What is Osteoporosis?
Osteoporosis is a term that refers to spongy (porous) bones.
Minerals, primarily calcium salts, are bonded together in bone by strong collagen fibers. Our bones are surrounded by a thick, hard outer shell (referred to as cortical or compact bone) that is plainly seen on x-rays. Within this lies a softer, spongier bone matrix (trabecular bone) with a honeycomb-like structure.
Bone is a living tissue that is continually renewing. Osteoclasts break down old bone tissue and replace it with new bone material created by osteoblasts.
The balance between bone breakdown and bone production varies throughout our lifetimes.
New bone is generated rapidly throughout infancy and adolescence. This promotes bone growth and strength (denser). By our mid-to-late-20s, our bone density has reached its maximum.
Following this, new bone is formed at a rate roughly equal to the pace at which older bone is broken down. This implies that during a period of 7–10 years, the adult skeleton is entirely regenerated.
After the age of roughly 40, the bone begins to degrade faster than it is replenished, and our bones gradually lose their density.
While we all experience some degree of bone loss as we age, the term osteoporosis is reserved for cases in which the bones become very fragile. When bone is afflicted by osteoporosis, the pores in the honeycomb structure get wider, and the total density of the bone decreases, which in turn increases the chances of fracture.
What are The Causes of Osteoporosis?
Here are some of the reasons for getting osteoporosis:
1) Corticosteroids
Corticosteroids (steroids) are used to treat a variety of inflammatory disorders, including rheumatoid arthritis. They may impair bone formation by decreasing calcium absorption from the stomach and increasing calcium excretion via the kidneys.
If your doctor thinks that you need corticosteroids (like prednisolone or cortisone) for more than three months, then he or she will recommend calcium and vitamin D supplements to help avoid osteoporosis.
2) Deficiency of Estrogen in the body
If you experience menopause prematurely (before the age of 45) or have a hysterectomy in which one or both ovaries are removed, your risk of getting osteoporosis rises.
This is because they significantly decrease your body’s estrogen production, which accelerates the process of bone loss. Although removing just the ovaries (ovariectomy or oophorectomy) is uncommon, it has been associated with an increased risk of osteoporosis.
3) Absence of Weight-Bearing Exercise
Exercise promotes bone formation, and a lack of exercise puts you at a higher risk of calcium loss from the bones and causes osteoporosis. Because muscle and bone health are interconnected, it’s also crucial to maintain muscular strength, which reduces your chance of falling.
Though women who exercise to such an extent that their menstruation stops are also at an increased risk, since their estrogen levels will get reduced.
4) Poor Nutrition
If your diet is deficient in calcium or vitamin D, or if you are very underweight, then you are at an increased risk of developing osteoporosis.
5) Smoking Excessively
Tobacco is directly damaging to the bones. In women, it decreases the estrogen levels and may result in early menopause. In males, smoking decreases testosterone activity, which may cause weakening of bones.
6) Excessive Drinking
Excessive alcohol consumption impairs the body’s capacity to make bone. Additionally, it raises the chance of fracturing a bone due to a fall.
7) Family History
Osteoporosis also runs in families, most likely due to hereditary factors affecting bone development. If your close relative has had an osteoporosis-related fracture then your own risk of getting a fracture is higher than normal.
Although we do not know if a specific genetic fault causes osteoporosis, we do know that individuals with a relatively very rare genetic disorder known as osteogenesis imperfecta are more prone to have fractures.
8) Other Causes of Osteoporosis
Here are some other causes:
- Underweight body
- Earlier fractures
- Ethnicity
- Medical diseases, (such as celiac disease) or sometimes treatments that restrict food absorption
What are The Symptoms of Osteoporosis?
Treating osteoporosis at an early stage is the most effective approach to avoid some of the more severe outcomes, such as bone fractures or bone pain.
Therefore, what symptoms should you be looking for and when do they manifest? Let’s take a closer look at what is known about the early and later stages of osteoporosis.
Signs and Symptoms of Early-Stage Osteoporosis
Early detection of bone loss is uncommon. Oftentimes, individuals are unaware they have weak bones until they break a hip, wrist, or other bone.
