Osteoporosis: Types, Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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A physiotherapist make exercise to an older women who suffer from osteoporosis

1Overview

The bones are very important in the body. They play an important role in the overall function of the body. The bones provide a frame for the body, protect important organs like the lungs, heart, and brain, and produce blood that is crucial for the delivery of oxygen and nutrients to the various tissues and cells.

Many conditions may affect the bones. One of the most common disorders is osteoporosis, a condition wherein there is a decrease in the bone density and enlargement of bone spaces. As a result, the bones become progressively brittle, fragile and porous. People with osteoporosis may fracture easily, making it hard for them to perform daily activities.

In history, osteoporosis is one of the most ancient diseases. In fact, during the 220 B.C., this disease has been present during the time of the Ancient Egyptians. Ancient mummies were found to have evidence of osteoporosis and osteoarthritis.

An estimated 75 million people in Japan, the United States, and Europe have osteoporosis. In 2010, approximately 22 million women and 5.5 million men were diagnosed with osteoporosis in Europe. In the other hand, in the same year, eight million women and two million men had osteoporosis.

Across the globe, the disease affects about 200 million women. Women are at a higher risk of developing the disease. In fact, one in 3 women who are 50 years old and above will experience osteoporotic fractures. Consequently, about one in five men over the age of 50 will also experience osteoporotic fractures.

The most common injuries in people with osteoporosis are hip fractures, wrist fractures, and fractures in the spinal column.

2Types

Primary Osteoporosis

It is considered as the most common type of osteoporosis. Primary Osteoporosis is tied to the process of normal aging and the condition progresses at menopause. Many studies have linked the two hormones, estrogen, and progesterone to the development of osteoporosis.

Idiopathic juvenile

Idiopathic juvenile osteoporosis occurs during infancy to adolescence. In this type of osteoporosis, the immune system of the child is weak and becomes overactive even when there is no infection to fight. As a result, it mistakenly attacks the healthy tissues.

Secondary Osteoporosis

An underlying condition causes this type of osteoporosis. It can be medical conditions or treatments that interfere with the amount of bone mass. Eventually, this leads to bone loss. The medical conditions may include multiple sclerosis, rheumatoid arthritis, liver impairment and others. Secondary osteoporosis can also have hormonal causes such as hyperthyroidism and diabetes.

Osteogenesis imperfecta

Osteogenesis imperfect is a condition characterized by abnormalities in the type I collagen synthesis. People with this condition regularly develop hyperplastic calluses in their long bones after having a fracture or orthopedic surgery that involves osteotomies.

3Symptoms

Osteoporosis is often called the “silent disease” because bone loss occurs without symptoms. However, the following may include if osteoporosis has caused weakened bones.

  • Cramps, muscle aches, and bone pain
  • Weak and brittle fingernails
  • Height loss
  • Stooped posture

4Causes

The bones are in a permanent state of change, wherein new bones are produced and old ones are broken down. In younger people, the body makes new bone faster than it breaks them down. When a person ages, there is a loss of bone mass because the body can’t make new bones faster than breaking it down.

Losing bone mass is normal in the aging process but in some cases, people lose bone density faster than others. This may lead to the condition called osteoporosis. Women also lose bone mass much faster than men, particularly when they reach menopause.

In most cases, the leading cause of the bone condition is the decreased levels of hormones in the body, like estrogen in women and androgen in men. When people have higher peak bone mass during their adult years, they are at a lower risk of developing the condition.

5Risk Factors

Some factors may increase the risk of a person developing osteoporosis in later life. These include:

Non-modifiable Factors

Age

The older a person gets, the higher the risk of developing osteoporosis.

Family history

People with family members who had the condition are more likely to develop it, too.

Gender

Women who had the menopause before the age of 45 are more likely to develop osteoporosis than men.

Body frame size

Men and women who have small body frames have a higher risk of having osteoporosis because they may have less bone mass.

Modifiable Factors

Diet

Osteoporosis is more likely to occur in individuals who have low calcium intake, gastrointestinal surgery, eating disorders and inadequate intake of calcium and vitamin D.

Physical activity

Lack of physical activity has been linked to the development of osteoporosis.

