Osteoporosis is a medical condition that softens the bones, characterized by a lower density of minerals inside the bone, leading to an alteration of its microstructure. This does not only predispose you to a higher chance of fracture resulting from minor injuries and low-impact traumas but may also affect your overall mobility and conduct of your everyday activities. Data shows that more than 50% of women who are post-menopausal and are suffering from osteoporosis undergo fracture once during their lifetime. Moreover, the majority of the women who undergo hip fractures caused by osteoporosis may not be able to return to their independent lifestyle, as only 33% of these women are able to do so.
Compared to females, males have a lower chance of undergoing osteoporosis and its associated fractures – however, the mortality rate associated with these fractures is much higher in them. With a gradual increase in the prevalence of osteoporosis in men and women in the United States, it is suggested to keep rising until correct interventions and awareness about the condition are given to the general public.
Osteoporosis Causes
Osteoporosis is caused by a lack of balance between the resorption of the bones of the body and their remodeling. This imbalance leads to a reduction in overall bone mass. In a healthy individual, the mass of bones is seen to peak when individuals are in their 30s due to an increased rate of bone formation as compared to bone resorption. However, after this age, the rate of bone resorption is reported to increase more than the bone formation, which leads to a gradual deterioration of the bone mass. If the body is unable to revive the bone mass to healthy levels, or acceleration of bone loss which is higher than what is considered normal – may cause osteoporosis.
The common diseases that are often reported to cause osteoporosis include Anorexia Nervosa, Hyperparathyroidism, Hypothyroidism, Malabsorption, Chronic Renal Failure, Cushing Disease, and any other condition which may be associated with Immobilization.
Risk Factors For Osteoporosis
The common factors that may put one at an increased risk for osteoporosis include increasing age, a bodyweight under 128 pounds, individuals belonging to an Asian background, premature menopause, and a lack of exercise.
It may also be associated with traumas or ground-level falls after the age of forty years. It is also found at a higher rate in females, individuals who use corticosteroids, habitual smokers, and habitual alcoholics.
Symptoms Of Osteoporosis
A good portion of individuals suffering from osteoporosis may not even be aware of the fact that they have the condition. However, the majority of the time, individuals with osteoporosis have visible signs and symptoms and may be mild to severe in nature. Common symptoms often reported are noticing your spine starting to curve inwards slightly, making you appear slightly shorter than you are. However, the same sign at an advanced stage may present itself as a stooped posture with a prominent hump at the top of the spine. This may be caused by fractures in certain parts of your vertebrae column, which may not only affect your appearance but may also cause significant pain as well.
Since osteoporosis presents itself with a plethora of symptoms, it is much easier to divide these into Early Onset Symptoms and Late-Onset Symptoms.
A) Early Onset Symptoms of Osteoporosis
Early signs and symptoms of osteoporosis include:
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- Gum Recession: Individuals may find their gums gradually moving away from their tooth structure due to the loss of jaw bone. This may also be detected by your dentist while screening and clinical examination.
- Loss of Grip: A weaker grip is also an early sign of osteoporosis, as it depicts a loss of mineral content from the bones of your body.
- Brittle Nails: Experts believe that strength of nails is an indication of bone health. Hence, brittle and weak nails are also an early sign of osteoporosis. However, this symptom is associated with osteoporosis and may also indicate other health conditions.
B) Late-Onset Symptoms of Osteoporosis
Late-Onset Signs and symptoms of osteoporosis include:
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- Height Loss: Height loss is a frequently reported symptom in individuals affected with late-onset osteoporosis. It is caused by a compression fracture of the spine, making it curve and appear shorter than you are.
- Fracture From Minor Trauma: If you get a fracture from minor trauma or a gentle hit, you are most likely suffering from osteoporosis. As the severity of the condition continues, so does the risk of fracture. Individuals with severe osteoporosis may even get a fracture after a sneeze or a cough.
- Constant Back Pain: Since severe osteoporosis can lead to a compression fracture of the spine, these collapsed vertebrae may pinch the surrounding nerves and cause pain to the individual. The degree of pain caused by pinching of nerves may range from mild to severely debilitating.
