Treatment   Symptoms  Causes & risk factors  Prevention  Diagnosis  Complications
Osteoporosis is a bone disease that leaves those affected with weak bones that can break easily. Bone tissue is constantly being broken down and replaced because it’s living tissue. But when someone has osteoporosis, the creation of new bone just can’t keep up as the old bone breaks down. This leaves osteoporosis patients with bones so weak and brittle that they can break during a simple fall, or even with small stresses like bending over. The disease affects both men and women of all races, but it is most common in women of white and Asian descent who are past menopause. The disease is preventable, though. Maintaining a healthy diet and exercising, you can significantly reduce your risk of being affected.

Fast facts on osteoporosis

Osteoporosis
Here are some key points about osteoporosis. More detail is in the body of this article.

  • Osteoporosis affects the structure and strength of bones and makes fractures more likely, especially in the spine, hip, and wrists.
  • It is most common among females after menopause, but smoking and poor diet increase the risk.
  • There are often no clear outward symptoms, but weakening of the spine may lead to a stoop, and there may be bone pain.
  • A special x-ray-based scan, known as DEXA, is used for diagnosis.
  • Treatments include drugs to prevent or slow bone loss, exercise, and dietary adjustments, including extra calcium, magnesium and vitamin D.

Treatment of osteoporosis

Treatment aims to:

  • slow or prevent the development of osteoporosis
  • maintain healthy bone mineral density and bone mass
  • prevent fractures
  • reduce pain
  • maximize the person’s ability to continue with their daily life

This is done through preventive lifestyle measure and the use of supplements and some drugs.

Drug therapy

Drug therapy
Drugs that can help prevent and treat osteoporosis include:

  • Bisphosphonates: These are antiresorptive drugs that slow bone loss and reduce fracture risk.
  • Estrogen agonists or antagonists, also known as selective estrogen-receptor modulators, SERMS), for example, raloxifene (Evista): These can reduce the risk of spine fractures in women after menopause.
  • Calcitonin (Calcimar, Miacalcin): This helps prevent spinal fracture in postmenopausal women, and it can help manage pain if a fracture occurs.
  • Parathyroid hormone, for example, teriparatide (Forteo): This is approved for people with a high risk of fracture, as it stimulates bone formation.
  • Monoclonal antibodies (denosumab, romosozumab): These are immune therapies given to some postmenopausal women with osteoporosis. Romosuzumab carries a black box warning due to possible adverse effects.

Other types of estrogen and hormone therapy may help.

The future of osteoporosis therapy?

In future, treatment may include stem cell therapy. In 2016, researchers found that injecting a particular kind of stem cell into mice reversed osteoporosis and bone loss in a way that could, potentially, benefit humans too.
Findings published in 2015 suggested that growth hormone (GH) taken with calcium and vitamin D supplements could reduce the risk of fractures in the long term.
Also in 2015, researchers in the United Kingdom (U.K.) found evidence that a diet containing soy protein and isoflavones may offer protection from bone loss and osteoporosis during menopause.
Scientists believe that up to 75 percent of a person’s bone mineral density is determined by genetic factors. Researchers are investigating which genes are responsible for bone formation and loss, in the hope that this might offer new ways of preventing osteoporosis in future.

Symptoms & Signs

Symptoms & Signs
Osteoporosis can be present without any symptoms for decades because osteoporosis doesn’t cause symptoms until bone breaks (fractures). Moreover, some osteoporotic fractures may escape detection for years when they do not cause symptoms. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. The symptom associated with osteoporotic fractures usually is pain; the location of the pain depends on the location of the fracture. The symptoms of osteoporosis in men are similar to the symptoms of osteoporosis in women.
Fractures of the spine (vertebra) can cause severe “band-like” pain that radiates from the back to the sides of the body. Over the years, repeated spinal fractures can lead to chronic lower back pain as well as loss of height and/or curving of the spine due to collapse of the vertebrae. The collapse gives individuals a hunched-back appearance of the upper back, often called a “dowager hump” because it commonly is seen in elderly women.
A fracture that occurs during the course of normal activity is called a minimal trauma, or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.
Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial slip-and-fall accidents. Hip fractures also may heal slowly or poorly after surgical repair because of poor healing of the bone.
Suggested Reading: Home Remedies to Treat Knee Pain

Osteoporosis Risk Factors

Osteoporosis Risk Factors
While osteoporosis is a preventable disease, there are some risk factors you can’t change, like your gender and age, that put you at a greater risk. On the other hand, there are lifestyle choices that can greatly affect your chances of developing the bone disease, so it’s important to understand where you land on this spectrum.
Risk factors of osteoporosis fall into the following categories:

Unchangeable Risks

  • Sex: Women are more likely to develop osteoporosis.
  • Age: As you get older, your risk for osteoporosis rises.
  • Family history: Having a family history of osteoporosis puts you at a greater risk for developing the disease.
  • Body frame: Both men and women who have smaller frames have a greater risk of developing osteoporosis because they might have less bone mass.

