Osteoporosis primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2], Cafer Zorkun, M.D., Ph.D. [3], Raviteja Guddeti, M.B.B.S.[4], Charmaine Patel, M.D. [5]
Overview
In osteoporosis, some of the lifestyle modification strategies would be beneficial for both primary prevention and also initial treatment; as osteoporosis mainly depends on lifestyle. Lifestyle modification, as well as calcium supplementation, are the best early and long-term measures for the prevention of osteoporosis. There are also medications available that can be used to prevent worsening of osteoporosis. The primary prevention of osteoporosis is particularly important because the micro-architectural changes that occur in osteoporosis are largely irreversible.
Primary prevention
In osteoporosis, some of the life style modification strategies would be beneficial for both primary prevention and also initial treatment; as osteoporosis mainly depends on life style.
Fall prevention
Major risk factors for falling are shown below:
- Environmental risk factors
- Lack of assistive devices in bathrooms
- Obstacles in the walking path
- Loose throw rugs
- Slippery conditions
- Low level lighting
- Medical risk factors
- Medications causing sedation (narcotic analgesics, anticonvulsants, and psychotropics)
- Anxiety and agitation
- Orthostatic hypotension
- Arrhythmias
- Poor vision
- Dehydration
- Previous falls
- Depression
- Vitamin D insufficiency [serum 25-hydroxyvitamin D (25(OH)D)<30 ng/ml (75 nmol/L)]
- Urgent urinary incontinence
- Malnutrition
- Neurological and musculoskeletal risk factors
- Kyphosis
- Reduced proprioception
- Poor balance
- Weak muscles/sarcopenia
- Impaired transfer and mobility
- Deconditioning
- Strategies for fall reduction:
- Maintaining adequate vitamin D levels
- Physical activity
- Individual risk assessment for falls
- Tai Chi and other exercise programs
- Home safety assessment, and modification especially when done by an occupational therapist
- Gradual withdrawal of psychotropic medication if possible
- Appropriate correction of visual impairment may improve mobility and reduce risk of falls
- Use of hip protectors
Behavioral modification (smoking cessation and reduced alcohol consumption):
Advise patients to stop smoking. The use of tobacco products is detrimental to the skeleton as well as to overall health. National osteoporosis foundation (NOF) strongly encourages a smoking cessation program as an osteoporosis intervention. Recognize and treat patients with excessive alcohol intake. Moderate alcohol intake has no known negative effect on bone and may even be associated with slightly higher bone density and lower risk of fracture in postmenopausal women. However, alcohol intake of more than two drinks per day for women or three drinks a day for men may be detrimental to bone health, increases the risk of falling, and requires further evaluation for possible alcoholism.[1]
Calcium and vitamin D
References
- ↑ Maurel DB, Boisseau N, Benhamou CL, Jaffre C (2012). "Alcohol and bone: review of dose effects and mechanisms". Osteoporos Int. 23 (1): 1–16. doi:10.1007/s00198-011-1787-7. PMID 21927919.