Osteoporosis — Know It All!

Editorial

Osteoporosis — Know It All!

All you need to know about Osteoporosis.

Osteoporosis 

Know your ailment well, so you can manage it better!!

Here we come with Osteoporosis today!

Overview:

Osteoporosis is a bone condition that occurs when bone mineral density decreases and bone mass decreases, or changes in bone strength or structure. This can result in a reduction in bone strength that may increase the likelihood of fractures (broken bones).

Osteoporosis is a “silent” disease because you usually have no symptoms, and when you break a bone you do not even know that you have the disease. The main cause of fractures in postmenopausal women and older men is osteoporosis. Fractures can occur in any bone but most frequently occur in hip bones, spine vertebrae and wrist.

But you should take measures to help avoid illness and fractures by:

  • Staying physically active by participating in weight-bearing exercises such as walking.
  • Drinking alcohol in moderation.
  • Quitting smoking, or not starting if you don’t smoke.
  • Taking your medications, if prescribed, which can help prevent fractures in people who have osteoporosis.
  • Eating a nutritious diet rich in calcium and vitamin D to help maintain good bone health.
Osteoporosis 

Who gets the disease:

Osteoporosis affects both men and women of every race and ethnic group. Osteoporosis can occur at any age, but as you get older the risk of developing the disease increases. For many women, a year or two before menopause the disease starts to evolve. Other considerations which should be considered include:

  • Osteoporosis is the most common among white women and Asian women who are not Hispanics.
  • The risk of developing osteoporosis is lower for African American and Hispanic women, but they are still at serious risk.
  • In non-Hispanic whites osteoporosis is more common among men.
  • Some medicines, such as some cancer drugs and glucocorticoid steroids, can increase the risk of developing osteoporosis.
  • Since more women undergo osteoporosis than men, many men do not believe they are at risk for the disease. Yet osteoporosis is at risk for both older men and women from all backgrounds.
  • A uncommon type of idiopathic juvenile osteoporosis occurs in some children and teenagers. The cause is not clear to doctors; but most children recover without treatment.
Osteoporosis 

Symptoms:

Osteoporosis is considered a “silent” condition because, usually, there are no signs before a bone is fractured or one or more vertebrae (fracture) breaks. Symptoms of vertebral fracture include extreme back pain, height loss, or spinal malformations such as a stooped or hunched posture (kyphosis).

There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

  • Back pain, caused by a fractured or collapsed vertebra
  • Loss of height over time
  • A stooped posture
  • A bone that breaks much more easily than expected

Osteoporosis-affected bones can become so weak that fractures can occur either naturally or as a result of:

  • Minor falls, such as a fall from standing height that would not normally cause a break in a healthy bone.
  • Normal stresses such as bending, lifting, or even coughing.
Osteoporosis 

Causes:

Osteoporosis happens when so much bone mass is lost, and changes in bone tissue composition occur. Any risk factors may contribute to the development of osteoporosis, or may increase the likelihood of developing the disease.

Many people with osteoporosis have many risk factors but there may be no clear risk factors for those who develop osteoporosis. There are some risk factors you can’t change and some you can change. However you may be able to avoid the disease and fractures by understanding these causes.

Factors which may increase the osteoporosis risk include:

  • Sex. Your chances of developing osteoporosis are greater if you are a woman. Women have lower peak bone mass and smaller bones than men. However, men are still at risk, especially after the age of 70.
  • Age. As you age, bone loss happens more quickly, and new bone growth is slower. Over time, your bones can weaken and your risk for osteoporosis increases.
  • Body size. Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger boned women and men.
  • Race. White and Asian women are at highest risk. African American and Mexican American women have a lower risk. White men are at higher risk than African American and Mexican American men.
  • Family history. Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.
  • Changes to hormones. Low levels of certain hormones can increase your chances of developing osteoporosis.

