Orthopedics and Traumatology

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OSTEOPOROSIS TREATMENT STRATEGIES

The sole purpose of medical treatment of osteoporosis known as “bone erosion” in common expression among the public is to prevent the development of a possible fracture.To this end, it is necessary to plan a road map comprising adjusting the lifestyle of the person, supplementation of diet with calcium and vitamin D and pharmacological treatment should be planned in order to increase bone mass and reinforce its quality.

NONMEDICATION TREATMENT

This treatment is used to contribute to pharmacological treatment. It mostly comprises calcium supplementation and vitamin D and patient exercise program.

Calcium Supplementation: Bone health depends on calcium intake. The level of calcium is determined by the level of serum calcium in the blood, which is 9.5-10 mg/dl. Recommended daily calcium intake is 1000 mg for males and females under 50 years of age and 1200 mg for males and females over 50 years of age. However, according to a research conducted among women in the United States, the maximum amount of calcium taken up with foods was found to be 600 mg.Calcium supplements are available in 2 forms. Calcium citrate and Calcium carbonate. Calcium citrate is preferable. The probability of developing kidney stones with this form of calcium is less than that with the other form. For optimal absorption, taking the daily dosage in 2 equal doses (e.g. 500 mg in the morning and evening) is recommended.

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Vitamin D supplementation

This vitamin promotes absorption of calcium. Vitamin D deficiency has been shown to increase the risk of falling in the elderly. In a study in the literature, researchers found that the risk of falling in the elderly taking 800 units (IU) of vitamin D2 daily decreased by 72% compared to those who did not. It is also stated that vitamin D deficiency results in continuous and unspecific muscle and bone pains.

Vitamin D has also been shown to strengthen brain, heart, intestine, pancreas, skin cells and immune system, in addition to bones.

Sources of vitamin D. We take vitamin D from three major sources. Through our skin from the sun, from nutrients and supplements.

7-dehydrocholesterol, a fat in our skin, is converted into a precursor of vitamin D with sunlight.We can produce enough vitamin D by taking advantage of sunlight for only about 15 minutes 2-3 days a week.

In a comprehensive study of vitamin D supplementation and risk of fracture, 800 IU of vitamin D was given daily to people with low vitamin D levels, and as a result, the risk of fractures in the spine or non-spine bones decreased. Today, recommended daily intake of vitamin D is 200 IU up to the age of 50, 400 IU between the ages of 50-70 and 600 IU over the age of 70. According to some researchers, these quantities are small and they recommend intake of 800-1000 IU of vitamin D daily. In some studies, 10,000 IU of vitamin D was supplemented and no toxicity (poisoning) was observed.

Balance-Posture and Exercise

Programs for ensuring balance, posture correction and muscle strengthening in osteoporosis patients reduce the risk of falls by 50%. In particular, proper posture exercises provide positive contributions to the back and muscle strength.

MEDICATION TREATMENT

It consists of two main groups. Antiresorptive medications (which prevent the weakening of the bone) and Anabolic medications (which increases cellular strength of the bone) .

Antiresorptive Medications

Calcitonin therapy, Hormone supplement, certain bisphosphonates

Calcitonins: Decrease formation and effects of cells involved in the destruction of the bone(osteoclasts). Its action is rapid but transient. Because it is quickly removed from the body. It does not help prevent post-menopausal osteoporosis. It is used in two forms as spray and injection. In a study on 1255 women with osteoporosis (PROOF study: a study on prevention of fractures due to osteoporosis), spinal fractures were found to be reduced by 33% with daily nasal spray treatment with 200 IU of calcitonin.

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Biophosphonates

They constitute a cornerstone in the treatment of osteoporosis. They reduce both the number and activity of bone destruction cells. They also increase the mineral density of the bone, creating a lasting effect in increasing bone strength and preventing fractures. Many of its derivatives are available in Turkey (Alendronate, Risedronate, Ibandironate). Each has a different method of use but their action is the same. They were found to reduce spinal fractures by 45-70%.

The side effects of products of these medications taken via oral route are similar. Ulceration may occur in the cells of the gastrointestinal tract.