Latest Cures for Osteoporosis
Alendronate acid, clodronic acid, etidronic acid, ibandronic acid, pamidronic acid, risedronic acid, tiludronic acid and zoledronic acid arc among the osteolysis inhibitors. They are used for Morbus Paget, postmenopausal osteoporosis, and other osteolytic processes. There are no systematic studies on their use during pregnancy. Animal experiments suggest a possible placental transfer and effect on fetal skeletal development (Omoy 1998). Recommendation. Biphosphonates and the other osteoporosis drugs are not indicated during pregnancy. Accidental acute use of individual doses in the first trimester does not justify either interruption of the pregnancy or additional diagnostic procedures.
Osteoporosis is a progressive, systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to bone fracture. A more clinically relevant definition of osteoporosis is made on bone mineral density measurement (BMD). BMD is usually measured at the lumbar spine, hip and the radius. Results are expressed in grams per centimetres squared (g cm2) as an area density expressed as standard deviations related to the BMD of young adults (T-score). Results can be expressed as standard deviation related to age this constitutes the Z-score. The WHO diagnostic classification is T-score between -1 and -2.5 osteopenia T-score below -2.5 osteoporosis T-score below -2.5 plus one or more osteoporotic fractures clinical osteoporosis.
Osteoporosis associated with pregnancy Vertebral collapse presenting for the first time in pregnancy is rare and making the diagnosis is all important. Characteristically, vertebral collapse occurs in the third trimester but may occur any time until after delivery. Sudden, severe back pain in the thoracic and or lumbar spinal region, persisting for some weeks or even months, are the main clinical features. Pregnancy-related osteoporosis of the hip For cases of sudden onset of pain in the hip, fracture, infection, tendonitis and muscle sprain osteoporosis will need to be considered. Some medications - steroids, prolonged heparin therapy - are associated with increased risk of osteoporosis. Identification of fractures in pregnant women raises a possibility of domestic violence. Hence, there is a theoretical risk of misattribution of fractures to domestic violence with the possibility of osteoporosis being overlooked. Osteoporosis associated with pregnancy Apart from calcium and vitamin...
The exercise recommendations from the American College of Obstetricians and Gynecologists (ACOG) mirror those of the Center of Disease Control (CDC), and the American College of Sports Medicine (ACSM). The ACSM recommends moderate intensity exercise for 30 min or more on most days of the week as part of a healthy lifestyle in the nonpregnant population 4 . A moderate level of exertion for 30 min duration has been associated with significant health benefits decreasing risk of chronic diseases including coronary heart disease, hypertension, type 2 diabetes mellitus, and osteoporosis 33 . Women who are sedentary prior to pregnancy should gradually increase their duration of activity to 30 min. Those who are already fit should be advised that pregnancy is not the time to greatly enhance physical performance and that overall activity and fitness tend to decline during pregnancy. Pregnant women should exercise caution in increasing intensity, especially when an exercise session extends...
In addition to the complications of the condition noted above treatment with oral corticosteroids is also associated with significant side effects. These include corticosteroid-induced myopathy, osteoporosis, diabetes mellitus and hypertension. This list is not exhaustive and highlights the potential issues of systemic corticosteroid therapy.
Vitamin D deficiency osteoporosis can present in pregnancy. Initial symptoms may be symmetrical lower back pain spreading to the pelvis and upper legs and ribs13. Persistent postpartum backache requires accurate investigation and a diagnosis made before further pregnancies are planned, as the pain may result from an underlying condition such as osteoporosis, which could be exacerbated by subsequent childbearing16
National Osteoporosis Foundation USA National Osteoporosis Society Compston, J.E. and Rosen, C.J. (2004) Fast Facts - Osteoporosis, 4th Edn. Oxford Health Press. Fordham, J. (2004) Your Questions Answered Osteoporosis. NOS (2003) Osteoporosis associated with pregnancy. Bath National Osteoporosis Society. Sutcliffe, A. (2006) Osteoporosis A guide for health professionals. Chichester Whurr John Wiley.
John's, NL, Canada Calcium Metabolism and Osteoporosis Program, American University of Beirut-Medical Center, Riad El Solh, Beirut, Lebanon * Corresponding authors. Basic Medical Sciences, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3V6 Canada (C.S. Kovacs) Calcium Metabolism and Osteoporosis Program, American University of Beirut-Medical Center, P.O. Box 11-0236, Riad E1 Solh 4407 2020, Beirut, Lebanon (G.E.-H. Fuleihan).
Osteoporosis associated with pregnancy and lactation Osteoporosis associated with pregnancy and lactation has been recognized for more than 5 decades 85 and usually presents during late pregnancy or early postpartum 85-88 . It is still debatable whether pregnancy and lactation are causal or accidentally associated with the condition. It is equally unclear whether these osteoporotic fractures reflect architectural deterioration of a previously abnormal skeleton or whether pregnancy and lactation themselves account in large part for the bone loss and fragility fractures, situations that may be compounded by low calcium intake and vitamin D deficiency. As reviewed previously, skeletal demineralization normally occurs during lactation as a consequence of the actions of mammary gland-derived PTHrP in the setting of low estradiol levels and is not preventable by increased calcium intake osteoporotic fractures may occur in some women during lactation when the demineralization is excessive or...
