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Last Updated on August 29, 2023 by Shabnam Sengupta
Osteoporosis results in low bone strength, making bones more prone to fractures that can occur accidentally and unexpectedly. The term ‘osteoporosis’ means porous bone. The fractures encountered in osteoporosis are mainly hip, wrist, and spine fractures. The disease arises from an imbalance between bone formation and resorption processes, influenced by genetic, hormonal, and lifestyle factors. The symptoms of osteoporosis can range from pain in bones to brittle bones to breathing problems.
In India, osteoporosis is a significant concern, especially among post-menopausal women and the elderly, with a prevalence ranging from 20% to 40% in women above 50 years. While one may not die from osteoporosis, the economic burden is substantial, with healthcare costs related to fractures adding to the overall expenditure. Fractures negatively impact the quality of life, mobility, and independence, worsening the societal impact. Pain and long-term home care can be long-term consequences of this disease. People with the condition or at risk should be aware of potential problems of the condition. And they must seek treatment before complications arise.
Currently, one of the treatment options for osteoporosis is pharmacological interventions (e.g., bisphosphonates, denosumab). Another treatment option for osteoporosis is lifestyle interventions (e.g., calcium and vitamin D supplementation, exercise). However, challenges exist, such as patient adherence, potential side effects, cost, individual response variability, and the need for personalised medicine. Future research focuses on improving treatment effectiveness, and patient education along with addressing limitations to better manage osteoporosis.
What are the symptoms of osteoporosis?
In most cases, there are no symptoms of Osteoporosis in an individual. The condition frequently advances without causing any symptoms, and it is only discovered when bones fracture. However, there are specific symptoms of osteoporosis that may indicate the condition.
Loss of vertebral height
Loss of height can be a symptom of osteoporosis. Weakened vertebrae, due to the condition, tend to fracture under normal stress or minor tumour. These are known as compression fractures. Every time such a fracture occurs, vertebrae lose some height, which eventually decreases the overall height of the spine decreases.
Stooping posture
Kyphosis, a crucial symptom of osteoporosis, is an excessive forward curvature of the upper spine (thoracic region), causing the back to appear rounded or hunched. In individuals with osteoporosis, the bones in the spine can weaken and lose their density, making them more prone to compression fractures.
Breathing problems
Osteoporosis may not directly cause breathing problems in an individual. However, other symptoms of osteoporosis like kyphosis, compression fractures, etc. can result in breathing troubles in some people suffering from the condition. You must know that not everyone with the condition will experience breathing problems. Its occurrence and severity vary from case to case.
Fractures due to brittle bones
Osteoporosis affects the density of bones, which makes them brittle. As a result, one of the common symptoms of osteoporosis is fractures due to brittle bones.
Aches and pains in the back
This occurs due to vertebral compression fractures and loss of bone density. A weak spine may develop tiny fractures or collapse under normal activities. This causes persistent back pain. Additionally, the reduced bone density weakens the overall bone structure. This leads to a decrease in overall stability and an increase in strain on the back.
What are the causes of osteoporosis?
The part inside a healthy bone appears like a sponge as it has numerous pores or holes. When osteoporosis sets in, the ‘holes’ in this part get bigger, weakening the bone.
Bone remodelling is a process of replacement of mature bone tissue with new bone tissue in the skeleton. Till the age of 30, you may gain more bone than you lose. However, after that bone breakdown outpaces bone formation, resulting in a steady loss of bone mass.
There are several factors contribute to the development of osteoporosis, including:
Ageing
One of the primary risk factors of osteoporosis is ageing. As people age, bone mass naturally decreases, and the rate of bone turnover slows down, leading to decreased bone density.
Hormonal Changes
Particularly among women, hormonal changes play a significant role in osteoporosis. During menopause, the decline in estrogen levels accelerates bone loss. Similarly, in men, a decrease in testosterone levels can contribute to bone loss.
Gender
Women are at a higher risk of developing osteoporosis compared to men. This is because women have lower peak bone mass than men and experience a significant decrease in estrogen levels during menopause.
