Osteoporosis (Kotsu-soshoh-shoh in Japanese)
Osteoporosis is a disease characterized by weak bones due to the reduction of bone density, a result of decreased bone minerals (calcium and phosphorus) and protein. The stooped back condition of osteoporosis (we call this condition a "cat back" in Japan) is the most obvious symptom. Additionally, fractures occur more easily when lifting heavy objects, struck on the waist or extremities and following falls. The cause of the stoop is a compression fracture of the spine and fore part of the spinal bone as it becomes collapsed. Patients with osteoporosis will often suffer from hip joint, wrist and other fractures. These fractures make patients bedridden and accelerates the deterioration of dementia. This is thought to be just a senility change, but the cause of osteoporosis is not only from aging. It is true that elderly people have osteoporosis, and tha the number of patients with osteoporosis increases proportionate to aging. One third of the people above the age of 65 have this disease, and postmenopausal women will develop osteoporosis more readily than men due to hormonal factors.

1. Symptoms of Osteoporosis
(1) mild cases
1. Back pain while standing
2. Back and waist pain while lifting heavy objects
3. A stoop back
4. Shrinking height
Spinal bone is a kind of mainstay of the human body, so a weaker spine results in diminished body support. This results in the muscles supporting the body instead of spinal bone, and the muscles will become chronically fatigued. This is the first stage back pain, so exercise (walking and gymnastics every day) will be effective to increase muscle power.
According to the progress of osteoporosis, the following symptoms are recognized;
(2) advanced cases
1. Being down with back pain and lumbar pain.
2. Hip and joint fractures from accidental strikes and falls cause many patients to become bedridden.
3. The stoop can become so serious that a patient will bend forward severely, causing some gastrointestinal disorders.
4. Patient's height shrinks further, and this posture will make a patient be conspicuous, causing the patient may become timid or depressive.

Sorry, there is only Japanese figure. Left 4 illustration are mild cases and right 4 illustration are advanced cases. But you can guess each symptoms by each illustration.

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2. The Cause of Osteoporosis
(1) Genetic factor
The period of menopause, history of delivery, the physique (skinny or slightly-built old people), family history of osteoporosis and one's race (Asian people and white people) etc. will influence on the onset of osteoporosis.
(2) Life style
An unbalanced diet, lack of exercise, excessive taking of alcohol and coffee, smoking and insufficient sunbath etc. will influence on the early onset of osteoporosis.
(3) Disease factor
Gastrectomy (resection of stomach), Diabetes Mellitus, hyperthyroidism, hypercalciuria, medication of steroid, ovarian dysfunction, primary hyperparathyroidism, renal failure etc will exacerbate osteoporosis.

3. Diagnosis of Osteoporosis
In a case with back pain or lumbar pain, a case with fracture on falling down (so-called brittle fracture), the bone mineral density should be measured.
(1) The measurement of bone mineral density
There are some methods such as DXA method (a spinal bone), MD method (a metacarpus), QTC method and ultrasonographic method etc, and we examine by MD method at our clinic.
According to the Diagnostic Standard of primary Osteoporosis (revised in 2000); a case with the data of bone mineral density of more than 80% of YAM* is regarded as normal; In a case with the data of 70-80% of YAM, osteoporosis is suspected (it means reduction of bone minerals), and a case with a history of fracture and 70-80% of YAM is diagnosed as osteoporosis; a case with less than 70% of YAM is diagnosed as osteoporosis.
*YAM : Young Adult Mean data = the mean data of bone mineral density of 20 - 44 years women
(2) The Marker of Bone Metabolism
BAP (blood: bone formation), NTX (blood and urine: resorption of the bone), DPD & CTX (urine: resorption of the bone) are available, and these markers can estimate the possibility of fracture and they are useful for selection of medicine.

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S. The Prevention of Osteoporosis
(1) Walking
Walking for 30 - 60 minutes every day brings good preventive effect.
(2) Sunbath
Sunbathing helps human metabolism to assimilate Vitamin D and it builds up bones.
Please be cautious not to get strong sun rays especially ultraviolet rays.
(3) Gymnastics & exercise
Training of back muscles and abdominal muscles prevents chronic tiredness of bones and resorption of the bones.
(4) Improvement of eating habits
The content of food is very important as the following explanation of dietetic therapy.
(5) Bathing and other reluxation
Bathing (especially Japanese style) reduces muscle contraction and pains, and makes us feel relaxed.

