Osteoporosis  “A silent disease”
by Professor Emeritus Charoen Chotigavanich, M.D.
Orthopedic Surgery, Samitivej Srinakarin Hospital

Orthopedic Surgery, Samitivej Srinakarin Hospital

 The most disturbing symptom that the persons who are over 50 years old is back pain,  whole body bone pain.  In certain circumstances an elderly lady can suffer broken hip, back bone, are the wrist for a mind fall.  All of the forementioned  phenomones are due to their bones are thin and brittle, medically called osteoporosis.  The definition of osteporosis then is the thinning of the bone tissue and loss of bone density over time. 

 Bone is a living tissue and constantly being broken down and rebuilt.  When the balance between breakdown and rebuilding is disturbed, such in a condition of hormone changes in the lady, dietary changes, bone may lose some of the minerals that contribute to its density and strength.  A condition of diminished bone density is called osteopenia, when significant loss in bone density occurs, the bone will be markedly weakened and susceptible to fracture which is a condition of osteoporosis.
 In Thailand, we have about 9 – 10% of the population who are older than 60 years of age, which will make up about over 6 millions of Thai population, and among those over 50% are female.  They are in a great chance of developing osteoporosis which will lead to bone pain or having fracture of the back bone hip, wrist or any where else.  According to The United States, the National Osteoporosis Foundation (NOF)  10 million people have osteoporosis and another 34 millions have low bone mass, and are at risk of developing the disease and these who have osteoporosis 70 – 80% are women. 
 Most of the people who are at risk of for osteoporosis are not aware of it.  It is then called a “Silent Disease” because there are usually no symptom until a person has bone fracture.  A great numbers of the patients who sustained facture particularly of are hip or spine will cause that person significant pain and protracted or permanent disability.  If the fracture cause severe debility, in the old day.  It may be a contributing factor in the death of the patient.
 Among the White and Asian women,  particularly those with a family history of osteoporosis, will have a greater than average risk of developing osteoporosis.  There are additional other risk factors namely-absence of menstrual periods, drinking large amount of alcohol, smoking, post menopause, eating disorders, more non protein diet, low body weight, use of certain medications such as steroids, antiseizure drugs.
 The test for osteoporosis, the bone mineral density (BMD) test is the primary test to identify osteoporosis and low body bone mass.  One of the preferred and most accurate ways to measure bone mineral density is DEXA Scan.  The result of the test will indicate whether a person has normal bone moss,  osteopenia,  osteoporosis.  The BMD is often reported in term of peak bone mass in young adults.  BMD value that is below or about -1 standard deviation is considered normal.  BMD in osteopenia has a value between -1 and -2.5 standard deviation, while osteoporosis BMD value is lower than -2.5 standard deviation.
 If a person found to have osteopenia, or osteoporosis through the diagnosis of dexa-scan, she should see the doctor who will explain how to manage.  Medication, change of life style, activity of daily living, expose more to the sunshine, participate in appropriate exercise will be prescribed and instructed. 
 However in case of fracture spine dose occur external support, bracing should be used.  If the fracture dose not heal and develope nonunion, excruciating back pain will be resulted.  Orthopedic surgeon will advice to have non invasive spinal procedure, called Vertebroplasty or Kyphoplasty.  These basic procedure is to inject liquid bone comment into the nonunion site in which the cavity will be filled with cement; consequently in about 15 minutes the liquid form  will be hardened and becomes an artificial bone and stabilize the fracture internally.
 Excruciating back pain will be drastically dissolved.