Osteoporosis

Most commonly observed in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications.

Signs and Symptoms:

Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.

Risk Factors:

Risk factors can be divided into:

1. Non-modifiable


2. Potentially modifiable

Non- modifiable Risk Factors:

The most important risk factors for osteoporosis are advanced age (in both men and women) and female sex; oestrogen deficiency following menopause is correlated with a rapid reduction in bone mineral density, while in men a decrease in testosterone levels has a comparable effect.

Potentially Modifiable Risk Factors:

1. Vitamin D deficiency: Mild vitamin D insufficiency is associated with increased Parathyroid Hormone (PTH) production. PTH increases bone resorption, leading to bone loss.


2. Tobacco smoking: It inhibits the activity of osteoblasts. Smoking also results in increased breakdown of exogenous oestrogen, lower body weight and earlier menopause, all of which contribute to lower bone mineral density.


3. Malnutrition: Low dietary calcium intake, low dietary intake of vitamins K and C. Also low protein intake is associated with lower peak bone mass during adolescence and lower bone mineral density in elderly populations.


4. Excess physical activity: Excessive exercise can lead to constant damages to the bones which can cause exhaustion of the structures. In women, heavy exercise can lead to decreased oestrogen levels, which predisposes to osteoporosis.


5. Heavy metals: Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in the elderly and in females.


6. Soft drinks: Soft drinks (many of which contain phosphoric acid) may increase risk of osteoporosis.

Diagnosis: 

1. The diagnosis of osteoporosis is made on measuring the bone mineral density (BMD).


2. The most popular method is dual energy X-ray absorptiometry (DXA or DEXA).


3. In addition to the detection of abnormal BMD, the diagnosis of osteoporosis requires investigations into potentially modifiable underlying causes; this may be done with blood tests and X-rays.


4. Depending on the likelihood of an underlying problem, investigations for cancer with metastasis to the bone, multiple myeloma, Cushing's disease and other above mentioned causes may be performed.

Treatment:

There are several medications used to treat osteoporosis, depending on gender, but lifestyle changes are the most important aspect of it's treatment.

Prevention:

Methods to prevent osteoporosis include changes of lifestyle. However, there are medications that can be used for prevention as well.

Lifestyle:

As tobacco smoking and unsafe alcohol intake have been linked with osteoporosis, smoking cessation and moderation of alcohol intake are commonly recommended in the prevention of osteoporosis.

Exercise:

Achieving a higher peak bone mass through exercise and proper nutrition during adolescence is important for the prevention of osteoporosis. Exercise and nutrition throughout the rest of the life delays bone degeneration.