Osteoporosis in Females

What is Osteoporosis in Females?

Osteoporosis significantly affects the physical, emotional, and mental health of women after menopause. This long-lasting disease affects one in three women and one in five men over the age of 50. The disease weakens bone density and quality, leading to the description ‘porous.’ Because of this, women with osteoporosis are more at risk of fractures resulting from minor slips, falls, or even spontaneously.

Osteoporosis is defined by the World Health Organization (WHO) as having a bone density less than 2.5 SD (standard deviation) compared to an average, healthy population of the same age and gender. This is a measure of how much someone’s bone density varies from what is typically expected.

The WHO uses measurements of Bone Marrow Density (BMD), to categorize bone health:

• Normal: If the T-Score value is greater than -1.0
• Osteopenia (early stage bone loss): If the T-Score value lies between -1.0 and -2.5
• Osteoporosis: If the T-Score value is less than -2.5
• Severe or established osteoporosis: If the T-Score value is less than -2.5 and there is a history of easy fractures

This grading system helps doctors to diagnose and treat the condition in a timely manner.

What Causes Osteoporosis in Females?

Osteoporosis, a condition that makes bones weak and brittle, is often seen in older women who don’t have other risk factors. However, it’s not only caused by old age.

There are many diseases, even in young women, that could increase the risk of developing osteoporosis. These diseases include having an overactive thyroid (hyperthyroidism), having an overactive parathyroid gland (hyperparathyroidism), celiac disease which is an intolerance to wheat type foods, chronic kidney disease, and autoimmune disorders like rheumatoid arthritis, systemic lupus erythematosus (an immune system disorder that causes joint pain and damage throughout your body), and ankylosing spondylosis (a type of arthritis that affects the spine). Smoking and high alcohol intake are risk factors that can be changed or stopped.

Health professionals always recommend women to quit smoking and reduce their alcohol consumption.

Vitamin D plays a vital role in strengthening bones and helping the body to absorb calcium. Lack of vitamin D is a risk factor for osteoporosis, especially in countries where there is not a lot of sun, which is important for the body to produce vitamin D.

There are also certain medications that could contribute to the development of osteoporosis. These are secondary risk factors and include steroids, thyroid hormone (thyroxine), heartburn medicines (antacids), and cancer treatment medicines, especially a class of drugs used for treating breast cancer known as aromatase inhibitors.

Risk Factors and Frequency for Osteoporosis in Females

Osteoporosis is a serious health issue affecting over 200 million people around the globe. It’s especially common in women after menopause, with about 25 to 30 percent of these women in the United States and Europe having this condition. Additionally, the number of osteoporosis cases has significantly grown due to people living longer and having an aging population.

If you’ve had a bone fracture before, you are at a higher risk of getting another one. Specifically, those who had a minor fracture in the past are over 80 percent likely to experience a new fracture. Also, if you’ve had a spinal fracture before, your risk of a hip fracture doubles, and your risk of a forearm fracture increases by about 50 percent.

Your ethnicity can also affect your likelihood of getting osteoporosis, and it’s associated with your bone mineral density (BMD).

• African American women usually have higher BMD than Asian women of the same age.
• The highest prevalence of osteoporosis is observed in Native Americans (11.9%), followed by Asians (10%), Hispanics (9.8%), Whites (7.2%), and African Americans (4%).
• Interesting to note, even though African American women have the highest BMD, they are most likely to suffer fatal hip fractures because of longer hospital stays.

Signs and Symptoms of Osteoporosis in Females

Osteoporosis, a condition that weakens bones, doesn’t show specific symptoms until a fracture occurs. Some people might experience bone aches (mainly in the hips and feet), though this is more often associated with a similar condition called osteomalacia. There’s a tool known as the Fracture Risk Assessment Tool (FRAX) that can predict your risk of fracture within the next ten years. This tool looks at factors like age, family history, whether you smoke, use of steroids, arthritis, and bone density in the femoral neck. Osteoporosis commonly results in vertebral fractures, hip fractures (in around 15% of women), and certain wrist fractures. Many vertebral fractures are discovered accidentally on imaging scans, as they usually don’t cause symptoms.

Unfortunately, worldwide screening for osteoporosis in women isn’t common. However, in the United States and Canada, it’s recommended that women over 65 have their bone mineral density tested, even if they don’t have risk factors. There are several risk factors for osteoporosis, and they can be divided into two groups: modifiable (meaning they can be changed) and non-modifiable (meaning they can’t be changed).

• Non-modifiable risk factors include a personal or family history of fractures, being white, being older or having dementia or frailty, and being female.
• Modifiable risk factors include currently smoking, having a low BMI, going through menopause early (before age 45) or having both ovaries removed, not getting enough calcium in your diet, drinking alcohol excessively, falling often, and not getting enough physical activity.

The causes of osteoporosis can be categorized into two types: primary and secondary. Primary osteoporosis is usually related to age or dietary factors. Secondary osteoporosis occurs as a result of other medical conditions and medications.

