Advances in Non-Pharmacological and Pharmacological Management of Osteoporosis

Review Article

Gerontol Geriatr Res. 2016; 2(4): 1023.

Advances in Non-Pharmacological and Pharmacological Management of Osteoporosis

Dawane J* and Dhande P

Department of Pharmacology, Bharati Vidyapeeth Deemed University Medical College, India

*Corresponding author: Jayshree Dawane, Department of Pharmacology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India

Received: September 04, 2016; Accepted: October 17, 2016; Published: October 19, 2016

Abstract

Osteoporosis is a skeletal disorder characterized by decrease in bone mass and micro- architectural alterations. It is a major public health concern because a bulk of bone mineral is lost even before the symptoms develop. Delay in diagnosis, lifelong treatment and complications, like disability; affect the quality of life. The availability of advanced techniques, for measuring bone mineral density, help in diagnosis and assessing fracture risk. New treatments with lifestyle interventions have been shown to reduce the risk of fractures at vulnerable sites. Two types of drugs are available for the treatment of osteoporosis, drugs inhibiting bone resorption and drugs stimulating bone formation. Inspite of all these management options, there is a need to discover new agents to reduce osteoporotic fractures for the better quality of life in these patients.

Keywords: Bone Mineral density; Anti-resorptive agents; Bone formation; Quality of life

Introduction

In most of the developed and developing countries, increasing trend towards the ageing population is observed due to increased life expectancy. Advancement in the age increases the problems associated with it. Activities of Daily Living (ADL) get affected because of ageing and age related conditions like osteoporosis, osteoarthritis, etc. Once ADL affected dependency increases and vice a versa, it leads to progression of disability. Osteoporosis is the common problem occurring in ageing population. It is an important public health issue because of the high rate of fractures associated with it. According to Marwaha et al, high prevalence of osteoporosis was observed in elderly Indian subjects [1]. Even fractures without injury are common [2]. 50% women and 36% of men over 50 years of age were noted to have low bone mass [3]. It affects 8. 5% of otherwise healthy males aged 50 years and above [4]. Osteoporosis is responsible for millions of fractures annually, mostly involving the lumbar vertebrae, hip, and wrist. Osteoporotic fractures also increase economic burden on health-care systems worldwide.

Osteoporosis

Osteoporosis is a skeletal disease characterized by low bone mass and micro architectural deterioration with a resulting increase in bone fragility and hence, susceptibility to fractures [5]. According to WHO, it is defined as-“A bone density that falls 2.5 Standard Deviation (SD) below the mean for young healthy adults of the same gender T-score of 2.5”. Low bone density- postmenopausal women who fall at the lower end of the young normal range of T-score [6].

Types of Osteoporosis

The commonest types of osteoporosis are postmenopausal (Type 1) and Senile (Type 2).

Osteoporosis may also occur as an adverse effect of long term administration of glucocorticoids, as a manifestation of thyrotoxicosis or hyperparathyroidism, as a feature of Malabsorption or as a consequence of alcohol abuse and cigarette smoking.

Risk factors [7]

Estimation of bone mass

Bone Mineral Density (BMD) is the amount of mineral matter per square unit area of bone. Bone mass is best estimated by bone densitometry which measures (BMD). It is expressed in terms of T-Score & Z- Score and Dual-energy X-ray Absorptiometry (DXA) is the important tool for the diagnosis of osteoporosis and a gold standard imaging technique since it has predictive value [8,9]. T-Score is the BMD at the bone site when compared to the young normal reference mean. Z-score is the comparison to the age-matched normal and is usually used in cases of severe osteoporosis. Negative scores indicate lower bone density, and positive scores indicate higher BMD [10].

Normal bone density=Tscore-1 to +1, Osteopenia= T score -1 to -2.5.

T score -1 to -2 requires only general health measures such as dietary advice, physical exercise, Calcium & Vitamin D supplementation, etc. T score from -2 to -2.5 requires anti-resorptive drug treatment in the presence of one or more risk factors for osteoporosis. The risk of fracture increases 1.5-3 times each standard deviation of BMD below the reference population. Early identification and management of osteopenic patients will help reduce the morbidity as well as economic burden.

Bone homeostasis

At the cellular level, bone is made up of three types of specialized bone cells: Osteoblasts, Osteocytes and Osteoclasts [11].

Bone remodeling

Consists of a sequence of events involving the dynamic interaction of osteoclasts (bone-resorbing cells) and osteoblasts (bone-forming cells) (Figure 1).

Citation: Dawane J and Dhande P. Advances in Non-Pharmacological and Pharmacological Management of Osteoporosis. Gerontol Geriatr Res. 2016; 2(4): 1023.