Osteoporosis is usually seen in women after 65 years and in males after 75 years of age.
There are usually no symptoms of Osteoporosis. Fracture occurring after minor injury makes your doctor to suspect Osteoporosis. Some elderly patients get general body pain.
Osteoporosis is most accurately diagnosed by BMD (DEXA) method. The machine measures bone strength at lower spine, hip and wrists. QCT, Ultrasonography (qualitative) are other methods to diagnose osteoporosis. Diagnosis done by Ultrasonography needs to be confirmed by DEXA method. WHO has defined parameters for diagnosis of osteoporosis.
No blood tests are routinely necessary for diagnosis of Osteoporosis. Calcium, vitamin D levels, thyroid and parathyroid hormone levels can be done if necessary. If Osteoporosis is diagnosed at younger age; a stepwise investigations are done to find cause of Osteoporosis.
- In first step bisphosphonate group of drugs like Alendronate, Risedronate, Ibandronate are used to treat Osteoporosis. Usually these drugs are given in weekly or monthly doses. These drugs are available usually in tablet form. They should be taken on empty stomach with large glass of water. Patient should not take tea, coffee or breakfast for 30-60 minute. They should maintain upright position for the same period. Patients who have diseases of food pipe or cannot sit for 30-60 minutes can be given injections of Ibandronate 3 monthly or Zolendronic acid every year.
- In patients who do not benefit after adequate trial of above drugs or who cannot be given above mentioned drugs—second line drug Teriparatide is given. This drug is available in injectable form. It needs to be given daily.
- In select group of women with early menopause Raloxifene is used.
- Calcitonin spray can be used to relieve pain related to vertebral fracture for short period.
- All patients with Osteoporosis are given calcium and vitamin D supplements.
Patients should take adequate amount of food which has high calcium/ vitamin D content like dairy products. They should make changes in home to reduce chances of fall. They can use walking stick. They should do gentle exercises to maintain muscle tone.
Osteoporosis drugs acts after few months and they are continued for few years. Necessary precautions are taken to monitor side effects of these drugs.