Osteoporosis: an Important Public Health Problem
Published on Oct 20, 2016 and last reviewed on Apr 11, 2023 - 4 min read
Abstract
Osteoporosis is a problem that is largely preventable. This article focuses on the causes of osteoporosis and the available treatment modalities.
Osteoporosis refers to a reduction in bone strength. The defining characteristics of a bone include its strength and quality. Osteoporosis can affect the strength, quality or both the characteristics. Osteoporosis is a major cause of pathological fractures in postmenopausal women and the elderly. Although earlier it was believed that it was an inevitable accompaniment of aging, recent data indicate that it is largely preventable.
Who Is at Risk?
Everybody does not develop osteoporosis. Certain populations are especially vulnerable to develop osteoporosis.
- These include females, postmenopausal women, people over 50 years of age and those having a positive family history of osteoporosis.
- Estrogen plays a protective role against the development of osteoporosis in women. This explains why postmenopausal women are at a greater risk for osteoporosis.
- Tall, slender and thin women also run the risk of developing osteoporosis.
- Women represent a vulnerable populace as they have a smaller peak bone mass as compared to men and they tend to lose bone mass more rapidly as they age.
- A diet lacking in vitamin D and calcium also make us prone to osteoporosis.
- Certain medications like Glucocorticoids, blood thinners like Heparin, immunosuppressants like Cyclosporine and anticonvulsants also increase the risk of osteoporosis.
- An inactive lifestyle, excessive smoking, and alcohol usage are additional risk factors.
- Medical conditions like hyperparathyroidism, malignancy, chronic renal and hepatic diseases, amenorrhea and early menopause are also important risk factors.
How Do I Know That I Have Osteoporosis?
Osteoporosis is a silent disease. Most often the individual is not aware of its existence until he suffers a fracture. These fractures occur with the slightest impact and happen during activities like bending, lifting weights, coughing or with other minor stresses. Hence, these fractures are called pathological fractures. This commonly results in the collapse of the spinal vertebrae. The presenting symptoms include severe back pain, a reduction in the height of a person due to the collapsed vertebrae and assumption of a stopped or hunched posture.
Investigations to Confirm Osteoporosis
Approach to the diagnosis should be holistic and comprehensive.
- Other medical diagnoses which can act as contributory factors need to be ruled out. Physical examination is of vital importance.
- An enquiry is made into the lifestyle habits and patterns of the individual. Family history is also ascertained.
- Careful consideration is also given to the drugs that the individual might be taking. Enquiry is also made about the dietary patterns and falls or fractures sustained in the past. Apart from the usual blood and urine tests, an x-ray of the spine is ordered to rule out spinal deformities.
- The gold standard investigation which confirms the diagnosis is the DEXA scan. It stands for dual energy x-ray absorptiometry which measures the bone mineral density. Minerals impart hardness to a bone and the bone mineral density is ascertained by a score known as the T-score. Specific cut-off values exist which confirm the diagnosis.
Treatment Options of Osteoporosis
- The primary goal in the treatment should be the prevention of fractures and falls.
- A comprehensive nutrition plan is put into place. This includes supplementation with calcium, vitamin D and vitamin K. Optimum calorie consumption is stressed upon.
- Medications aim to achieve one or more of the following goals. Reducing bone loss, increasing bone mineral density and ensuring new bone growth. After weighing the pros and cons, drugs that may be causing bone mineral loss will be stopped.
- Lifestyle changes include getting optimum exercise which ensures reduced age-related bone loss. Data have consistently shown that exercise also increases bone density. Quitting smoking and alcohol is highly beneficial.
- Prevention of falls is also vital. Doormats are used outside the bathroom to prevent falls. Outdoor and indoor canes may be used for additional support. Flooring that is least susceptible to cause slips and falls is encouraged, especially in the bathrooms.
Specific Interventions and Drugs for Osteoporosis
1. Bisphosphonates
These are medications that inhibit osteoclastic activity. Osteoclasts are cells that accelerate bone loss. Commonly used bisphosphonates include Alendronate, Pamidronate, Etidronate, Zoledronic acid, and Risedronate.
2. Parathormone Analogue
This is available in the form of an injection. The generic name of this analogue is Teriparatide. Usage beyond two years is not recommended. This is particularly employed in postmenopausal women and men who are at high risk for fractures.
3. Strontium Ranelate
This is a RANK ligand (RANKL) inhibitor and is beneficial in postmenopausal women.
4. SERMs
These are selective estrogen receptor modulators. These act as estrogen agonists in some tissues and block estrogen's effects in some other tissues. These are not estrogen preparations but they themselves have estrogen-like effects in certain tissues.
5. Calcitonin
This is involved in the metabolism of calcium. It also plays a part in bone metabolism. This is used in women who are at least five years postmenopausal.
6. Hormone Replacement Therapy (HRT)
This is used for both the prevention of osteoporosis in high-risk women and also to treat the hot flushes of menopause.
Emotional After-Effects of Osteoporosis
Osteoporosis comes with its fair share of emotional effects. Since mobility gets impaired, people feel disabled. This paves way for a host of negative mood states like anxiety, depression, panic, and phobia. It is vital to liaise with a mental health professional who will offer appropriate treatment to improve the overall quality of life. Such liaison also helps the patient to better cope with the crisis.
In summary, osteoporosis represents an important public health problem and the aphorism 'prevention is better than cure' sounds very apt in dealing with osteoporosis.
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Frequently Asked Questions
1.
What Is the Most Common Cause Of Osteoporosis?
