Osteoporosis
Osteoporosis is a systemic bone disease that results in reduced bone density, making the bones more fragile and increasing the risk of fractures. Although it affects both men and women, women are more predisposed to developing this condition due to hormonal imbalances typical of menopause and post-menopause, which affect bone density. The bones most commonly affected by fractures related to osteoporosis are:
- Ankle.
- Proximal femur.
- Proximal humerus.
- Wrist.
- Vertebrae.
Many people do not realize they have osteoporosis until a fracture occurs. Vertebral fractures, in particular, may remain undiagnosed until symptoms such as back pain or a reduced range of motion appear. This is particularly noticeable when experiencing intense pain when transitioning from a lying to a standing position.
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On this page
- What Is Osteoporosis?
- What Are the Symptoms of Osteoporosis?
- How Do You Diagnose Osteoporosis?
- How Do You Treat Osteoporosis?
What Is Osteoporosis?
Osteoporosis is a condition that leads to a decrease in bone mineral density, making the bones more fragile and susceptible to fractures. Often asymptomatic, it can go unnoticed until a fracture occurs. It primarily affects postmenopausal women, but can also impact men. Although it can affect all bones in the body, the areas most commonly affected are the neck, spine, upper arm, femur, and wrist.
How is Osteoporosis Classified?
There are two classifications:
- Generalized Osteoporosis – A patient is diagnosed with generalized osteoporosis when it affects all bones in their body. Generalized osteoporosis may be primitive or secondary. Primitive osteoporosis is the most common type and includes postmenopausal and senile osteoporosis. Secondary osteoporosis is often due to prolonged cortisone intake.
- Postmenopausal Osteoporosis – This is caused by a decrease in estrogen in women that occurs during menopause. Approximately one third of women aged 50+ experience an osteoporosis-related fracture. Twelve percent of them experience a vertebral fracture.
- Senile Osteoporosis – This condition is the result of older age and people living longer, resulting in weaker bones over time. It can affect men and women.
- Localized Osteoporosis – A patient has localized osteoporosis when it affects only one or some bones.
What Are the Symptoms of Osteoporosis?
A patient could have generalized osteoporosis and not know it until they are diagnosed with a fracture. In some cases, these fractures can occur in the bones along the spine, and it isn’t until the patient notices back pain and some decline of movement that a vertebral fracture is diagnosed. A vertebral fracture should be suspected if an older patient reports sudden severe back pain when lying on their back or when returning to a sitting position.
How Do You Diagnose Osteoporosis?
While X-ray is one option, deterioration needs to be at 30% before it is detectable. A more common diagnostic tool is DEXA (or MOC). This machine measures bone density and compares it to young adults. Patients are then scored and given a diagnosis:
- Osteopenia – Osteopenia is less severe and is diagnosed when values are between -1 to -2.5 compared to young adults.
- Osteoporosis – Osteoporosis is defined as a condition when values are below -2.5. Thirty percent of postmenopausal women with -2.5 or lower values have a high risk of fracture and require medication. Fifteen percent of women below -1 require preventive treatment.
How is a fracture determined?
Recent vertebral fractures may not be identified on X-ray, or it may be impossible to distinguish a recent fracture from an older one. In these cases, spine doctors might order an MRI which can distinguish new fractures from older fractures.
Can Osteoporosis be Prevented?
In some cases, it is possible to prevent osteoporosis or slow its onset, especially for those at risk or in the early stages of osteopenia. Some preventive steps include:
- Adequate intake of protein – calcium, and vitamin D, which are essential for maintaining bone health. Calcium and vitamin D can also be taken through supplements, as recommended by a doctor.
- Increased physical activity – weight-bearing and resistance exercises, such as walking, running, or lifting weights, help maintain bone density.
- Early menopause – in some cases, the use of estrogen may be recommended to counteract bone density loss and prevent osteoporosis.
How Do You Treat Osteoporosis?
In early stages, treatment involves administering calcium, vitamin D, and diphosphonates. Estrogens, SERM (selective estrogen receptor modulators) medicines or fluorine may be used as an alternative to diphosphonates.
In elderly patients and those with low bone mass, calcium and vitamin D significantly decreases the frequency of fractures. Diphosphonates reduce bone loss as well. In post-menopausal women, diphosphonates appear to be particularly effective in the first five years, when rapid bone loss occurs. These drugs must be taken continuously for a few years.
In postmenopausal osteoporosis, estrogen has been shown to be highly effective in reducing osteoporosis. However, its use carries the risk of menstrual bleeding, cardiovascular disease, as well as uterine and breast cancer. Women at low risk for these conditions may wish to consider estrogen. Drugs classified as SERMS, such as raloxifene, have similar effects as they even reduce the incidence of breast cancer. They do, however, come with increased risk of deep vein thrombosis and reduce only the incidence of vertebral fractures. Fluorine is another drug option but was not shown to decrease the frequency of fractures of the vertebrae and femoral neck.
Reviewed April 2024.