Osteoporosis is a disease of the bones. The name comes from Latin for “porous bones.” Our bones comprise of small honeycomb-like spaces. And when the spaces increase in size, the bones lose strength and density which leads to bones growing weak and thin.
People from any age can suffer from osteoporosis, though it’s common to adults, especially women. Each year it affects around 10 million people in India of which 80% turn out to be women, mostly above 65.
People with Osteoporosis are prone to fracture, or bone breaks even while doing their routine activities. The most commonly affected bones are the ribs, hips, and the bones in the wrists and spine.
Some Facts about Osteoporosis
- Bone mass (bone density) decreases after 35 years of age, and bone loss occurs more rapidly in women after menopause.
- Key risk factors for osteoporosis include genetics, lack of exercise, lack of calcium and vitamin D, personal history of fracture as an adult, cigarette smoking, excessive alcohol consumption, history of rheumatoid arthritis, low body weight, and family history of osteoporosis.
- Patients with osteoporosis have no symptoms until bone fractures occur.
- The diagnosis of osteoporosis can be suggested by X-rays and confirmed by tests to measure bone density.
- Treatments for osteoporosis, in addition to prescription osteoporosis medications, include stopping use of alcohol and cigarettes, and assuring adequate exercise, calcium, and vitamin D
What are osteoporosis causes and risk factors?
The following are the factors that increase the risk of developing osteoporosis:
- Female gender
- Caucasian or Asian race
- Thin and small body frame
- Personal history of fracture as an adult
- Cigarette smoking
- Family history of osteoporosis (for example, having a mother with an osteoporotic hip fracture doubles your risk of hip fracture)
- Excessive alcohol consumption
- Poor nutrition and poor general health, especially associated with chronic inflammation or bowel disease
- Lack of exercise
- Diet low in calcium
- Low estrogen levels in women (which may occur in menopause or with early surgical removal of both ovaries)
- Low testosterone levels in men (hypogonadism)
- Chemotherapy that can cause early menopause due to its toxic effects on the ovaries
- Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from bowel diseases, such as celiac sprue that can be associated with skin diseases, such as dermatitis herpetiformis
- Amenorrhea (loss of the menstrual period) in young women is associated with low estrogen and osteoporosis; amenorrhea can occur in women who undergo extremely vigorous exercise training and in women with very low body fat (for example, women with anorexia nervosa)
- Chronic inflammation, due to chronic inflammatory arthritis or diseases, such as rheumatoid arthritis or liver diseases
- Hyperthyroidism, a condition wherein too much thyroid hormone is produced by the thyroid gland (as in Grave’s disease) or is ingested as thyroid hormone medication
- Immobility, such as after a stroke, or from any condition that interferes with walking
- Certain medications can cause osteoporosis. These medicines include long-term use of heparin (a blood thinner), anti-seizure medicine such as phenytoin (Dilantin) and phenobarbital, and long-term use of oral corticosteroids (such as prednisone).
- Hyperparathyroidism is a disease wherein there is excessive parathyroid hormone production by the parathyroid gland, a small gland located near or within the thyroid gland. Normally, parathyroid hormone maintains blood calcium levels by, in part, removing calcium from the bone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis.
- When vitamin D is lacking, the body cannot absorb adequate amounts of calcium from the diet to prevent osteoporosis. Vitamin D deficiency can result from dietary deficiency, lack of sunlight, or lack of intestinal absorption of the vitamin such as occurs in celiac sprue and primary biliary cirrhosis.
- Inherited disorders of connective tissue, including osteogenesis imperfecta, homocystinuria, osteoporosis-pseudoglioma syndrome and skin diseases, such as Marfan syndrome and Ehlers-Danlos syndrome (These causes of hereditary secondary osteoporosis each are treated differently.)
What are osteoporosis symptoms and signs?
Osteoporosis symptoms can’t be identified easily since it can be present in anybody for decades until the bone fractures. In fact, some osteoporotic fractures might even escape detection for years. The symptom associated with osteoporotic fractures usually is the pain; the location of the pain depends on the location of the fracture. The symptoms of osteoporosis in men are similar to the symptoms of osteoporosis in women.
Fractures of the spine (vertebra) usually causes “band-like” pain radiating from the back to the sides of the body. Eventually, repeated spinal fractures can lead to chronic lower back pains as well as loss of height or curving of the spine. The collapse gives individuals a hunched-back appearance of the upper back, often called a “dowager hump” since it’s commonly seen in elderly women.
Any fracture occurring during the course of normal activity is known as minimal trauma or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.
Hip fractures normally occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial slip-and-fall accidents. Hip fractures also may heal slowly or poorly after surgical repair because of poor healing of the bone.
What are the consequences of osteoporosis?
Osteoporotic bone fractures cause considerable pain, lost workdays, decreased quality of life, and disability. Almost 30% of the patients suffering a hip fracture require long-term nursing/home care. Elderly patients can develop pneumonia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after the hip fracture. Osteoporosis has even been linked with an increased risk of death. Some 20% of women with a hip fracture eventually die in the subsequent year as an indirect result of the fracture. Moreover, once a person has experienced a spine fracture due to osteoporosis, he or she is at very high risk of suffering another such fracture in the near future. About 20% of postmenopausal women who experience a vertebral fracture suffer a new vertebral fracture of the bone in the following year.
What factors determine bone strength?
Without appropriate treatment, osteoporosis can be worse. As bones get thinner and weaker, the risk of fracture increases. Symptoms of severe osteoporosis may include a fracture from a fall or even from a strong sneeze or a cough. They can also include back or neck pain or loss of height. After having a fracture from osteoporosis, the healing time depends on many factors such as where the fracture is, how severe it is, as well as your age and health history.
Treatment for osteoporosis, and can osteoporosis be prevented?
The treatment of osteoporosis is all about the prevention of bone fractures by reducing bone loss or, preferably, by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fractures, none of the available treatments for osteoporosis can cure it completely. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment.
The following are osteoporosis treatment and prevention measures for optimal health of the bone:
- Lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D
- Medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin(Calcimar), zoledronate (Reclast), and denosumab (Prolia)
- Medications that increase bone formation such as teriparatide (Forteo)
Newer medications, medicine with different methods of delivery, and research into the optimal management of osteoporosis will bring even better options for the health care of patients with osteoporosis in the future.
Get in touch with Grecian Hospital to know more about Osteoporosis and its treatment.