Osteoporosis is of two types, primary and secondary. Primary osteoporosis occurs without an underlying disease or medication, which can be idiopathic and involutional type, and the leading common cause is estrogen loss. Secondary osteoporosis is attributed to a number of factors and conditions, such as chronic anemia, acromegaly, hepatic disease, hyperparathyroidism, hypogonadism, starvation, and thyrotoxicosis, or as an effect of medications (anticonvulsants).
2.
What Are the Symptoms of Osteoporosis?
During the early stages of osteoporosis, the symptoms are not found. Later, the patient may identify with clinical signs and symptoms, which occur when the bones have almost become weaker and easy to fracture. Back pain is the commonest symptom that could be experienced due to fractures or collapse in the vertebrae. The back pains become worse when bending forward, walking, twisting the body, standing, and lying down where the pain is sudden and severe. Kyphosis is known as a curved spine, which occurs as a result of osteoporosis. As the bones become weaker and curved over a period of time, it results in loss of height.
3.
How Does Osteoporosis Affect the Organs?
Osteoporosis makes the bone weaker and brittle, which are easy to break. The fractures related to osteoporosis occur in the spine, hip, and wrist when there is excessive tension while bending, walking, coughing, etc. The musculoskeletal system, the central nervous system, and gastrointestinal (inflammatory bowel disease and celiac disease) are most commonly affected.
4.
Is Standing Better Than Sitting For Osteoporosis?
Sitting adds strain to the bones. Standing and walking give a lesser strain when compared to sitting. Exercises also add strain to bones, which can lead to fractures. When excessive force or pressure is applied to the brittle bones, such as forward bending, sit-ups, abdominal crunches, toe-touch gives forceful compressions to the bones of the spine. So avoid bringing the knee up to the chest forcefully while sitting or lying down.
5.
What Foods Are Bad For Osteoporosis?
The foods that should not be consumed during osteoporosis are high salted foods, alcohol, beans or legumes, wheat bran, excessive vitamin A, caffeine, and soft drinks.
6.
What Is the Best Form Of Vitamin D to Treat Osteoporosis?
Vitamin D helps to treat osteoporosis and is found in various foodstuffs such as fatty fish, like tuna, salmon, mackerel, cheese, eggs, beef, and foods with added vitamin D are present in milk cereal, orange juice. Vitamin D is also available in multivitamins along with calcium supplements.
7.
What Is the Best Form Of Calcium to Take?
For postmenopausal women, men, younger individuals, 1200 milligram of calcium is necessary, including both diet and supplemental form. Calcium is available as Calcium carbonate and Calcium citrate. Calcium carbonate supplements are taken with a meal as it requires stomach acids to dissolve. Calcium citrate supplements can be taken at any time.
8.
How Can I Reverse Osteoporosis Naturally?
By maintaining a proper body ailment, eating calcium-rich foods, practicing weight-bearing exercises helps with osteoporosis. The degree of the condition differs for each person, and identifying the condition in the early stage helps to prevent osteoporosis. Otherwise, it is impossible to reverse the bone loss.
9.
What Is the Safest Osteoporosis Medication?
Bisphosphonates are the first line of drugs used for osteoporosis treatment. The safest osteoporosis medication are:
- A weekly pill of Alendronate of class bisphosphonates.
- Tablet or injection Ibandronate every three months.
- Tablet Risedronate, which is a daily, weekly, or monthly tablet.
10.
Can Osteoporosis Shorten Life Expectancy?
Osteoporosis involves multiple bones where there is the quantitative reduction of bone tissue mass. It is common in elderly people and more frequent in postmenopausal women and has excess mortality in men than women under 70 years. The life expectancy was 18.2 years and 7.5 years for men and 26.4 years and 13.5 years for women who began treatment at 50 and 75 years of age.
11.
What Are the Best Foods to Eat When You Have Osteoporosis?
Patients with osteoporosis have a calcium deficiency which makes the bone brittle. So, the consumption of foods that are rich in calcium can help to overcome the disease. Avoid a salt-rich diet as it is harmful to bones. High intake of Vitamin C substitutes such as oranges, bananas, apples, and including green leafy vegetables such as broccoli, collard greens, turnip greens, kale and fish, nuts, almonds, and dairy products aids in strong bones.
12.
What Is the Result of Untreated Osteoporosis?
Osteoporosis may remain asymptomatic or may cause the only backache. This condition is common in women and elderly people. However, if untreated, more extensive involvement of disease occurs associated with fractures, particularly of the distal radius, femoral neck, and vertebral bodies, which causes pain and disability.
13.
Which Posture Is Good For People With Osteoporosis?
Osteoporosis occurs due to excessive osteoclastic resorption and slow bone formation, which may cause severe pain and discomfort. During sleep, the pain can be relieved by placing the pillow under the knees, which will help to relieve the tension and flex the knees. If you want to turn and sleep on the required side, place the pillow lengthwise between the legs to present the pillow between the knees and ankles.
14.
What Is the Rate of Progression of Osteoporosis?
Osteoporosis occurs commonly in postmenopausal women and elderly people. The rate of bone loss increases five to ten years after menopause. Bone loss also occurs due to estrogen deficiency more after menopause at a rate of 2%. Bone loss in men and women occurs at the rate of 0.3% in men and 0.5% in women.
15.
Why Should We Not Drink Coffee With Osteoporosis?
Caffeine should not be consumed if we have osteoporosis. Consumption of high coffee may result in cortical bone loss. Increased caffeine intake causes increased release of calcium in the urine, leading to the risk of fracture. Caffeine consumption results in:
- Decreased bone mineral density.
- Increased risk of hip fracture.
- Impaired calcium retention.
Last reviewed at:
11 Apr 2023 - 4 min read
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