But a few signs and symptoms may indicate possible bone loss, which are as follows:
1) Receding Gums
If your jaw is losing bone, your gums may recede. You can inquire with your dentist about screening for jaw bone loss.
2) Reduced Grip Strength
Researchers discovered that poor handgrip strength was associated with decreased bone mineral density in postmenopausal individuals (1). Additionally, decreased grip strength may increase your chance of falling.
3) Weak and Fragile Fingernails
Nail strength may be a good indicator of bone health. However, you should consider other variables that may impact your nails, such as exposure to very hot or cold temperatures, frequent use of nail paint remover or artificial nails, or prolonged submersion in water.
Apart from changes in bone density, osteoporosis does show a few initial symptoms. The best way to diagnose osteoporosis early is to speak with your doctor or healthcare expert, particularly if you have a family history of this ailment.
Signs and Symptoms of Later-Stage Osteoporosis
Once your bone density continues to degrade, you may begin to encounter more noticeable symptoms, like:
1) Loss of Height
Compression fractures in the spine may result in a loss of height. This is a very visible indication of osteoporosis.
2) Back or Neck Pain
Osteoporosis may result in compression fractures of the spine.
These fractures can be very painful as the collapsing vertebrae may potentially pinch the nerves that radiate from the spinal cord. The possible pain symptoms present are minor tenderness to excruciating pain.
3) A Fracture Caused By a Fall
A fracture is one of the most typical indications of fragile bones. Fractures may develop as a result of a fall or as a result of little movements, such as stepping off a curb. Certain types of osteoporosis fractures may be precipitated by a strong sneeze or cough.
4) Stooped Posture
Compression of the vertebrae may also result in a little curving of the upper back. A stooped back is referred to as kyphosis, and it may result in back and neck discomfort.
It may even impair breathing owing to the increased pressure in the airway and the lungs’ restricted expansion.
What are The Risk Factors for Osteoporosis?
Numerous factors, including your age, race, lifestyle choices, and medical conditions and medications, might raise your risk of developing osteoporosis.
A) Unchangeable Risk Factors
Certain risk factors for osteoporosis are beyond your control, like:
1) Age
As you get older, your risk of developing osteoporosis increases.
2) Your Gender
Women are significantly more prone than males to develop osteoporosis.
3) Race
If you are white or of Asian ancestry then you are at higher risk of osteoporosis.
4) Body Frame
Men and women with small body frames are at an increased risk, since they may have less bone mass to draw from as they age.
5) Family history
If you are having a parent or sibling with osteoporosis then you have a higher risk of osteoporosis.
B) Hormone Levels
Osteoporosis is more prevalent in those who have abnormally high or low levels of particular hormones in their body. Following are some of these examples:
1) Thyroid Problems
Excess thyroid hormone might result in bone loss. This may happen if your thyroid is too active or if you use an excessive amount of thyroid hormone therapy to treat an underactive thyroid.
2) Sex Hormones
Lowered sex hormone levels are associated with bone deterioration. Menopause-related decrease in estrogen levels is one of the biggest risk factors for developing osteoporosis.
Prostate cancer therapies that decrease testosterone levels in males and breast cancer treatments that decrease estrogen levels in women are both likely to hasten bone loss.
3) Some Other Glands
Additionally, osteoporosis has been linked to hyperactive parathyroid and adrenal glands.
C) Some Medical Conditions
The risk of development of osteoporosis is greater in people who have certain medical problems, like:
- Kidney or liver disease
- Celiac disease
- Cancer
- Multiple myeloma
- Inflammatory bowel disease
- Rheumatoid arthritis
D) Steroids and Some Other Medications
Long-term use of corticosteroids (like prednisone, cortisone, etc.) affects the bone-rebuilding process.
The development of osteoporosis is also linked with some other medications used to combat or prevent the following diseases:
- Cancer
- Gastric reflux
- Seizures
- Transplant rejection
E) Dietary Factors
Following individuals are more prone to develop osteoporosis who have:
1) Eating Issues
Severe dietary restriction and being underweight impair both men’s and women’s bones.
