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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 1087-1089
Osteoporosis: The present concern on screening and nonmedication management


1 KMT Primary Care Center, Bangkok, Thailand
2 Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria

Click here for correspondence address and email

Date of Web Publication5-Oct-2017
 

How to cite this article:
Yasri S, Wiwanitkit V. Osteoporosis: The present concern on screening and nonmedication management. Ann Trop Med Public Health 2017;10:1087-9

How to cite this URL:
Yasri S, Wiwanitkit V. Osteoporosis: The present concern on screening and nonmedication management. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 21];10:1087-9. Available from: http://www.atmph.org/text.asp?2017/10/4/1087/196744


Dear Sir,

Osteoporosis is the important public health problem in the present day around the world. It can be seen worldwide. Clinical assessment and screening is an important issue.[1] Measurement of bone density is the main tool frequently mentioned for screening of osteoporosis. Bone mass density, BMD, can be measured by several tools including to dual energy x-ray absorptiometry (DXA).[2]

To screen osteoporosis with axial DXA for general people is not recommended due to no cost-effectiveness in medical economics.[1],[3] Nevertheless, in the present day, the screening by OSTA or KKOS is feasible due to its low cost and ability to detect the risk of osteoporosis for further BMD investigation.[3] The data and risk factors are recorded and calculated by computer program, which can allow to predict 10-year probability of fracture. The program namely FRAX can be accessed on Internet at http://www.shef.ac.uk/FRAX/tool.jsp.[4] Indeed, the 10-year probability also varies with country and race. In the Web site, there are many nation-specific FRAX of several countries including Thailand, which has already been studied and approved by the Foundation of Osteoporosis. There are two values: 10-year probability of hip fracture and 10-year probability of other major osteoporotic fractures. The two values can be used for estimation of therapeutic threshold. For example, in the United States, if the patient has no fracture and BMD not less than –2.5, the 10-year probability of a fracture will be the value used for determining the therapeutic threshold. If the patient has the 10-year probability of a hip fracture of 3% or more or the 10-year probability of other major osteoporotic fractures of 20% or more, the start of drug treatment will be set. The diagnosis of osteoporosis is based on the WHO criteria.[5] This depends on the comparison of measured BMD and maximum BMD in a young female adult. The value less than or equal to –2.5 SD is the criterion for diagnosis of osteoporosis. The risk of bone fracture gradually increases from 1.4 to 2.6 times for each 1 decrease in SD.[5]

Talking about the osteoporosis, the problem of vitamin D deficiency should be mentioned. The risk factors for vitamin D deficiency is due to several problems including (a) the decrease in the ability of skin to synthesize 7-dehydrocholesterol, (b) less exposure to sunlight, (c) decrease in renal function resulting in decreased synthesis of 1,25(OH)2D, (d) malabsorption, and (e) low intake of vitamin D nutrition.[6] To manage the problem, exercise has become an interesting nonmedication manipulation in the present day. This is due to the fact that vitamin D can be synthesized after exposure to sunlight. The recommended exercise is the same activity as that suggested for patients with osteoporosis. However, exercising to increase the muscle strength is prohibited. For lifting of weights, the limitation is 10 lbs. (5 kg) 3 days per week. International Osteoporosis Foundation (IOF) suggests the program for exercise for patients with osteoporosis as warm up by stretching of muscles and walking followed by exercises to increase muscle strength, posture training, and end up with a cool down.[5],[7] However, there are also precautions while exercising for patients with osteoporosis. These patients should avoid strenuous exercises such as high-impact aerobic dance, heavy weight lifting, running, mountain biking, all which might increase the risk of fracture.[7] In addition, inappropriate running should be avoided in case of an underlying degenerative knee or hip, as running results in one to two times more weight bearing on the knee and the hip. Avoid back bending and body twisting in daily activities and exercises such as bending to lift an object, playing golf, and situps. Weight lifting is not appropriate for patients with recent vertebral fracture but allowed in patients with chronic back pain. Swimming and underwater exercises have no effect in prevention or treatment of osteoporosis. If there is muscle ache after exercising for more than 2 days, stop the exercises until the pain subsides and then restart exercises with decreased strength.[7],[8]

In addition to exercising, lifestyle modification is an important topic.[5],[8] The general rules are smoking cessation, avoiding coffee and caffeine-added beverages, avoiding salted food and high-protein diet, limiting alcoholic drinks, increasing physical activities, controlling chronic disease, which is a risk for osteoporosis, and avoiding drugs that might induce osteoporosis. In addition, the big concern is fall. Fall Risk Assessment is needed. The risk assessment can be assessed by several tools including Hendrich II Fall Risk Model, Morse Fall Scale, Falls Risk Assessment Tool (FRAT), Falls Risk Assessment Score (FRAS), and Fall Risk Assessment and Screening Tool (FRAST).[9]

To assess the posture skill, the tools are timed up and go test, chair stand test, functional reach, single-leg stance, and tandem stance. The risk group can be determined by interviewing about the history of fall in the previous 1 year or using tools for risk assessment, as well as tools for assessment of posture skill and review of medication. It is reported that the use of drug that affect the central nervous system can increase the risk of fall up to 10 times. Special precaution is needed while using sedatives, hypnotics, antidepressants, and benzodiazepine. The use of these drugs can increase the risk of fall, and it is recommended that the least number of drugs should be used as indicated and at an appropriate dosage.[8]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kageyama G. The diagnosis and treatment of osteoporosis. Rinsho Byori 2015;63:570-9.  Back to cited text no. 1
[PUBMED]    
2.
Ito M. Radiological assessment of bone quality. Clin Calcium 2016;26:49-56.  Back to cited text no. 2
[PUBMED]    
3.
Kleerekoper M, Nelson DA. Is BMD testing appropriate for all menopausal women?. Int J Fertil Womens Med 2005;50:61-6.  Back to cited text no. 3
[PUBMED]    
4.
Güngör HR, Ok N, Akkaya S, Kıter E. Orthopedic surgeons' view for the prevention of osteoporotic secondary fractures: a survey. Eklem Hastalik Cerrahisi 2014;25:148-53.  Back to cited text no. 4
    
5.
Hosoi T. On “2015 Guidelines for Prevention and Treatment of Osteoporosis.” Diagnostic criteria of primary osteoporosis and the criteria for pharmacological treatment. Clin Calcium 2015;25:1279-83.  Back to cited text no. 5
[PUBMED]    
6.
Wintermeyer E, Ihle C, Ehnert S, Stöckle U, Ochs G, de Zwart P. et al. Crucial role of vitamin D in the musculoskeletal system. Nutrients 2016;8: pii, E319.  Back to cited text no. 6
    
7.
Gupta A, March L. Treating osteoporosis. Aust Prescr 2016;39:40-6.  Back to cited text no. 7
[PUBMED]    
8.
Ivanova S, Vasileva L, Ivanova S, Peikova L, Obreshkova D. Osteoporosis: therapeutic options. Folia Med (Plovdiv) 2015;57:181-90.  Back to cited text no. 8
[PUBMED]    
9.
Cummings-Vaughn LA, Gammack JK. Falls, osteoporosis, and hip fractures. Med Clin North Am 2011;95:495-506.  Back to cited text no. 9
[PUBMED]    

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Correspondence Address:
Sora Yasri
KMT Primary Care Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196744

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