Research Article

A Review of Effects and Medications for Osteoporosis

Ram Ishwar Yadav¹*, Cao Yanming², Ling Long¹ and Jian Liang Gao¹

Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou Medical University, China

²Department of Surgery, Hue University of Medicine and Pharmacy, Vietnam

Head of Orthopaedic Department, The second Affiliated Hospital of Guangzhou Medical University, China

Submission: April 15, 2019; Published: August 09, 2019

*Corresponding author: Ram Ishwar Yadav, A senior resident in the second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China Open Access

How to cite this article: Ram Ishwar Yadav, Cao Yanming, Ling Long, Jian Liang Gao. A Review of Effects and Medications for Osteoporosis. Open Access J Surg. 2019; 11(1): 555801. DOI: DOI:10.19080/OAJS.2019.10.555801.

Abstract

Osteoporosis is a type of condition having high chances of occurrence and spreading at a rapid way and it is increasing with the increase in the life expectancy of the general population. It is by far the commonest metabolic bone disease which is characterized by a diffuse reduction in the bone density due to decrease in the bone mass. Osteoporosis occurs when the rate of bone resorption exceeds the rate of bone formation. We know that now there is great advancement in the field of bone mineral density measurement, and it is conceivable now to work on early detection and rapid treatment which can help to recover early for the patient, and it may prove less harmful for the society as well.

Keywords: Bone Mineral Density; Osteoporosis; Climacteric

Introduction

Osteoporosis can be termed as the silent condition which is rising in the recent time due to the growth in life expectation for the patients [1]. All of this will ultimately affect the physical, mental as well as the socioeconomic condition of the patient. Here we will work on summarization of the important aspects of this type of treatment. The working group of world health organization gave a definition which was totally built on the calculation based on T score of the BMD (Bone Mineral Density) and is said to be less than -2.45 and it can be considered as the osteoporosis [2].

The number of patients facing osteoporosis in them is rising in United State of America (USA) and it is expected that soon the number of patients will reach to figure of 34 million in USA [3]. The percentage of women is considered to be at 80 percent in total figure. The occurrence of osteoporosis increases with the age and there is rapid rise in case if females are facing menopause. The incidence of osteoporosis is also linked with the increase in occurrence of fractures which also work for the decrease in bone mineral density [4].

Pathophysiology of Postmenopausal Osteoporosis

There are 2 causes of postmenopausal osteoporosis

i. Low peak bone mass

ii. Increase bone loss which is explained by 70% of genetic factors [5-8].

As soon as we will accomplish the peak bone mass, the rule of bone will take place by local remodeling, which is controlled by RANK, protein and OPG. Here Rank is a type of reception based of nuclear factor and is presented in the osteoblasts and works on increase their activity. It is synthesized by the osteoblasts and is blind with the Rank receptor based on osteoclasts. Whereas, OPG is also synthesized by the osteoblasts and works for the prevention of the binding of Rank by itself to RANKL(Receptor Activator of Nuclear Factor-kappa B ligand, the product of the TNFSF11 gene).

In females suffering from postmenopausal, hormones are changed with the increase in the RANKL which causes increase in the osteoclastic activity and the bone remodeling is shift towards the bone resorbing balance as it leads to osteoporosis. It has been noted that the bone loss is maximum 3 years before the menopause and even after 5 years of menopause. The loss of bone is faster than the average loss in bone in the senile osteoporosis which is mostly seen in males. The research also suggests the modification in micro architecture of the bone with the osteoporosis. Though the research and changers of quantification are still in experimental stages and they are not available for commercial use [9]. The factors which are accelerating the bone loss are discussed in Table 1 and the factors which rise the danger of tumbling and fractures are involved in the Table 2.

Clinical Features of Postmenopausal Osteoporosis

The features of postmenopausal osteoporosis are:

i. Low bone mass which is measured by body mineral density

ii. Fractures are most important indicator of the osteoporosis

Lifestyle and Non pharmacologic Measures for Bone Health

The goal of the therapy is given below

i. Prevention of the secondary bone loss.

ii. Prevention from fractures

iii. Preservation of skeletal structural integrity

iv. Optimization of skeletal growth to increase the peak bone mass

The diet plan which should be taken into consideration is given below:

Good general Nutrition: There is need of proper balance diet for the growth of good peak bone mass. It also depends upon the intake of protein as well as the activity level of the patient [10-12].

