Osteoporosis

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.

Causes:
Several factors contribute to the development of osteoporosis:

• Age: Bone density naturally decreases after peak bone mass is reached (around age 30).
• Hormone levels:
  • Estrogen: Lower estrogen levels in women after menopause are a significant risk factor.
  • Testosterone: Reduced testosterone levels in men also contribute to bone loss.

• Dietary factors:
  • Low calcium intake: A lifelong lack of calcium plays a role in diminishing bone density.
  • Vitamin D deficiency: Vitamin D helps the body absorb calcium, so a deficiency can weaken bones.

• Medications: Long-term use of certain medications, such as corticosteroids, thyroid hormone replacement, some diuretics, and some anti-seizure drugs, can damage bone.
• Medical conditions: Certain medical conditions increase the risk of osteoporosis, including:
  • Endocrine disorders (e.g., hyperthyroidism, Cushing’s syndrome)
  • Gastrointestinal diseases (e.g., celiac disease, inflammatory bowel disease)
  • Rheumatoid arthritis
  • Kidney disease

• Lifestyle factors:
  • Sedentary lifestyle: Lack of physical activity weakens bones.
  • Smoking: Tobacco use contributes to weak bones.
  • Excessive alcohol consumption: Regularly consuming more than 2 alcoholic drinks a day increases the risk of bone loss.

• Family history: Having a parent or sibling with osteoporosis puts you at greater risk.
• Body frame size: Small-framed people tend to have a higher risk because they may have less bone mass to draw from as they age.

Symptoms:
Osteoporosis is often called a “silent disease” because bone loss occurs without symptoms. You may not know you have osteoporosis until you:

• Break a bone: A fracture, especially in the hip, spine, or wrist, is often the first sign.
• Develop vertebral compression fractures: These fractures in the spine can cause:
  • Loss of height
  • Severe back pain
  • Stooped posture (kyphosis or “dowager’s hump”)

Diagnosis:
Doctors diagnose osteoporosis using several methods:

• Bone densitometry (DXA scan): A dual-energy X-ray absorptiometry (DXA) scan measures bone mineral density (BMD). It is the most common and accurate test for diagnosing osteoporosis. It typically measures bone density in the spine, hip, and sometimes the forearm.
• Medical history and physical exam: Your doctor will ask about your risk factors, symptoms, and any previous fractures.
• X-rays: While standard X-rays can show fractures, they are not as accurate as DXA scans for detecting early bone loss.
• Laboratory tests: Blood and urine tests may be done to check for underlying medical conditions that contribute to bone loss or to rule out other causes of bone loss, such as hyperparathyroidism or vitamin D deficiency.

Treatment:
Treatment for osteoporosis aims to:

• Prevent fractures
• Slow bone loss
• Increase bone density
• Control pain

Treatment options include:

• Medications:
  • Bisphosphonates: These are the most commonly used medications for osteoporosis. They slow bone loss and help prevent fractures. Examples include alendronate, risedronate, ibandronate, and zoledronic acid.
  • Monoclonal antibody: Denosumab is given as an injection and helps increase bone density and reduce fracture risk.
  • Selective estrogen receptor modulators (SERMs): Raloxifene helps increase bone density in postmenopausal women and reduces the risk of spinal fractures.
  • Hormone therapy (estrogen replacement therapy): Can help prevent bone loss in postmenopausal women, but is not a first-line treatment due to potential risks.
  • Bone-building medications:
    • Teriparatide and abaloparatide: These medications stimulate new bone formation and are given by daily injection.
    • Romosozumab: This medication is given as a monthly injection and both increases bone formation and decreases bone resorption.
• Lifestyle changes:
  • Diet:
    • Calcium: Adequate calcium intake is crucial for bone health. Adults aged 19-50 need 1,000 mg daily, and women over 50 and men over 70 need 1,200 mg daily.
    • Vitamin D: Aim for 600 IU of vitamin D daily for adults up to age 70 and 800 IU daily for those over 70.
  • Exercise: Weight-bearing exercises (e.g., walking, jogging, dancing) and resistance exercises (e.g., weightlifting) help strengthen bones.
  • Fall prevention: Measures to reduce the risk of falls include:
    • Using assistive devices (e.g., canes, walkers) if needed
    • Making your home safer (e.g., removing tripping hazards, installing grab bars)
    • Improving balance with exercises
  • Quit smoking: Smoking increases the risk of bone loss and fractures.
  • Limit alcohol intake: Excessive alcohol consumption weakens bones.
• Surgery: If a fracture occurs, surgery may be necessary to repair it. For example:
  • Hip replacement
  • Vertebroplasty or kyphoplasty: Procedures to repair vertebral compression fractures.

It’s important to work with your doctor to develop a personalized treatment plan that addresses your individual needs and risk factors.