Introduction to osteoporosis
Osteoporosis is a disorder of the bone that is characterized by decreased density of the bones and their progressive microscopic destruction making them vulnerable towards the physical stress. Worldwide, osteoporosis affects about 1 in every 3 women and 1 in every 8 men. White and Asian women are at an increased risk when compared to others. It is commonly noted in individuals between the age group 50 and 70 years, and is considered as a common reason for bone fracture in the elderly. Women are more frequently affected than men.1, 2
Signs and symptoms of osteoporosis
No symptoms or signs are noticed during the initial stages of osteoporosis. The destruction of the bones is a chronic process that remains asymptomatic until a fracture occurs in the weakened bones. In case of women, bone loss may be initiated either with the commencement of menopause or just before. Fracture of the hip, vertebral bones and the wrist are the most common fractures associated with osteoporosis. There may also be tenderness or pain felt in the bones. The fractures may at times result in permanent disability depending on its severity. The time required for bone healing is also prolonged. Fracture of the vertebral bones may result in sudden pain or chronic dull pain in the back that limits the day-to-day tasks of the affected individual. Progressive demineralization of the bone also results in gradual reduction in height and bending or stooping of the back.1
Causes of osteoporosis
Osteoporosis is a condition marked by a reduction in bone mass, either due to reduced bone formation or accelerated bone resorption. Osteoporosis is a result of complex interaction of multiple factors that eventually result in bones becoming brittle and fracture when exposed to minimal stress.
Postmenopausal women commonly suffer from this condition owing to the decrease in the levels of a hormone known as estrogen during menopause. Estrogen deficiency makes the bone more sensitive to the resorbing effect of another hormone known as the parathyroid hormone (PTH). While in men osteoporosis may result from the decreased production of testosterone in the body. Older men and women suffer from osteoporosis (referred to as senile osteoporosis) owing to decreased formation of bone that gets worn out naturally. This type of osteoporosis wherein no underlying disorder or condition can be attributed to bone loss other than changes associated with normal ageing is referred to as primary osteoporosis.
In some cases, consumption of medications such as glucocorticoids or certain underlying disorders such as Cushing’s syndrome and hyperthyroidism can result in increased dissolution of the minerals of the bone thereby leading to osteoporosis (referred to as secondary osteoporosis).2
Risk Factors for osteoporosis
Various risk factors have been observed to be associated with an increased risk of osteoporosis. These factors include:
- Female gender
- Low body mass index (BMI)
- White or Asian race
- Sedentary lifestyle or chronic immobilization
- Increasing age
- High caffeine intake
- Kidney disorders
- Lifelong low calcium intake
- Smoking and excessive alcohol use
- Long-term use of certain medications
- Postmenopausal women
All these factors may increase the chance of the individual developing osteoporosis by either reduced deposition of calcium and other minerals required for bone formation or by increased destruction of the bone cells and tissues.4
Diagnosis of osteoporosis
Osteoporosis of the primary type is generally not diagnosed until the affected individual becomes symptomatic. However, a specialized test known as the bone density measurement provides vital clues about the density of the bone remaining and predicts whether intervention is required or not. Commonly employed bone densitometry tests include dual-energy X-ray absorptiometry (DXA) and quantitative computerized tomography (CT). Osteoporosis occurring secondarily to certain underlying causes is usually suspected based on the type of disorder and periodic measurement of the bone density. Certain specific laboratory tests may be advised by the doctor to confirm or rule out the presence of underlying disorders.4
Treatment of osteoporosis
The aim of the treatment of osteoporosis is to reduce the pain associated with it, decrease the amount of bone loss and prevent further fractures. Various medications have been advised that either decrease the amount of bone loss or augment the amount of bone formation in individuals affected with osteoporosis. These include hormone replacement therapy with hormones, calcium and vitamin D supplementation (available as over-the-counter medications), cacitonin, bisphosphonates and raloxifene therapy. The type of medication, its dosage and duration of therapy is decided by the doctor, based on the severity and stage of osteoporosis.5
Alternative therapy for osteoporosis
Modification of the lifestyles practised by individuals who suffer from osteoporosis is beneficial in augmenting the effects of the medications being consumed. Discontinuation of smoking and reduced consumption of alcohol and caffeine are helpful. A balanced diet, which ensures adequate supply of calcium and vitamin D with regular exercise is also advantageous.5
Prevention of osteoporosis
The bones of the body undergo regular demineralization and remineralization throughout the life. Providing essential vitamins and minerals to the body and avoiding factors that enhance bone destruction is considered essential to prevent osteoporosis. Maintaining a healthy diet rich in calcium and vitamin D among other essentials nutrients goes a long way in both preventing osteoporosis and also other conditions. Regular exercise, avoidance of increased alcohol and caffeine consumption along with cessation of smoking has also been proven to be beneficial. Periodic determination of the bone density is generally advised in women past menopausal age and men above the age of 65 years.5
Complications for osteoporosis
Fracture of the bones is the most common complication of osteoporosis. Such fractures may be either mild or may at times result in serious consequences such as immobility. Although rare, cases of death have also been reported due to fractures associated with other severe underlying disorders or old age.3, 4
Living with osteoporosis
Most individuals suffering from osteoporosis are able to lead a normal life, when appropriate care is taken. Strict adherence to the therapeutic protocols and maintenance of a healthy lifestyle can prevent severe bone loss and prevent complications. Some individuals may however become disabled owing to the weakened bones and ability to perform regular tasks may also be reduced.
- Christodoulou C, Cooper C. What is osteoporosis? Postgrad Med J. 2003; 79: 133–138.
- Iqbal MM. Osteoporosis: Epidemiology, diagnosis, and treatment. South Med J. 2000; 93(1): 2–18.
- Kenny AM, Prestwood KM. Osteoporosis. Pathogenesis, diagnosis, and treatment in older adults. Rheum Dis Clin North Am. 2000; 26(3): 569–591.
- South-Paul JE. Osteoporosis: Part I. Evaluation and assessment. Am Fam Physician. 2001; 63: 897–904, 908.
- South-Paul JE. Osteoporosis: Part II. Nonpharmacologic and pharmacologic treatment. Am Fam Physician. 2001; 63: 1121–1128.