osteoporosis

Osteoporosis

Osteoporosis is the weakening of bone tissue and loss of bone density over time.

Literature says that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine). The good part is that osteoporosis can be treated and prevented.

Osteoporosis occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both. Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women over age 50 and men over age 70 have a higher risk for osteoporosis.

Other causes include:

·           Being confined to a bed

·           Chronic rheumatoid arthritis, chronic kidney disease, eating disorders

·       Taking corticosteroid medications (prednisone, methylprednisolone) every day for more than 3 months, or taking some antiseizure drugs

·         Hyperparathyroidism

·         Vitamin D deficiency

White women, especially those with a family history of osteoporosis, have a greater than average risk of developing osteoporosis. Other risk factors include:

·         Absence of menstrual periods (amenorrhea) for long periods of time

·         Drinking a large amount of alcohol

·         Family history of osteoporosis

·         History of hormone treatment for prostate cancer or breast cancer

·         Low body weight

·         Smoking

·         Too little calcium in the diet

                                                                     Symptoms

There are no symptoms in the early stages of the disease.

Symptoms occurring late in the disease include:

·         Bone pain or tenderness

·         Fractures with little or no trauma

·         Loss of height (as much as 6 inches) over time

·         Low back pain due to fractures of the spinal bones

·         Neck pain due to fractures of the spinal bones

·         Stooped posture or kyphosis, also called a "dowager's hump"

Treatment

The goals of osteoporosis treatment are to:

·         Control pain from the disease

·         Slow down or stop bone loss

·         Prevent bone fractures with medicines that strengthen bone

·         Minimize the risk of falls that might cause fractures

There are several different treatments for osteoporosis, including lifestyle changes and a variety of medications.

Medications are used to strengthen bones when:

·         Osteoporosis has been diagnosed by a bone density study.

·         Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred.

BISPHOSPHONATES

Bisphosphonates are the primary drugs used to both prevent and treat osteoporosis in postmenopausal women.

·         Bisphosphonates taken by mouth include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Most are taken by mouth, usually once a week or once a month.

·         Bisphosphonates given through a vein (intravenously) are taken less often.

CALCITONIN

Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection. The main side effects are nasal irritation from the spray form and nausea from the injectable form.

Calcitonin appears to be less effective than bisphosphonates.

HORMONE REPLACEMENT THERAPY

Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis and are not approved to treat a woman who has already been diagnosed with the condition.

Sometimes, if estrogen has helped a woman, and she cannot take other options for preventing or treating osteoporosis, the doctor may recommend that she continue using hormone therapy. If you are considering taking hormone therapy to prevent osteoporosis, discuss the risks with your doctor.

PARATHYROID HORMONE

Teriparatide (Forteo) is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. You can give yourself the shots at home.

RALOXIFENE

Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. However, it does not appear to prevent other fractures, including those in the hip. It may have protective effects against heart disease and breast cancer, though more studies are needed.

The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

EXERCISE

Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include:

·         Weight-bearing exercises -- walking, jogging, playing tennis, dancing

·         Resistance exercises -- free weights, weight machines, stretch bands

·         Balance exercises -- tai chi, yoga

·         Riding a stationary bicycle

·         Using rowing machines

Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures.

DIET

Get at least 1,200 milligrams per day of calcium and 800 - 1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium.Your doctor may recommend a supplement to give you the calcium and vitamin D you need.

Follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include:

·         Cheese

·         Ice cream

·         Leafy green vegetables, such as spinach and collard greens

·         Low-fat milk

·         Salmon

·         Sardines (with the bones)

·         Tofu

·         Yogurt

STOP UNHEALTHY HABITS

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

PREVENT FALLS

It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include:

·         Avoiding walking alone on icy days

·         Using bars in the bathtub, when needed

·         Wearing well-fitting shoes

MONITORING

Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1 - 2 years.

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

RELATED SURGERIES

There are no surgeries for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebrae from becoming fractured by strengthening the bones in your spinal column.

The procedure involves injecting a fast-hardening glue into the areas that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

further reading :

http://www.nlm.nih.gov/medlineplus/tutorials/osteoporosis/htm/index.htm

Cervicogenic Headache

A  cervicogenic headache is simply another name for a headache which originates from the neck and is one of the most common types of headache. Cervicogenic headaches are mild to moderately severe, unilateral headaches which originate in the neck or suboccipital musculature and can evolve into temporal and forehead pain.  Several authors have hypothesized that dysfunction in the upper cervical segments (Occiput-C3) is a primary component in these headaches.

These headaches are usually insidious in onset secondary to postural faults, but may also be resultant of trauma.

Contributing factors to the development of cervicogenic headache

• poor posture
• neck and upper back stiffness
• muscle imbalances
• muscle weakness
• muscle tightness
• previous neck trauma (e.g. whiplash)
• inappropriate desk setup
• inappropriate pillow or sleeping postures
• a sedentary lifestyle
• a lifestyle comprising excessive slouching, bending forwards or shoulders forwards activities.
• stress
• dehydration

The main symptom of cervicogenic headaches are unilateral head and neck pain, however, they may cause a variety of symptoms in addition to pain.

These symptoms include cervical trigger points, motion loss, blurred vision, sleep

changes, and lower energy level. Several authors have studied the effectiveness of therapeutic interventions for the treatment of cervicogenic headaches. There is evidence for the use of postural education, postural strengthening, mobilization/manipulation to the cervical and thoracic spine, and soft tissue mobilization.

Physiotherapy intervention should be focused on regaining normal cervical mobility in the upper cervical spine, decreasing soft tissue dysfunction (triggers and tightness), and patient education on posture. Using the above interventions, various studies have shown a significant decrease in frequency, intensity and duration of headache.

Exercises for cervical headache:

Neck ROM exercises,chin tucks, scapular sets 

Reference

Body one physical therapy

Physioadvisor.com.au

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