Osteoporosis is easily manageable and treatable with early diagnosis and certain lifestyle modifications and dietary changes.
Osteoporosis, often dubbed as the “Silent thief of bone health” is a medical condition that weakens bones, making them susceptible to fractures. It is characterized by a decrease in bone density and the quality of bone due to an increased catabolic-to-anabolic ratio in bone metabolism, leading to losing more bone architecture than making it. This results in the loss of bone mass and microarchitectural deterioration. Osteoporosis results in a decreased quality of life and an increased disability-adjusted life span. Early diagnosis, before fractures occur, and the assessment of the patient's bone mineral density, along with early treatment, can help prevent osteoporosis.
Causes and risk factors of Osteoporosis
Non Modifiable |
Modifiable |
Advancing age |
Inadequate nutrition |
Oriental & Caucasian ethnicity |
Sedentary lifestyle and immobilisation |
Female gender- after menopause, due to a dip in estrogen, including premature menopause(<45years) or surgical menopause |
Low body weight |
Genetics- Family history of osteoporosis |
Cigarette smoking |
History of fractures as an adult or in the family |
Estrogen deficiency |
Medications- Long - term usage of some medications, like corticosteroids, some anti-epileptics, immunomodulators, certain antidepressants, and antipsychotics. |
Excessive alcohol intake |
Diseases- Autoimmune disorders such as rheumatoid arthritis, Crohn's disease/ ulcerative colitis, celiac disease, cancer, CKD, Diabetes, COPD, etc. |
Low testosterone in men |
Symptoms
Osteoporosis is often referred to as the 'silent disease' because it is typically diagnosed very late in the course of the disease, usually after a fracture or when the disease has reached an advanced stage. Symptoms include:
1. Long-standing back pain
2. Loss of height
3. Stooped posture
4. Low-impact injuries leading to fractures, with the hip, wrist, and spine being the most common sites.
Diagnosis
Osteoporosis is typically diagnosed through bone density tests, such as Dual-Energy X-ray Absorptiometry (DEXA) scans. Fracture risk is strongly linked to bone strength and increases significantly as bone mineral density (BMD) decreases. The most reliable predictor of hip fracture risk is the measurement of hips using Dual-Energy X-ray Absorptiometry (DEXA). The preferred measurement sites include the total hip, femoral neck, total lumbar spine, or a combination of these sites.
For cases of secondary osteoporosis, additional tests are necessary to diagnose the root cause behind the development of osteoporosis, whether it be hormonal, genetic, autoimmune, or related to cancer.
Prevention and Management
Osteoporosis is easily manageable and treatable with early diagnosis and certain lifestyle modifications and dietary changes.
- Balanced Diet rich in calcium, vitamin D, and protein, which are essential for bone development.
- Engage in weight-bearing exercises like walking, low-impact exercises such as cycling, aerobics, yoga, core strengthening, and light-weight strength training exercises.
- Quit Smoking and avoid excessive alcohol and overconsumption of caffeinated beverages.
- Maintain a Healthy Weight.
- For the elderly, practice balance and postural exercises, take measures to prevent falls, and consider vision improvement to prevent accidents.
Pharmacological Therapy
The primary objectives of therapy for patients with osteoporosis are to prevent fractures by enhancing bone strength, reducing the likelihood of falling and injury, alleviating symptoms of fractures and skeletal deformity, and maintaining normal physical function.
Anabolic therapy
Treatment options for osteoporosis include calcium and vitamin D3 supplementation, as well as Teriparatide, a recombinant form of parathyroid hormone (PTH) that stimulates osteoblasts (bone-forming cells) to produce more bone.
Antiresorptive Therapy
Bisphosphonates are the most commonly prescribed class of medications. They are primarily used in cases of postmenopausal, corticosteroid-induced, and male osteoporosis. These medications work by inhibiting osteoclast resorption and inducing osteocyte apoptosis.
Denosumab is a monoclonal IgG2 antibody that targets RANKL, inhibiting its ability to bind to RANK and resulting in the inhibition of osteoclast activation.
Selective estrogen receptor modulators, such as raloxifene, bind to estrogen receptors in bone and reduce osteoclast activity.
Hormone Replacement Therapy
Treating the underlying cause, such as addressing the primary disease in cases of secondary osteoporosis, often leads to a consequential improvement in symptoms.
Conclusion
Osteoporosis is a common but often underestimated bone disorder that can have serious consequences, such as painful fractures and reduced quality of life. It is crucial to understand the risk factors, recognize early symptoms, and take proactive steps to prevent and manage this condition in order to maintain strong and healthy bones throughout life. Regular checkups with a healthcare provider and adopting a bone-healthy lifestyle can help in the fight against this "silent thief" of bone health.