Osteoporosis

Overview:

The word osteoporosis means 'porous bones.' It is a bone disease causing the bones in the body to become brittle and weak.

The body continually absorbs old bones and forms new bones. This keeps the bones healthy and strong. However, after individuals reach the age of 25, this process slows down. The bones begin to lose mineral density. Losing bone is a natural process of ageing. Sometimes, the body loses more bones than it can form. This makes the bones weaker and results in osteoporosis.

The loss of bones may be due to natural causes, medical causes, or an insufficient diet. A diet low in calcium and vitamin D is one of the primary causes of osteoporosis. Women experiencing menopause also lose bone density rapidly. This makes them more susceptible to osteoporosis than men.

The disease develops slowly over the years and is often called the 'silent' disease as the symptoms appear much later in life. It can affect men and women of all ages, but individuals above fifty are more at risk.

The condition results in brittle bones that break easily. As a result, sudden movement can fracture bones. Fractures in the hip, wrist, or spine are common due to osteoporosis.

This condition cannot be cured, but there are ways to prevent the disease or manage the symptoms.

Stages of Osteoporosis:

Osteoporosis progresses gradually, and the symptoms often remain undiagnosed until a bone is fractured. This can be prevented if the disease is diagnosed in its early stage.

Osteoporosis goes through four different stages before the disease becomes severe. The body's bone density determines the disease's condition and each stage. The different stages of osteoporosis include:

• First stage: In this initial stage, the body's bone formation and the loss of bone are equal. No significant disease symptoms exist, and the bone density score is not too low.
• Second stage: No significant symptoms appear except osteopenia, a condition where the body does not make new bones as quickly as it loses. The loss of bone mineral density weakens the bone. There are no visible indications of this condition. A bone density test can reveal low scores.
• Third stage: This stage is when the individual is at a high risk of fracture even from performing daily activities. There are no additional symptoms. Bone loss increases in this stage, and the bones become very weak.
• Fourth stage: This is where osteoporosis symptoms like stooped posture and back pain are visible. Due to extreme bone loss, the risk of fracture becomes high. Individuals may already have a fracture or two before reaching this stage.

Types of osteoporosis:

There are two types of osteoporosis: primary (Type I) and secondary (Type II). 

Primary osteoporosis is the most common type of the disease, including postmenopausal osteoporosis. Type I is characterized by a loss of estrogen and androgen, resulting in increased bone turnover, bone resorption exceeding bone formation, and a greater loss of trabecular bone than cortical bone. 

The secondary is senile osteoporosis, with a clearly defined etiological mechanism. Type II represents the gradual age-related bone loss found in both sexes caused by systemic senescence and is induced by the loss of stem-cell precursors, with a predominant loss of cortical bone.

Symptoms:

No symptoms usually accompany the early stages of bone loss. However, once your bones are weakened by osteoporosis, you may experience signs and symptoms such as:

• Back pain caused by a broken or collapsed spinal bone.
• Height loss occurs over time.
• A stooping posture.
• A bone that fractures more easily than expected.

Causes: 

Osteoporosis develops as you age, and your bones lose the ability to regrow and reform themselves.
Certain medical conditions, such as hyperthyroidism, can contribute to osteoporosis development. They also cover the use of specific medications.
These medications include long-term oral or injected corticosteroids like prednisone or cortisone. 

Risk factors:

A variety of factors can increase your risk of developing osteoporosis, including your age, race, lifestyle choices, medical conditions, and treatments.

Age

The main risk factor for osteoporosis is age. Throughout your life, your body breaks down old bones and grows new ones.
However, by your 30s, your body begins to break down bone faster than it can replace it. This results in less dense and more fragile bone, making it more susceptible to breakage.

Lifestyle choices

Some bad habits can raise your risk of osteoporosis. Examples are:
The sedentary lifestyle: People who sit for a long period of time are more likely to develop osteoporosis than those who exercise regularly. Walking, running, jumping, dancing, and weightlifting are especially beneficial to your bones.
Excessive alcohol consumption: Drinking more than two alcoholic beverages per day increases the risk of osteoporosis.
Tobacco use: The exact role of tobacco in osteoporosis is unknown, but tobacco use has been linked to weak bones.

Race 

You are most likely to develop osteoporosis if you are white or of Asian descent.

Family history

Having a parent or sibling with osteoporosis increases your risk, especially if your mother or father fractured a hip.

Hormonal levels

Osteoporosis is more common in people who have excessive or insufficient levels of certain hormones in their bodies. Here are some examples:
Sex hormones: Lower sex hormone levels tend to weaken bones. One of the strongest risk factors for developing osteoporosis in women is a drop in estrogen levels during menopause. Treatments for prostate cancer that lower testosterone levels in men and breast cancer that lower estrogen levels in women are likely to hasten bone loss.
Thyroid issues: Excess thyroid hormone can cause bone loss. This can happen if your thyroid is overactive or if you take too much thyroid hormone medication to treat a hypoactive thyroid.
Other glands: Osteoporosis has also been linked to overactive thyroid and adrenal glands.

Menopause 

Menopause is another primary risk factor which occurs in women around the ages of 45 to 55 years. Menopause can cause a woman's body to lose bone even faster because of the changes in hormone levels that accompany it.

Men continue to lose bone at this age, albeit slower than women. However, by age 65 to 70, women and men typically lose bone at the same rate.