Family History
A family history of osteoporosis or fractures can increase the risk of developing the condition. Genetic factors influence bone health as well as the likelihood of developing osteoporosis.
Inadequate calcium and vitamin D intake
A diet low in calcium and vitamin D, essential nutrients for bone health, can contribute to the development of osteoporosis. Inadequate intake over time can lead to decreased bone density and increased fracture risk.
Sedentary lifestyle
Lack of physical activity or a sedentary lifestyle can weaken bones and increase the risk of osteoporosis. Weight-bearing exercises and activities that subject the bones to mechanical stress help stimulate bone formation and maintain bone density.
Chronic medical conditions
Certain chronic medical conditions can increase the risk of osteoporosis. These include rheumatoid arthritis, inflammatory bowel disease, celiac disease, and hormonal disorders.
Medications
Long-term use of certain medications and some cancer treatments can contribute to bone loss and increase the risk of osteoporosis. These medications include corticosteroids (e.g., prednisone), and anticonvulsants.
Smoking and excessive alcohol consumption
Smoking and consuming excessive alcohol can negatively affect bone health and increase the risk of osteoporosis. There is an interference of smoking with calcium absorption, while alcohol can interfere with the body’s ability to absorb calcium and impair bone formation.
Low body weight or eating disorders
Being underweight or having a history of eating disorders can increase the risk of osteoporosis. Insufficient nutrient intake can compromise bone health and contribute to low bone density.
Which complications are associated with osteoporosis?
- The most serious complication of osteoporosis is fractures, particularly in the spine or hip. A decrease in bone mass is the most common cause of hip fractures, which can result in disability and an even greater risk of death within the first year after injury.
- Even without a fall, you may suffer a spinal fracture. Backache and a decrease in height can be a result of the bones that make up the spine (vertebrae), weakening to the point of collapse.
What is the process of diagnosis of osteoporosis?
The diagnosis of osteoporosis typically involves assessing an individual’s bone mineral density (BMD) and evaluating their fracture risk. The following steps are commonly followed in diagnosing osteoporosis:
Medical history
One of the tools to diagnose osteoporosis is medical history. The healthcare provider will review the individual’s medical history, including any personal or family history of fractures, risk factors for osteoporosis (e.g., menopause, low body weight, certain medications), and underlying medical conditions.
Physical examination
The doctor may perform a physical examination to diagnose osteoporosis for the assessment of height loss, posture, and signs of vertebral fractures, such as kyphosis (abnormal curvature of the spine).
Bone Mineral Density (BMD) testing
Dual-energy X-ray absorptiometry (DXA) is the most common method to measure BMD. DXA scans, usually performed on the spine and hip, provide T-scores that compare an individual’s BMD with a young, healthy population. T-scores are used to classify bone health:
- Normal: T-score above -1.0
- Osteopenia (low bone mass): T-score between -1.0 and -2.5
- Osteoporosis: T-score at or below -2.5
Additional tests
In some cases, doctors may order further tests to evaluate the underlying causes of osteoporosis or assess fracture risk. These tests may include blood tests to measure calcium, vitamin D, hormone levels, and other markers of bone turnover.
Fracture Risk Assessment
Doctors may opt for different ways of fracture risk assessment. They may use various tools, such as the FRAX® tool, to estimate an individual’s 10-year probability of experiencing a major osteoporotic fracture or hip fracture. These assessments take into account age, sex, BMD, and additional clinical risk factors.
Doctors do the diagnosis of osteoporosis on the basis of a combination of clinical evaluation, BMD results, and fracture risk assessment.
What is the treatment of osteoporosis?
The treatment of osteoporosis includes combination therapies and the potential for personalized medicine which holds promise for improving treatment efficacy and outcomes in the future. The treatment mostly includes a combination of medicines, nutritional supplements, dietary modifications, exercise programs, and regenerative medicine approaches.
