Osteoporosis is literally defined as bone thinning. Over time, without knowing about it, you may be losing substantial amounts of your bone density. This gradual process may even go unnoticed till it’s too late. Simple measures can ensure that this doesn’t happen to you.
Causes of Osteoporosis
This condition alone is the single most common form of bone disease. In women a 1:5 ratio of diseased to healthy, exists in the age group above 50. It’s a dis-balance between new bone formation and old bone re-absorbtion.
With too much of old bone being reabsorbed and not enough new bone being formed.
Most women present with serious complications like hip fractures, or spine fractures and even wrist fractures with very little trauma involvement.
The two building blocks of bone are calcium and phosphate minerals. These minerals may even be reabsorbed from your bones as you age.
This is why it is important to keep the levels replenished by consuming foods rich in these minerals or taking supplements.
Women and Osteoporosis
The leading cause of this problem coming up in women is the decline of estrogen hormones as menopause sets in. Women over 50 and even men in their seventies are at greater risk. White women and women of Asian descent who are small boned with weights under 125 pounds are also more prone to develop osteoporosis.
Women with certain conditions or habits are at an increased risk of developing osteoporosis:
- Amenorrhic for long times
- A strong family history of the disease
- She’s received hormone treatment for breast cancer
- She smokes
- If her diet is deficient in calcium. Eg if she’s lactose intolerant and can’t consume dairy products
Other Osteoporosis Causes
This condition is often seen in bed-ridden patients. People with diagnosed rheumatoid arthritis or chronic kidney ailments are at increased risk. Even young people who have eating disorders such as anorexia are at an increased risk due to insufficient dietary intake of minerals.
Some patients who have epilepsy and have to take antiseizure medications are also at increased risk of losing valuable bone. Steroids used for long periods of time also demineralises bone.
Hyperparathyroidism and deficiency of vit.D are also predisposing factors.
Early on this disease is rather silent. But later, once the bones have suffered a long period of resorptive stress patients develop:
- Bone pain
- Brittle bones that fracture with very little trauma
- Decreased height due to small vertebral fractures. This decrease can be as marked as 6 inches.
- Low back pain also due to spinal fractures.
- Also neck pain due to minute fractures of the cervical spine
- Kyphosis which is the stooping posture seen in the elderly.
If you are found to be at an increased risk for osteoporosis such as being 65yrs or having had fractures in the past, your doctor will advise you to undergo several tests that will determine your BMD (bone mineral density).
DEXA is one of the most effective methods of determining your bone density. It’s a scan that is dual energy X-ray absorptiometry, this scan checks the conditions of your bones.
HEEL ultrasound may also be done to test for bone density. It’s not enough though and so if a heel ultrasound comes up faulty then you must go for a DEXA.
Two tests such as CAROC and FRAX are used by doctors to assess your ten-year absolute fracture risk. BMD testing may even be continued for three years annually if your doctor gives you medication to improve your bone density. BMD can also be used to test for rapid bone loss in patients who aren’t on medication yet but are at an increased risk of developing the disease.
Treatment and Prevention of Osteoporosis
Many treatments aim at prevention. To maintain good bone strength doctor’s advice that men and women between the ages of 19-50 ensure that their daily calcium intake is 1200mg. Vitamin D intake should also be in daily doses of 400-1000IU for people under 50, and 800-2000IU for adults with osteoporosis over 50. Higher doses require medical supervision.
Exercises which include weight bearing routines are very important for maintenance of bone health. Walking, weight training and stair climbing are all good undertakings.
Medical treatment for osteoporosis includes:
- Bisphosphonates. They slow down bone loss and also aid in repair
- SERM’s: selective estrogen reuptake modulators are useful in women.
- Calcitonin: this is a hormone, naturally occurring in the body but can be taken through a nasal spray to help bone buildup and slow resorption.
- Denosumab: A RANK ligand inhibitor which stops bone breakdown and can be given through injection.
- Testosterone: only recommended when hypogonadism is the cause of osteoporosis. In such cases alone should testosterone replacement be done with bisphosphonates.
- HRT’s: hormone replacement therapy available for menopausal women.
- Parathyroid hormone analogues: severe osteoporosis is treated by this method.
- Raloxifene: this can reduce the risk of spinal fractures by 50%. Useful also because it may have protective effects against heart disease and breast cancer. It does have a serious side effect of causing DVT, which is clotting in the deep leg veins.
Combination therapy is used in some resistant cases.