• Primary osteoporosis can be further divided into two types:
  • Type 1 is linked to hormonal changes in postmenopausal women. Following menopause, the balance between estrogen and progesterone, which regulate bone formation and breakdown, changes. As a result, more bone is lost than is formed.
  • Type 2, or senile osteoporosis, often results from a long-term lack of dietary calcium or occasionally from factors that affect calcium metabolism, such as an overactive parathyroid gland. This type of osteoporosis is more common in women and often leads to hip fractures.
• Secondary osteoporosis can result from several medical conditions that cause an imbalance between new bone production and old bone loss. Conditions that can promote osteoporosis include an overactive parathyroid or thyroid gland, diabetes, certain blood disorders, various cancers, malabsorption conditions, liver disease, and diseases that affect collagen, such as scurvy and Marfan syndrome. Additionally, certain medications, such as aluminum-based antacids, heparin, seizure medications, thyroid hormones, and steroids, can cause osteoporosis.

Understanding a patient’s medical history is crucial for identifying known osteoporosis risk factors and the risk of an osteoporosis-related fracture. This includes recognising conditions like COPD (chronic obstructive pulmonary disease), asthma, and other autoimmune disorders that require long-term steroid use, which can increase the risk of osteoporosis. Risk factors for falls in older adults include poor balance, muscle weakness, certain medications, impaired vision or hearing, and deconditioning.

Patients might experience pain, decreased height, severe disability from hip fractures or gait disturbances. Certain fractures, especially of the vertebrae, might only be discovered by chance in x-ray examinations. Also, a condition called sarcopenia (loss of muscle mass) could also occur.

Testing for Osteoporosis in Females

When checking for the possibility of osteoporosis, your doctor will begin by running some basic blood tests. This look at your complete blood count, as well as your levels of things like calcium, phosphorus, albumin (a protein that carries hormones and vitamins), and 25-hydroxyvitamin D (a form of Vitamin D), will give your doctor a good idea of your overall bone health. Depending on the results, you might then need additional tests to check for other potential problems such as celiac disease, cancer, or multiple myeloma, which are conditions that can affect the health of your bones.

Your doctor might also order an X-ray. While an X-ray can’t definitely confirm osteoporosis, it can show if you have low bone density, which is a strong indicator of the condition. The X-ray can also show if there’s any abnormal shaping of the spine, which would suggest a higher risk for fractures.

A more specialized test used to measure bone health and diagnose osteoporosis is called a DEXA (Dual-energy x-ray Absorptiometry) bone density scan. This test looks at your bone density compared to both young, healthy individuals (the T-score) and people in your same age group (the Z-score). If your T-score is between -1.0 and -2.5, you may have low bone density or osteopenia; if it’s lower than -2.5, you might have osteoporosis. However, each case is different based on individual health factors, so treatment decisions will be made accordingly.

Besides the DEXA scan, your doctor may use other imaging techniques like CT scans, MRIs, or a bone scan to differentiate the cause of a fracture. Recent additions to monitoring treatment response or failure include the use of bone turnover markers.

This could include tests for serum alkaline phosphatase (an enzyme found in many body tissues), bone-specific ALP (an enzyme related to bone growth), serum osteocalcin (a hormone that helps regulate bone), and serum carboxy-terminal collagen crosslinks (a breakdown product of bone). These markers offer additional information to guide treatment decisions for complex cases where a DEXA scan might not be enough.

While rarely used, a bone biopsy is a test that can precisely identify the composition and structure of the bone. This might be considered in specific circumstances if new treatments are being used for your bone health.

Treatment Options for Osteoporosis in Females

Managing osteoporosis in women often involves lifestyle changes and medication. Recommendations for treatment are based on assessing the risk of fractures, existing health conditions, and any history of fragile bones.

Non-Medication Therapy:

One of the recommended lifestyle changes involves quitting smoking. It is found that smoking increases bone loss. Regular exercise should also be incorporated, as it has been shown to improve bone mineral density (BMD). This is a measure of the amount of minerals (such as calcium) in your bones, which indicates their strength. It is suggested to exercise for about 30 minutes a day, three to four times a week; however, it needs to be done consistently, as stopping can revert the positive effects.

It’s also key to follow a diet rich in calcium and vitamin D. If you’re not getting around 1200 mg of calcium per day from your food, you should either take daily calcium supplements or eat more calcium-rich foods like dairy products. Due to its vital role in bone health, if needed, you should also take Vitamin D supplements. Another crucial step is doing everything possible to prevent falls which could lead to fractures.

Medication Therapy:

Once there is assurance of adequate vitamin D and calcium intake, specific medications for osteoporosis can be started. The World Health Organization recommends using the FRAX tool to assess fracture risk.