Pharmacological interventions
Pharmacological interventions for osteoporosis include antiresorptive agents, anabolic agents, and emerging drug targets. Combination therapies and the potential for personalized medicine hold promise for improving treatment efficacy and outcomes in the future. Antiresorptive agents, such as bisphosphonates and denosumab, reduce bone resorption and lower fracture risk. Anabolic agents like teriparatide and romosozumab stimulate bone formation, especially in severe cases. Ongoing research explores new drug targets, including signalling pathways and mesenchymal stem cells, while combination therapies and personalized medicine show potential. Advancements in osteoporosis treatment are crucial to improving outcomes and reducing complications.
Hormonal interventions
Estrogen, testosterone, and the selective estrogen receptor modulator raloxifene are all members of this class. Doctors are more likely to use estrogen treatment in women who need to address menopause symptoms and in younger women due to the risk of blood clots, certain malignancies, and heart complications as age increases. A man with low testosterone levels can be prescribed testosterone to increase bone density. Raloxifene has an estrogen-like effect on the bones. The medication comes in tablet form and is taken daily.
Nutritional Interventions
Exercise, vitamins, mineral supplements, and medicines can be used to treat osteoporosis. Calcium and vitamin D play essential roles in maintaining bone health. Supplementation with calcium and vitamin D is often recommended, especially for individuals with inadequate dietary intake or those at high risk of deficiency. Adequate levels of these nutrients support bone mineralization and reduce the risk of fractures. Emerging research suggests that other micronutrients, such as magnesium, vitamin K, and omega-3 fatty acids, may also influence bone health. Magnesium is involved in bone mineralization, while vitamin K contributes to bone formation and remodelling. Omega-3 fatty acids have been associated with a potential protective effect against bone loss. Further investigation is needed to determine optimal intake levels and their impact on bone health.
Phytoestrogens and Dietary Modifications
Phytoestrogens, found in certain plant-based foods, have been studied for their potential beneficial effects on bone health. Dietary modifications, such as increasing fruit and vegetable intake, reducing sodium consumption, and maintaining a balanced diet, can support overall bone health. Promoting a healthy diet rich in calcium, vitamin D, and other essential nutrients is crucial for optimal bone health. Encouraging a balanced and varied diet that includes dairy products, leafy greens, fortified foods, and adequate protein intake can support bone health and reduce the risk of osteoporosis.
Exercise Programmes
Physical activity has a positive impact on bone health. Weight-bearing exercises and activities that subject the bones to mechanical loading help stimulate bone formation and improve bone density. Regular physical activity is associated with a reduced risk of fractures and better overall bone strength. Resistance training, including weightlifting and resistance band exercises, can promote bone growth and strengthen muscles. Weight-bearing exercises like walking, running, and dancing help load the bones and improve bone density. Also, balance and coordination exercises, such as tai chi and yoga, enhance stability and reduce the risk of falls and fractures, particularly in older individuals. These exercises improve muscle strength, posture, and balance, improving overall bone health. People suffering from osteoporosis may play certain sports as well. However, people with osteoporosis must consult healthcare professionals before opting for any physical activity including going to the gym for exercise.
Emerging research explores novel exercise modalities and technology-based interventions for osteoporosis management. Virtual reality, exergaming, and wearable devices are being investigated for their potential to enhance exercise adherence, motivation, and outcomes in individuals with osteoporosis.
Regenerative Medicine Approaches
Mesenchymal stem cell (MSC) therapy involves the use of specialized cells that have the potential to differentiate into various cell types, including bone-forming cells. MSC therapy holds promise for bone regeneration and the treatment of severe cases of osteoporosis. However, further research and clinical trials are needed to establish its safety and efficacy. Growth factors, such as bone morphogenetic proteins (BMPs), are being studied for their role in promoting bone formation and regeneration. Bone tissue engineering approaches, utilising scaffolds and cells, aim to develop engineered bone tissues for transplantation and repair of bone defects. Emerging research focuses on understanding the cellular and molecular mechanisms involved in bone regeneration. This includes investigating novel signalling pathways, exploring the potential of stem cell-based therapies, and developing innovative biomaterials for bone tissue engineering.
