Osteoporosis & Mrs. Patel
Dr Liz Lee
General Information
Osteoporosis is the thinning of bones and is the most common risk of fractures in people under the age of 70. Throughout life there is a constant removal and replacement of bone cells and our bones are at their strongest in early adult life. Following the menopause bone reabsorption exceeds the formation of new bone and bone density is gradually reduced. There are no symptoms from low bone density but osteoporosis can be suspected if women show rapid loss of height or rounding of the spine. It becomes a problem if fractures occur. Bone density is influenced by lack of exercise, smoking and intake of dietary calcium. Genetic factors are also important and some families are more likely to develop problems than others. People who have taken corticosteroids for long periods of time are also at risk. There are several approaches to treatment. Giving hormone replacement therapy reduces bone loss and may even improve bone density. Biphosphonates are a class of drug that reduces the turn over of bone and can also produce an increase in bone density. Thirdly calcium supplements given with vitamin D are prescribed particularly where the diet is low in calcium and and where there is a risk of vitamin D deficiency. Sunlight on the skin is essential for the synthesis of vitamin D and so housebound elderly patients are at risk. It is also more common in Asians who eat unleavened bread.
Case Study
Mrs Patel is a seventy one year old Indian woman who lives with her family in Bristol. She has both osteoporosis and arthritis. When she was sixty two she was lowering herself into her bath when she got a terrible pain in her hip and found she was unable to get out. Eventually her family had to break the bathroom door down to rescue her. Their GP came and examined her. Although he did not think she had broken her hip, because after all she had not fallen, he revisited the next day and then diagnosed a fracture. She was sent into hospital where a fracture due to osteoporosis was confirmed. At operation two weeks later the fractured hip was replace by a prosthetic joint. She continues to walk using a stick but gets no pain from her hip. She does however have constant back pain from arthritis which has also been diagnosed in her knees.
For her osteoporosis she takes calcium and vitamin D twice a day. For her arthritis she takes pain killers. At times in the past she has had indigestion and this is a common complication of the non steroidal antiinflammatory drugs (NSAIDS) which are effective in treating arthritic pain. An alternative is to take the paracetamol and codeine based pain killers which do not cause indigestion but can be constipating. If arthritis pain is intractable many patients need to take both the NSAIDS and paracetamol or codeine together as well as medication to counteract their side effects. These include laxitives and indigestion or ulcer healing drugs.
Mrs Patel’s Sari is made from pill packaging and the tablets she takes for her arthritic pain and for her osteoporosis. It also incorporates alternative treatments such as HRT for osteoporosis and NSAIDS for arthritis. Treatment for the common side effects are also included. Many patients are forced to take ten or more tablets of these tablets on a daily basis in order to minimise the pain disability caused by these chronic conditions. Shown with the sari is a prosthetic hip joint as a reminder that there are 60,000 hip fractures a year in the UK.