Osteoporosis

Osteoporosis develops when bone density decreases. The body reabsorbs more bone tissue and produces less to replace it.
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.
SIGNS AND SYMPTOMS 
Osteoporosis develops slowly, and a person may not know they have it until they experience a fracture or break after a minor incident, such as a fall. Breaks will often occur in the hip, wrists, or the spinal vertebrae. People who have osteoporosis might have signs and symptoms that include:
• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that breaks much more easily than expected
 When to see a doctor
Severe discomfort in any of the common locations for osteoporotic bone damage could indicate an unexpected or unidentified fracture. People should seek medical evaluation as soon as they notice this type of pain.
CAUSES AND RISK FACTORS
Several risk factors for osteoporosis have been identified. Some are modifiable, but it is not possible to avoid others.
Unavoidable factors
According to the American College of rheumatology, nonmodifiable risk factors include:
• Age: Risk increases after the mid-30s and especially after menopause.
• Reduced sex hormones: Lower estrogen levels appear to make it harder for bone to regenerate.
• Ethnicity: White people and Asian people have a higher risk than other ethnic groups.
• Height and weight: Being over 5 feet 7 inches tall or weighing under 125 pounds increases the risk.
• Genetic factors: Having a close family member with a diagnosis of hip fracture or osteoporosis makes osteoporosis more likely.
• Fracture history: A person over 50 years of age with previous fractures after a low-level injury is more likely to receive a diagnosis of osteoporosis.
 Modifiable risk factors include 
• Sedentary lifestyle: People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active.
• Immobility
• Excessive alcohol consumption
• Tobacco use.
Medical conditions that increase the risk include:
• Some autoimmune diseases, such as rheumatoid arthritis and ankylosing spondylitis.
• Pituitary gland disorders.
• Hyperthyroidism and hyperparathyroidism
• A shortage of estrogen or testosterone
Medications that raise the risk include:
• Glucocorticoids and corticosteroids, including prednisone and prednisolone
• Thyroid hormone
• Anticoagulants and blood-thinners, including heparin and warfarin
• Some antidepressant medications
• Some vitamin A (retinoid) medications
• Thiazide diuretics
Glucocorticoid-induced osteoporosis is the most common type osteoporosis that develops due to medication use.
TREATMENT 
People at risk of osteoporosis and fractures can use preventive lifestyle measures, supplements, and certain medications to achieve these goals.
Drug therapy
Drugs that can help prevent and treat osteoporosis include:
  • Bisphosphonates: These are antiresorptive drugs that slow bone loss and reduce a person’s fracture risk.
  • Estrogen agonists or antagonists: Also called Selective Estrogen-receptor Modulators, SERMS. Raloxifene (Evista) is one example. These can reduce the risk of spine fractures in women following menopause.
  • Calcitonin (Calcimar, Miacalcin): This helps prevent spinal fracture in postmenopausal women and can help manage pain after a fracture.
  • Parathyroid hormone, such as teriparatide (Forteo): The U.S. Food and Drug Administration (FDA) has approved this hormone for treating people with a high risk of fracture as it stimulates bone formation.
  • Monoclonal antibodies (denosumab, romosozumab): These are immune therapies that some people with osteoporosis take after menopause. Other types of estrogen and hormone therapy may help.
PREVENTION
Certain alterations to lifestyle can reduce the risk of osteoporosis.
Calcium and vitamin D intake
Calcium is essential for bones. People should make sure they consume enough calcium daily.
Adults aged 19 years and above should consume 1,000 milligrams (mg) of calcium a day. Women who are over 51 years of age and all adults from 71 years onward should have a daily intake of 1,200 mg.
Dietary sources include: Dairy foods such as milk, cheese, and yogurt, green leafy vegetables, such as kale and broccoli, fish with soft bones, such as tinned salmon and tuna, fortified breakfast cereals
If a person’s calcium intake is inadequate, supplements are an option.
Vitamin D also plays a key role in preventing osteoporosis as it helps the body absorb calcium. Dietary sources include fortified foods, saltwater fish, and liver.
However, most vitamin D does not come from food but from sun exposure, so doctors recommend moderate, regular exposure to sunlight.
Lifestyle factors
Other ways to minimize the risk are:
• Avoiding smoking, as this can reduce the growth of new bone and decrease estrogen levels in women
• Limiting alcohol intake to  encourage healthy bones and prevent falls
• Getting regular weight bearing exercise, such as walking, as this promotes healthy bones and strengthens their support from muscles
• Exercises to promote flexibility and balance, such as yoga, which can reduce the risk of falls and fractures
 Complications
Bone fractures, particularly in the spine or hip, are the most serious complications of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury.
In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up your spine (vertebrae) can weaken to the point of collapsing, which can result in back pain, lost height and a hunched forward posture.
CONCLUSION 
Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.
Treatment aims to: Slow or prevent the development of osteoporosis,  maintain healthy bone mineral density and bone mass, prevent fracture, reduce pain, maximize the person’s ability to continue with their daily life.
