Medicosnext
Osteoporosis is chronic metabolic bone disease which develops when bone mineral density and bone mass decrease. As a result, the bones become weak, brittle, and porous, compromising bone strength and increasing the risk of fractures. Since this condition is characterized by increased bone fragility, the resulting fractures are termed as fragility fractures. Although all the bones in the body can be affected by the disease, certain bones are more likely than others to become weakened by osteoporosis. Fragility fractures are common, especially in the hip, spinal vertebrae, and wrist.
Bones are living tissue that form our skeletal system. They provide shape and structural support to our body, as well as protection for some of our vital organs. Bone is made up of minerals, mainly calcium, bound together by strong collagen fibers. Our bones have a thick, hard outer shell called cortical bone. Cancellous bone/ trabecular bone is the inner spongy mesh that has a honeycomb-like structure. When a bone is affected by osteoporosis, the holes in the honeycomb structure become larger and more numerous, cortical layer becomes thinner, bone minerals deplete, and the overall bone density lowers. Since there is a deterioration of bone tissue and disruption of bone micro architecture, osteoporosis brings about both compositional and structural changes in the bone.
Cause
The bone tissue is constantly renewing itself and is engaged in a continuous cycle of breaking down and rebuilding. Old bone tissue is broken down and is replaced by new bone tissue so as to maintain bone health, density, strength, and structural integrity, a process called bone remodelling. An imbalance between the breakdown of old bone and the formation of new bone, where the break down is faster than the rebuilding, causes osteoporosis.
Risk factors
Several factors may put us at a risk of developing osteoporosis. Some are not in our control, but there are others that you may be able to change, like changes in our lifestyle.
• Age
After age 35 to 40, bone breakdown occurs faster than new bone formation; this could cause a gradual loss of bone mass. We all have some degree of bone loss as we get older, but the term osteoporosis is used only when the bones become quite fragile. Osteoporosis is most common in people older than 50 years.
• Gender
Everyone is at a risk for osteoporosis fractures as we age. However, women are at a greater risk than men, especially after menopause. After menopause, the production of estrogen decreases. Estrogen is a hormone produced by the ovaries that protects against excessive bone mass loss. Surgical removal of ovaries and hormonal imbalance may also lead to osteoporosis due to the lack of estrogen.
• Ethnicity
Osteoporosis is more prevalent in people of Caucasian and Asian descent. According to International Osteoporosis Foundation (IOF), osteoporosis is greatly under-diagnosed and under-treated throughout Asia, especially in the rural areas.
• Calcium and vitamin D deficiency
About 99 percent of calcium in the human body is stored in the bones. The remaining one percent circulates in the bloodstream, where it performs a variety of important functions, including regulation of muscle contraction, transmission of nerve impulses, blood clotting, etc. If a person’s calcium intake or absorption is inadequate, less calcium is available for the body in the blood stream. To rectify this, the body begins to transfer calcium from the bones to maintain its presence in the bloodstream. This insufficiency of calcium over a long period may be a factor in causing osteoporosis.
Vitamin D plays a role in facilitating intestinal absorption and processing of calcium. In the absence of vitamin D, dietary calcium is not absorbed efficiently, which leads to an overall calcium deficiency that could lead to osteoporosis.
• Family history
Research has found that our risk for osteoporosis may increase if one of our parents has a history of osteoporosis.
• Hormones
o Low estrogen levels in women due to a medical condition, or after menopause
o Low level of testosterone in men
o Overactive thyroid and parathyroid hormones
• Low body weight
• Medical conditions
Some medical conditions like endocrine and hormonal diseases, kidney and liver diseases, gastrointestinal disease leading to malabsorption of calcium , rheumatoid arthritis, certain types of cancers, and HIV/AIDS can increase the risk of osteoporosis.
• Medications
Long-term use of certain medications like oral steroids, certain cancer medications, antiepileptic medicines, certain anti-anxiety and depression medications may make one more likely to lose bone mass and develop osteoporosis. Surgical interventions like gastric bypass surgery (poor absorption of calcium in the gut) and transplant surgeries (due to steroid intake).
• Lifestyle
A healthy lifestyle is for our bone health. Factors that contribute to bone loss are:
o An inactive lifestyle: lack of exercise, low level of physical activity, or inactivity due to certain conditions can contribute to an increased rate of bone loss.
o Chronic heavy drinking, smoking, and use of tobacco.
o Poor diet: Diet deficient in calcium, vitamin D, and protein from an early age to old age increases your risk for osteoporosis. Certain eating disorders like bulimia or anorexia and severe fasting could be risk factors in developing osteoporosis.
