Osteoporosis

Osteoporosis represents a medical condition that affects the bones making them fragile and susceptible to painful fractures. Bone brittleness is extremely severe, which means that even normal and simple actions like falling, coughing or bending over could lead to a broken spine, wrist or hip. Normally, bones contain protein, calcium and collagen, which are imperative for maintaining their strength. In addition, similar to a honeycomb, bones have small spaces inside. Nevertheless, when osteoporosis occurs, the bones lose density and strength after the respective spaces increase in size. Not only the inside of the bone, but also the outside bears consequences, taking into consideration that it starts giving signs of weakness and thinning. Even though all people, regardless of the age, can develop osteoporosis, elderly women face the greatest risk of developing this condition. According to specialists, bone mass starts to decrease from the age of 35 so the damage begins earlier in life. Besides age, other risk factors refer to genetics, excessive alcohol consumption and cigarette smoking, lack of exercise and low body weight. People with osteoporosis do not experience alarming symptoms until the apparition of bone fractures. For establishing a diagnosis of osteoporosis, doctors use X-rays and other medical tests for bone density measurement. The treatment includes prescription medications, adequate physical exercise, calcium and vitamin D.

 

Osteoporosis Causes and Risk Factors

Even though people are not familiar with the concept of bone renewal, it represents a normal process that consists in breaking down bone tissue to release minerals, namely calcium and phosphate, thus enabling the passage of calcium from bone tissue in the blood. Practically, bone renewal refers to breaking down old bone and making new healthy and strong bone. When young, forming new bone occurs faster than breaking down old bone. However, with age, things change and the body fails to make sufficient new bone. The imbalance between bone formation and bone destruction provokes osteoporosis. Calcium is fundamental for bone production and proper functioning of various organs, which means that if the body does not absorb calcium properly bones become fragile and brittle, increasing the chances of bone fractures.

The main cause of osteoporosis is the lack of estrogen, androgen and other hormones. Menopause represents an event that increases the likelihood of developing this condition by lowering estrogen levels, which explains statistics results, namely that women over 60 are more prone to suffer from osteoporosis. This inevitably leads us to the next cause, which is age. Apparently, after the age of 30, the body is not able to replace bone as fast as needed, resulting in weaker bones susceptible to breakage. Apart from age and menopause, specialists recognize another cause that may lead to osteoporosis, which refers to the presence of other medical conditions, which implies the use of medications like cortisone and prednisone, either orally or intravenously for a long period.

Researchers also link several risk factors with osteoporosis, which involve a history of fracture, thin body frame, poor nutrition, lack of vitamin D, physical inactivity, exceeding the limits of alcohol consumption and cigarette smoking, immobility, chronic inflammation provoked by rheumatoid arthritis or other diseases and family history, more exactly having a close relative, a sibling or a parent, with osteoporosis.

 

Signs and Symptoms of Osteoporosis

People with osteoporosis do not experience any signs or symptoms in the early stages of the disease. Nevertheless, after decades of silent bone damage, fractures become inevitable. Surprisingly, even osteoporotic fractures pass undetected if they do not come associated with pain. The only situation when people react accordingly and seek medical attention is when they feel pain caused by a fracture in a certain area of their body. Osteoporosis manifests the same in both men and women. With the passage of time, patients start experiencing chronic back pain due to multiple spinal fractures as well as curving of the spine, also called swayback, because of collapsed vertebrae. As a result, people get a “dowager hump”, name given due to the hunched-back appearance. Those with osteoporosis may engage in normal, everyday activities without even crossing their mind the possibility of a bone fracture, which specialists refer to as a minimal trauma. In some cases, walking can lead to fractures in the lower limbs while in other cases a minor slip and fall accident may result in hip fractures. A surgical intervention becomes the most logical step in these situations, but the problem is that, because of bone weakness, the fractures heal very slowly. Besides painful fractures, which represent the most alarming sign of osteoporosis, occasional symptoms of the condition may involve brittle nails, receding gums and loss of grip strength.

 

Complications of Osteoporosis

Osteoporotic bone fractures can dramatically impact the life of a person by provoking considerable pain and disability, which result in lost workdays and frustration. A good percentage of patients experiencing a hip fracture need nursing-home care for a long period. Elders are susceptible to developing pneumonia and pulmonary embolism due to physical inactivity and prolonged bed rest. In severe cases, osteoporosis can even lead patients to death. Furthermore, a person that suffered a spine fracture in the past faces a high chance of experiencing another similar fracture in the following years. Many postmenopausal women suffering a vertebral facture will experience another vertebral fracture in the subsequent year. In some cases, women die approximately a year after experiencing a hip fracture. Patients should not take lightly potential complications of osteoporosis.

 

Prevention of Osteoporosis

Even if people do not pay great attention to this aspect, they can maintain the health of their bones over the years by making certain beneficial choices, like exercising regularly and consuming good foods. Protein represents the main element that stands at the base of strong bones and people can get plenty of it by educating themselves regarding the suitable sources. For vegans and vegetarians, legumes, soy, nuts and eggs, among others are ideal. Protein supplementation also represents an option.