Dietary factors 

Osteoporosis is more likely to occur in people with:

Insufficient calcium intake: A lifelong lack of calcium contributes to the development of osteoporosis. Low calcium intake causes decreased bone density, early bone loss, and an increased risk of fractures.
Eating disorders: Both men's and women's bones weaken when they severely restrict their food intake or are underweight.
Gastrointestinal surgery: Surgery to reduce the size of your stomach or remove a portion of the intestine reduces the amount of surface area available for nutrient absorption, including calcium. These surgeries include those used to help you lose weight and treat other gastrointestinal disorders.

Steroids and other medications 

Long-term use of oral or injected corticosteroid medications, such as prednisone and cortisone, disrupts bone regeneration. Osteoporosis has also been linked to medications used to treat or prevent:

• Seizures
• Gastric reflux
• Cancer
• Transplant rejection 

Medical problems

Some medical conditions, such as:

• Celiac Disease
• Inflammatory bowel disease
• Kidney or liver disease
• Cancer
• Multiple myeloma.Rheumatoid arthritis
   

Complications

If osteoporosis is left untreated, it worsens. It increases the risk of fractures. Regular movements like bending down, bumping into a hard object, sneezing or coughing, and a sudden jerk can result in bone fractures.

Osteoporosis usually results in bone fractures in the hip or back area. A hip fracture or a fracture in the spine takes time to recover, and individuals will have to experience other problems. Age and health history influence the process of recovery.

Prevention of osteoporosis: 

Throughout life, both men and women can take simple steps to promote bone health:
Consume calcium-rich foods as part of a healthy diet that includes fresh fruits, vegetables, and whole grains. 
To maintain good health, it's important to get enough vitamin D, avoid smoking and alcohol, and engage in regular weight-bearing and strength-training activities. 

When to Consult a Doctor?

Osteoporosis symptoms go unnoticed until it's too late. If individuals experience any symptoms, which they will in the fourth stage, they should immediately consult an orthopaedic.

The typical warning signs of osteoporosis include:

• Receding gums
• Frequent fractures in bones
• Height loss
• Stooped posture
• Weak vertebrae
• Lower back pain

Diagnosis:

There are different ways to measure bone health that determine osteoporosis before any symptoms arise. Doctors usually consider family history, risk factors, and the current medical condition of an individual when diagnosing the disease.

Lab Tests: Doctors who suspect osteoporosis recommend a bone mineral density test, often called a bone density test. If the mineral content is high, the bone density will increase, indicating strong bones.

Doctors usually suggest bone density tests as part of regular check-ups. The test can also help to monitor the treatment of osteoporosis.

The doctor also recommends different blood or urine tests to understand markers such as enzymes, protein levels, vitamin D levels and other essential blood components. These tests help to identify other problems associated with the disease.

Treatment:

Treatment cannot cure osteoporosis or reverse bone damage. But it can prevent further bone loss and boost calcium to keep bones healthy. Depending on the age, health condition, and family history, the doctor draws up the best treatment plan for the patient.

• Home Care: Changing diet and exercising regularly can manage osteoporosis at home. Home remedies, followed by medication, can prevent issues like back pain or fractures.
• Diet: Try to get the daily source of calcium from food. Eat food fortified with calcium. Include low-fat yoghurt, cheese, milk, eggs, and other calcium-rich food in the diet. Vegetables like broccoli, kale, and leafy green vegetables are good sources of calcium that can be incorporated into the daily diet as well.
• Exercise: Daily exercise to avoid weight gain can help patients with osteoporosis. Also, strength training exercises to improve bone and muscle strength are recommended for patients with osteoporosis. Regular physical activity can prevent the condition of weak bones in older women and men. However, if an individual starts exercising after being diagnosed with osteoporosis, he/she should be careful with the activity plan he/she has decided to follow. The individual should find exercises that are safe for him/her and will not damage the bones further. Consulting a doctor for a proper exercise program before starting anything is recommended.
• Things to avoid: If an individual has the habit of smoking or drinking, cutting down on alcohol consumption or cigarettes is advisable. Avoiding excessive sugar or salt in a daily diet is also necessary.

Individuals should not practice high-impact exercises that can increase the risk of fractures.

Medication: Different medicines like Alendronate, Ibandronate, Zoledronic acid, and Tamoxifene are used to treat the condition of osteoporosis.

To help build strong bones, doctors often prescribe vitamin D and calcium supplements. These are some of the primary medications that a general practitioner may also prescribe after going through the test reports.

Surgical Treatment: When options like medication, dietary changes, exercise, and other methods fail after months of treatment, the doctor may resort to surgical treatment for issues like hip fracture or spine fracture.

The two most common surgical procedures for fractures due to osteoporosis include kyphoplasty and vertebroplasty.

Kyphoplasty is a procedure used to repair damage in vertebrae. This method involves creating space in the vertebrae using a balloon-like device. This helps to bring the fractured pieces close to their original position. The surgeon then performs vertebroplasty, inserting a cement-like liquid to heal the fracture and the pain.

These procedures are minimally invasive as they do not involve making a primary incision in the skin.

Alternative Management:

Menopausal Hormone Therapy (MHT) or hormone replacement therapy can help prevent osteoporosis symptoms. Estrogen hormone therapy, if started soon after menopause, reduces the risk of bone fractures and delays the onset of osteoporosis.

Although vitamin supplements and lifestyle changes remain the most commonly adopted treatment for osteoporosis, many individuals try alternative management for the disease.

Traditional Chinese medicines, which employ herbs like Drynaria fortunei, Bushen Yigu and Migu, treat osteoporosis.

Acupuncture is another therapy predominantly used in traditional Chinese medicines to manage osteoporosis. This therapy involves the insertion of needles through the skin at strategic points in the body. This therapy can be used alone or with herbal treatment.

Most alternative methods aim to manage osteoporosis symptoms and reduce pain.