Types of Osteoporosis
A) Primary
Primary Osteoporosis is the most common type of osteoporosis, and there are severe triggering factors for it. These include aging, the diet that an individual consumes, and their daily activity levels. It may also be associated with females more than males due to their bodies’ changes at menopause. This form of osteoporosis is mainly caused by the changes in hormones like Testosterone and Estrogen that occur after a certain age. Since these hormones play a role in bone health and its growth, the deterioration of these hormones may lead to the bones becoming weak – leading to osteoporosis.
B) Secondary
Secondary osteoporosis occurs in association with a particular disease and does not develop in the body on its own. The diseases associated with Secondary Osteoporosis are the ones that can alter the hormone levels in the body and, in turn, affect bone metabolism. These may include hyperparathyroidism, Cushing’s disease, and chronic liver disease.
D) Osteogenesis Imperfecta
Osteogenesis imperfect is an aware form of osteoporosis that occurs, as a result, is a genetic mutation. It is so rare that it is only seen in 6 to 7 individuals out of every 100,000 individuals. Osteogenesis imperfect may further be divided into several subtypes depending on its degree of severity. Individuals who are diagnosed with osteogenesis imperfect are often found to have certain identifying features like a small rib cage, height defects, and mild to moderate respiratory issues. They may also undergo fractures easily after the application of minor stress. Severe cases of osteogenesis imperfect may also result in death due to severe respiratory issues.
C) Juvenile Osteoporosis
Juvenile osteoporosis is a type of osteoporosis that occurs in pediatric patients. Individuals suffering from this may start to experience symptoms just before they hit puberty. The common symptom associated with Juvenile Osteoporosis is brittle and porous bones, which may be treated with early medical intervention.
Diagnosis Of Osteoporosis
There are various methods and tests that can be used to diagnose osteoporosis effectively. However, experts recommend the early screening tests for this condition to comprise of Calcium, Vitamin D, and thyroid levels tests.
Another screening method that is recommended by the WHO is the Dual Xray Absorptiometry – which allows clear and concise assessment of the total bone mineral density. It is also highly convenient for the medical professional as this device’s scan may be taken in under five minutes. Moreover, it is superior to the other screening techniques because it involves minimum radiation exposure, making it highly safe for the patients. Tests like Peripheral and Ultrasound are also available to measure the bone density of parts of the body that are not high risk – however, they are usually not used for the purpose of diagnosis or treatment planning of osteoporosis.
Another tool that has been introduced by the WHO for the diagnosis and risk evaluation of osteoporosis is the Osteoporosis Risk Assessment Tool, which allows an individual to know the ten-year probability of a major fracture. This tool assesses the individual’s body mass index and the independent factors that put them at a greater risk for fracture.
Treatment of Osteoporosis
Once the diagnosis of osteoporosis is made, it is up to the doctor and the patient to decide if the treatment plan should be preventative or curative in respect to the fracture risk. Many different interventions can then be conducted to achieve your treatment or preventative plan – both are equally effective at preventing fracture.
In order to understand the treatment option, it is important to first understand the anatomy of the bone and the functioning of the cell types. The three major cells which are involved in bone growth and remodeling are osteoblasts, osteoclasts, and osteocytes. The osteocytes are the mature bone cells found in the body, which undergo cell death from time to time and new cells replace them. Just before being destroyed, these cells send signals to cell structures for the production of bone-forming cells known as Osteoblasts. Hence when an individual undergoes trauma or is put through a certain degree of stress, the osteocytes send signals to the bone-forming cells known as Osteoblasts to increase their production. Osteoblasts then produce certain factors which cause the production of another cell known as Osteoclasts. Osteoclasts are bone-resorbing cells and are necessary for bone remodeling. The resorbed area of the bone is then refilled by the osteoblasts, which do this by filling the gaps with hydroxyapatite crystals. In case of a disturbance of the balance between osteoclasts and osteoblasts production, more bone will start to be dissolved as compared to the bone that is getting formed. Hence the major target for osteoporosis treatment is to decrease the activity of the bone-resorbing cells known as osteoclasts and increase the activity of the bone-forming cells known as Osteoblasts.
