Osteoporosis

Osteoporosis is a disease of the bone. In this disease, the bones start to get thinner and brittle. They also lose their density and become more porous, much like a sponge. As a result, they have a tendency to break more easily, causing fractures. The process of degeneration of bone density can take several years before the onset of osteoporosis. Apart from causing fractures, osteoporosis can cause other problems like decreased mobility, pain and a stoop in posture.

Most people with osteoporosis have no symptoms. A minor injury or fall resulting in a fracture is usually how osteoporosis presents itself. Although osteoporosis can involve bones in any part of the body, it is known to commonly involve the wrist, hip, and spine. Studies have shown that the incidence of osteoporosis among women over the age of 50 is about 20%. This is a clear indicator of just how intense the problem is. What is more alarming is the fact that osteoporosis is no longer a problem affecting only those with advancing age but it is experienced even by those who are significantly younger.

The common belief is that osteoporosis only starts to affect the body around the onset of menopause. Osteoporosis is, however, a disease that affects the body in different ways and stages. Depending on when osteoporosis occurs and what the nature of its symptoms are, the condition is classified into the following kinds:

• Type 1 Osteoporosis
  Type 1 or post-menopausal osteoporosis affects women who reach menopause. This is therefore seen more in women than in men. It typically affects women between 50-70 years of age. The strength of the bone decreases because the spongy mass contained in the bone reduces, making a person more prone to fractures in the wrist and spine.
  It is observed that the bone is at its healthiest around the age of 30. After this age, bone health tends to decline marginally with every passing year. Women who attain menopause tend to lose bone mass at a more rapid rate than men of the corresponding age. This is caused due to lowered levels of oestrogen in the body. If the bones do not attain their maximum health by the age of 30, the chances of developing the disease later in life increase considerably. Preventive measures are the best defences for such conditions.
• Type 2 Osteoporosis
  This form, known as senile osteoporosis is experienced after 70. Women are twice as likely to develop type 2 osteoporosis than men. In this type, both the spongy mass in the bone and the hard exterior degenerate. The common bones to get affected are hip and spine causing hip and spinal fractures.
• Juvenile Osteoporosis
  ​Osteoporosis of this kind affects children between the age of 8 and 14. In some younger children, it may also occur during a growth spurt. This kind of the disease is of most serious concern since children are still building their bone strength. Any loss of mass at this stage means putting the body at risk of fractures for the rest of one’s life. Juvenile Osteoporosis can be divided into 2 types:
  • Secondary Osteoporosis
    This is caused due to an underlying disease or another medical condition. Common diseases that could trigger juvenile osteoporosis include leukemia, diabetes, celiac disease, hyperthyroidism, kidney disease, eating disorders like anorexia, osteogenesis imperfecta (brittle bone disease), Cushing’s syndrome, juvenile arthritis, and cystic fibrosis. Among girls, the female athletic triad may also cause juvenile osteoporosis. Like its name, this is a syndrome of 3 conditions which are a result of missed periods and poor diet. Medication for any of the above conditions may lead to juvenile osteoporosis. (Read more - Period pain home remedies)
  • Idiopathic Osteoporosis
    ​In this form of juvenile osteoporosis, the exact cause for osteoporosis is not known. It is known to affect boys more than girls. Beginning just before puberty, the child may grow to experience pain in the lower body, including feet, ankles, hip, knee and lower back. The child may have trouble walking and be prone to fractures in the legs, feet, and ankles. While bone density may be gained again during puberty, there is no certainty that it will attain optimal levels in adulthood. 

It is difficult to identify osteoporosis in the early stages because there are no typical signs that can set off an alarm. Symptoms likely to be experienced are very generic and can be confused for an isolated case of pain or stress. It is only after the disease has progressed significantly that there is a likelihood that individuals sit up and take notice. The classic signs of having osteoporosis include:

