Bone Loss – Perils of Treating Osteoporosis
Fragility fractures resulting from osteoporosis often require a long recovery period and can result in severe residual pain and immobility. Such fractures in the elderly often represent sentinel events and resulting in significant morbidity and even mortality. The prevention of such fractures involves fall prevention and the proper management of the underlying osteoporotic condition.
Osteoporosis is a systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue. World Health Organisation defines it as a bone mineral density (measured using a dual-energy X-ray absorptiometry scan) of 2.5 standard deviations or more below the young adult mean. Based on this definition, one-third of all adult females can be said to suffer from osteoporosis. One might even consider the onset of menopause as a harbinger for this condition.
The management of osteoporosis is based on 2 main principles: one seeks to attain maximum peak bone mass, even while reducing resorption. Most of our current first-line pharmacological treatments focus on the reduction of resorption. That said, bone is a living structure that has to heal and repair the accumulated damage it acquires. Anti-resorptive medication halts this process, leading to undesirable sequelae such as severe suppression of bone turnover (SSBT) and atypical fractures.
Careful patient selection, introduction of drug holidays, monitoring for signs of SSBT and management of atypical fractures have been undertaken by doctors dealing with osteoporosis with great interest over recent years, though many questions are still unanswered. Newer intramedullary nailing techniques have helped in the management of atypical fractures. In addition, the use of Vitamin D supplements has also played a great role in the management of the disease.
For peak mass and maximal resorption reduction, bone needs to be used and stressed – hence one would not be far off the mark to say: use it or lose it!
