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What is Osteoporosis?

Osteoporosis is a disease that affects all the bones of our body and it is characterized by a decrease in bone mass, leading to brittle bones. In simple words it makes bones porous. Bone is a living tissue that is in a state of continuous turnover and renewal due to daily wear and tear, which enables it to repair its structural defects. This process of continuous bone formation and resorption occurring at a particular site in the bone is called as bone remodeling.

In elderly people, the rate of bone resorption exceeds the rate of bone formation leading to osteoporosis or brittle bone disease.

Hormonal factors strongly determine the rate of bone resorption. Lack of estrogen (e.g. as a result of menopause) increases bone resorption, as well as decreases the deposition of new bone that normally takes place in weight-bearing bones. Also as the patient ages the para-thyroid hormone (PTH) increases leading to decreased calcium absorption and Vitamin D formation. Osteoporosis is a condition leading to low bone mass and thus enhancing bone fragility and increasing the risk of fracture.

There are two types:

1) Post-Menopausal Osteoporosis (Type I): Usually affects women after menopause between the ages of 40 to 70 years. It usually affects the spongy bones like vertebras, ends of long bones, etc. Fractures of vertebrae (bones forming the spinal cord) and wrist are common in this type.

2) Senile Osteoporosis (Type II): This type of osteoporosis affects both men and women aged over 70 years. But men are more likely to develop this condition with a sex ratio of 2:1. Fractures of hip are common in this type.

How common is Osteoporosis?

This is the commonest metabolic bone disease in the world. In India, osteoporosis affects 65% of Indians aged 60 and above. Of this approximately 80% are women. 50% of women over age 50 years will sustain a fracture in her lifetime. Its probability increases with age and 3 lakh new cases are detected per year

What are the symptoms of Osteoporosis?

This disease has no particular complaints, hence is called a ‘silent disease’. Patients report to their doctors with its complications, usually a fracture. The following symptoms may show up:

  • Pain: This occurs due to a fracture. Its site and intensity depends on the bone fractured.
  • Slight loss of height: occurs due to collapse of vertebrae making the patient look older
  • Increased curvature of back (bent forward posture or a hump)

Who is at risk for Osteoporosis?

  • Elderly population
  • Postmenopausal females
  • People with sedentary lifestyle
  • People who smoke and drink alcohol regularly
  • Diet deficient in calcium
  • Lack of sunlight exposure
  • People on long term steroid medications
  • People with endocrine disorders
  • People suffering from mal-absorption syndromes
  • Underweight individuals
  • Malnourished individuals

What are the causes of Osteoporosis?

  • Senility (commonest cause in males)
  • Menopause (commonest cause in females)
  • Protein deficiency
  • Endocrinal disorders
  • Long term steroid therapy
  • No physical activity

What are the complications of Osteoporosis?

The most common complication of osteoporosis is a fracture. Osteoporotic fractures commonly occur at the following sites:

  • Spine (vertebrae): leads to long standing back pain at a particular point, mild loss of height and bent forward posture.
  • Hip: is very dangerous and can be life threatening.
  • Wrist: Commonly termed as Colle’s fracture, leading to acute pain.

How is Osteoporosis diagnosed?

  • DEXA scan (dual energy x-ray absorptiometry): This is the most popular method to measure bone mass.
  • X-ray spine and hip – to identify fractures and reduced bone mass (not very reliable)
  • Blood tests: low protein levels, normal calcium and phosphate levels.
  • CT scan

Watch: Prof. Tahir Masud, President of British Geriatric Society talks about Osteoporosis in Elderly

Screening

Since this is a silent disease, it is important to screen people having risk factors for osteoporosis to prevent its complications. It is done by doing DEXA scan in the following people:

  • Post-menopausal women
  • Patients with spine deformities
  • Elderly patients
  • Men with hormonal disorders
  • Patients on long term steroid therapy

DEXA scan measures the density of mineral in the bone, especially at radius, lumbar vertebrae and greater trochanter of thigh bone.

In common terms it is called as Bone Mineral Density test or BMD.It is amount of mineral matter per square unit area of bone. And it is expressed as gm/cm2.  The results are generally scored by two measures:

  • T score
  • Z score

Negative scores indicate lower bone density and positive scores indicates higher bone density.

  • Normal: -1.0 or higher
  • Osteopenia: -1.0 to -2.5
  • Osteoporosis: -2.5 or lower

How can Osteoporosis be prevented?

It is better to build up your bone mass than to get treated for frequent fractures in the future. Here’s how you can modify your lifestyle and prevent this from happening:

  • Exercise: Weight bearing exercises like lifting weights particularly stimulate bone formation. This should be combined with cardio exercises like walking, jogging, swimming, etc. Back strengthening extension exercises
  • Dietary modifications: High protein diet and high calcium diet decreases the probability of osteoporosis.
  • Sunlight: Exposure to sunlight helps in building up Vitamin D
  • Smoke and alcohol: Smoking and drinking are important risk factors here, hence should be stopped

Preventing post-menopausal osteoporosis:

Hormonal replacement therapy (HRT) is supplementing estrogen in high risk females. Estrogen helps in reducing the bone resorption process and increases the bone mineral density.

Other medications like bisphosphonates can be used as an alternative for HRT.

How is Osteoporosis treated?

The four major goals in the treatment of osteoporosis are:

  • To prevent fracture
  • To stabilize bone mass or increase bone mass
  • To relieve symptoms of fractures ad skeletal deformity
  • To maximize physical function

The treatment is mainly focused on the following:

  • Symptom relief: painkillers for pain relief.
  • Treating the fracture: orthopedic management.
  • Pain Management: By improving posture, infrared therapy for superficial pain and if the pain persists penetrating heat like ultrasound or short-wave diathermy. If the pain still persists, one should consult the doctor to rule out malignancy.
  • Increasing the bone mass by following ways:
  1. Calcium and vitamin D supplementation
  2. High protein diet
  3. Hormone replacement therapy (estrogen supplementation)
  4. Anti-resorptive drugs (medicines that reduce resorption of bone) like bisphosphonates, calcitonin
  5. Fluoride therapy
  6. Parathyroid hormone therapy
  7. Calcitonin (Salmon spray) therapy

This new device offers long term pain relief from back pain

What are the steps for Osteoporosis rehabilitation?

  • Improve posture
  • Relieve pain
  • Activity and movement
  • Low self-esteem and depression have to be treated

Please consult an orthopedic surgeon for your diagnosis and treatment. Understand more about your bone and joint health to avoid Osteoporosis.

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