• Chronic backaches, which are most pronounced when getting out of bed. The pain is usually the worst when walking or standing. Sudden, severe pain in the back is also another common experience. Back pain may sometimes be extremely severe due to compression fractures in the spine. These may, however, not cause any symptoms sometimes.
• The body tends to lose flexibility when suffering from osteoporosis. Simple activities including bending, twisting and stretching the body become difficult, or cause severe pain when being performed.
• Fractures are a common symptom of osteoporosis. The occurrence of fractures, especially after minor falls and injuries are a clear sign. The most common places for fractures include spine, hip, and wrist. Simple daily activities like lifting bags, getting into and out of the car and sitting on a low stool or chair may prove dangerous.
• Body posture tends to suffer as a result of osteoporosis. The person may start to stoop and it is also observed that some people may lose height as a result of the disease.
• Once a person loses weight, he/she may notice that the upper body is starting to curve downwards. This curvature of the spine, known as the Dowager’s Hump causes the body posture to weaken and makes the stoop very pronounced. This condition of the curved spine is called kyphosis. (Read more - Weight loss diet plan)
• Another common symptom which is visible through dental X-rays is loss of bone in the jaw.

Causes

Bone health is at its peak around the age of 20. By this time, the body has spent a considerable amount of time building and repairing bones. The cause for an increase in bone mass at this stage is because of the ability for bones to build faster than they break down. With advancing age, the ability to build and repair is slowed down, causing bones to weaken progressively. The higher the bone mass is during youth, the greater will be the reserves that are created in the body for the future. An inadequate build up of bone mass is the single largest cause of osteoporosis.

Risk factors

There are several risk factors that are linked to osteoporosis. Some of these are those factors which we can do nothing about such as advancing age or gender. However, there are many others that if avoided can help in reducing the risk of osteoporosis. Here are the common risk factors related to osteoporosis:

• Age-related risks
  The tendency to develop osteoporosis increases with an increase in age. Once over 40, we are 1.5 times more at risk of developing the condition. Moreover, the likelihood increases 1.5 with each passing decade of our life. This occurs due to a reduction in the absorption of calcium in the body, reduced levels of the hormone calcitonin produced in the body, and rise in the parathyroid hormone.
• Gender
  Osteoporosis affects women more than men, especially after women enter menopause. 
• Genetic risks
  Genes are also responsible for an increase in the risk of osteoporosis. Whites and Asians are among those who are in the highest risk group. The chance among monozygotic twins is also significantly higher. Those who have a family history of osteoporosis also fall under the high-risk group.
• Nutritional Risk
  Our diet can play an important role in increasing the risk of osteoporosis. Increased amounts of alcohol and caffeine, high sodium diets and diets high in animal protein can contribute to the disease. Inadequate consumption of calcium in the diet is one more factor that increases the risk of osteoporosis.
• Hormonal Risk
  Anorexia induced by exercise and early onset of menopause put women at greater risk of osteoporosis. Obesity is another risk factor. However, the most major contributor is oestrogen in women and testosterone in men. Those undergoing treatment for prostate related problems and women undergoing treatment for breast cancer are at higher risk.
• Disease-related risk
  Those who have a history of, or are being cured for diseases like cancer, Celiac disease, Lupus, liver or kidney disease, myeloma, and inflammatory bowel disease are at higher risk.
• Lifestyle
  Smoking cigarettes and sedentary lifestyle are other factors that add to the risk of osteoporosis.

Preventing osteoporosis is of greatest importance when dealing with the disease since the condition is irreversible for life. Science has still not managed to find a way to reverse damage to bones and tissue once lost, and looking after the body and paying attention to tell-tale signs is critical.

The best way to prevent osteoporosis is to understand if you are in the high-risk group for one or more factors and care for the body accordingly. Understanding higher risks help in two ways. Firstly, it helps to be aware of and sensitive to the needs of the body. Secondly, it helps find alternatives and coping mechanisms in modifying diet and lifestyle to keep the patient safer.