2) Low Calcium Intake
A chronic deficiency of calcium contributes to the development of osteoporosis. Calcium deficiency is associated with decreased bone density, early bone loss, and a higher risk of fractures.
3) Gastrointestinal Surgery
Surgery for reducing the size of your stomach or removing a portion of your intestine reduces the amount of surface area available for nutritional absorption, including calcium.
These procedures include those that aid in weight loss and those that treat other gastrointestinal diseases.
F) Lifestyle Habits
Some bad lifestyle habits can raise your risk of osteoporosis, like:
Alcohol Consumption
Prolonged consumption of more than two alcoholic drinks a day raises your risk of osteoporosis.
Sedentary Lifestyle
People who are more active have a lower risk of osteoporosis than those who spend a lot of time sitting. Activities that promote balance and good posture and weight-bearing exercises are beneficial for your bones and decrease the risk of osteoporosis.
Use of Tobacco
It has been revealed that the use of tobacco contributes to weaker bones.
Diagnosis of Osteoporosis
To diagnose osteoporosis, your doctor will review your medical history and any risk factors, and also do a physical exam. He/She may also suggest tests of your blood and urine to check for medical conditions that may lead to bone loss.
If your doctor suspects osteoporosis then they will suggest you a bone mineral density (BMD) scan.
This scan helps to diagnose osteoporosis, estimate your risk of fracture, and decide if you need therapy.
It is most often conducted using dual-energy X-ray absorptiometry (DXA or DEXA) or densitometry of bone. The DXA equipment measures the number of x-rays received by tissues and bone and connects it with bone mineral density.
The DXA device transforms your bone density data to a T and Z score. The T score compares your bone density to that of a typical population of younger individuals and is used to determine your risk of fracture and the requirement for treatment. Your Z score indicates how much bone you have in relation to others of your age. This figure may assist in determining if more medical testing is necessary.
An ultrasound scan of the heel bone is also used by doctors in the primary care setting (2). It normally tests the heel of your foot and can also detect early signs of osteoporosis.
The following techniques may be used to identify osteoporosis-related bone fractures:
1) Bone X-Ray
A bone x-ray generates pictures of the bones in the body, such as the hand, wrist, arm, elbow, shoulder, foot, ankle, leg (shin), knee, thigh, hip, pelvis, or spine.
It assists in the detection of broken bones, which are sometimes caused by osteoporosis.
2) CT Scan of the Spine
A CT scan of the spine is used to determine the alignment and presence of fractures. It may be used to estimate bone density and the likelihood of vertebral fractures.
3) Magnetic Resonance Imaging (MRI) of the Spine
MRI of the spine is applied to analyze vertebral fractures for indications of the underlying illness, such as cancer, and to determine if the fracture is new or old. New fractures often respond more favorably to vertebroplasty and kyphoplasty.
What is the Treatment of Osteoporosis?
The aim of the treatment of osteoporosis is to:
- Sustain healthy bone mineral density and bone mass
- Prevent fractures
- Slow or stop the development of osteoporosis
- Maximize the individual’s ability to carry on with their daily life
- Diminish pain
Individuals who are at risk of developing osteoporosis and fractures can use supplements, preventive lifestyle measures, and certain medicines to attain these goals.
Osteoporosis Medications
There are several FDA-approved medications available for the treatment of osteoporosis, including the following:
Bisphosphonates
Bisphosphonates like alendronate, ibandronate acid, and risedronic acid are antiresorptive drugs that slow down bone loss and reduce a person’s fracture risk.
It is important to follow the instructions exactly because if you take these medicines incorrectly, they can lead to ulcers in your esophagus.
Calcitonin
Calcitonin helps to prevent spinal fracture in postmenopausal women and also help to manage pain after a fracture.
Parathyroid Hormone
The U.S. FDA (Food and Drug Administration) has approved this hormone for treating people who have a high risk of fracture as it can stimulate bone formation.
