About osteoporosis
Osteoporosis is a condition characterized by weak or brittle bones. In people with osteoporosis, the bones are so fragile that a fall or a cough is fracture them. Women are more likely to develop osteoporosis than men. Caucasian and Asian women, especially when post-menopausal, are most frequently affected by osteoporosis. Osteoporosis is an age-related condition that worsens as a person gets older.
What are the causes of osteoporosis?
The bones in our bodies are undergoing constant remodeling: bone is being broken down and replaced with new bone. Osteoporosis results when the rate of breakdown exceeds the rate of new bone formation. Bone density is highest around the age of 20, and thereafter bone density declines with age. A person’s risk for osteoporosis partially depends on the peak bone density achieved in their youth. The more bone that was present in young adulthood, the longer the bone will last as one ages. A family history of osteoporosis is a risk factor for developing the disease. Men and women with smaller body frames are also more prone to develop osteoporosis since they have less bone that those with larger body frames.
The reduction in the sex hormones, estrogen and testosterone, which decline as we age, results in weakened bones. In fact, the reduction in estrogen at menopause is the strongest risk factor for development of osteoporosis. An overproduction of thyroid hormones (hyperthyroidism) can cause bone loss. Overactivity of the parathyroid and the adrenal glands has also been associated with osteoporosis.
Nutrition also plays in an important role in maintaining healthy bones. A diet low or deficient in calcium is a strong risk factor for the development of osteoporosis. Anorexia limits the amount of calcium that can be taken in through the diet and can facilitate osteoporosis onset. Corticosteroid medications inhibit new bone formation, and long-term use can lead to osteoporosis. Other lifestyle choices including excessive alcohol consumption, tobacco use, and a sedentary lifestyle can promote bone thinning.
Symptoms of osteoporosis
Osteoporosis often develops silently, without noticeable symptoms until a fracture occurs. Common signs include:
- Fractures: Fragile bones are prone to fractures, particularly in the spine, hip, and wrist. Minor falls or even mild stress can cause fractures.
- Back Pain: Vertebrae fractures can cause severe back pain, leading to a stooped posture or a loss in height.
- Gradual Loss of Height: Over time, vertebral fractures can cause a gradual reduction in height and a stooped posture.
- Bone Pain and Tenderness: Bones may ache or be tender to touch due to weakened structure.
- Fractured or Collapsed Vertebrae: A fractured or collapsed vertebra in the spine may result in loss of mobility, a hunched posture, or chronic pain.
- Loss of Teeth, Receding Gums: Weakened jawbone may lead to tooth loss and receding gums.
Regular check-ups and bone density tests can help detect osteoporosis early, especially for those at higher risk.
Detection
Osteoporosis is diagnosed through various methods, including:
- Bone Density Measurement (DEXA scan): Dual-energy X-ray absorptiometry (DEXA) is the most common test to measure bone density. It assesses bone mass in areas like the hip, spine, and wrist, indicating bone strength and the risk of fractures.
- FRAX Assessment: Fracture Risk Assessment Tool (FRAX) estimates a person’s 10-year probability of a major osteoporotic fracture or hip fracture. It considers clinical risk factors along with bone density.
- Physical Examination and Medical History: A thorough examination and discussion of medical history help in assessing risk factors and potential causes of bone loss.
- X-Rays and Imaging: X-rays may reveal fractures and bone loss, although they may not be as sensitive as DEXA scans for detecting early osteoporosis.
- Blood and Urine Tests: These tests can identify specific markers related to bone health, providing additional information to aid in the diagnosis.
Early detection is crucial in managing osteoporosis effectively. If you suspect osteoporosis or have risk factors, consult with one of our doctors for appropriate evaluation and testing.
Treatment
The treatment for osteoporosis aims to strengthen bones, reduce the risk of fractures, and manage pain associated with the condition. Treatment strategies may include:
Medications
- Bisphosphonates: Alendronate, risedronate, ibandronate, and zoledronic acid can help slow bone loss and reduce fracture risk.
- Hormone-related therapies: Estrogen agonists/antagonists (e.g., raloxifene) mimic estrogen’s bone-preserving effects.
- Calcitonin: Helps prevent bone loss and reduce pain associated with fractures.
- Parathyroid hormone (teriparatide): Stimulates bone formation and increases bone density.
- Denosumab: An antibody that helps reduce bone loss.
Supplementation
- Calcium. Adequate calcium is vital for bone health and may be recommended if dietary intake is insufficient.
- Vitamin D. Plays an important role to enhance calcium absorption.
Additionally, it is important to understand the emotional landscape of a person who has been diagnosed with heart disease. There can be “emotional congestion” in the heart that has not been dealt with, from grief to anger to fear, which may need to be off-loaded and dealt with emotionally. Our doctors are prepared to help patients process whatever emotions exist.
Lifestyle modifications
- Dietary changes: A diet rich in calcium, vitamin D, and protein is essential.
- Regular exercise: Weight-bearing and muscle-strengthening exercises help improve bone density and strength.
- Quitting smoking and limiting alcohol: Smoking and excessive alcohol consumption can weaken bones.
- Fall prevention: Taking steps to prevent falls, such as removing hazards at home and ensuring good lighting.
Physical therapy
- Physical therapists can design exercise programs to improve balance, posture, and overall strength to reduce the risk of falls and fractures.
Pain management
- Pain relief measures can include over-the-counter or prescription pain medications, depending on the severity of pain.
Education and counseling
- Providing education about osteoporosis, its progression, and preventive measures is essential for effective management.
Individualized treatment plans are crucial, considering factors like age, gender, bone density, overall health, and risk of fractures. It’s important to work closely with one of our doctors to determine the most appropriate treatment for osteoporosis.