Osteoporosis is a condition characterized by a decrease in the density of bone (bone mass), decreasing its strength and resulting in fragile bones with an increased susceptibility to fracture.
"Osteoporosis" literally means "porous bones." The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.
Osteopenia, by definition, is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis.
A normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bone mass decreases after 35 years of age.
Osteoporosis can affect both males and females, but it is most likely to occur in women after menopause, because of the sudden decrease in oestrogen, the hormone that normally protects against osteoporosis.
Causes and Risk Factors of Osteoporosis?
It's caused by a lack of bone strength or bone density. Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.
As you age, your bones get thinner naturally. But some things can make you more likely to have the severe bone thinning of osteoporosis. These things are called risk factors.
The following are factors that will increase the risk of developing osteoporosis:
Age: Risk increases after the mid-30s
Caucasian or Asian race
Bone structure: Being tall (over 5 feet 7 inches) or slim (weighing less than 125 pounds) increases the risk
Genetic factors: Having a close family member with a diagnosis of hip fracture or osteoporosis makes osteoporosis more likely
Personal history of fracture as an adult: Someone who has previously experienced a fracture during a low-level injury, especially after the age of 50 years, is more likely to receive a diagnosis
Excessive alcohol consumption
Lack of exercise
Diet low in calcium
Poor nutrition and poor general health, especially associated with chronic inflammation or bowel disease
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
Low oestrogen levels in women (which may occur in menopause or with early surgical removal of both ovaries). Lower oestrogen levels appear to make it harder for bone to reproduce
Chemotherapy that can cause early menopause due to its toxic effects on the ovaries
Amenorrhea (loss of the menstrual period) in young women is associated with low oestrogen 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
Immobility, such as after a stroke, or from any condition that interferes with walking
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
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.
Certain medications can cause osteoporosis. These medicines include long-term use of heparin (a blood thinner), antiseizure medicine such as phenytoin (Dilantin) and phenobarbital, and long-term use of oral corticosteroids (such as prednisone).
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.)
Osteoporosis Signs and Symptoms
Bone loss that leads to osteoporosis develops slowly. There are often no symptoms or outward signs, and a person may not know they have it until they experience a fracture after a minor incident, such as a fall, or even a cough or sneeze.
Commonly affected areas are the hip, wrist or spinal vertebrae. Breaks in the spine can lead to changes in posture, a stoop, and curvature of the spine.
Diagnosis of Osteoporosis
A doctor will consider the patient's family history and their risk factors. If they suspect osteoporosis, they will request a scan, to measure bone mineral density (BMD).
Your bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked, usually in the hip, wrist and spine.
Anyone who is concerned that they may be at risk of osteoporosis should ask their doctor about screening.
What types of health care professionals treat osteoporosis?
Health care professionals who treat osteoporosis include generalists and internists as well as gynaecologists, endocrinologists, rheumatologists, and for fractures, bone surgeons (orthopaedists).
What is the Treatment and Prevention for Osteoporosis?
Treatment for osteoporosis includes medicine to reduce bone loss and to build bone thickness. Medicine can also give you relief from pain caused by fractures or other changes to your bones.
It's important to get enough calcium and vitamin D and take prescribed medicine for the disease. You need calcium and vitamin D to build strong, healthy bones.
The goal of treatment of osteoporosis is 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 are complete cures. 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:
1. Lifestyle changes such as:
a. quitting cigarette smoking,
b. curtailing excessive alcohol intake,
c. getting regular weight-bearing exercise, such as walking, as this promotes healthy bone and strengthens support from muscles,
d. doing exercises to promote flexibility and balance, such as yoga, as these can reduce the risk of falls and fractures, and
e. consuming a balanced diet with adequate calcium and vitamin D
2. Use of prescribed medications that stop bone loss and increase bone strength and bone formation
As bones become weaker, fractures occur more frequently, and, with age, they take longer to heal.
It is important to take action to prevent falls among people with osteoporosis.
removing trip hazards, such as throw rugs and clutter
having regular vision screenings and keeping eyewear up to date
installing grab bars, for example, in the bathroom
ensuring there is plenty of light in the home
asking the doctor to review medications, to reduce the risk of dizziness
A word of caution about exercise: It is important to avoid exercises that can injure already weakened bones. In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure, exercise should be prescribed and monitored by physicians. Extreme levels of exercise (such as marathon running) may not be healthy for the bones. Marathon running in young women that leads to weight loss and loss of menstrual periods can actually promote osteoporosis.
What are Complications of Osteoporosis?
The primary complication of osteoporosis is bone fracture. This may lead to no symptoms or be associated with severe, intractable pain. Recurrent fractures are common and can lead to deteriorating skeletal structure. Occasionally, fractures of the spinal vertebrae can push bone into adjacent nerves and/or spinal cord. This can require neurosurgical intervention. Osteoporotic vertebral fractures can also be relieved by vertebroplasty (kyphoplasty) procedures whereby the collapsed vertebra is inflated by a balloon and a cement (methylmethacrylate) is injected to reform structure to the vertebra.
Repeated vertebral compression fractures can lead to severe deformity of the spine of the chest (kyphosis) that can compromise breathing along with cause extreme loss of height. This can increase the risk of problems with any respiratory infections.
What is the prognosis (outlook) for patients with osteoporosis?
The outlook for patients with osteoporosis depends greatly on where fractures occur. Additionally, if treatment is begun when the bone disease is detected early, the outcome is better.
Hip fractures are a particularly dangerous consequence of osteoporosis in the elderly. Approximately 20% of those who experience a hip fracture will die in the year following the fracture. Only one-third of hip-fracture patients regain their pre-fracture level of function. One-third of hip-fracture patients are discharged to a nursing home within the year after fracture.
Newer medications, medicine with different methods of delivery, and research into the optimal management of osteoporosis will bring even better options for health care of patients with osteoporosis in the future.
The Future of Osteoporosis Therapy
In future, treatment may include stem cell therapy. In 2016, researchers found that injecting a particular kind of stem cell into mice reversed osteoporosis and bone loss in a way that could, potentially, benefit humans too.
Findings published in 2015 suggested that growth hormone (GH) taken with calcium and vitamin D supplements could reduce the risk of fractures in the long term.
Also in 2015, researchers in the United Kingdom (U.K.) found evidence that a diet containing soy protein and isoflavones may offer protection from bone loss and osteoporosis during menopause.
Scientists believe that up to 75 percent of a person's bone mineral density is determined by genetic factors. Researchers are investigating which genes are responsible for bone formation and loss, in the hope that this might offer new ways of preventing osteoporosis in future.
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