What is Osteoporosis?

Osteoporosis is a disease that results from loss of bone density. It often affects post-menopausal women. It can impact all bones in the body, but is most common in the neck, back, upper arm, 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 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 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 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.

If you have symptoms of osteoporosis, book an appointment online with Prof. Pier Paolo Maria Menchetti at UPMC Salvator Mundi International Hospital for a diagnosis and treatment options.

How is Osteoporosis Diagnosed?

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?

Some osteopenia (early stage) patients can take appropriate amounts of protein, calcium, and vitamin D. Calcium and vitamin D may be administered in a clinical setting. Increasing physical activity is also important and in early menopause, estrogen may be recommended.

How is Osteoporosis Treated?

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.

Should surgery be necessary, the procedure would be similar to any orthopaedic procedure.

Spine Center at UPMC Salvator Mundi International Hospital

The Spine Center at UPMC Salvator Mundi International Hospital is an innovative and multispecialty center for the diagnosis and treatment of spine disorders and diseases. For a diagnosis and treatment options, book an appointment online today with Prof. Pier Paolo Maria Menchetti.