Osteoporosis: Causes, Risk Factors & Prevention!

Osteoporosis is a disease of weakening of the bone which progresses to breaking of the bone. It is the most common reason for bone breaking in the elderly.

SIGNS & SYMPTOMS OF OSTEOPOROSIS

  • Fractures are the most common manifestation of osteoporosis.
  • Fractures of the wrist, spine, hip, shoulders & legs are the most common.
  • Many problems can arise due to fractures;
  • Acute or chronic pain
  • Sudden onset of back pain
  • Pain that radiates to the legs
  • Spinal cord compression
  • Rarely numbness of the anus
  • Also rarely loss of bowel or bladder control
  • Stooped posture
  • Loss of height
  • Decreased movement of arm & leg.

COMPLICATIONS

  • Fractures like hip fracture require prompt surgery
  • Deep Vein Thrombosis
  • Pulmonary Embolism
  • Reduction in bone density
  • Scoliosis
  • Osteomyelitis
  • Problems in balance
  • Risk of falls due to underlying conditions like Parkinson’s disease, dementia, loss of skeletal muscles, heart problems & hypotension, etc.
  • Fainting

CAUSES & RISK FACTORS

Non-modifiable

  • Old age
  • Decrease in estrogen in women
  • Decrease in testosterone in men
  • Genetics
  • Small posture
  • Ethnicity, Europeans & Asians are more at risk.

Potentially modifiable

  • Excessive alcohol intake
  • Smoking of tobacco
  • Vitamin D deficiency
  • Malnutrition, especially low dietary calcium
  • High dietary protein from animals
  • Being underweight
  • Inactivity
  • Exposure to heavy metals
  • Consumption of soft drinks
  • Proton Pump inhibitors

Medical Disorders

  • Diminished functional activity of the gonads
  • Endocrine disorders like diabetes, thyroid disease & adrenal gland insufficiency
  • Due to GIT disorders & diseases like Crohn’s Disease, Ulcerative Colitis, Lactose intolerance, celiac disease, etc.
  • From surgery
  • Due to disease like lupus, RA, spondylitis, sarcoidosis, etc.
  • Chronic Kidney Disease
  • Disorders & various cancer of the blood

Due to medications

  • Steroid induced osteoporosis for example from prednisone.
  • Anti-epileptic drugs
  • Levothyroxine overdose
  • Anti-cancer drugs for breast cancer
  • Anti-metabolite drugs
  • Progesterone injection
  • GTRH agonists
  • Anti-coagulant drugs
  • Some classes of anti-diabetic drugs
  • Chronic lithium therapy that is used for mood disorders.

DIAGNOSIS OF OSTEOPOROSIS

  • Conventional Radiography is done for detection of decreased bone mass, fractures & for differential diagnosis.
  • Dual energy X-ray absorptiometry or DEXA scan is the gold standard for detection of osteoporosis. The extent of the disease is classified on the basis of T score (Bone mineral density)
Category T-score range % young women
Normal T-score ≥ −1.0 85%
Osteopenia −2.5 < T-score < −1.0 14%
Osteoporosis T-score ≤ −2.5 0.6%
Severe osteoporosis T-score ≤ −2.5 with fragility fracture.
  • Detection of chemical biomarkers that may be present at elevated levels such as calcium, phosphate, alkaline phosphatase & parathyroid hormone.
  • Quantitative computer tomography for measurement of bone mineral density (BMD) values.
  • Cheaper & quicker detection by quantitative ultrasound.
  • Screening of women older than 65 and men older than 70 by a bone densitometer. Also screening of younger women at risk.

TREATMENT

  • Medications used for management of the condition & symptoms;
  • Bisphosphonates when taken for 3 to 4 years show a reduction in incidence of future fractures for people who have already suffered fractures.
  • The patients with higher risk factors are prescribed oral doses for 10 years.
  • Alendronic acid for decreasing of risk of spine fractures.
  • Teriparatide (a recombinant parathyroid hormone) has been shown to be effective in treatment of women with postmenopausal osteoporosis.
  • Hormone replacement therapy only in women with post menopausal symptoms.
  • Raloxifene
  • Vit D3 supplements (Cholecalciferol) for more absorption of calcium.

PREVENTION & MANAGEMENT FOR OSTEOPOROSIS

  • Intake of adequate Calcium
  • Modification of diet to include dairy products, legumes, beans & green vegetables. 
  • 1000 mg intake of calcium is recommended.
  • Enough exposure to sunlight for absorption & synthesis of Vitamin D, although this is not physiologically possible in the bus lives of people.
  • Vitamin D3 supplements (800 IU/day) in the form of granules & tablets are prescribed for increased absorption of calcium from the diet.
  • Intake of milk is to be controlled when Vit D3 supplements are taken.
  • Vitamin K supplements & diet.
  • Engaging oneself in physical exercise can improve the health of the bones.
  • Use of hip protectors for people prone to falling & fractures.
  • Physiotherapy for management of pain & improving muscle movement.