A Review of Effects and Medications
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
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.
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
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 . 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 .
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 . 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 .
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 . 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.
iii. Preservation of skeletal structural integrity
iv. Optimization of skeletal growth to increase the peak
The diet plan which should be taken into consideration is
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
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
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 .
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 . The normal level is 30-32ng/ml and
the upper limit is 60ng/ml . Although the daily doses are
present till it has been intermittent dose was found to be 3 times
more strong .
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 . The excessive
usage of Vitamin A was harmful for the bone because of usage
in large doses which is more than 100000IU . Vitamin K
has been found as the source to work on decreasing the bone
turnover and the decrease in bone loss . 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 .
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 .
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 .
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.
i. Imaging of spine so we can rule out of any type of
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).
All the applicants who require the treatment for the
osteoporosis will include :
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 . Although, further research has
work for the giving recommendation against the practice .
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 .
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.
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.
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