OSTEOPOROSIS AND ITS MANAGEMENT
Domlur, Bengaluru Feb 14, 2017
Osteoporosis is a major public health issue associated with increasing fractures, especially in the elderly population. Paradoxically, it is often not diagnosed in time and neglected until an adverse event occurs.
Osteoporosis is a skeletal disorder causing reduced bone strength leading to an increased risk for fracture. The diagnosis of osteoporosis and osteopenia is made by the BMD test (DEXA scan) which is an effective way of picking up high risk patients and also to track improvements of bone health when done sequentially.
By definition, on bone mineral density (BMD) testing, osteoporosis has a T-score of≤−2.5 at the lumbar spine, femur neck, or hip. As T-scores decrease, the relative risk for fracture increases. Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis. Osteopenia has a T-score of between -2.5 and -1 on BMD. Anything over -1 is considered normal bone density.
Another way to identify individuals at high fracture risk is by using of fracture risk algorithms such as FRAX.
FRAX is a risk assessment tool, developed by the World Health Organization. It uses risk factors along with DEXA measurements for fracture risk estimation and helps to identify people who may be at risk of developing osteoporosis. Personal history details like height and weight, medication history, smoking history and family history needs to be entered to to generate a score which predicts whether the person in question is at risk of developing osteoporosis in the next 10 years.
- The population for whom the clinical osteoporosis diagnostic criteria are most useful are post- menopausal women and men over the age of 50 years.
- Some of the treatment guidelines for osteoporosis include lifestyle and dietary measures, or medication.
- Adequate fruits and vegetables rich diet to ensure calcium intake
- Adequate vitamin D intake (800-1,000 IU per day), including supplements if necessary.
- Regular weight-bearing and muscle-strengthening exercise to improve agility, strength, posture and balance and reduce the risk of falls and fractures.
- Assess and advice on medical and non medical risk factors for falls with appropriate To look at home safety assessment, caution with medications causing dizziness, balance issues and drowsiness, Vision/hearing problems.
- Use of bisphosphanates to promote positive calcium assimilation.
- Use of Hormones which influence calcium metabolism.
At Portea, we have an integrated approach at addressing the Osteoporotic persons.
- A complete range of diagnostic tests are available to establish the degree of the ailment as a baseline. This includes blood tests, X-rays, Bone mineral densitometry assessment and estimation of various fracture risks based on these investigations.
- A periodic doctor visit is organised for a comprehensive medical check up and assessment of the degree of illness. The doctor also monitors associated illnesses and outlines the management of osteoporosis.
- Nurses and nursing attendants visit to take care of medication administration and helping elderly with their activities of daily living.
- Physiotherapists visit to assess degree of agility, mobility and flexibility of joints and muscle groups.
- Medication supply and refills are ensured with periodic delivery as required against a prescription.
- Psychological counselling services, both face to face and on telephone are available to mentally boost the morale and concerns of an aggrieved individual.
- Nutritional assessment and guidance is provided at periodic intervals to ensure that adequate nutrients are ingested to maintain good health.
- Home modification plans depending on challenges faced by the patient in ease of movement : engineering and electrical solutions, guide rails, carpets, stairs etc.
- Solutions for convenience of movement and activities : walkers, braces, special cutlery for arthritics, hearing aids, etc.
- An integrated care plan is constructed taking into account all the above and a patient care co-ordinator ensures a channel of communication on a one to one basis for smooth management of Osteoporosis.