The National Osteoporosis Foundation lists three scenarios where medication therapy should be started:

1. If there has been a hip or vertebral fracture in the past
2. If your T-score, a measure of bone density, is less than or equal to -2.5 at your femoral neck or spine
3. If your T-score between -1 and -2.5 and you have a 10-year possibility of more than 3 percent hip fracture or a more than 20 percent probability of a major osteoporosis-related fracture

The primary treatment for osteoporosis is bisphosphonates, which work by inhibiting an enzyme that prevents bone resorption, helping to reduce overall bone loss. There are various types of bisphosphonates that can be taken orally or intravenously. The dosage and administration methods vary and should be taken exactly as prescribed by your healthcare provider.
For people with certain existing conditions like severe hiatal hernia or gastrointestinal surgery, oral bisphosphonates are not recommended. Instead, they can consider an intravenous form of bisphosphonate.

Likewise, there are other kinds of medications for those who cannot tolerate bisphosphonates. Some commonly used alternatives include denosumab, hormone replacement therapy with estrogen for postmenopausal women, selective estrogen receptor modulators (SERMs), and even anabolic agents for those at a very high risk of fractures. Also, for patients who do not fit the categories to receive the above-mentioned therapies, intranasal calcitonin could be an alternative option. However, if you have a history of deep vein thrombosis, it’s important to take this into consideration before starting hormone replacement therapy.

Surgical Treatment:

For a small number of patients who do not respond to medication treatment, orthopedic procedures could be helpful, especially for stabilizing fractures and relieving pain. These procedures include kyphoplasty, which involves surgically introducing a balloon-like device, and vertebroplasty, where a cement-like material is injected into the fractured bone. However, such procedures come with their own risks, including persistent pain, allergic reactions, and, in rare cases, paralysis or blood clots in the lungs.

Management of osteoporosis in women should always be tailored to the individual’s specific situation, and a healthcare provider should be consulted before starting any treatment.

What else can Osteoporosis in Females be?

Even though fractures, particularly those in the spine and unusual fractures, are often caused by osteoporosis, it’s essential not to rush to this conclusion, especially for younger patients. These fractures could be the result of various medical conditions, so careful consideration and testing are important before diagnosing osteoporosis.

The following are some medical conditions that doctors should consider:

• Leukemias
• Lymphomas
• Melanomas
• Any metastatic cancers, specifically breast and ovarian cancer
• Inherited metabolic and genetic disorders
• Disorders that can be acquired like homocystinuria, sickle cell anemia, mastocytosis, Paget’s disease, hyperparathyroidism, and scurvy.

What to expect with Osteoporosis in Females

If this disease is detected in the early stages where bone loss is minimal, the outlook is generally positive. Starting treatment early with a class of drugs known as bisphosphonates can help with this process. However, if the disease is only recognized after a hip fracture has occurred, the situation becomes more severe. In these cases, there is a 10 to 15 percent increase in the chance of death, especially in women who are 80 years or older.

Because this disease is so common, it’s crucial that we identify it as early as possible so we can prevent and treat it effectively. The most commonly occurring fractures associated with this disease occur in the hip, followed by fractures in the spine.

Fractures from this disease are frequent across the globe, including 80% of fractures in the forearm, 75% in the humerus (the bone that runs from the shoulder to the elbow), 70% in the hip, and 58% in the spine. Hip fractures can significantly impact a person’s life, causing chronic pain, disability, reduced ability to move, and decreased independence, all of which can lead to a poorer quality of life.

Spine fractures, when compared to hip fractures, are associated with an eight times higher risk of death related to aging. These fractures can lead to severe back pain that persists over time, a decrease in height, deformation and kyphosis (an abnormal rounding of the spine), and even reduced lung function. When someone has a spinal fracture, they are at a higher risk of experiencing more spinal fractures and fractures in other places. Women who have had a spinal fracture are at risk of suffering from additional fractures within 1 to 2 years.

Possible Complications When Diagnosed with Osteoporosis in Females

Fractures caused by osteoporosis can lead to serious health problems and can even increase the risk of death. They can also be costly to treat and can significantly affect a woman’s quality of life. It’s particularly dangerous when these fractures occur in the hip and spine, as these can cause severe disability. Some patients might require surgery if the fractures lead to a narrowing of the spinal canal or pressure on the spinal cord. Particularly concerning is that patients who suffer hip fractures have a higher chance of dying within the first year after the fracture.

Key Points:

• Osteoporosis can lead to fractures that can dramatically affect health and quality of life
• These fractures can sometimes require surgical intervention
• Fractures in the hip and spine can cause significant disability
• Patients with hip fractures face a higher risk of death within a year of the fracture

Preventing Osteoporosis in Females

When it comes to managing osteoporosis, the effectiveness of treatments can be greatly affected by actual or perceived difficulties in tolerating the therapies, as well as not sticking to the treatment recommendations. Studies show that a lot of patients stop their prescribed treatment before finishing their first year. It’s extremely important to educate patients to prevent osteoporosis in the first place.

Staying away from changeable risk factors – things in your lifestyle that you can control – is crucial. Similarly, maintaining a healthy diet, engaging in regular exercise, and taking good care of your bones is key. These elements remain the fundamental aspects of care and prevention for osteoporosis, a condition that is worryingly on the rise.