Hormone therapy
Estrogen used during and after menopause can aid stop bone density loss in women. But estrogen therapy is linked associated with increased risk of certain types of cancer, blood clots, and heart disease.
Selective estrogen receptor modulators (SERMs)
The estrogen agonists or antagonists, also known as selective estrogen-receptor modulators (SERMS), can reduce the risk of spine fractures in women following menopause.
Raloxifene is its one example, which mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks linked with estrogen. But it may increase your risk of blood clots.
Testosterone
Testosterone therapy in men may help to increase bone density.
Monoclonal antibodies
Monoclonal antibodies like denosumab, and romosozumab, are immune therapies that treat women who have gone through menopause and are at a high risk of having fractures.
Denosumab is given by injection and is an antibody that prevents the formation of cells that break down bone, resulting in less bone loss.
Romosozumab is a monoclonal antibody which blocks the effects of the protein sclerostin and works mainly by increasing new bone formation. It is also given by injection under the skin once a month with a limit of 12 doses.
These medications need a prescription and a medical examination will be required prior to treatment.
Vertebroplasty and Kyphoplasty
Osteoporosis may result in compression fractures of the vertebra. Vertebroplasty and kyphoplasty may be options in some circumstances to treat painful spine fractures. Vertebroplasty is a procedure that utilizes imaging guidance to inject a particular cement mixture into the broken bone using a hollow needle. A balloon is injected via the needle into the cracked bone to create a cavity during kyphoplasty. After removing the balloon, a cement mixture is injected into the cavity.
Surgical therapy may be necessary for certain instances of compression fracture, particularly if there is evidence of significant spinal canal constriction.
What are the Complications of Osteoporosis?
Along with increasing your vulnerability to breaks and fractures, osteoporosis may result in the following complications:
1) Restricted Mobility
Osteoporosis may be crippling and severely limit your physical activity. Reduced physical activity may result in weight gain. Also, it can put additional strain on your bones, mainly your knees and hips. Excess weight gain can raise your risk of developing other health concerns, like diabetes and heart diseases.
2) Pain
Osteoporosis-related fractures may be very painful and debilitating.
Spinal fractures may cause:
- Reduction in height
- Chronic back and neck discomfort
- A hunched posture
3) Depression
Reduced physical activity might result in diminished independence and social isolation. You may find that activities you formerly loved are now too painful. This loss, when combined with the possibility of fractures, might result in depression. A negative mental state can also inhibit your ability to handle health problems. An optimistic, forward-thinking attitude is beneficial when confronted with any medical problem.
4) Hospital Admission
Certain individuals with osteoporosis may shatter a bone without realizing it. However, the majority of shattered bones need hospitalization. This process often requires surgery, which may need a lengthier hospital stay and significant medical costs.
5) Nursing Home Care
A hip fracture often needs long-term care in a nursing facility. If a person is bedridden while getting long-term care, they are more likely to encounter the following:
- Greater vulnerability to infectious illnesses
- Cardiovascular complications
- Raised predisposition to numerous other health complications
You should consult with your doctor to learn more about these possible risk factors. Also, the doctor can assist you in developing a proper treatment and care plan as and when needed.
What are the Stages of Osteoporosis?
Osteoblasts and osteoclasts are two distinct types of bone cells (osteocytes). Osteoblasts are cells that synthesize bone in response to both mechanical stresses on your bones and growth stimuli such as hormones.
Osteoclasts are responsible for breaking down and resorbing bones. They resemble miniature demolition and recycling plants.
Both of these cells function in tandem to constantly remodel your bones as you develop and progress through life’s stages. By the time you reach the age of around 30, you can assume to have regenerated five whole skeletons.
1) Peak Bone Density and the First Stage of Osteopenia and Osteoporosis
Your peak bone density is reached when the pace of fresh bone remodeling by osteoblasts exceeds the rate of bone breakdown by osteoclasts.
Between the age of 30-35 (or perhaps 25-30 in some people), the rate of bone deposition reduces to about equal to that of bone disintegration. This condition of equilibrium may be considered the first stage of decreasing bone mineral density, a process known as leaching.