Hormones

  • Osteoporosis is more common in people who have too much, or too little, of certain hormones.  For women, lowered estrogen levels, which usually occurs around menopause, puts them at a greater risk. For men, a gradual reduction of testosterone as they age can also trigger osteoporosis.
  • Thyroid problems, like too much of the thyroid hormone, can cause bone loss.
  • Overactive parathyroid and adrenal glands have also been linked to osteoporosis.

Diet

  • Low calcium intake over a lifetime can affect the development of osteoporosis.
  • Eating disorders also put people at a greater risk of osteoporosis because proper nutrients don’t get to the bones.
  • Gastrointestinal surgery, which reduces the size of the stomach, limits the amount of nutrients that can be absorbed.

Steroids and Some Medications

  • Long-term use of corticosteroid medications interferes with how your body rebuild’s your bones.
  • Medications that are used to treat seizures, gastric reflux, cancer and transplant rejections can also increase osteoporosis risk.

Lifestyle Choices

  • Those who aren’t active and who spend a lot of time sitting have a higher risk for developing osteoporosis.
  • Excessive alcohol consumption contributes to the risk.
  • Smoking tobacco causes weaker bones.

Prevention

prevention
Certain alterations to lifestyle can reduce the risk of osteoporosis.

Calcium and vitamin D

Dairy produce is a good source of calcium and can help prevent osteoporosis.
Calcium is essential for bones, and ensuring an adequate calcium intake is important.
Adults aged 19 years and above should consume 1,000 milligrams (mg) a day. Women aged 51 years and over, and all adults from 71 years should have a daily intake of 1,200 mg.
Dietary sources are preferable and include:

  • dairy produce, such as milk, cheese, and yogurt
  • green leafy vegetables, such as kale and broccoli
  • fish with soft bones, such as tinned salmon and tuna
  • fortified breakfast cereals

If a person’s dietary intake is not enough, supplements are an option. Calcium supplements are available for purchase online.
Vitamin D plays a key role, as it helps the body absorb calcium. Dietary sources include fortified foods, saltwater fish, and liver.
However, most vitamin D does not come from food but from sun exposure, so moderate, regular exposure to sunlight is recommended.
Vitamin D supplements are available for purchase online.

Lifestyle factors for preventing osteoporosis

Other ways to minimize the risk are:

  • not smoking, as this can reduce the growth of new bone and decrease estrogen levels in women
  • limiting alcohol intake, to encourage healthy bones and prevent falls
  • getting regular weight-bearing exercise, such as walking, as this promotes healthy bone and strengthens support from muscles
  • doing exercises to promote flexibility and balance, such as yoga, as these can reduce the risk of falls and fractures

For people who already have osteoporosis, nutrition, exercise, and fall prevention play a key role in reducing risks and bone loss.

Tests and diagnosis

Tests
A doctor will consider the patient’s family history and their risk factors. If they suspect osteoporosis, they will request a scan, to measure bone mineral density (BMD).
Bone density scanning uses a type of x-ray technology known as dual-energy X-ray absorptiometry (DEXA) and bone densitometry.
Combined with the patient’s risk factors, DEXA can indicate the likelihood of fractures occurring due to osteoporosis. It can also help monitor response to treatment.
Two types of device can carry out a DEXA scan:

  • A central device: A hospital-based scan measures hip and spine bone mineral density while the patient lies on a table.
  • A peripheral device: A mobile machine that tests bone in the wrist, heel, or finger.

DEXA test results

The results of the test are given as a DEXA T-score or a Z-score.
The T-score compares the patient’s bone mass with peak bone mass of a younger person.

  • -1.0 or above is normal
  • from -1.0 to -2.5 suggests mild bone loss
  • -2.5 or below indicates osteoporosis

The Z-score compares the patient’s bone mass with that of other people with similar build and age.
The test is normally repeated every 2 years, as this allows for comparison between results.

Other tests

A lateral vertebral assessment (LVA) may be recommended for an older patient who is more than one inch shorter than they used to be, or who has back pain that is not related to another condition.
An ultrasound scan of the heel bone is another way to assess for osteoporosis. It can be carried out in the primary care setting. It is less common than DEXA, and the measurements cannot be compared against DEXA T-scores.

What are the consequences of osteoporosis?

Complications of Osteoporosis
Osteoporotic bone fractures are responsible for considerable pain, decreased quality of life, lost workdays, and disability. Up to 30% of patients suffering a hip fracture will require long-term nursing-home care. Elderly patients can develop pneumonia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after the hip fracture. Osteoporosis has even been linked with an increased risk of death. Some 20% of women with a hip fracture will die in the subsequent year as an indirect result of the fracture. In addition, once a person has experienced a spine fracture due to osteoporosis, he or she is at very high risk of suffering another such fracture in the near future (next few years). About 20% of postmenopausal women who experience a vertebral fracture will suffer a new vertebral fracture of bone in the following year.

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