Personalised Medicine and Biomarkers
Genetic factors play a role in determining an individual’s susceptibility to osteoporosis. Genetic testing and analysis can help identify specific gene variants associated with increased fracture risk. This information can contribute to personalized risk assessment and guide treatment decisions. Besides this, biomarkers, such as markers of bone turnover and bone formation, can provide valuable information about bone health and predict fracture risk. Measuring these biomarkers through blood or urine tests can aid in monitoring treatment response and adjusting therapeutic strategies accordingly. Also, imaging techniques, including dual-energy X-ray absorptiometry (DXA) scans, quantitative computed tomography (QCT), and high-resolution peripheral quantitative computed tomography (HR-pQCT), are commonly used to assess bone mineral density and evaluate bone quality. These techniques help diagnose osteoporosis, monitor disease progression, and assess treatment efficacy.
How can you prevent osteoporosis?
Prevention plays a crucial role in reducing the risk of developing osteoporosis. Here are some key strategies for osteoporosis prevention:
Adequate calcium and vitamin D intake
Ensure a sufficient daily intake of calcium and vitamin D through diet or supplementation. Calcium-rich foods include dairy products, leafy greens, and fortified products. Vitamin D can be obtained from sunlight exposure and dietary sources like fatty fish, egg yolks, and fortified foods.
Balanced diet
Maintain a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. A well-rounded diet provides essential nutrients for bone health, including magnesium, phosphorus, potassium, and vitamins C and K.
Regular exercise
Engage in weight-bearing exercises and resistance training regularly. Weight-bearing activities like walking, jogging, dancing, and strength training help stimulate bone remodelling and improve bone density. Balance and flexibility exercises can also reduce the risk of falls and fractures.
Fall prevention
Take precautions to prevent falls, as they can lead to fractures, especially in older individuals. Keep the home well-lit and free of tripping hazards, use handrails on stairs and in bathrooms, wear appropriate footwear, and consider balance-enhancing exercises or programs.
Limit alcohol consumption and avoid smoking
Excessive alcohol consumption and smoking have negative effects on bone health. Limit alcohol intake to moderate levels (up to one drink per day for women and up to two drinks per day for men) and avoid smoking altogether.
Maintain a healthy body weight
Maintain a healthy body weight through a balanced diet and regular physical activity. Excessive weight loss or being underweight can increase the risk of osteoporosis.
Regular health check-ups
Regularly visit your healthcare provider for check-ups and screenings. Discuss your risk factors for osteoporosis and evaluate whether further assessments, such as bone mineral density testing, are necessary.
Medication review
Consult with your healthcare provider to review any medications you are taking, as some medications may have adverse effects on bone health. They can help assess the benefits and risks and explore alternative options if necessary.
Hormonal health
For women approaching menopause, discussing hormone therapy with a healthcare provider can be beneficial for maintaining bone health. Hormone therapy may help reduce bone loss and fracture risk in certain cases.
Education and awareness
Stay informed about osteoporosis, its risk factors, and prevention strategies. Knowledge empowers you to make informed decisions about your lifestyle and seek appropriate medical advice.
FAQ on Osteoporosis
Can osteoporosis cause heart problems?
The available scant evidence suggests that heart health and osteoporosis are related to each other. A low bone density may increase the risk of cardiovascular diseases.
Does high cholesterol cause osteoporosis?
High cholesterol and osteoporosis may share some risk factors, such as a sedentary lifestyle or inadequate nutrient intake. But there is no direct causal relationship between the two. However, both conditions can be influenced by similar lifestyle factors, such as poor diet and lack of exercise, which can increase the risk of developing both conditions independently.
Why osteoporosis is a sign of weak bones?
Osteoporosis is considered a sign of weak bones because it is a condition characterised by low bone density and deterioration of bone tissue. This leads to an increased risk of fractures and bone fragility, making the bones more susceptible to breaking even with minor trauma or stress.
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