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Osteoporosis

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Osteoporosis means parous & weak bones. This leads to structural deteroration of the bone. It predisposes a human being to fractures, deformities due to fragility of bone.

Osteoporosis is a major public health threat for approximately Indians 80% of whom are women. In U.S. today 10 million people are already diagnosed to have osteoporosis. Unfortunately in India the awareness about the disease is not there in community as well as many medical practitioners. The incidence is so high that one out of every two women and one in eight men over 50 will have an osteoporosis related fracture.

Osteoporosis is responsible for more than 1.5 million fractures annually. These include about 3 lac hip fractures, 7 lac vertebral fractures and 2.5 lacs wrist fractures. This poses a huge economical, social burden on society. This increases immobility and can pose serious threat to the life of person due to prolonged bed ridden condition. Worldwide statistics shows that the risk of death increases by about 20% within one year of fracture of hipbone. In earlier days there was a saying that the “man enters the world through pelvis & goes through hip joint” signifying the seriousness of hip fractures due to osteoporosis.

Vertebral fractures cause kyphosis, i.e. forward abnormal curvature of spine, back pain, height loss limiting the activities and depression due to loss of self-esteem.

Let us see why it happens.

Bone is a living and growing tissue. It consists of collagen, which is a type of protein, which provides a soft framework for deposition of calcium, which adds strength to the skeletal system. Throughout life old bone tissue is removed and is replaced by fresh & strong new bone tissue. When we are young the deposition of new bone is faster than resorption of old bone. But after age of 30 to 35 the resorption starts increasing than deposition due to hormonal changes and is most rapid in the first few years of menopause.

There are some risk factors. Some are those, which you cannot change and some, which you can change

A] Factors which you can not change.

  • Gender – females are mare more
  • Age
  • Body Size – small ladies are more prone
  • Ethnicity – Asians are at far more risk family history.

B] Factors which you can change

  • - Hormonal imbalance
  • - Diet low in calcium & vitamin D
  • - Lack of exercises
  • - Cigarette smoking
  • - Excessive alcoholism
  • - Medication such as steroids

Symptoms :

Osteoporosis is called silent disease as the bone loss occurs without any pain or symptoms. Most people do not know that they have osteoporosis till a small bump or jerk or injury causes fracture giving them unbearable pain.

Diagnosis :

It is mandatory that we do screening of “bone mineral density” periodically to defect early osteoporosis so that we can prevent serious outcome or complication like fracture. BMD is a noninvasive test takes hardly 5 minutes and can tell us what percentage of calcium is there in the bone and how weak our bones have become. In some indicated and diagnosed cases one may have to undergo DEXA Scan to predict risks of hip Vertebral or wrist fractures.

Thus BMD can

  1. Defect low bone density before fracture occurs.
  2. Confirm diagnosis of osteoporosis after fracture.
  3. Predicts risks of fractures in future.
  4. Determines rates of bone loss and guides in planning treatment.

Treatment :

PREVENTION

  • Eat green leafy vegetables like methi, palak, milk.
  • Exercise
  • Exercises that do not put sudden excessive force on our bones are recommended. Many senior citizens do activities like jumping to show that they are fit and in the process fracture their bones, Brisk walky, swimming, are some very useful exercises.

Medications :

  • If T scores are less than – 2 then adequate supplements of calcium & vitamin D is a must. Sometimes hormone replacement therapy & protein.
  • Thus screening for this silent disease is a must periodically to prevent serious problems.
  • BMD testing should be performed on –
  1. All post menopausal women
  2. All men more than 60 years of age.
  3. Patients on long-term steroids.
  4. Smokers and chronic alcoholics.

A) Nursing staff and physiotherapist will help you to turn on either sides with pillows kept in between the legs and avoid twisting movements at back.

B) Ice Packs / cryotherapy around the site of reduce pain.

C) Deep Breathing exercises in Bed.

These exercises should be done in set of 5, twice in a day along with application of iace packs twice-thrice / day.

DISCHARGE :

A) Discharge is planned after

  • · You are able to get out of bed unaided.
  • · You are able to walk to the toilet.
  • · You are able to sit and get up comfortably on your own with lumbar brace.
  • · You do not have any other complaints.

B) On discharge, you are allowed to ride in a regular car but make sure it is easy to get

  • in and out of it. It goes without saying that you are not be allowed to drive your own vehicle home.
  • At home upto 2 weeks post-surgery

    A) Home modifications :-

    Put things that you think you will need close to where you can get them without stressing your back i.e. without bending forwarded.

    B) Exercises :-

    • You will be spending half of your time resting is bed and other half up and around.
    • Same set of exercises as told to you during your discharge should be continued in set of 10, twice-thrice / day till 2 weeks post-surgery.

    Do’s and Dont’s *****until 2 weeks post-surgery

     

    Do’s

    1. a) You are allowed to sit upright with lumbar brace for about 20-30 minutes according to your comfort level.
    2. b) Change your position from sitting after every 30 minutes.
    3. c) You are allowed to stand for sessions of about 30 minutes with lumbar brace.
    4. d) Walking should be carried out 4-5 / day.
    5. e) Slowly increase the frequency and distance of walking.
    6. f) Sleep either on your back or either sides with pillows for support.
    7. g) You are recommended to sue shower while bathing. You can remove the brace when in shower. Use Rubbermaid chair while bathing.
    8. h) Use of commode is must.

    Don’t’s

    1. a) Avoid forward bending in sitting for about 6 weeks.
    2. b) Avoid crossed legged sitting for 6 weeks.
    3. c) Twisting movements at back are to be avoided while getting in and out of the bed.
    4. d) Lifting of heavy weights more than 10 pounds by bending forwarded is avoided.
    5. e) Avoid sleeping on stomach for 4-6 weeks.
    6. f)  Complete No to Indian toilet.

    2 – 4 weeks post surgery

    As week program, you can gradually increase your amount of activities but your restrictions do not change at this point.

    Exercises :

    Set of exercises is modified to progressive exercises programme here

    1. a) Stretching of tight strucheres and strengthening of back and limb muscles is started.
    2. b) Abdominal strengthening exercises  - upper-lower
    3. c) Unilateral buttock lifting with one leg straight raising.
    4. d) Knee to chest position exercises.
    5. e) Sitting and waling should be progressed as per comfort level.
    6. f) As a guide, you likely to be off work for about 4-6 weeks.
    7. g) Driving can be initiated by end of 4 weeks for shorter distances only. Long journeys should be avoided. If at all anavoidable, should be done with pillows to support your back and change in position frequently.

    4-6 weeks post spinal fusion surgery

    Activities :

    • You will now begin to increase your level of activities at home.
    • But at any event exercise motion at lumbar spine and pelvis is to be avoided.

    Exercises :- Vigorous and male dynamic exercise protocol

    • Abdominal exercises  1. upper     2.lower
    • Stretching of tight strucheres

     

    Till 2 weeks post-operative surgery

    I) Home modifications :-

    Put things that you think you will need close to where you can get them without stressing your back i.e. without bending forwarded.

    II) Activities :-

    As the time progresses, you can gradually increase your amount of activities at home are to your comfort level, forward bending and lifting heavy weights being only the restrictions.

    III) Exercises :-

    Continue the same set of exercises told you during the discharge in set of 10, twice a day.

    IV) Sitting, standing, walking can be done for more than 30-40 minutes according to your comfort level at least 4-5 times a day

    V) While bathing, shower is recommended. You can remove the brace when in shower room. Sit on a chair while in shower. Use of commode is recommended. Complete No to Indian toilet.

    VI) Sexual activities can be resumed back by end of 2 weeks according to comfort level.

     

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