Osteoporosis

OSTEOPOROSIS

Osteoporosis is a condition wherein your bones become weak and fragile. It is predominantly a disease of the elderly and is mostly noticed in women after menopause. Estrogen, the female sex hormone, has a protective effect on the bones. After menopause there is a decrease in estrogen thereby leading to weakening of the bones. All postmenopausal women more than 50 years, especially if they present with a fracture, should be evaluated for osteoporosis.

 

Low intake of calcium rich food and vitamin D deficiency both contribute to deterioration in bone health. Intake of alcohol, smoking, chronic abuse of steroid medications, prolonged periods of inactivity all contribute to osteoporosis. Those with a family history of osteoporosis or hip fracture are also at an increased risk of osteoporosis. Sometimes osteoporosis can also present at a younger age. Detailed evaluation of these patients is necessary as osteoporosis may be one of the manifestations of a much more serious condition that the patient might be harbouring. Furthermore, the osteoporosis can be reversed by treating this underlying condition.

 

The diagnosis of osteoporosis is made based on an investigation called as Bone mineral density estimation. This is done by a DXA scan. The major concern of osteoporosis is that the weakening of bones leads to increased risk of fractures. Most of the times there may not be any trauma leading to these fractures.  The spine and hip are especially at a higher risk for developing osteoporotic fractures. Spinal fractures generally go unnoticed and ppatients frequently present with just chronic backache or with stooping forward position.

 

One of the keys to prevent osteoporosis is to maintain a healthy lifestyle which includes regular exercise, decreased consumption of alcohol and smoking, healthy eating habits with consumption of diet adequate in calcium, regular exposure to sunlight for Vitamin D levels and control of other comorbidities such as diabetes. There are multiple medications which are available to treat osteoporosis and prevent fractures. These acts either by preventing bone loss or by increasing new bone formation. Consult your endocrinologist to get the treatment appropriate for your condition.

 

Obesity is the commonest predisposing factor for PCOS. Obesity leads to insulin resistance and increased insulin levels which can predispose a women to develop PCOS. Other common factors which can lead to PCOS are thyroid disorders, diabetes, increased prolactin levels, intake of certain drugs, stress, sedentary lifestyle and poor sleeping habits. PCOS is also hereditary which suggests that certain genes may predispose you for PCOS. Having PCOS puts you at a greater risk for developing diabetes, especially during pregnancy. Other complications of PCOS include miscarriages, uterine cancer, depression, cholesterol disorders, hypertension and fatty liver.

 

The most important modality of PCOS management is diet and lifestyle modification with emphasis on weight loss. In most cases weight loss can restore fertility with some sub-fertile patients requiring additional medications for ovulatory dysfunction. Furthermore weight loss also reverses the other obesity associated complications of PCOS. Metformin, which is primarily an anti diabetic drug, is effective in decreasing insulin resistance and helps in subsequent fertility.

Oral contraceptive pills are effective in normalising menstrual patterns and decreasing facial hair. Anti androgens are given if the clinical features of increased testosterone, such as increased facial hair and acne, are predominant. Anti androgens should generally be given along with oral contraceptive pills since they can be harmful to foetus if patient becomes pregnant.

 

Some of the conditions which mimic PCOS include ovarian tumours, adrenal tumours and  conditions associated with increased adrenal gland production of male hormones, such as congenital adrenal hyperplasia and Cushing syndrome. Consult your endocrinologist for appropriate evaluation since they are all treatable conditions.

 

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