For example:

  • Low estrogen levels in women after menopause.
  • Low levels of estrogen from the abnormal absence of menstrual periods in premenopausal women due to hormone disorders or extreme levels of physical activity.
  • Low levels of testosterone in men. Men with conditions that cause low testosterone are at risk for osteoporosis. However, the gradual decrease of testosterone with aging is probably not a major reason for loss of bone.
  • Diet. Beginning in childhood and into old age, a diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures. Excessive dieting or poor protein intake may increase your risk for bone loss and osteoporosis.
  • Other medical conditions. Some medical conditions that you may be able to treat or manage can increase the risk of osteoporosis, such as other endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.
  • Medications. Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as:
  • Glucocorticoids and adrenocorticotropic hormone, which treat various conditions, such as asthma and rheumatoid arthritis.
  • Antiepileptic medicines, which treat seizures and other neurological disorders.
  • Cancer medications, which use hormones to treat breast and prostate cancer.
  • Proton pump inhibitors, which lower stomach acid.
  • Selective serotonin reuptake inhibitors, which treat depression and anxiety.
  • Thiazolidinediones, which treat type II diabetes.
  • Lifestyle. A healthy lifestyle can be important for keeping bones strong. Factors that contribute to bone loss include:
  • Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. They also leave you in poor physical condition, which can increase your risk of falling and breaking a bone.
  • Chronic heavy drinking of alcohol is a significant risk factor for osteoporosis.
  • Studies indicate that smoking is a risk factor for osteoporosis and fracture. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis.
Osteoporosis 

Risk Factors:

Age:

The main risk factor for osteoporosis is age. Your body breaks down the old bone in your life, and develops new bone.

But while you are in your 30s, your body tends to break down bone faster than it can replace it. This contributes to less compact and weak tissue, and thus more vulnerable to breakage.

Menopause:

Menopause is another key risk factor that occurs in women aged between 45 and 55. Menopause can cause a woman’s body to lose bone even faster because of the shift in the hormone levels associated with it.

At this age, men begin to lose bone but at a slower pace than women do. However, women and men typically lose bone at the same pace by the time they enter the 65–70 age ranges.

Other risk factors for osteoporosis include:

  • being female
  • being Caucasian or Asian
  • having a family history of osteoporosis
  • poor nutrition
  • physical inactivity
  • smoking
  • low body weight
  • small-boned frame

Any of those risk factors for osteoporosis can be managed, such as inadequate diet and inactivity. You should change your diet, for example, and start an exercise programme, which will help your bone health. But other risk factors, such as your age or gender, can not be regulated.

Diagnosis:

Doctors usually diagnose osteoporosis during routine screening for the disease

  • Women over age 65.
  • Women of any age who have factors that increase the chance of developing osteoporosis.

Due to a lack of available evidence, they don’t recommend osteoporosis screening in men.

During your visit with your doctor, remember to report:

  • Any previous fractures.
  • Your lifestyle habits, including diet, exercise, alcohol use, and smoking history.
  • Current or past medical conditions and medications that could contribute to low bone mass and increased fracture risk.
  • Your family history of osteoporosis and other diseases.
  • For women, your menstrual history.

The doctor may also perform a physical exam that includes checking for:

  • Loss of height and weight.
  • Changes in posture.
  • Balance and gait (the way you walk).
  • Muscle strength, such as your ability to stand from sitting without using your arms).

In addition, your doctor may order a test that measures your bone mineral density (BMD) in a specific area of your bone, usually your spine and hip. BMD testing can be used to:

  • Diagnose osteoporosis.
  • Detect low bone density before osteoporosis develops.
  • Help predict your risk of future fractures.
  • Monitor the effectiveness of ongoing treatment for osteoporosis.

Treatment Options:

The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures. Your health care provider may recommend:

  • Proper nutrition.
  • Lifestyle changes.
  • Exercise.
  • Fall prevention to help prevent fractures.
  • Medications.

People who develop osteoporosis from a different disorder should work with their health care provider to determine the underlying cause and treat it. If you are taking a medication that causes bone loss, for example, your doctor can lower the dosage of that medication or move you to another medication. If you have a condition requiring long-term glucocorticoid therapy, such as rheumatoid arthritis or chronic lung disease, you can also take some approved drugs for the prevention or treatment of aging-related osteoporosis or menopause.