Lifestyle choices

People who spend a lot of time sitting down are at a heightened risk of developing osteoporosis. Any exercise, weight-bearing, and cardio could benefit your bones. Moreover, excessive alcohol consumption and cigarette smoking increase the risk of osteoporosis.

Other risk factors for osteoporosis:

6Complication and Related Diseases

If left untreated, osteoporosis may lead to other conditions like bone fractures.
These fractures usually occur in the hip and spine. When there is severe osteoporosis, a simple cough or sneeze may induce painful fractures in the spine and ribs. When these fractures happen regularly, they may lead to bone deformity.

An estimated 50 percent of women and 25 percent of men who are more than 50 years old will have an osteoporosis-related fracture in their lifetime. In fact, there are about 250,000 broken wrists, 300,000 hip fractures, 700,000 spinal fractures and more than 300,000 fractures of other bones every year. All these are related to osteoporosis.

Some related diseases also attribute having osteoporosis like Rheumatoid arthritis, type 1 diabetes, an overactive thyroid and any condition that causes poor mobility.

7Diagnosis

Here are the diagnostic tests for osteoporosis:

Risk assessment tools

If the doctor suspects osteoporosis in a patient, there is an online program called Q-fracture and FRAX. These risk assessment tools predict a person’s risk of fracture when they reach the age of 40 to 90 years old.

DEXA scan

A doctor may also recommend the DEXA (DXA) scan to measure the mineral density of the bone.

8Treatment

The treatment of osteoporosis is based on the estimate of the risk of having fractures in the next ten years. The treatment aims to prevent the development of osteoporosis or slow down its progression, maintain a healthy bone mass, reduce the pain, prevent fractures and maximize the person’s lifestyle and use of supplements.

Medicines

The treatment methods and prevention are keys to the management of osteoporosis. The most commonly-used drugs to help prevent and treat osteoporosis include:

Estrogen agonists or antagonists

These drugs are also called selective estrogen-receptor modulators (SERMS). They can help reduce the risk of fractures in the spinal column in women after menopause.

Biphosphonates

These drugs are antiresorptive drugs that can help slow down bone loss and dramatically decrease the risk of fractures.

Parathyroid hormone

This is recommended for people with a high risk of fracture. For example, teriparatide or Forteo is a drug which can stimulate bone formation.

RANK ligand (RANKL) inhibitors

Included in this group is denosumab (Xgeva), which is a drug that is part of immune therapy.

Calcitonin

This will help prevent spinal fracture in women who have reached their post-menopausal stage.

Fall prevention

An important objective for everyone who’s dealing with osteoporosis patients is to prevent falls and fractures. Falls are common in older adults that’s why the use of assistive devices like walkers and crutches is vital.

9Prevention

You can build strong bones and prevent osteoporosis with these measures:

Good nutrition

Good nutrition with adequate amounts of proteins, which are the building blocks of bones, calcium, and vitamin D is important to promote bone health.

Maintain a healthy body weight

Being underweight may predispose a person to bone loss. In the other hand, being overweight may increase the risk of fractures. Thus, maintaining a healthy weight is important.

Exercise

Exercise can help build strong and sturdy muscles and slow the progress of bone loss. Regular exercise has many benefits – to the bones, muscles and cardiovascular health. Aside from improving the circulation in the body, exercise helps strengthen the bones and muscles, warding off fractures and weak bones.

Here are other ways to prevent the development of osteoporosis:

  • Eat the proper foods is essential for good nutrition.
  • Eat a diet rich in calcium. If the doctor recommends, you can also take calcium supplements.
  • Have adequate vitamin D supply through diet and sunlight exposure.
  • Engage in weight-bearing exercises including jogging, climbing stairs, playing tennis, hiking, walking and dancing.
  • Practice resistance exercises like those activities that use muscle strength to promote the build-up of muscle mass. These activities include weight lifting.
  • Quit smoking because tobacco use is bad for the bones.
  • Limit your alcohol intake. Excessive alcohol drinking may damage your bones.
  • Restrict caffeine and salt intake. The limitation of these two substances has been linked to the reduction of bone loss.