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Osteoporosis: Advancing Care and Treatment at Ohio Valley Hospital
By Kevin Brown

Ajay K. MathurIt might be funny to say “Break a Leg” to a performer about to go on stage. To those with osteoporosis, it’s no laughing matter.

“Osteoporosis is responsible for more than 1.5 million fractures annually in the United States,” says Ajay K. Mathur, M.D., F.A.C.P., a rheumatologist at Ohio Valley Hospital. Dr. Mathur is certified by the American Board of Internal Medicine and the Rheumatology Board and has been practicing for more than 30 years.

Among other areas of his specialty in rheumatology, Dr. Mathur diagnoses and treats patients at Ohio Valley Hospital with osteoporosis and low bone mass.

Based on current osteoporosis statistics, there’s no shortage of patients. Some 54 million people in the United States have osteoporosis or low bone mass, according to the National Osteoporosis Foundation. By 2020, that number is expected to grow to more than 64 million.

“Almost half of all women over 50 will break a bone because of osteoporosis. One in four men over age 50 will break a bone as well,” Dr. Mathur says.

What is Osteoporosis?
“Osteoporosis is a serious disease that weakens bone and makes it more susceptible to fractures,” explains Dr. Mathur. “The word ‘osteo’ means ‘bone’ and ‘porosis’ stands for ‘porous’ or ‘riddled with holes.’”

“Bones are living tissue, constantly undergoing remodeling,” notes Dr. Mathur. “Remodeling means the bone is constantly being broken down and new bone is built back to keep the bones strong. Up until age 25 to 30, a person is making more new bone than what is lost.”

“In osteoporosis, there is a loss of bone mass and strength as well as the architecture of the bone becomes abnormal, resulting in breaks and fractures. These can occur from a minor fall or, in severe cases, just from sneezing or minor bumps,” Dr. Mathur says.

Risk Factors
According to Dr. Mathur, there are multiple risk factors that can lead to osteoporosis.

“Some risk factors are natural and unavoidable such as old age, strong family history and menopause,” he says. “Others are related to certain diseases such as rheumatoid arthritis, celiac disease, chronic lung and kidney diseases, thyroid and parathyroid disorders, to name a few.”

“There are also certain drugs such as the cortisone family of drugs, anti-convulsants such as Dilantin, blood thinners such as heparin, as well as aromatase inhibitors used for breast cancer such as an anastrozole that puts people at risk for premature osteoporosis,” Dr. Mathur explains.

Dr. Mathur also notes that avoidable risk factors for osteoporosis can be an inactive lifestyle, cigarette smoking, and excessive alcohol intake.

Symptoms, Complications and Progression
Osteoporosis is a silent disease according to Dr. Mathur. “In many patients, the first sign of osteoporosis may be a fracture of the spine or hip or forearm. It may be non-traumatic or with minimal trauma,” he says.

Major complications of osteoporosis include persistent pain, progressive loss of height, difficulty in doing activities of daily living which, in turn, can cause multiple other complications such as bed sores, muscle wasting, blood clots in the legs and loss of self-esteem and depression.

“Osteoporosis is progressive in the sense that it is related to age,” explains Dr. Mathur. “The rate of progression will depend on the risk factors. Some people are built heavier and have bigger bones and normally that will take longer to become osteoporotic whereas people of small frame and thin build will lose bone faster irrespective of the risk factors.”

Diagnosis and Screening
Fortunately, the diagnosis of osteoporosis is not complicated or invasive. Dr. Mathur says that a simple x-ray of the spine or hip may show that the bone is brittle, but that is not very accurate.

“Bone mineral density tests, also called DEXA scans (Dual-Energy X-ray Absorptiometry), are simple, inexpensive, very low radiation x-rays done in conjunction with a computer program that generates a number called a ‘T’ score. This is a sensitive test which can detect even small amounts of bone loss. The scoring system has been developed which helps us determine which patient needs treatment and which patient just needs to be periodically monitored,” he says.

Dr. Mathur recommends a baseline bone density test for all women at age 65. Patients with high risk factors should be tested at a younger age.

According to Dr. Mathur, a comprehensive treatment plan should be developed after the diagnosis of osteoporosis has been established with a bone density test or evidence of fracture of the spine or hip.

“It is very important that the patient and family clearly understand the risks and benefits associated with treating, as well as not treating osteoporosis,” he notes.

Dr. Mathur advises that treatment of osteoporosis usually includes a diet rich in calcium and supplemental vitamin D, weight-bearing exercise and appropriate use of medications when needed. Avoidance and minimization of risk factors also is critically important in the long run.

According to Dr. Mathur, there are two different types of drugs approved for the treatment of osteoporosis: ones that can slow the breakdown of bones, and ones that can help to build your bone. Any drug utilized for osteoporosis should be done under the direction of a physician.

He notes that surgical procedures may also be a very rare option in treatment. Rather, physical and occupational therapy can be very helpful to help relieve pain and keep the patient functional.

When it comes to preventing osteoporosis, Dr. Mathur recommends having an awareness of the problem, good nutrition, a non-sedentary lifestyle, and avoiding smoking and falls.

Dietary supplements such as calcium are helpful, but Dr. Mathur believes that calcium supplements are helpful only to a certain extent.

“Pre-menopausal women need 1,000 to 1,200 mg of calcium each day while post-menopausal women need 1,200 to 1,500 mg per day. You need to be careful to avoid too much calcium if you have kidney stones,” cautions Dr. Mathur.

He also recommends exposure to sunlight, fortified milk, and use of supplements such as 800 to 1,000 international units (IU) of vitamin D3 per day.

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While osteoporosis is a serious and progressive disease, diagnostic and treatment resources are available locally at Ohio Valley Hospital. Online resources to learn more about the condition include the National Osteoporosis Foundation (www.nof.org) and the Arthritis Foundation (www.arthritis.org). To make an appointment with Dr. Mathur, contact Ohio Valley Hospital at (724) 258-9680.

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