There are some aspects that can be considered in preventing osteoporosis, and these include:

• Diet
  Protein and calcium are the main nutrients that help build the bone. Protein helps build stronger bones, and if you do not receive enough through your diet, you may need to opt for supplements. Healthy, natural sources of calcium are another way to help prevent osteoporosis. Vitamin D helps in the absorption of calcium in the blood and very important for bone health. Not many people get sufficient Vitamin D naturally since the greatest source is sunlight.
• Weight
  Watching your weight is important in preventing osteoporosis. There are dangers to being both overweight and underweight. Those who are overweight stand a greater chance of fracturing the arm and wrist. Being underweight may make you prone to loss of bone density.
• Exercise
  Exercise has benefits no matter when you start, but there is no substitute for the benefits of exercising when you are young. Working out with weights and using a varied exercise regimen helps make the muscles surrounding the bones more flexible, and also improves the strength of the arms and spine. Exercises targeting the lower body help strengthen the hips, legs, and spine.
  Weight-bearing exercises are very effective in strengthening the bones and in preventing osteoporosis. Examples of weight-bearing exercises include squats, push-ups, leg presses, climbing stairs and use of weights. These exercises should always be performed under supervision and after seeking a doctor’s approval.
• Use of hormone therapy with caution
  Women who are prescribed hormone replacement therapy should take it cautiously and weigh the benefits as well as the possible risks of osteoporosis by following the advice of their doctor.
• Quit smoking
  Since smoking increases the risk of osteoporosis, it is best to give up smoking. Talk to your doctor about ways to quit smoking. 

Anyone who has a family history of osteoporosis, who has suffered a fracture or who is above the age of 40 should be screened carefully for the disease. It is also important to check those who have symptoms of other diseases that could be the possible triggers of osteoporosis.

There are several ways of diagnosing osteoporosis.

• Blood and urine test
  This is usually the first step to a diagnosis and is carried out for various reasons. The first, most important step is to check for various parameters which could indicate a related ailment that may, in future, cause osteoporosis if not causing it already. Various markers found in blood and urine samples including hydroxyproline and N-telopeptides help indicate to what level reabsorption occurs in the bone, and also whether treatment is proving useful. It is not, however, the most accurate in predicting the risk of fracture. Various substances tested in the urine and blood help flag patients who do not have adequate reabsorption and bone formation.
• Radiography
  This is yet another commonly used test to diagnose osteoporosis since radiodensity is markedly lower among such patients. However, in order to be visible in the radiograph, there must be at least a 30 percent reduction in bone calcium. If the levels are any less, it is unlikely that a conventionally used radiograph will recognise it. Depending on how the film has been developed, the weight of the patient and exposure to X-rays, several discrepancies may be noticed in radiographs.
• Bone Densitometry
  This is by far the most accurate test to measure bone density and check for the risk of developing fractures. There are several tests that fall under this method including quantitative ultrasound, single-energy X-ray absorptiometry, quantitative computed tomography, and others. Of these, dual-energy X-ray absorptiometry has been known to be the quickest, taking less than 7 minutes, and is most accurate in determining bone mineral content. Using an x-ray beam to determine bone mineral density, it can help predict the risk of fractures. For every single deviation from the desired range, the risk of fracture doubles.

A variety of courses of treatment are available for osteoporosis. However, optimal treatment includes a combination of medical intervention and changes made to lifestyle. Treatment always begins with a complete study of the patient’s history and an analysis of all possible factors that may contribute to the disease. Following this, the most suitable method of treatment may be chosen.