This may be achieved in two ways: Anabolic and Anticatabolic Treatment. The anabolic treatments include Physical Activity, Vitamin D administration, Steroid therapy, growth hormone therapy, parathyroid hormone therapy, and administration of Calcium and Calcitriol. On the other hand, the anti-catabolic interventions include the ways in which the activity of bone-resorbing cells can be prevented. This may include Estrogen Therapy, Hormone Replacement Therapy, giving bisphosphonates, and Osteoprotegerin and Strontium Ranelate therapy.
1) Exercise
One of the first things recommended by experts for osteoporosis is physical therapy, which may act as a preventative therapy and as a co-adjuvant treatment form. Bone mass that has been lost due to osteoporosis can be regained by undergoing exercises that involve weights and speed activities. This is because physical activity causes the stimulation of Osteocytes and Osteoblasts, which cause the formation of new bone.
An added benefit of regular exercise will also lead to an increase in muscle mass and a general improvement of neuromuscular coordination. This will prevent unnecessary falls and lower the risk of fractures associated with the condition. This is also proven by studies conducted to evaluate the effectiveness of exercise in the elderly. Results of one such study showed that those elderly individuals who undergo regular exercise are at a lower risk for osteoporosis-related fracture as compared to the elderly individuals who practice a more sedentary lifestyle.
2) Calcium Supplements
Calcium is an integral part of all bones of the body and gives bone mechanical strength and resistance to bone injuries and fractures. Other than its protective role on the bone, it also helps the coagulation of blood and allows the regulation of hormones and neurotransmitters in the body. It also has an active role in the contraction of muscles and is important for the regulation of heart function and contractility.
Calcium can be taken either in the form of supplements or it may be taken through natural food sources. The foods which are rich in calcium include milk and milk derives products like butter, cheese, and yogurt. It is also found in vegetables that have dark leaves, beans, and Sardines. However, it must be remembered that not all calcium that is taken via supplements or food is absorbed into the body, and it requires certain compounds and vitamins to increase its absorption – one of which is Vitamin C. Hence it is usually recommended to take Calcium supplements with Vitamin C supplements or a glass of orange juice.
3) Vitamin D Supplements
Vitamin D is required for various cells and organs systems all over the body. Similar to Vitamin C, Vitamin D also affects Calcium absorption inside the body. It is found to increase the levels of calcium by increasing the reabsorption of calcium in the kidney, so it is not lost in the urine but also lowers the levels of the Parathyroid hormone, which is known to have an inverse relationship with Calcium levels of the body. Other than its effect on the body’s calcium levels, Vitamin D also increases bone strength by stimulating the bine-forming cells to produce and strengthen bone structures.
Besides its highly effective preventative and curative role for osteoporosis, its administration may also provide the body with various other benefits. Studies have found Vitamin D requirement to increase by age, and it may have antibacterial activity on the respiratory system. It also increases muscle strength and helps prevent muscle diseases like Sarcopenia.
Although Vitamin D is commonly taken in the form of Supplements, it may also be found in various other natural sources. The most potent natural source of Vitamin D is the sun’s UV rays, which is followed by several other food sources. These include Cod Liver Oil, Salmon, Tuna, Swordfish, Sardines, and Beef Liver. However, since Vitamin D is a fat-soluble vitamin, it must not be taken in access as it can lead to toxicity. It is always advisable to follow a doctor’s recommended dose when you start taking Vitamin D supplements to prevent or treat your osteoporosis.
How To Choose The Right Treatment?
The ideal treatment plan for osteoporosis may differ from person to person according to the doctor’s evaluation; however, it is generally believed to be the one that decreases the risk and incidence of fractures and improves the microarchitecture and geometry of the bones. The new forming bone as a result of the treatment should be highly mineralized and contain good cells and matric quality.
The results of the treatment should cause an increase in the bone remodeling rate and should have long-lasting effects. Moreover, the treatment should be safe for the patient and does be highly expensive or inconvenient for them.
Prognosis For Osteoporosis
The overall prognosis for osteoporosis is good if it is detected at an earlier stage. Treatment at this stage can lead to favorable outcomes, and the patient is able to recover completely.
On the other hand, if osteoporosis remains undetected and untreated, it can lead to severe pain and discomfort for the patient later. It may also cause extensive fractures on minor traumas.