OSTEOPOROSIS

50

Osteoporosis, often dubbed the “silent thief,” stealthily weakens bones, making them fragile and prone to fractures. Osteoporosis, meaning “porous bones,” is a condition that silently weakens bones, making them more prone to fractures. In the US alone, an estimated 2 million fractures each year are linked to osteoporosis.

While any bone can be affected, the spine, hip, and wrist are most vulnerable to breaks. For older adults, hip fractures can be particularly serious. The extended period of inactivity required for healing can increase the risk of life-threatening complications like blood clots or pneumonia.

Women are disproportionately affected by osteoporosis, with an estimated 80% of diagnosed cases occurring in women. This is likely due to two factors: women generally have lighter and less dense bones to begin with, and hormonal changes after menopause accelerate bone loss.

Causes

Osteoporosis stems from an imbalance between new bone formation and old bone resorption. Our bones are constantly changing! Throughout our youth, a process called “bone remodeling” keeps our bones strong by breaking down old bone and building new bone. This reaches a peak in our mid-to-late 20s.

However, as we enter our mid-30s, things start to shift. Bone breakdown often outpaces bone building, leading to bone loss. This happens because bones lose calcium, the mineral that gives them strength, faster than they can replace it. This slows down bone remodeling and makes bones thinner.

For women, menopause brings a significant jump in bone loss during the first 5-7 years. Scientists believe this is due to a sharp decline in estrogen production, which seems to play a role in keeping calcium in bones.

Osteoporosis stems from an imbalance between new bone formation and old bone resorption. As people age, bone mass decreases, and the rate of bone loss accelerates. Hormonal changes, particularly decreased estrogen in women and reduced testosterone in men, contribute significantly. Additionally, lifestyle factors such as inadequate calcium and vitamin D intake, sedentary habits, and smoking exacerbate bone density loss.

Prevalence

Osteoporosis is alarmingly prevalent, affecting over 200 million individuals worldwide. Women are more susceptible, especially after menopause due to declining estrogen levels. However, men also face osteoporosis risks, particularly with advancing age.

Symptoms

Initially, osteoporosis often presents no symptoms. However, as bone density diminishes, individuals may experience back pain, loss of height over time, stooped posture, and fractures, particularly in the spine, hip, or wrist.

Risk Factors

Several factors increase the likelihood of developing osteoporosis and porous bones, including:

• Thinness or small frame
• Smoking, excessive alcohol consumption, or leading a sedentary lifestyle
• Family history of hip fracture
• Surgical removal of ovaries, particularly before age 40
• Ethnicity, with white and Asian individuals at higher risk
• Certain medical conditions that increase bone breakdown, such as kidney disease, Cushing’s syndrome, overactive thyroid or parathyroid glands
• Long-term use of glucocorticoids (steroids), anti-seizure drugs, or immobility due to paralysis or chronic illness

Lifestyle and bone Health

Maintaining bone health involves adopting healthy lifestyle habits while avoiding detrimental behaviors. Here’s how your habits can impact bone health:

1. Vitamin D and Calcium Intake: Sufficient intake of vitamin D and calcium is crucial for strong bones. Adults up to 70 years old should aim for 600 IU of vitamin D daily, increasing to 800 IU for those over 70. Similarly, men up to age 70 and women up to age 50 need 1000 mg of calcium daily, while men over 70 and women over 50 require 1200 mg per day.
2. Fruits and Vegetables: Consuming plenty of fruits and vegetables provides essential nutrients like magnesium, potassium, and vitamin K, which support bone health.
3. Protein Consumption: While adequate protein intake is important for bone health, excessive consumption of nondairy animal protein can weaken bones. Consult your doctor for guidance on the appropriate amount of protein for your needs.
4. Caffeine and Alcohol: Excessive caffeine consumption can threaten bone health, while excess alcohol intake can decrease bone formation and increase the risk of falls, particularly in older individuals.
5. Physical Activity: Regular physical activity, especially weight-bearing exercises like fast walking or weight lifting, helps maintain bone strength and density.
6. Smoking: Smoking has been linked to weakened bones, highlighting the importance of quitting smoking for overall bone health.

Diagnosis

When it comes to diagnosing osteoporosis, your doctor will typically:

• Assess your medical history, including menopausal status, previous fractures, family history, and lifestyle habits.
• Review your medication history, as certain medications like corticosteroids can weaken bones.
• Conduct a physical examination, including measuring your height and inspecting your spine for signs of curvature that may indicate spinal fractures.
• Perform a bone density test, a noninvasive procedure that measures bone mineral density in the hip, spine, and sometimes forearm. Results are compared to normal values to diagnose osteopenia (low bone density) or osteoporosis.
• Bone density scans, such as dual-energy X-ray absorptiometry (DEXA), are the primary diagnostic tool for osteoporosis. These scans measure bone mineral density (BMD) and assess fracture risk. Blood tests may also be conducted to rule out other conditions contributing to bone loss.