• Oestrogen and hormone replacement
  This is prescribed to people who have lower levels of oestrogen and androgen. By modifying levels of sex hormones and restoring normal ranges, the risk of fractures can be reduced. Using hormone replacement therapy is most effective among women in early menopause. Along with treating osteoporosis, it also helps maintain the health of the heart, reduce hot flushes and also maintain sexual traits. However, oestrogen therapy may cause some vaginal bleeding or tenderness in the breasts. Due to reported complications of administering oestrogen without progesterone, it is important that this form of treatment is only begun after consulting a gynaecologist or endocrinologist. (Read more - Breast pain treatment)
• Bisphosphonates
  These help by preventing the breakdown of bones, and are most effective for post-menopausal women. They may be taken orally as tablets or injected into the bloodstream. However, there are several side effects that can be experienced including irritation in the throat, nausea, trouble swallowing and pain in the abdomen.
• Calcitonin
  Usage of calcitonin is primarily to reduce bone loss in the post-menopausal stage. This is usually administered in nasal form and can have similar effects as oestrogen replacement therapy. The normally prescribed dosage requires spraying into the alternate nostrils. This has been found to be the ideal treatment for those who have symptoms of acute vertebral fractures. This method, in some cases, has even shown a marginal increase in bone mineral density. There are accompanied side effects which may include rashes, facial flushes, and gastrointestinal problems.
• Sodium Fluoride
  This is the only known agent that stimulates cells that develop bone (osteoblastic cells) and aids bone formation. In studies conducted where subjects were given high doses of sodium fluoride, bone mineral density in the spine increased significantly. The rate of spinal fracture, however, remained unchanged. This is an ideal form of treatment for those with a mild or moderate form of osteoporosis. Another encouraging fact about this therapy is that there are almost no known side effects. What goes against it is that sodium fluoride treatment is yet to receive FDA approval.
• Calcium
  Calcium is among the most popularly known minerals for bone strength. The body is incapable of making its own calcium, but loses it quite regularly, making dietary intake calcium extremely vital. The incidence of calcium deficiency is growing among people, and a common cause of increased incidence among the elderly is the tendency to develop an intolerance to lactose. Consumption of calcium supplements has shown stabilisation of skeletal bone mass, and consuming a recommended dose every day can lower the rate of bone loss.
• Vitamin D
  Vitamin D is needed to increase absorption of calcium in the body. Supplements are recommended for those with insufficient vitamin D levels since it counters bone loss during the post-menopausal stage. It is important that the dosage is monitored carefully since excessive consumption can cause complications including nausea, hypercalcemia and kidney stones.
• Exercise 
  Exercise can be highly beneficial when performed under supervision and after seeking doctor’s approval. Exercises that focus on strength training are recommended for people with osteoporosis. These include squats, push-ups, use of dumbbells and resistance bands. Exercises help strengthen and make the body more flexible, improve coordination and also helps increase bone density.

Lifestyle management

Unlike several other medical conditions which rely on medicines and have little difference in the role played by lifestyle, osteoporosis is all about managing lifestyle and making the right choices.

• Safety
  For people who are at risk for osteoporosis, it is important to prevent falls and fractures. This is more critical in people with an advanced age, as they tend to lose balance faster and have a greater chance to trip. Improve flooring indoors so it isn’t slippery and offers you a good grip. Make sure you have a high bed so it is easier to get in and out. Install grab bars and handles in the toilet to help support you as you sit and get up. Avoid having to climb stairs within your house.
• Exercise
  Regular exercise is a must for those high at risk and those who already suffer the condition. Exercise allows more flexibility and ease of movement. A common symptom of osteoporosis and related ailments is pain and stiffness in the back, spine, thighs, and legs. While the body may crave rest and more sedentary lifestyle owing to these troubles, it becomes more necessary to loosen the surrounding muscle and keep it supple. Exercise also helps in movement and maintains better body balance and alignment, lowering the chances of having a fall.
• Diet
  Having a proper diet rich in foods that help in boosting calcium levels in the body can prove to be useful.
• Maintaining Body Weight
  Those who are overweight are not just more prone to osteoporosis, but also put the body at greater risk of falls and fractures. Managing body weight can be done through diets, exercise and consulting a nutritionist.
• Tobacco and Alcohol
  Excessive consumption of alcohol has been shown to contribute to osteoporosis, and tobacco is known to weaken the bones.
• Getting outdoors
  Being outdoors helps cut down on the sedentary lifestyle, allows some refreshment and recreation and also gives the body much-needed vitamin D. Those at risk sometimes prefer staying confined to the house because of the fear of falls and fractures, but it only causes more damage than good.

Prognosis

Prognosis for osteoporosis is encouraging when it is detected early, and also when the age of the patient is lower. With treatment, risks of fracture may be reduced and density of the bone improves. Even in cases of mild osteoporosis, it is possible for bones to heal quickly and completely. When diagnosed and treated, it is possible for patients to live a quality life.

Complications

Fractures are the most common complication of osteoporosis. The most commonly occurring fractures include fractures of the hip and spine. Hip fractures, in some severe cases, can even cause death as a result of the disability. Bones in the spine may weaken to such a great extent that they are not just susceptible to breaking from a fall or injury, but also cause them to crumple or even bend and result in a hunch. (Read more - Spine fracture)