Nutrition:

An important part of treating osteoporosis is eating a healthy, balanced diet, which includes:

  • Plenty of fruits and vegetables.
  • An appropriate amount of calories for your age, height, and weight. Your health care provider or doctor can help you determine the amount of calories you need each day to maintain a healthy weight.
  • Foods and liquids that include calcium, vitamin D, and protein. These help minimize bone loss and maintain overall health. However, it’s important to eat a diet rich in all nutrients to help protect and maintain bone health.

Calcium and Vitamin D:

Calcium and vitamin D are essential nutrients for osteoporosis prevention and helping bones achieve peak bone mass. If you don’t take enough calcium, the body can flush it out of the bones, which can result in bone loss. This can make the bones fragile and thin, which can contribute to osteoporosis.

Good sources of calcium include:

  • Low-fat dairy products.
  • Dark green leafy vegetables, such as bok choy, collards, and turnip greens.
  • Broccoli.
  • Sardines and salmon with bones.
  • Calcium-fortified foods such as soymilk, tofu, orange juice, cereals, and breads.

Vitamin D is essential for calcium absorption from the intestine. After exposure to sunlight it is made in the skin. Naturally, some foods contain ample vitamin D including fatty fish , fish oils, egg yolks and liver. Other foods fortified with vitamin D form a significant mineral source, including milk and cereals.

Osteoporosis 

BiPhosphonates:

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

  • Alendronate
  • Risedronate
  • Ibandronate
  • Zoledronic acid

Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly.

Intravenous forms of bisphosphonates don’t cause stomach upset but can cause fever, headache and muscle aches for up to three days. It might be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so.

Monoclonal Antibodies:

Compared with bisphosphonates, denosumab (Prolia, Xgeva) produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months.

If you take denosumab, you might have to continue to do so indefinitely. Recent research indicates there could be a high risk of spinal column fractures after stopping the drug.

A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thigh bone.

A second rare complication is delayed healing of the jawbone (osteonecrosis of the jaw). This can occur after an invasive dental procedure such as removing a tooth.

You should have a dental examination before starting these medications, and you should continue to take good care of your teeth and see your dentist regularly while on them. Make sure your dentist knows that you’re taking these medications.

  • Hormone therapy will also be suggested sometimes.

Coping with Osteopetrosis:

  • Aside from the medications prescribed by your doctor, the following suggestions will help you manage and live with osteoporosis, avoid fractures and avoid falls.
  • When you have osteoporosis, it is important to avoid fractures, since fractures can cause other medical complications and lose your independence. When your health care professional tailors a programme to your particular needs, exercise will help avoid injuries that occur as a result of falling and strengthen bone strength. If you have osteoporosis or bone loss, consult with your doctor or physical therapist before starting any exercise programme.
  • Additionally, falls avoidance helps avoid fractures. Umbles improve the risk of breaking a bone in the shoulder, leg, spine or other skeleton. Taking precautions both inside and outside the house to avoid falls will help prevent fractures.

Some factors which could contribute to falling include:

  • Loss of muscle mass.
  • Illnesses that impair your mental or physical functioning, such as low blood pressure or dementia.
  • Use of four or more prescription medications.
  • Poor vision.
  • Poor balance.
  • Certain diseases that affect how you walk.
  • Alcohol use.
  • Side effects of some medications, such as:
  • Sedatives or tranquilizers.
  • Sleeping pills.
  • Antidepressants.
  • Anticonvulsants.
  • Muscle relaxants.
  • Heart medicines.
  • Blood pressure pills.
  • Diuretics.

 

References:

https://www.mayoclinic.org/diseases-conditions/osteoporosis/diagnosis-treatment/drc-20351974

https://www.healthline.com/health/osteoporosis#osteopenia

https://www.niams.nih.gov/health-topics/osteoporosis/

 

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.