze) Laos Vientiane Latvia Riga Lebanon Beirut Lesotho Maseru Liberia Monrovia Libya Tripoli Liechtenstein Vaduz Lithuania Vilnius Luxembourg Luxembourg Macedonia Skopje Madagascar Antananarivo Malawi Lilongwe Malaysia Kuala Lumpur Maldives Malé Mali Bamako Malta Valletta Marshall Islands Majuro Mauritania Nouakchott Mauritius Port Louis Mexico Mexico City Micronesia Palikir Moldova Chisinau Monaco Monaco Mongolia Ulaan Baatar Morocco Rabat Mozambique Maputo Myanmar Rangoon (Yangon) Namibia Windhoek Nauru Yaren Nepal Kathmandu The Netherlands Amsterdam (official) ; The Hague (administrative capital) New Zealand Wellington Nicaragua Managua Niger Niamey Nigeria Abuja Norway Oslo Oman Muscat Pakistan Islamabad Palau Koror Palestinian State (proposed) Undetermined Panama Panama City Papua New Guinea Port Moresby Paraguay Asunción Peru Lima The Philippines Manila Poland Warsaw Portugal Lisbon Qatar Doha Romania Bucharest Russia Moscow Rwanda Kigali St. Kitts and Nevis Basseterre (on St. Kitts) St. Lucia Castries St. Vincent and the Grenadines Kingstown Samoa Apia San Marino San Marino São Tomé and Príncipe São Tomé Saudi Arabia Riyadh Senegal Dakar Serbia and Montenegro Belgrade Seychelles Victoria Sierra Leone Freetown Singapore Singapore Slovakia Bratislava Slovenia Ljubljana Solomon Islands Honiara (on Guadalcanal) Somalia Mogadishu South Africa Pretoria; Legislative capital and largest city: Cape Town; Judicial capital: Bloemfontein . No decision has been made to relocate the seat of government. South Africa is demarcated into nine provinces consisting of the Gauteng Northern Province Mpumalanga North West KwaZulu/Natal Eastern Cape Western Cape Northern Cape and Free State. Each province has its own capital Spain Madrid Sri Lanka Colombo; Legislative and Judicial capital: Sri Jayawardenepura Kotte Sudan Khartoum Suriname Paramaribo Swaziland Mbabane Sweden Stockholm Switzerland Bern Syria Damascus Taiwan Taipei Tajikistan Dushanbe Tanzania Dar es Salaam ; Official capital: Dodoma Thailand Bangkok Togo Lomé Tonga Nuku'alofa Trinidad and Tobago Port-of-Spain Tunisia Tunis Turkey Ankara Turkmenistan Ashgabat Tuvalu Funafuti Uganda Kampala Ukraine Kyiv (Kiev) United Arab Emirates Abu Dhabi United Kingdom London United States Washington DC Uruguay Montevideo Uzbekistan Tashkent Vanuatu Port Vila Venezuela Caracas Vietnam Hanoi Western Sahara (proposed state) El Aaiun Yemen Sanaá Zambia Lusaka Zimbabwe Harare

Facilities

Services              

Location       

Health check and health consultation

Power health talks and seminars

Beauty and treatment sessions

Relaxation and sport massages

Weekly family bonding activities

Montaine outdoor activities

Fitness, self defence & leisure classes available

Fully equipped gym sets, steam, sauna, Jacuzzi

Personal trainers available.

Health drinks available.

At

Relaxation / Swedish Massage Remedial / Deep Tissue Massage Physiotherapy, Sport / Work-Related Injuries Stress / Anxiety Management Acupuncture, Shiatsu Aromatherapy / Essential Oils Reflexology Slimming and Weight loss Beauty and treatment sessions Ions Detox, Ozone Spa More....... Corporate Massage Mobile/home visit Hotels Montaine Center Massage Courses Montaine outdoor activities www.montaine.com.au

PLEASE CALL TO MAKE AN APPOINTMENT
 Tel :  (+603) 5636 6788 www.montaine.com.my
 No 16, 1st Floor, Jalan PJS 11/28, Bandar Sunway, 46150, Selangor, Malaysia
Tel : (612) 9264 4567 www.montaine.com.my 23/203 Castlereagh St, Sydney, NSW 2000, Australia