Men and women under 50 need approximately 1000 milligrams of calcium daily. After the age of 50 in women and 70 in men, the amount increases. For this reason, people need to seek more and more good sources of calcium. These involve calcium-rich cereals, salmon and sardines, dairy products, tofu and orange juice. For people who simply cannot track their meals every day, calcium supplements once again come in handy. On the other hand, excessive calcium intake could lead to kidney stones, which means that finding a balance is advisable. According to specialists, elders should not exceed 2000 milligrams calcium intake per day. Vitamin D ensures better calcium absorption and improves bone strength. Exposure to sunlight can help in this regard.  However, people should not exceed the limits set by scientists. Otherwise, they could face a higher risk of skin cancer. When sun exposure does not represent a viable option, vitamin D supplements are a good alternative.

Physical activity, more specifically balance and weight bearing exercises, can increase bones strength and prevent fast bone loss. Those who start exercising in their youth and continue over the years enjoy the most benefits. In terms of balance exercises, tai chi is very helpful especially in elders because it minimizes the chance of falling. Weight bearing exercises like jogging, stair climbing, skiing and skipping rope affect the bones in the lower part of the body, which includes hips, legs and lower spine while strength training works the muscles and strengthens the bone in the upper part of the body including upper spine and arms.

 

Diagnosis of Osteoporosis

Establishing a diagnosis of osteoporosis requires a complex and time-consuming process. The doctor begins by speaking with the patient in order to discover more information concerning his medical history, which will help him to determine if the patient may have osteoporosis or may be at risk for developing the condition. Some questions may refer to the patient’s lifestyle and the presence of other medical conditions. A history of broken bones and a relative diagnosed with osteoporosis represent major clues for the doctor who proceeds by performing several blood tests with the purpose to measure testosterone, phosphorus, vitamin D, calcium, kidney and thyroid function. After a thorough medical examination, the doctor may suggest a bone mineral density test, which together with the blood tests constitutes the base of an accurate diagnosis. Doctors give major importance to the results of these tests because it practically allows them to establish a diagnosis of osteoporosis and provide the necessary medical treatment.

If the patient has osteopenia, his bone density is lower than normal but not serious enough to classify it as osteoporosis. However, experts take the presence of osteopenia as a sign that the person in question will eventually suffer from osteoporosis. The bone mineral density test has many functions. First, it impedes potential fractures from occurring by helping doctors detect osteoporosis early. Secondly, it enables doctors to assess the bone loss rate after the treatment in order to establish its efficiency. For measuring bone density in various parts of the body, doctors can use several machines, which are non-invasive and painless. For instance, central machines like DXA are suitable for hip and spine while peripheral machines like SXA are more adequate for heel, kneecap, wrist, finger and other areas. The patient simply needs to lie on his back and let the X-ray machine move over the hip and lower spine. For measuring bone density in the heel, the doctor asks the patient to place his bare foot in a water bath and allow the machine to examine the area by using ultrasound waves. If this test gives signs of bones loss, the doctor usually recommends a DXA in order to confirm the results and obtain a more exact bone density measurement. Finally, he makes a comparison between the patient’s bone mineral density results and the normal standards, according to his age, sex and weight. If there is a major difference, more exactly if the patient’s bone mineral density is much lower than normal, the doctor can safely establish a diagnosis of osteoporosis. Moreover, the results will help him decide which represents the most efficient method for the patient to manage his bone health.

 

Treatment for Osteoporosis

Doctors cannot provide a miracle treatment that has the power to reverse osteoporosis. For this reason, they focus mainly on slowing down the mineral loss, building stronger bones, impeding fractures from occurring and managing the pain caused by this condition. The treatment for osteoporosis demands work team meaning that generalists, internists, endocrinologists, gynecologists, rheumatologists and bone surgeons must collaborate in order to offer the patient the needed care. The medical solutions for dealing with osteoporosis are similar with the prevention methods recommended by experts and refer to lifestyle changes involving reducing excessive alcohol intake, quitting cigarette smoking, exercising regularly and approaching a healthier diet rich in vitamin D and calcium. Doctors may add medications to these beneficial changes, which include calcitonin and alendronate because they can increase bone strength and formation as well as stopping bone loss.

Doctors warn patients to choose their exercise program with caution because they could provoke injuries to already weakened bones. Elders with high blood pressure, diabetes mellitus, heart disease and obesity should really consult a physician who can suggest the most adequate exercises and monitor the patients’ activity. Taking this efficient method to the extreme may result in promoting osteoporosis instead of preventing and healing it. Cigarette smoking can lead to decreased estrogen levels and bone loss as well as earlier menopause in women. Researchers link smoking to a great risk of developing osteoporosis. Therefore, by eliminating this vicious habit from their life, patients contribute to their own treatment. In what concerns alcohol and caffeine, experts cannot strongly confirm their link with osteoporosis. However, they suggest moderated consumption of both.  These methods do not provide excellent results if the patient does not include in his diet the necessary calcium and vitamin D. Generally, patients tolerate well calcium supplements, even though side effects may include constipation and indigestion. If the patient already takes certain medications like omeprazole, used in treating GERD, this can interfere with calcium carbonate absorption. Patients with celiac disease must avoid certain foods that contain gluten.

AAOM Editor

Academic Association of Medicine is the go to resource for all health related issues. We are an independent body that seeks to offer general information on various health topics and unbiased reviews on health products.

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