Treatments

Treatment options for osteoporosis aim to limit bone breakdown, maintain bone density, and reduce the risk of fractures. Your doctor may recommend prescription medications, such as:

1. Bisphosphonates: These drugs, including alendronate (Fosamax), ibandronate (Boniva), and zoledronic acid (Reclast), help to prevent bone loss and reduce the risk of fractures, particularly in the hips and spine.
2. Other Medications: Additional drug options to protect against bone loss include:
   • Raloxifene (Evista): An estrogen-like drug that increases bone density and reduces fracture risk.
   • Romosozumab-aqqg (Evenity): An anti-sclerostin antibody that stimulates bone formation and reduces bone loss.
   • Abaloparatide (Tymlos) and teriparatide (Forteo): Synthetic forms of parathyroid hormone that help build bone density.
   • Denosumab (Prolia, Xgeva): An antibody that inhibits bone breakdown, resulting in reduced bone loss.
   • Calcitonin: A hormone that helps prevent fractures and may slow bone loss.

It’s essential to inform your doctor about all medications you’re taking, as some drugs can affect bone health, and adjustments may be necessary.

If you’re prescribed a bisphosphonate, your doctor may consider switching to another drug after five years due to the low risk of thigh bone fractures associated with long-term use.

Hormone replacement therapy (HRT), which includes estrogen alone or in combination with progestin, can prevent and treat osteoporosis. However, due to increased risks of breast cancer, heart disease, and stroke associated with HRT, it’s not generally recommended as the initial treatment for osteoporosis in most women. Women who have previously used HRT and then discontinued it may experience bone thinning at a similar rate to that observed during menopause.

Home Care Tips

Incorporate these habits into your daily routine to promote bone health:

1. Consume a balanced diet rich in calcium and vitamin D.
2. Engage in weight-bearing exercises like walking, dancing, or weightlifting.
3. Ensure a safe home environment to prevent falls.
4. Avoid smoking and limit alcohol consumption.

Expectations from Fracture

Fractures resulting from osteoporosis, often occurring in the hip, wrist, and spine, may necessitate various treatments and entail specific expectations:

1. Hip Fractures: Typically require surgery for stabilization.
2. Wrist Fractures: May necessitate casting or surgical intervention.
3. Spinal Fractures: Common among seniors, compression fractures in the vertebrae can alter spine strength and shape over time. Symptoms may include height loss and chronic back pain, sometimes severe, leading to other health issues.

Fracture pain relief

Pain relief options for fractures include:

• Over-the-counter medications: Aspirin or acetaminophen, and non-steroidal anti-inflammatory drugs like ibuprofen or naproxen, can help alleviate pain and swelling.
• Prescription painkillers: Stronger medications like opioids (codeine or morphine) may be prescribed, although long-term use is typically discouraged due to associated risks.
• Physical Therapy: Helps in proper movement, reducing the risk of further fractures.

Fracture-related back pain Surgical procedure

Surgical procedures for fracture-related back pain include:

• Kyphoplasty: Involves inserting a balloon to expand fractured vertebrae, followed by filling the space with bone cement.
• Vertebroplasty: Cement injection into the fractured vertebrae, without balloon insertion.

Considerations for these procedures include discussing benefits, risks, and potential side effects with your doctor, as they may carry serious risks such as cement leakage and tissue damage.

Complications of osteoporosis-related fractures

Fractures resulting from osteoporosis can significantly impact daily activities and overall well-being. Here are some potential complications:

1. Interference with Daily Activities: Osteoporotic fractures can hinder routine tasks such as bending, walking downstairs, or cooking, leading to decreased mobility and independence.
2. Chronic Pain: Fractures can cause chronic pain, reducing quality of life and affecting mood and sleep patterns.
3. Functional Limitations: Depending on the severity and location of the fracture, individuals may experience functional limitations, such as difficulty standing, walking, or lifting objects.
4. Reduced Quality of Life: Fractures and associated pain and limitations can contribute to a decreased overall quality of life, affecting physical, emotional, and social well-being.

Prevention

Prevention is key in mitigating osteoporosis risk. Adopting a healthy lifestyle from a young age, including regular exercise, balanced nutrition, and avoiding smoking and excessive alcohol, can significantly reduce the likelihood of developing osteoporosis later in life.

When to See a Doctor

Consult a healthcare professional if you experience unexplained back pain, loss of height, or suspect fractures, especially if you have risk factors for osteoporosis. Early detection and intervention are crucial in managing this condition effectively.

Outlook/Prognosis

While osteoporosis is a chronic condition, early diagnosis and appropriate management can significantly improve outcomes and quality of life. With a proactive approach to bone health, individuals can minimize the impact of osteoporosis and maintain independence and mobility as they age.

Sources

1. National Osteoporosis Foundation.
2. Mayo Clinic.
3. Centers for Disease Control and Prevention (CDC).
4. International Osteoporosis Foundation.
5. NIH Osteoporosis and Related Bone Diseases National Resource Center.
6. American Society for Surgery of the Hand.
7. American Academy of Orthopaedic Surgeons.
8. State Pearls.
9. National Institutes of Health.