There are many advantages to breastfeeding for the mother herself The process facilitates the rapid recovery postpartum, with a reduccd loss of blood and the prompt involution of the uterus to its pre-pregnant state (Labbok 2001). Further breastfeeding prevents post-partal depression (Groer 2005), and reduces the long-term risk of obesity and osteoporosis for the nursing mother. Studies of specific diseases show that there is a reduced risk of breast cancer and ovarian cancer for women who breastfeed (Lawrence 2005, Collaborative Group 2002). Finally, the special relationship between mother and
Physical activity at any stage of the life cycle is associated with a decreased prevalence of cardiovascular disease, colon cancer, type 2 diabetes, and overweight, and it decreases mortality rates from all causes. Specifically in lactation, regular activity improves cardiovascular fitness, plasma lipid levels, and insulin response 14 . Regular activity also has the potential to benefit psychosocial well-being in lactation, such as improving self-esteem and reducing depression and anxiety. Other potential benefits include promotion of body weight regulation and optimizing bone health. Engagement in regular activity by the mother may also encourage the same in her offspring, promoting a healthy lifestyle and body weight management for the entire family.
Radiograph of the skull in an infant with osteogenesis imperfecta. Note the lack of mineralization with wormian bones. Clinically one feels multiple small bones over the skull. There is a thin cortex with minimal skull ossification and generalized osteoporosis.
Possible mediators of the osteopenia are microangiopathy at the bone tissue, and changes in insulin, insulin-related growth factors (IGF) and other cytokines involved in bone metabolism.44 Recent studies have also tentatively attributed the higher incidence of hip fractures in Type 1 diabetics to the absence of amylin, a 37-amino-acid polypeptide normally secreted by the pancreatic beta cells. Amylin binds to calci-tonin receptors, lowers plasma calcium concentrations,
Brayshaw E 2002 Pregnancy associated osteoporosis. Journal of the Chartered Physiotherapists in Women's Health, 91 3-9 8. Hollick MF 1998 Vitamin D requirements for humans of all ages new increased requirements for women and men 50 years and older. Osteoporosis International, Suppl. 8 S24-29 10. Department of Health 1998 Report on health and social subjects Nutrition and bone health with particular reference to calcium and vitamin D. Report No. 49 of the sub-group on bone health. Working Groups on the nutrition status of the population, of the Committee on Medical Aspects of Food and Nutrition Policy. London HMSO 9.5 Osteoporosis 1. Compston JE and Rosen CJ 2004 Fast Facts - Osteoporosis, 5th Ed. Oxford Health Press 3. Smith R, Athenasou NA, Ostlere SJ, et al. 1995 Pregnancy associated osteoporosis. QJM, 88 865-878 4. NOS 2003 Osteoporosis Associated With Pregnancy. Bath National Osteoporosis Society
Mediated through the repression of genes encoding inflammatory mediators. However, inhibition of other transcription factors may account for the deleterious effects of glucocorticoids, such as adrenal suppression and osteoporosis (Roumestan 2004). In contrast with these genomic effects, some actions of corticosteroids can be immediate and mediated by membrane-bound receptors (Christ 1999). Pharmacokinetic parameters such as the elimination half-life, and pharmacodynamic parameters like the concentration producing the half-maximal effect, determine the duration and intensity of glucocorticoids' effects.
Women with osteoporosis or osteogenesis imperfecta Re-referral to a physician if an existing treatment is associated with osteoporosis, in particular low-molecular-weight heparin (LMWH) and certain steroids Specific relaxation techniques to help with pain, and exercises to develop muscle strength, are found in the National Osteoporosis Society's booklet (see Essential Reading) Women having had osteoporosis in a previous pregnancy need careful assessment and advice prior to planning a future pregnancy
Effects of antiepileptic drug therapy on bone mineral density in ambulatory epileptic children. Brain Dev. 1994 16 382-385. Sheth R, Wesolowski C, Jacob J, et al. Effect of carbamazepine and valproate on bone mineral density. J Pediatr. 1996 127 256-262. Valimaki M, Tiihonen M, Laitinen K, et al. Bone mineral density measured by dual-energy x-ray absorptiometry and novel markers of bone formation and resorption in patients on antiepileptic medications. J Bone Miner Res. 1994 9 631-637.