Anyone concerned that they may be at risk of osteoporosis should ask their doctor about screening.
Written by: Chinonye Machie
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Arthritis

Arthritis is an acute or chronic inflammation of the joint but the term is used to describe around 200 conditions that affect joints, the tissues that surround the joint, and other connective tissue. It is a rheumatic condition. Arthritis is more common among adults aged 65 years or older, but it can affect people of all ages, including children.
TYPES 
The most common form of arthritis include:
Osteoarthritis
More people have this condition than any other form of arthritis. It’s the “wear and tear” that happens when your joints are overused. It usually happens with age, but it can also come from joint injuries or obesity, which puts extra stress on your joints.
Joints that bear weight like your knees, hips, feet, and spine are the most common places it affects. It often comes on gradually over months or years. It makes the affected joint hurt. But you don’t feel sick or have the fatigue that comes with some other types of arthritis.
What happens?
You lose your body’s shock absorber. Cartilage, the slippery material that covers the ends of bones, gradually breaks down.
The damaged cartilage makes movement painful.
Symptoms
Depends on which joint or joints are affected. You may have:
• Deep, aching pain
• Trouble dressing, combing your hair, gripping things, bending over, squatting, or climbing stairs, depending on which joints are involved
• Morning stiffness that typically lasts less than 30 minutes
• Pain when walking
• Stiffness after resting
Your joint may be:
• Warm to the touch
• Swollen and harder to move
• Unable to move through a full range of motion.
Rheumatoid Arthritis (RA)
RA is an autoimmune disease. That means the immune system attacks parts of the body, especially the joints. That leads to inflammation, which can cause severe joint damage if you don’t treat it. About 1 out of every 5 people who have rheumatoid arthritis get lumps on their skin called rheumatoid nodules. These often form over joint areas that receive pressure, such as over knuckles, elbows, or heels.
What happens?
Some experts believe the immune system becomes “confused” after an infection with a bacteria or virus and starts to attack your joints. This battle can spread to other areas of the body.
Symptoms
Can come on gradually or start suddenly. They’re often more severe than with osteoarthritis.
The most common include:
• Pain, stiffness, and swelling in your hands, wrists, elbows, shoulders, knees, ankles, feet, jaw, and neck.
• Rheumatoid arthritis usually affects multiple joints; more than one swollen joint. Usually, it’s small joints in your wrists, hands, or feet.
• Morning stiffness than can last for hours or even most of the day. You may also feel fatigued and notice that your appetite is down and you’ve lost weight.
Psoriatic Arthritis
What is it?
People with this condition have inflammation of the skin (psoriasis) and joints (arthritis).
Psoriasis causes patchy, raised, red and white areas of inflamed skin with scales. It usually affects the tips of the elbows and knees, the scalp, the navel, and skin around the genital areas or anus.
What happens?
This type of arthritis usually starts between ages 30 and 50, but it can start as early as childhood. It’s equally common among men and women. The skin disease (psoriasis) usually shows up first.
Symptoms:
• Swelling of the fingers and toes.
• People who have it often have fingernails that are pitted or discolored, too.
Sometimes it can affect the spine.
Gout
What is it?
A buildup of uric acid crystals in a joint. Most of the time, it’s your big toe or another part of your foot.
Gout results from one of three things:
• Your body is making more uric acid.
• Your kidneys can’t process the uric acid your body makes.
• You’re eating too many foods that raise uric acid levels.
Symptoms
• Intense joint pain, probably in the big toe, but could also be in your ankles, knees, elbows, wrists, or fingers.
• Discomfort: Even after the sharp pain goes away, your joint will still hurt.
• Inflammation and redness: The joint will be red, swollen, and tender.
TREATMENT 
A range of medications and lifestyle strategies can help treat arthritis and protect joints from further damage.
Medication
Non-inflammatory types of arthritis, such as osteoarthritis, are  often treated with pain-reducing medications, physical activity, weight loss if the person is overweight, and self-management education.
Medications will depend on the type of arthritis. Commonly used drugs include:
*Analgesics: These reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol), tramadol (Ultram) and narcotics containing oxycodone (Percocet, Oxycontin) or hydrocodone (Vicodin, Lortab).
*Non-steroidal anti-inflammatory drugs (NSAIDs): These reduce both reduce both pain and inflammation. NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Some NSAIDs are available as creams, gels or patches which can be applied to specific joints.
*Counterirritants: Some creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these on the skin over a painful joint modulate pain signals from the joint and lessen pain.
CONCLUSION
Treatment for arthritis aims to control pain, minimize joint damage, and improve or maintain function and quality of life.
Treatment might involve: Medications, physical or occupational therapy, splints or joint assistive aids, patient education and support, weight loss, surgery, including joint replacement.
Physical examination, antibody blood  tests, full blood count are used to diagnose arthritis.
Written by: Chinonye Machie
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