DISEASE INFLUENCING FACTORS : DIET, LIFE STYLE, ENVIRONMENT, SMOKING, ALCOHOL, DRUG ABUSE & LACK OF EXERCISE
Medical Care: Osteoporosis is largely asymptomatic until a fracture occurs. Taking steps to identify patients at risk and implementing preventive measures, such as changes in diet and activity levels, are important.
Preventive measures should begin in childhood and adolescence, with adequate calcium intake and exercise. In patients who must take glucocorticoids for other medical conditions, some protective measures can be implemented. These include using the lowest dose possible, using inhaled (rather than oral) forms of glucocorticoids, instituting alternate-day dosing of steroids, and performing muscle-strengthening exercises.
Effective medical therapy is available to help prevent and treat osteoporosis, including gonadal hormone replacement, calcitonin, selective estrogen-receptor modulators, and bisphosphonates. However, these agents reduce bone resorption with little, if any, effect on bone formation. Experimental evidence indicates that slow-release sodium fluoride and low-dose PTH are capable of increasing bone formation and thus preventing bone loss in women who are estrogen deficient. The former has also been used to decrease vertebral fracture rates. These are not yet approved for the treatment of osteoporosis. A newer medication approved by the US Food and Drug Administration (FDA) for the treatment of osteoporosis is an anabolic agent, recombinant human PTH (rhPTH) (1-34), which has been shown to stimulate the formation of new bone. The newest medication to receive FDA approval is ibandronate, a once daily oral bisphosphonate.
Surgical Care: The goals of surgical treatment of fractures are rapid mobilization and return to normal function and activities.
Diet:
" Adequate calcium and vitamin D intake are important for persons of any age, particularly in childhood as the bones are maturing. If dietary intake is inadequate, add supplements.
" For women who are postmenopausal, men who are older than 50 years, and other persons at risk for osteoporosis, the recommendation is 1500 mg of calcium daily.
" For women who are premenopausal and men who are younger than 50 years without osteoporosis risk factors, the recommendation is 1000 mg/d.
" Vitamin D intake should be 400-800 IU/d.
Activity:
" Weight-bearing exercise has been shown to have a positive effect on BMD, although the exact mechanism is not known. Regular exercise should be encouraged in all patients, including children and adolescents in order to strengthen the skeleton during the maturation process.
" Exercise also improves agility and balance, thereby reducing the risk of falls.
" Encourage patients to be as active as possible.
" Physical therapists can assist in developing exercise regimens, instructing patients in proper techniques, and monitoring progress and consistency.