2) Second Stage of Osteopenia and Osteoporosis
Between the age of 25-35, bone degradation will finally outpace bone deposition. Bone loss occurs at a rate of around 0.25 percent per year and is very variable based on a variety of hereditary and environmental factors. This is known as the second stage of osteopenia and osteoporosis.
It is important to recognize that this is an entirely natural component of the ageing process. However, unlike the first wrinkle or a few stray grey hairs, the changes in bone with age are not obvious. It’s also worth noting that, just as some people develop wrinkles or grey hair at younger age than others, the pace of bone loss varies according to your genetic composition, as well as dietary and environmental factors.
3) Third Stage of Osteopenia and Osteoporosis
Between the ages of 45 and 55, women have a quicker rate of bone breakdown owing to the effects of menopause and the resulting decrease in the hormone estrogen, which is necessary for the health of all body tissues, like bone, ligament, muscle, and tendon.
Women may lose up to 10% to 20% of their bone density over the period of five years or so after menopause. Some of them may lose up to 30%. During menopause, it is also not uncommon for women to lose up to 2% of their bone mineral density a year. Men exhibit comparable reductions in bone density at the age of 60 to 65 as a result of testosterone deficiency. This time of hormonal alterations may be considered the third and most sensitive stage of decreased bone density.
This third stage is associated with a rise in fragility fractures, in which pressure on a bone that was previously deemed normal in younger years may now be sufficient to cause a fracture. Slamming into a door, tripping over a pet, or even leaning forward to pick up something heavy like a pail of water, or running more than normal may produce enough stress to cause a fracture in the area of greatest impact.
It is crucial to understand that around 50% of adults over the age of 50 who experience a fracture have underlying osteoporosis. Here equally significant is the fact that 50% do not have.
A T score of less than -2.5 (the official definition of osteoporosis) does not guarantee that you will resist a fragility fracture. However, it does indicate that you are at a greater risk. But when this score is paired with poor balance and/or significant muscle mass loss (a condition known as sarcopenia), the chance of falling and incurring a fracture increases significantly.
You should prevent a combination of osteoporosis, poor balance, and loss of muscle mass and strength if you want to lower your risk of fragility fractures.
4) Fourth Stage of Osteopenia and Osteoporosis
Osteoporosis may proceed to stage four in the absence of treatment. This stage reveals the consequences of substantial bone loss. The deformity occurs as a consequence of bone softening and cumulative fragility fractures, particularly in the spine.
The anterior wedging of the vertebral bodies of the spine results in the rounded bent over appearance (kyphosis, sometimes referred to as a dowagers hump) that you may have noticed in some frail elderly persons. Pain and increasing difficulty handling everyday tasks such as getting into and out of a vehicle, bed, or chair, climbing stairs, hanging out laundry, etc. are all linked with this deformity.
Prevention of Osteoporosis
Some alterations to lifestyle can lower the risk of osteoporosis.
1) Exercise
Exercise can help in building strong bones and slowing bone loss. The health of your bones will get benefit no matter when you start, but you will get the most benefits if you start exercising regularly, especially weight-bearing exercises when you’re young, and continue to exercise throughout your life.
Exercise on a consistent basis is important. Adults aged 19 to 64 years old should engage in at least two hours and thirty minutes of moderate-intensity aerobic exercise each week, such as cycling or rapid walking.
Weight-bearing activity and resistance training are critical for bone density improvement and osteoporosis prevention.
Along with aerobic exercise, adults aged 19 to 64 should engage in muscle-strengthening activities on two or more days per week. These activities should target all major muscle groups, including the legs, hips, back, abdomen, chest, arms, and shoulders.
If you’ve been diagnosed with osteoporosis, it’s a good idea to see your primary care physician or a health expert before beginning a new fitness regimen to ensure that it’s appropriate for you.
You should combine strength training exercises with weight-bearing and balance exercises. Strength training helps to strengthen your muscles and bones in the arms and upper spine. Weight-bearing exercises, like jogging, walking, skipping rope, running, stair climbing, skiing, and impact-producing sports, affect mainly the bones in your hips, legs, and lower spine. Balance exercises like tai chi can reduce your risk of falling particularly as you get older.