Feldman, 2005 Epilepsy and the Ketogenic Diet, edited by Carl E. Stafstrom and Jong M. Rho, 2004 Handbook of Drug-Nutrient Interactions, edited by Joseph I. Boullata and Vincent T. Armenti, 2004 Nutrition and Bone Health, edited by Michael F. Holick and Bess Dawson-Hughes, 2004 Diet and Human Immune Function, edited by David A. Hughes, L. Gail Darlington,
Characterized by extreme voluntary weight loss due to self-starvation or binge eating followed by purging, AN occurs in 0.5-3 of the female population 3, 4 . Clinical signs and symptoms of AN include an emaciated appearance, prepubertal features, lethargy, lanugo, alopecia, acrocyanosis, hypothermia, swollen joints, pitting edema, and bradycardia and hypotension. Biochemical evaluation often shows fluid and electrolyte disturbances and hypercarotenemia as well as endocrine and hematologic abnormalities such as hypothyroidism and anemia, respectively. Several cardiovascular irregularities develop along with a host of gastrointestinal complications, particularly in those with the binge eating-purging type of AN. Osteoporosis and skeletal fractures are common in persons with AN. Some may experience peripheral neuropathy and seizures. Mortality is as high as 22 in women with long-term AN 5 .
Low molecular-weight heparins (LMWHs) are increasingly preferred to unfractioned heparin (UH) for thromboprophylaxis, as well as for the treatment of VTE, and in the pregnant patient. They arc heparin fragments produced by chemical or enzymatic depolymeriza-tion, and their molecular weight ranges from 4000-6000 daltons. They specifically inhibit factor Xa. Their advantage lies in a longer half-life (injecting once a day), their better bioavailability (85 ), and their association with a lower incidcncc of osteoporosis, allergy, and heparin-induced thrombocytopenia (HIT), which may cause thrombotic events. There is evidence that LMWH. just like UH, do not cross the placenta. Based upon safety data, UH was previously considered to be the anticoagulant drug of choice during pregnancy for most indications. Maternal disadvantages include the risk of HIT, allergy, and osteoporosis. Long-term heparin therapy ( 1 month) may be associated with increased bone loss, particularly during pregnancy,...
Osteoporosis leads to bone fracture, especially lower radius, vertebral and hip fractures. There are estimated to be around 250,000 osteoporotic fractures each year in the UK. Osteoporosis is common, with up to one in three women over the age of 50 years affected, especially very elderly women. In women of child-bearing age, osteopenia and osteoporosis are less common, but those with a family history of repeated fractures, prolonged amenorrhoea, and steroid use are at risk of worsening bone density during pregnancy and breast-feeding. This may increase chances of worsening post-menopausal bone health with risk of fractures in later life.
Mineralization hardens bone, and if the process doesn't h appen at th e correct rate , th e bones may be weakened. It may not happen properly if a chi Id grows r api dly in in fan cy or e arly ch ildh ood to c ompensate for a previous peri od of slow growth . There is some evidence th at improper mineralization in the e arly ye ars affects th e mineral loss that we all experience as we get older, resulting in weak bones th at fracture e asi ly, alth ou gh much rese arch still n eeds to be don e on why osteoporosis develops in later life. The skeleton of a newborn baby is made up of more than 300 parts. As the baby grows, some of its bones fuse together, and by adulthood the skeleton contains j ust 206 bones.
Whether a fluoride supplement during pregnancy of about 1 mg day in tablet form (equivalent to about 2mg sodium fluoride), or ingested via fluoridated drinking water (about 1 mg l), actually reduces the incidence of caries in the baby is somewhat controversial. However, such fluoride prophylaxis does not appear to harm the fetus. Earlier suspicions regarding the possible toxic effect of regular fluoride on reproduction - for example, an increased rate of Down syndrome -is biologically implausible. Even high fluoride doses as a result of environmentally contaminated drinking water (above 10mg l) do not apparently cause any increase in birth defects, Prenatally induced fluorosis of the teeth and bones in the second half of pregnancy is theoretically possible, and has been described in individual cases after extreme continuous exposure, but would not be expected after (as has occasionally happened) accidental intake of an osteoporosis preparation containing about 25 mg of fluoride....
Calcium is important for the normal development and maintenance of the skeleton, with over 99 of total body calcium found in bones and teeth 21 . The remainder of total body calcium is tightly regulated in blood, extracellular fluid, and muscle, where it plays a role in blood pressure regulation, muscle contraction, nerve transmission, and hormone secretion. Calcium homeostasis is maintained by parathyroid hormone, which increases blood calcium, and calcitonin, which lowers blood calcium. If blood calcium levels fall, parathyroid hormone is secreted, stimulating the release of calcium from bone. Chronic calcium deficiency, due to inadequate intake, will result in progressive loss of skeletal mass and osteoporosis.
Malnutrition can be a severe complication of celiac disease. Particularly if untreated for years, the disease also puts a person at increased risk for lymphoma and adenocarcinoma (two forms of cancer that can develop in the intestine), osteoporosis (in which the bones become brittle and weak), and short stature.
The most well appreciated function of vitamin D is to maintain normal blood calcium and phosphorus concentrations thereby promoting bone health. Vitamin D can be obtained from food, or synthesized in the skin by exposure to ultraviolet light. Solar ultraviolet-B (UVB) photons are absorbed by 7-dehydrocholesterol in the skin, transformed to previtamin D, and then rapidly converted to vitamin D. Total body exposure to 10-15 min peak sunlight during the summer months in a Caucasian is equivalent to approximately 20,000 IU of vitamin D 41, 42 . Seasonal changes, time of day, latitude,