What is Osteoporosis?
Osteoporosis is a condition where the density of the bones is low due to changes in the bone’s tiny structures. This makes patients more likely to get fractures even from minor bumps or falls, which are often referred to as ‘fragility fractures’. These fractures can significantly lower a person’s quality of life, increase their chances of getting ill, dying, or becoming disabled.
More than half of white women who have gone through menopause will experience a fracture linked to osteoporosis. Unfortunately, only a third of older women who have a hip fracture will regain full independence. For white men, there’s a 20% risk of getting an osteoporotic fracture, but if they have a hip fracture, the likelihood of passing away within a year is double that of women.
Interestingly, Black men and women are less likely to suffer from osteoporosis compared to their white counterparts. But, if they do have osteoporosis, their chances of getting fractures are similar. With the aging population in America, the number of osteoporosis-related fractures is expected to triple.
What Causes Osteoporosis?
Primary osteoporosis is usually due to aging or a decrease in sex hormones. This means that the bones start to weaken or break down, resulting in a lower bone density or thickness and an increased chance of fractures or breaks. Secondary osteoporosis, on the other hand, is caused by other diseases or treatments for those diseases. Men are more likely to have this type of osteoporosis than women. Certain medications, like steroids, anti-seizure drugs, cancer drugs, and some others, could also lead to secondary osteoporosis.
Certain medical conditions can also cause osteoporosis. These might include hyperparathyroidism (overactivity of the parathyroid glands), eating disorders like anorexia, malabsorption (where the body can’t absorb nutrients properly), hyperthyroidism (overactive thyroid), or over-treatment of hypothyroidism (underactive thyroid). Other causes could be long-term kidney disease and Cushing’s disease, as well as any health condition that results in long-term immobility or being bedridden. The absence of menstrual periods for over a year due to low body weight, excessive exercise, or hormonal therapies can also lead to rapid bone loss.
There are many risk factors for osteoporosis, including getting older, weighing under 128 pounds, smoking, having a history of osteoporosis in your family, being of White or Asian heritage, going through menopause early, not exercising enough, or having had a fracture from a minor fall or accident after the age of forty. People with conditions like spinal cord injuries, which affect their ability to move, could also see a rapid decline in their bone thickness in just two weeks after the injury.
What increases the risk of fractures? Advanced age, a previous fracture, being female gender, using corticosteroids, having a low body mass index, being a smoker, secondary osteoporosis, and drinking alcohol.
Risk Factors and Frequency for Osteoporosis
Osteoporosis is a widespread condition affecting over 200 million people. The likelihood of having osteoporosis increases as people age. It affects more than 70% of people over the age of 80. Women are more likely to get osteoporosis than men. In developed countries, between 2% and 8% of men and between 9% and 38% of women have this condition. Osteoporosis is responsible for approximately 9 million fractures worldwide every year.
- One in three women and one in five men over the age of 50 will experience a fracture due to osteoporosis.
- People living in areas of the world with less sunlight, and therefore less vitamin D, have higher fracture rates compared to those living closer to the equator.
Signs and Symptoms of Osteoporosis
To assess the risk of bone loss, a detailed history and physical examination is required. This should include determining any behaviors linked with secondary bone loss. It’s important to know about a person’s habits like smoking and regular alcohol consumption. They should also ask if any family members have osteoporosis. Furthermore, it helps to understand the patient’s history of fractures including any low-energy falls or fractures after the age of 40.
A physical exam usually doesn’t show any signs of osteoporosis until the disease has advanced significantly. At this stage, people may have lost height or developed a noticeable hunch due to fractures in their vertebrae.
For people who don’t have any risk factors, experts generally suggest that women start screening for osteoporosis at 65 years old and men at 70 years old. However, it’s worth noting that there’s not enough evidence to recommend routine osteoporosis screening for men according to the United States Preventative Services Task Force. People with risk factors or high scores on an osteoporosis risk test should consider getting screened sooner.
For women who have already had a dual-energy X-ray absorptiometry (DEXA) scan and it was normal, a follow-up scan is not necessary. Research has shown that most women with normal initial DEXA scan results don’t end up developing osteoporosis. Even when monitoring treatment for osteoporosis, these scans rarely lead to changes as long as doctors can check that patients are taking their medications correctly through other methods.
Testing for Osteoporosis
If you’ve been diagnosed with osteoporosis, your doctor will likely perform laboratory tests to check your kidney and thyroid function, as well as your levels of 25-hydroxyvitamin D and calcium. These tests will give your doctor a better understanding of your overall health and how to best treat your condition.
The best test for assessing bone strength or density is known as a dual X-ray absorptiometry scan, recommended by the World Health Organization (WHO). This quick test, which only takes about five minutes and uses minimal radiation, measures all hard tissue in its path, including your bones.
There are also peripheral dual X-ray absorptiometry tests and ultrasound, which measure bone density in less vulnerable bones. However, these tests don’t correlate well with the standard dual X-ray absorptiometry scan of the hip and spine and aren’t as useful for making a diagnosis or treatment decision.
The results from a dual X-ray absorptiometry scan come in the form of a t-score and a z-score. The t-score measures the difference between your bone density and the average bone density in healthy young adults. If your t-score indicates your bone density is somewhat lower than the average (a score between -1 and -2.5), you may be diagnosed with osteopenia, a condition that can lead to osteoporosis. If your t-score is even less (below -2.5), you may be diagnosed with osteoporosis.
The z-score measures your bone density compared to what’s expected for someone your age and can help identify if you have secondary osteoporosis, a form of the condition caused by other medical issues. If your z-score is less than -1.5, your doctor may investigate further for secondary causes of osteoporosis.
