Osteoporosis - Diagnosis, Prevention, and Therapy

Introduction:

Osteoporosis is a silent condition that progresses over time as people age. It is called a silent condition because people do not face or complain of noticeable symptoms during the early stages of progression. It is a condition where the bones in the body become weak, thus making an affected individual prone to fractures.

What Are the Clinical Features of Osteoporosis?

Osteoporosis is one such condition that shows no symptoms in the early stage but progresses to manifest as various symptoms like:

• Even with minor trauma or injury, the patient may complain of extreme pain, and on inspection, fractures will be diagnosed. This is very common in sites prone to the incidence of fractures like the spine, hip, foot, or wrist.

• As there is a deficiency in bone density, the structural integrity of bones, especially the spine, is completely compromised. This can lead to loss of height. Increased weight of the affected persons may make them stoop. This stooped or hunched posture for a long time can result in kyphosis or Dowager’s hump. There is also an increased likelihood of developing vertebral compression fractures.

• Patients complain of chronic back and hip pain. This will affect the patient’s mobility and limit their daily activities.

• Patients will be asked to walk, and loss of balance will be noted.

Fragility fractures developing from very low-impact activities are considered pathognomonic for osteoporosis.

How to Diagnose Osteoporosis?

As mentioned, osteoporosis is a silent condition, and it would be difficult to diagnose without apparent symptoms. Some common diagnostic procedures done after eliciting any clinical features are:

• Physical examination and past medical history can help assess any previous fracture sites, height of the affected individual, hunched posture, or compressed vertebrae.

• Physical examination also helps diagnose painful sites that indicate the initiation of osteoporotic destruction.

• This is a condition where there is reduced bone structure density. To diagnose this condition correctly, bone density should be measured. The common method employed is dual-energy X-ray absorptiometry or DEXA scan. This method enables X-rays to pass over fracture-prone sites, especially the spine, hip, or wrist. The mineral density at the spine and hip region is considered standard for diagnosing osteoporosis. A similar scan used over the wrist and heel region is a peripheral DEXA scan. However, they are not considered the most reliable sites.

• Several risk factors may be responsible for the causation of osteoporosis. Such underlying risk factors can be estimated through various hematological investigations. Investigating the levels of vitamin D, calcium, and hormones like estrogen, parathormone, or testosterone can pinpoint the cause of osteoporosis.

• Bone markers like alkaline phosphatase or CTX can be estimated.

• FRAX (fracture risk assessment tool) is used to determine the probability of incidence of hip fractures or fractures at any osteoporotic sites in individuals over ten years. Similarly, vertebral fracture assessment can also be done.

Based on the tests of bone mineral density, the World Health Organisation states that a score of more than one is normal. If the score ranges between -1 and -2.5, there is a reduced bone mass (osteopenia), and a score lesser than -2.5 indicates osteoporosis.

How to Treat Osteoporosis?

• Medications are given if diagnostic investigations indicate reduced calcium, vitamin D, or hormonal levels. Diet changes based on the deficiency will be prescribed.

• Bone breakdown has to be stopped to prevent further incidence of fractures. To ensure this, the first choice of medications is bisphosphonates like Alendronate or Zoledronic acid. Denosumab is an injection that is administered once in six months.

• In women, especially after menopause, estrogen therapy is advised.

• In severe osteoporotic cases, new bone formation is needed. To achieve this objective, medicines like Teriparatide are prescribed. It is a parathyroid hormone and is generally used to induce the formation of bone-producing cells (osteoblasts).

• In advanced cases, vertebroplasty or kyphoplasty is done. In this, bone cement will be added to fill in the defect caused at the fracture site.

• Any fractures caused due to osteoporosis should be treated by fixation as early as possible.

How to Prevent Osteoporosis?

• Preventing osteoporosis is essential because preventing such a condition is easier than curing it. Regular screening for osteoporosis by postmenopausal women and people aged over 60 years is necessary because it would be late by the time of onset of symptoms. Screening can detect osteoporotic changes at an early stage or changes that will be seen in the osteopenia stage. This can aid in easy treatment of the condition.

• Doctors will generally advocate supplements and food rich in vitamin D and calcium.

• Engage in activities that stress bones and muscles, like walking, jogging, dancing, weightlifting, and resistance training. These exercises help improve bone density and strength.

• Habits like tobacco or alcohol consumption can perpetuate the process of osteoporosis and loss of bone mass. Hence, it is necessary to abstain from such harmful activities.

• Make homes safer by removing tripping hazards, installing handrails, using non-slip mats, adequate lighting, and other measures to prevent falls.

Can Osteoporosis Be Reversed?

Once there is an onset of osteoporosis, there is an onset of loss of bone density and an increase in fragility. While the loss of bone density can be managed and slowed down through various treatments, the complete reversal of osteoporosis to regain original bone density is challenging. However, with appropriate interventions like lifestyle changes, medications, and proper management, it is possible to halt further bone loss and, in some cases, slightly increase bone density. The likelihood of incidence of uneventful instances like kyphosis or fractures can be reduced. However, reversing osteoporosis entirely to return bones to their original density remains complex and challenging.

Conclusion:

In conclusion, while osteoporosis poses a significant health challenge, proactive steps in diagnosis, prevention, and therapy can empower individuals to maintain strong and healthy bones, enhancing their overall quality of life. The fight against osteoporosis requires a comprehensive approach, encompassing both individual responsibility and societal support, to ensure better bone health and well-being for all.