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Bone, a living tissue that continually remodels (destruction-reconstruction) itself according to the traction exerted by muscles on them, that's the piezoelectric effect. Astronauts now use exerciser devices and CEMP to avoid disuse demineralization. Bone mass reaches its peak at 35 years and begins to decrease around the age of 40 with a loss of 3% to 5% per year. Women are more prone to osteoporosis due to a gradual cessation of ovarian function. Estrogens inhibit the activity of osteoclasts that break down bone, causing bone destruction to occur more quickly than its construction by osteoblasts. This leads to bone decalcification, known as osteoporosis.
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Osteoporosis is a disease characterized not only by a decrease in bone quantity, bone mass, but also by deterioration in the quality of bone tissue, its microarchitecture. Osteoporosis leads to greater bone fragility, with risks of fractures of the spine (vertebral compression fractures), wrist, and particularly the hip (femoral neck). Hip fractures are increased by 50 times, vertebral fractures by 15 to 30 times. One in four women and one in eight men will suffer from it. One in three women (with osteoporosis) is at risk of experiencing a fracture after menopause. 25% of hip fractures occur in men.
Osteoporosis Screening:
Evaluation of Bone Mineral Density (BMD): less than -2.5 ( < -2.5) Dual-energy X-ray absorptiometry (DXA) evaluates bone quantity.
Quantitative peripheral CT scan evaluates bone architecture.
Prevention of Osteoporosis:
Preventive measures for osteoporosis are based on physical activity, avoiding tobacco and excess alcohol, calcium supplements, such as 500mg/day calcium carbonate with vitamin D, 400IU starting at age 30 to avoid reaching menopause with a calcium deficit, supplement increased to 1200mg/800IU/day at menopause.
Osteoporosis Treatment:
Various treatments are available, either to decrease the activity of osteoclasts, or to increase the activity of osteoblasts, or the combination of both approaches.
Treatment to Decrease Bone Destruction (Osteoclast Activity):
In women, the treatment of choice to prevent osteoporosis is hormone replacement therapy with estrogen like Premarin. Evista (raloxifene) 60 mg per day, a selective estrogen receptor modulator, is an alternative to estrogen hormone therapy but only reduces the incidence of vertebral fractures. In hysterectomized women, estrogen should start within the first 3 years after the onset of menopause for at least 7 years, preferably 10 years and more. There is a slight increase in the risk of breast cancer if estrogen is taken for more than 12 to 15 years, either 0.5% in women without risk factors (without familial breast cancer) or 2.5% in women with risk factors (with familial breast cancer). Hormone replacement therapy with estrogen reduces the risk of hip fracture by 35% to 65% and the risk of vertebral fracture by 50% to 70%.
In women with a uterus, prescription of a progestogen with estrogen. This treatment should not exceed a period of 5 years, due to an increased risk of uterine cancer. This treatment (estrogen plus progesterone) is mainly prescribed to relieve vasomotor symptoms such as hot flashes and night sweats.
For several years, medications have been developed to treat osteoporosis. Bisphosphonates Family: Fosamax (alendronate) 10 mg tablet once daily, can be taken once weekly at 70 mg. To further ensure compliance, the pharmaceutical industry has developed bisphosphonates with longer duration of action. Didronel (etidronate) 400 mg is prescribed for 14 days with a 2-month break, Actonel or Atelvia (risedronate) 75mg is taken for 2 days once a month, Bonviva (ibandronate) 150 mg is taken once a month, Aclasta (Reclast in the USA) (zoledronic acid) 5 mg is given by intravenous injection once a year. Under the name Zometa, it is given every 3 to 4 weeks. It has numerous side effects, including hypocalcemia, deterioration of kidney function, and osteonecrosis of the jaw. All medications in the bisphosphonate class can lead to atypical femoral fractures (at the diaphysis instead of the femoral neck) associated with a certain inhibition of osteoblasts.
After 5 to 10 years of bisphosphonates, it is recommended to continue with a selective estrogen receptor modulator, a biologic therapy with human monoclonal antibodies that inhibit osteoclast formation, Prolia (denosumab), 60mg subcutaneous injection every 6 months.
Myacalcin NS (calcitonin) 200mg nasal spray was withdrawn from the market on October 1, 2013, due to a cancer risk.
Treatments to Increase Bone Formation (Osteoblast Activity)
Forteo (teriparatide, parathyroid hormone) which the person administers by subcutaneous injection every day (as with type 1 diabetes) at a cost of $10,000 per year. This treatment is reserved for cases of osteoporotic fractures.
BMP (Bone Morphogenetic Proteins). Indicated for anterior lumbar spinal fusion due to a lumbar vertebral fracture (lumbar compression fracture). It is the only technique approved by the FDA to induce bone formation.
PEMF Therapy
A therapy to increase bone formation. PEMF therapy is an important addition to the existing pharmacological therapeutic arsenal and works synergistically to strengthen the bone rebuilding effect and reduce fracture risks related to bone decalcification in both women and men.
In June 1992, T.W. Bilotta and his team from the Rizzoli Orthopedic Institute, Bologna, Italy, presented at the 1st World Congress on Electricity and Magnetism in Biology and Medicine held in Orlando, Florida, the results of a 2-year clinical study, either associating or not associating nasal calcitonin at a dose of 100 IU per day for 2 months with a 2-month break, with PEMF stimulation at an intensity of 50 Gauss, a frequency of 50 and 100 Hz, 30 minutes per day for 20 days every 6 months. The control group (without any treatment) saw their annual bone density decrease by 3.03%, the group treated with PEMF saw their annual bone density decrease by 1.44%, the group treated with calcitonin saw their annual bone density increase by 0.42%, and the group combining calcitonin and PEMF saw their annual bone density increase by 2.3% on average. This demonstrates synergy between the medication that decreases the activity of cells (osteoclasts) that break down bone and PEMF therapy that stimulates the activity of cells (osteoblasts) that make bone.
After 60 years of use, PEMF therapy has demonstrated no negative side effects. On the contrary, this therapy used regularly helps reduce the incidence of several health problems, with its only contraindication being the presence of a functional implanted neurostimulator. (Refer to the article on osteoarthritis.)
Case report: Treatment of multiple fragmented unhealed fractures of the right leg (tibia and fibula) following an accident in a 75-year-old man in July 2003 with the Bio-Stim System. Tibia fracture immobilized by metal rod. No signs of healing after 10 weeks, with signs of disuse demineralization. Daily pain 2 out of 5, poorly relieved by medication and TENS. Therapy using the Bio-Stim System, supervised by a physiotherapist, with a morning treatment at 6-60-2-30 and an afternoon treatment at 6-30-2-30, 5 days a week. Gradual disappearance of pain from the 3rd to the 10th day. After 4 weeks of treatment, the X-ray shows healing so that the orthopedic surgeon allows weight-bearing and discharge to home. This treatment should be used from the outset to stimulate the healing of fractures at risk of not healing, such as distal tibia fractures, scaphoid fractures (wrist), and multiple fragmented fractures. This therapy is also used to promote the healing of bone grafts and osteosyntheses. PEMF therapy has been approved by the FDA since 1979 for non-healing fractures and spinal fusions (bone grafts).
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