Calcium: The recommended dose of requirement of calcium on daily basis is different depending upon the situation and the details is given in Table 3. Some points are needed to be taken in consideration for the calcium as it is absorbed better with the food as well as with the calcium citrate which will give the least amount of GI side effects as compared to other compounds of calcium.

Vitamin D: It is a significant thing to work on the assessment of the all vitamins including Vitamin D in all the patient suffering from osteoporosis and Vitamins are available in food like fish oil. Mil, cereals and breads. As far as the recommendation of National osteoporosis foundation is concern, they have recommended a dose of 800-1000 IU for the patient less than 50 years old [13]. On the other hand, many experts suggest that the dose should be between 1000-2000IU and the safer limit for a human being is 4000IU per day [14]. The normal level is 30-32ng/ml and the upper limit is 60ng/ml [15]. Although the daily doses are present till it has been intermittent dose was found to be 3 times more strong [16].

Other dietary supplements: As we know that the magnesium will never increase the calcium absorption, but it will work for the decrease in GI side effects [17]. The excessive usage of Vitamin A was harmful for the bone because of usage in large doses which is more than 100000IU [18]. Vitamin K has been found as the source to work on decreasing the bone turnover and the decrease in bone loss [19]. It was expected that natural estrogens work for the prevention of bone loss, but no scientific evidence was found for it [20-22].

Alcohol: When someone will do excessive use of alcohol it will create bone loss. So, women suffering from postmenopausal should only take maximum of 7 drinks in a week [23].

Caffeine: The women suffering from osteoporosis should limit their caffeine to a level of 1 serving per day as it will work for decreasing the level of intestinal absorption of calcium [24].

Smoking: It is linked with the osteoporotic fractures and the patients will give up smoking as it is lesser risk container than for those who are active smokers [25].

Exercise: Exercise is necessary for human beings as the regular exercise of 30-40 mints will work for increasing the strength of muscles and it play the same role for increasing the strength of bones [26,27]. Though the patients suffering from high osteoporosis should avoid the heavy exercises like weightlifting and pulling or pushing.

Prevention of Risk Factors for Post-Menopausal Osteoporosis

i. Imaging of spine so we can rule out of any type of fractures.

ii. Body mineral density is measured either at the spine or at the neck of the femur.

It is used for getting assessment for the expectation of fractures in the coming 10 years with the help of using the FRAX tool. Even, this type of modality is still expensive and the benefit for the society can be still not confirmed (Table 4).

Treatment of Osteoporosis

All the applicants who require the treatment for the osteoporosis will include [28]:

i. spine fracture

ii. T score<-2.45

iii. T score should remain between +1 to -2.45 with an expectation of fracture and is calculated with the help of tool known as FRAX tool

All the medicines which are accepted for the dealing of postmenopausal osteoporosis have been listed and their dosage is shared at Table 5 as well as the possible effects of fracture risk reduction are mentioned in the Table 6. It was expected that the concomitant use of anti-osteoporosis drugs will work for the reduction of the fracture risk and it will be better than the using the single medicine [29]. Although, further research has work for the giving recommendation against the practice [30]. the consecutive use of drugs for the first anabolic group was followed by the anti-restorative drugs as they have been found to be the beneficial for the patients [31].

BMD in Progression of the Treatment

For the treatment of osteoporosis and prognosis; body mineral density is used. The treatment will never work and ultimately will fail if the substantial will fall in the body mineral density or if any other type of fracture occurs.

Operative Treatment for Osteoporosis

There are many fractures occurring, but the most common fractures are known with the name of vertebral fractures and there is always difference of opinion on the basis of the management of the same. Although the vertebroplasty will decrease the pain rapidly but it will never work for the increase in vertebral height to a normal level. On the other side, Kyphoplasty works for the increase in vertebral height as well as the reduction of pain but it is very expensive [32-36]. The specialist should be careful in the fixation of the other type of fractures with the help of using the locking plates as well as the HA coated implants for the purpose of providing a stable fixation.

Conclusion

The research shows that the chances of occurrence of osteoporosis based on postmenopausal is on rise and one should work for the careful management and suitable medication should be given for proper treatment and fully recovery for every patient.

Funding

National Natural Science Foundation of China (NSFC) 81574002.

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