Disease |
OSTEOPOROSIS |
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Quotation |
Old Mrs. Dumpty sat on a wall Old Mrs. Dumpty had a small fall All the world’s Calcium And Oestrogens ad nauseum, Could not put her ghostly Spine Together again. |
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Definition |
A multifactorial bone disease characterized by low bone mass (osteopenia) with increase in bone fragility with susceptibility to pathological fractures of the spine, upper femora, distal radius, proximal humerus, pubic rami and ribs.
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Prognosis |
In 70% of cases, treatment will lead to stabilization of skeletal manifestations. There could be small increases in bone mass. Treatment leads to reduced pain and increased mobility as well.
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Treatment |
For Fracture:
Bed rest till the pain is controlled. Then early mobilization with walker support.
Brace or Corset to support the spine No plaster cast or Traction.
Avoid back strain, bending, jumping, traveling.
Back exercises after the fracture is healed.
For Osteoporosis:
Inj. Arachitol 3 lacs i.u. IM (loading dose) Or Calcirol 1gm. Sachet (60,000iu) Inj. Calcium gluconate 10ml x slow I.V. x daily x 5-10 days Tab. Sandocal 500mg 1 daily x 23 months Or Tab. Calcimax forte 1 daily x 2-3 months. Ink. Calsynar 100 i.u IM x every week x 5. In Post-menopausal females- Tab. PREMARIN 0.625 mg x 1 bd. Tab. Osteofos 10mg x 1 OD. In renal rickets, Tab. One Alpha 0.25mg x 1-2 tabs/day.
Inj. Arachitol Calcirol 1gm Inj. Calcium gluconate Tab. Sandocal Tab. Calcimax forte Ink. Calsynar 100 i.u IM Tab. OsteofosPREMARIN ONE ALPHA |
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General Measures |
Diet, exercise and ensuring adequate exposure to sun. Increased calcium (1500 mg/day) and vitamin D (400-800 IU/day) intake. Minimum immobilisation/Spinal corset not generally recommended due to adverse effect on spinal musculature
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Advice to Patient |
Maintain ambulation by walking daily. Avoid maneuvers that increase compressive forces on spine and peripheral bone sites. Reduce weight by dieting, if over weight. |
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Follow Up |
Check up every 2-4 months. X-ray of spine every 3 years or earlier if there is pain or even minimal trauma. Gynaecologic and mammographic check for those on HRT, annually.
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Inadequate Response |
Try editronates or biphosphonates. |
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Prevention |
(All woman to be advised as detailed below, preferably before menopause) Walking daily, stair climbing, low impact aerobic exercise, gentle weight bearing exercise 3 times a week. Post menopausal women-calcium intake 1000-1500 mg daily, Vitamin Done 800 IU daily. Avoid excess coffee intake (negative calcium balance), avoid tobacco, alcohol. Hormone Replacement Therapy in minimum effective dose; ideal within 5 years of menopause, but efficacy demonstrated even in women over 70. |
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Reference From |
www.mja.com.au/public/issues/172_05_060300/samrook.html |