The bone density of your hip is critical because it offers the best prediction of future fractures. Spine bone density can sometimes be misleading due to increased hardness from degenerative joint disease. However, spinal density measurements are useful in younger, perimenopausal women without significant joint disease since it can reveal early signs of osteoporosis before they appear in the hip.
The World Health Organization has also developed a tool called the osteoporosis risk assessment tool. This handy tool calculates a ten-year probability of suffering a significant fracture, considering factors like body mass index, independent risk factors, and some causes of secondary osteoporosis. It can be particularly useful in determining the need for treatment in patients with osteopenia and identifying younger patients who could benefit from a dual X-ray absorptiometry scan due to a high risk of fractures. However, this tool is not intended for patients who are already being treated for osteoporosis.
Treatment Options for Osteoporosis
It’s crucial to make certain lifestyle changes to maintain your health, especially if you have osteoporosis. Doing weight-bearing activities and exercises that improve balance, like yoga and tai chi, can help. Trying to quit smoking and limit how much alcohol you drink is also recommended. And don’t forget about your diet – getting enough calcium and Vitamin D3 is essential. People who don’t have enough Vitamin D should take additional supplements to reach the recommended levels.
For those who already have osteoporosis, with a t-score of -2.5 or lower, treatment is necessary. Treatment is also advised for anyone who has osteopenia (a pre-osteoporosis condition where bone density is lower than normal, with a t-score between -1 and -2.5), and has a 3% or higher risk of hip fracture. If you’ve had a fracture before due to minor stress, such as a fall, you’re likely to benefit from treatment too.
There are many different medicines that can help manage osteoporosis. Some work by slowing down the process where old bone is removed in the body (anti-resorptive medications), while others encourage the growth of new bone (anabolic medicines). Women may be prescribed risedronate, alendronate, zoledronic acid, or denosumab as initial treatments to lower the risk of bone fractures. These medications can help protect against fractures in your spine and other areas. Another medicine, bazedoxifene, is FDA-approved to help prevent osteoporosis, but it’s not used to treat osteoporosis.
Men with osteoporosis can take bisphosphonates as well, as this type of medication is considered a top choice. If someone can’t tolerate these medications, other alternatives, such as teriparatide, can be considered. Teriparatide, along with a bisphosphonate or denosumab, might be suggested for people with severe osteoporosis and hip and vertebral fractures.
Monitoring your treatment using dual X-ray absorptiometry scans, which measure bone density, might be helpful, although research on this practice is not clear. Some studies do show that women had reduced fractures with treatment, even if their follow-up bone mineral density test didn’t change.
How long you will be on the medication depends on the type of medication used–some medications need follow-up treatment, or you could risk quickly losing bone mass after stopping the medication. There’s some ongoing research into whether it’s better to take a break from bisphosphonate therapy after five years or continue it constantly. Your doctor will discuss this with you.
Remember, if you’re on bisphosphonates and start to feel mild discomfort in your thigh, stop any weight-bearing activity immediately and get full-length femur and hip radiographs, as thigh pain could be a sign of a pending fracture. Contact your doctor immediately for direction on next steps.
What else can Osteoporosis be?
These are various medical conditions that can affect the human body:
- Homocystinuria
- Hyperparathyroidism
- Osteomalacia and renal osteodystrophy, which can be studied through medical imaging
- Mastocytosis
- Multiple myeloma
- Paget’s disease
- Scurvy
- Sickle cell anemia
What to expect with Osteoporosis
Osteoporosis is a condition that makes your bones weak and more likely to break. If caught and treated early, you can expect good results. But if it’s left untreated, it can lead to chronic (long-lasting) pain and fractures (broken bones).
You can lower your risk of getting osteoporosis with methods like using a type of medication called bisphosphonates, staying active, and eating a diet rich in calcium. However, bisphosphonates can be costly and come with serious side effects. And there’s some uncertainty about whether they can actually reduce the chance of fractures. One group often at high risk for osteoporosis are women who have gone through menopause, and often fractures to the hip in these women can lead to messy recoveries and extended stays in nursing homes.
A particular concern with osteoporosis is fractures in the spine (vertebral fractures), which are also common. These can lead to kyphosis (a humpback), chronic pain, issues breathing, and a high risk for developing pneumonia, a lung infection. Many patients with severe osteoporosis end up losing their ability to live independently because they can’t function as they used to.
Possible Complications When Diagnosed with Osteoporosis
The most severe complications of osteoporosis are pathological fractures. These are fractures that occur in bones weakened by disease rather than trauma. They commonly happen in the hip or spine. Hip fractures often result from falls and can lead to significant physical impairment and an increased risk of death within the first year after the injury. Additionally, there are also spinal fractures that do not result from falls. These compression fractures may cause back pain and a hunched posture, known as kyphotic posture.
Possible Complications:
- Pathological fractures, especially in the hip or spine
- Increased risk of death within the first year after a hip fracture
- Physical disability due to hip fractures
- Spinal fractures resulting in back pain
- Kyphotic posture due to spinal fractures
Preventing Osteoporosis
Your healthcare team will likely stress the importance of maintaining good nutrition and keeping a regular exercise routine to keep your bones healthy throughout your life.
What you eat is key to bone health. This includes eating enough protein, and taking supplements for calcium and vitamin D if needed. It’s also important to keep a healthy body weight. Being underweight can make bone loss and fractures more likely. Being overweight can make wrist and arm fractures more likely.
To help your bones, consider doing weight-bearing exercises such as walking, jogging, and climbing stairs. Coupled with strength training and balance exercises, these activities can have the best effect on preventing bone problems. Keep in mind that while swimming, cycling, and other exercises aren’t weight-bearing, they are still good for your heart. However, they won’t specifically help improve your bone health.