These exercises help as they cause your muscles to pull and push against your bones. This action tells your body to form new bone tissue, which strengthens your bones.
But always consult with your doctor before starting any new exercise program.
2) Calcium and Vitamin D Intake
Everyone should have a healthy, balanced diet. It may aid in the prevention of a variety of significant health problems, including heart disease, diabetes, and various types of cancer, as well as osteoporosis.
Calcium is critical for bone health. Experts recommend that all adults of age 19 years and above should consume 1,000 mg of calcium per day. Women who are above 51 years of age and men from 71 years onward should have a daily intake of 1,200 mg (3).
Calcium-rich foods include the following:
- Milk and other dairy products, like yogurt, and cheese
- Green leafy veggies, such as kale and broccoli
- Fish with soft bones, like tinned salmon and tuna
- Calcium-fortified cereals and orange juice
- Soy products, such as tofu
Vitamin D is necessary for strong bones and teeth because it aids in the absorption of calcium. Most individuals require at least 600 international units (IU) of vitamin D per day. And this requirement increases to 800 IU a day after the age of 70.
The following are some excellent dietary sources of vitamin D:
- Fatty fish – salmon, sardines, herring, and mackerel
- Beef liver
- Egg yolks
- Fortified foods like milk, cereal, and orange juice
However, getting enough vitamin D from diet alone might be challenging. Individuals with limited sun exposure may need a supplement. Most of the available multivitamin products contain between 600 and 800 IU of vitamin D.
3) Don’t drink too much alcohol
Having more than two drinks per day is linked to higher chances of bone loss. Thus, limiting alcohol consumption can encourage healthy bones and prevent falls.
4) Quit smoking
Smoking can reduce the growth of new bone and lower estrogen levels in women.
5) Drink less soda
Some findings have shown that colas (more than other carbonated soft drinks) may lead to bone loss. It may be because of the extra phosphorus present in them that keeps your body from absorbing calcium.
6) Fall prevention
In older adults falls significantly increases the risk of osteoporotic fractures. Thus, taking measures to avoid falls can lower the risk of fractures.
Such measures for fall prevention may include the following:
- Removing things in the home that could cause tripping, slipping, or falling, like loose rugs, electrical cords, or any other loose items.
- Installing grab bars, like in the bathroom
- Ensuring there is plenty of light in all areas inside and around the home, including stairwells and entrance ways.
- Visiting an ophthalmologist for having regular vision screenings and keeping eyewear up to date
- Avoid walking on slippery surfaces, such as wet or polished floors.
- Requesting the doctor to review medications, to decrease the risk of dizziness
- Avoid walking in unfamiliar areas outside.
If you follow these tips and maintain a healthy diet you can prevent osteoporosis and live a happy as well as productive life.
What is the Outlook for Osteoporosis?
Osteoporosis is a condition that can lead to fractures, which can be painful, take a long time to heal, and cause other complications.
For example, treatment for a hip fracture can include staying in bed for long periods, which raises your risk of pneumonia, blood clots, and other infections.
But there is a lot that you can do both to prevent and treat osteoporosis, from consuming right, exercising, and taking appropriate medications.
If you think that you are at risk of osteoporosis, or have been diagnosed with this condition, then you must consult your doctor. The doctor can work with you on a prevention or treatment plan that can help improve your bone health, halt your bone loss, and reduce your risk of complications, like fractures.
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References:
1) Low Grip Strength is a Strong Risk Factor of Osteoporosis in Postmenopausal Women
https://pubmed.ncbi.nlm.nih.gov/29430846/
2) Heel Ultrasound Scan in Detecting Osteoporosis in Low Trauma Fracture Patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933818/
3) Calcium – Fact Sheet for Health Professionals
https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
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Disclaimer: This article is intended for informational purposes only. Any information associated with this article should not be considered as a substitute for prescriptions suggested by local health care professionals.
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