5. Therapy of Osteoporosis
There are 2 therapeutic points. One is to reduce and remove lumbar (back) pains, and another is to prevent fracture. There are physical therapy, dietetic therapy and medicines, and there are various kinds of medicine for every indication.
(1) Physical Therapy
A. Exercise Cure
Proper exercise is necessary for the prevention of osteoporosis and increase of bone minerals. In the acute stage, exercise should be restricted, but in the chronic stage the aerobics and exercise for low back management are easy and effective.
B. Physiotherapy
Thermotherapy (the Embrace III and the microwave therapy at our clinic etc), phototherapy, electrotherapy and massage are effctive to reduce pains themselves and analgesic medicine dosage and so side effects of them.
C. Hip Protector
Prevention of the femoral neck fracture.
(2) Dietetic Therapy
It is important to avoid undernourishment and an unbalanced diet. You shoould take not only adequate calcium but potassium, magnesium and vitamins especially Vitamin D, C and K, and enough proteins. Also it is important not to increase your body weight ( heavy weight can be a overload to bone and muscles.).
In the standard for Japanese people recommended by Japanese Ministry of Health, Labour and Welfare, we should take 600mg of calcium a day, and aged people and postmenopaused women should take more than 800mg of calcium a day. Taking dairy products (200 - 400 ml of milk every day), soybean products such as tofu, vegetables with rich Carotin, fish and shellfish are recommended. On the other hand, overtaking of salt, caffein, alcohol, vitamin A, precooked food (fast food) with much phosphorus that disturbs absorption of calcium, and smoking will aggravate osteoporosis, so you should be cautious for dietary habits.
(3) Medicine
By Japanese Therapeutic Guideline for Osteoporosis revised in 2002;
A. Estrogen complex
Estrogen complex is often used for postmenopausal women with high risk of fracture, because estrogen inhibits the resorption of the bone (elution of calcium from bone) both directly and indirectly. Estrogen complex is a hormonal agent, so it has a side effect to increase the possibility of breast cancer.
B. Bisphosphonate
This has become a main medicine recently. This medicine has both strong inhibitor action for resorption of the bone and further calcification of bone, so good therapeutic effect can be expected for especially postmenopausal women (etidronate). As the side effect, there are gastrointestinal disturbance such as nausea and ulcer formation etc. Alendronate, a kind of biphosphonate, is useful for men with osteoporosis and especially steroid osteoporosis by both reliable action to increase bone minerals and to prevent fracture. And, risedronate has an action to increase bone mineral density for every aged person with no relation to passing years of postmenopause. So this medicine may be used for the fixed case of osteoporosis diagnosed by the association of bone metabolism.
C. Calcium complex
In a definite case of calcium deficiency disease or condition such as gastic resection, intestinal resection, anorexia nervosa, excessive poor appetite and lactose intolerance, calcium complex should be used with other medicine.
D. Calcitonin complex
Calcitonin acts to the osteoclasts directly and controls resorption of the bone, then acts as the central analgesics. It is effctive to reduce back pain and lumbar pain, but it is the parenteral injection of every week, so an injection itself may become a kind of torment and a patient sometimes feels nausea as a side effect, so the patient may abandon this treatment.
E. Steroid for assimilation of protein
This promotes the ossification (bone formation). But recently this medicine is not so used.
F. Activated vitamin D3 complex
Vitamin D helps absorption of phosphorus and calcium in the intestine, and it also controls synthesis and secretion of PTH (parathormone) in the parathyroid. This medicine is used for cases of senile osteoporosis of more than 70 year old and cases of gastric resection and intestinal resection in which the absorption of calcium may be disturbed. Overdose of this medicine increses calcium concentration in blood and it may be a cause of calculus. ED-71 which is highly specific to bone has been developed recently.
G. Vitamin K complex
This medicine has weak action to increase bone minerals, but the preventive action for fracture has been reported. Various vegetables, meats, eggs and fermented soybeans (Natto) have rich vitamin K, so vitamin K complex is uaually used according to the patient's condition and dietary habits.
H. Ipriflavone
This medicine is non-hoemonal flavonoid and its action is mild for both bone formation and resorption of the bone. It can be adapted to just menopausal women and women with ovarial resection, and also old aged women.

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