Symptoms
Osteoporosis often progresses without any symptoms or any significant pain. It is termed a “silent” disease, because one may not even know they have the disease, especially in the early stages. It develops slowly over several years. When the bones have been weakened by osteoporosis, one may have signs and symptoms that include:
Low impact fractures or breaks after a minor incident, such as a fall from a standing height
Fracture caused during simple everyday activity like bending or lifting
Loss of height, stooped posture, back pain because of compressed vertebrae due to fracture
Osteoporosis may be undiagnosed, but once fractures occur due to significant loss of bone mass, it could be a potentially debilitating disease that affects many women and men. Fractures may cause chronic pain, prolonged disability, increased dependence, poor quality of life, and increased chances of recurring fracture, especially in the elderly. Recent studies indicate that some osteoporotic fractures not only cause morbidity and increased burden of financial cost, but are also associated with excess mortality. Deaths are predominately due to comorbidities, but may also be attributed to the fracture event itself, either directly or indirectly.
Prevention
About 200 million people are estimated to have osteoporosis throughout the world. The IOF advises that once people reach 50 years of age, 1 in 3 women and 1 in 5 men will experience fractures due to osteoporosis. However, we can take steps to prevent this disease.
Diet rich in calcium, vitamin D, and protein: Calcium and vitamin D are important nutrients for preventing osteoporosis and helping bones reach peak bone mass. Foods rich in protein and calcium, such as dairy products like milk, cheese, and yogurt, fish, nuts, seeds, dried fruits, eggs, tofu, green leafy vegetables like spinach, kale, and broccoli, beans, chickpeas, and legumes should be a part of our daily meal. The recommended amount of calcium for men and women is 1000 mg per day; women older than 50 years and men older than 70 need at least 1300 mg every day. Vitamin D is made in the skin after exposure to sunlight. Some foods containing enough vitamin D are fish/fish oils, egg yolks, and liver. Mild exposure to sunlight every day is good for our bones.
Daily exercise: Even a simple weight-bearing exercise like walking can decrease our chances of bone loss. Weight training and resistance exercises, along with flexibility exercises like yoga, help.
Making lifestyle changes: Quitting smoking and excessive drinking.
Maintaining a healthy weight.
Regular health checkups: especially if you have associated risk factors.
If diagnosed with osteoporosis/ osteopenia (decreased bone mass that may eventually lead to osteoporosis), measures should be taken to prevent falls in order to prevent fractures. Having regular vision screenings and wearing glasses if required, walking with a stick or walker if necessary, avoiding clutter in the house, and installation of grab bars in areas like the bathroom helps ensure safety.
When to see a doctor
For all women over the age of 65 and all men over the age of 70, a talk with your doctor about your risk of osteoporosis may be a good idea. However, if you have associated risk factors, an earlier visit is advisable.
If you have a family history of osteoporosis.
If you have had a fracture with a low impact activity, or if you have had recurring fractures.
If you have noticed a loss in height or stooping.
If you have chronic back pain.
If you have had a lifestyle of excessive smoking and drinking.
If you have an inactive lifestyle due to any reason, medical or otherwise.
If you are an individual on medications, or with medical conditions that can affect bone density.
Diagnosis
If your doctor suspects you have osteoporosis, or are at risk of developing osteoporosis, he will order a bone density test (DXA/DEXA), which is a non-invasive method to measure bone mineral content and density. It helps determine whether or not you have osteoporosis. Is also helps determine whether you have osteopenia. Early assessment and treatment are medically prudent steps to reduce the risk for osteoporosis and related complications.
Treatment
If you think you are at risk of developing osteoporosis, seeing your doctor is important. Early treatment of osteoporosis and osteopenia can limit or stop bone loss and prevent fractures. Treatment depends on age, gender, medical history, overall health, how advanced is the disease, and tolerance to medication and therapies. Your doctor will decide, depending on all the factors, what mode of treatment is the right one for you. A number of FDA-approved drugs in various forms like injections, IV infusions, tablets, nasal sprays, and patches, along with hormonal therapies, have shown to reduce fractures in randomized studies. Along with these, preventive methods need to be followed. Meeting with a physical therapist to discuss an exercise regime consisting of weight-bearing and muscle-strengthening exercises customized to your own needs and abilities is an important step in preventing and living with osteoporosis.
