Osteoporosis develops when bone density decreases. The body reabsorbs more bone tissue and produces less to replace it.
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.
SIGNS AND SYMPTOMS
Osteoporosis develops slowly, and a person may not know they have it until they experience a fracture or break after a minor incident, such as a fall. Breaks will often occur in the hip, wrists, or the spinal vertebrae. People who have osteoporosis might have signs and symptoms that include:
• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that breaks much more easily than expected
When to see a doctor
Severe discomfort in any of the common locations for osteoporotic bone damage could indicate an unexpected or unidentified fracture. People should seek medical evaluation as soon as they notice this type of pain.
CAUSES AND RISK FACTORS
Several risk factors for osteoporosis have been identified. Some are modifiable, but it is not possible to avoid others.
According to the American College of rheumatology, nonmodifiable risk factors include:
• Age: Risk increases after the mid-30s and especially after menopause.
• Reduced sex hormones: Lower estrogen levels appear to make it harder for bone to regenerate.
• Ethnicity: White people and Asian people have a higher risk than other ethnic groups.
• Height and weight: Being over 5 feet 7 inches tall or weighing under 125 pounds increases the risk.
• Genetic factors: Having a close family member with a diagnosis of hip fracture or osteoporosis makes osteoporosis more likely.
• Fracture history: A person over 50 years of age with previous fractures after a low-level injury is more likely to receive a diagnosis of osteoporosis.
Modifiable risk factors include
• Sedentary lifestyle: People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active.
• Excessive alcohol consumption
• Tobacco use.
Medical conditions that increase the risk include:
• Some autoimmune diseases, such as rheumatoid arthritis and ankylosing spondylitis.
• Pituitary gland disorders.
• Hyperthyroidism and hyperparathyroidism
• A shortage of estrogen or testosterone
Medications that raise the risk include:
• Glucocorticoids and corticosteroids, including prednisone and prednisolone
• Thyroid hormone
• Anticoagulants and blood-thinners, including heparin and warfarin
• Some antidepressant medications
• Some vitamin A (retinoid) medications
• Thiazide diuretics
Glucocorticoid-induced osteoporosis is the most common type osteoporosis that develops due to medication use.
People at risk of osteoporosis and fractures can use preventive lifestyle measures, supplements, and certain medications to achieve these goals.
Drugs that can help prevent and treat osteoporosis include:
- Bisphosphonates: These are antiresorptive drugs that slow bone loss and reduce a person’s fracture risk.
- Estrogen agonists or antagonists: Also called Selective Estrogen-receptor Modulators, SERMS. Raloxifene (Evista) is one example. These can reduce the risk of spine fractures in women following menopause.
- Calcitonin (Calcimar, Miacalcin): This helps prevent spinal fracture in postmenopausal women and can help manage pain after a fracture.
- Parathyroid hormone, such as teriparatide (Forteo): The U.S. Food and Drug Administration (FDA) has approved this hormone for treating people with a high risk of fracture as it stimulates bone formation.
- Monoclonal antibodies (denosumab, romosozumab): These are immune therapies that some people with osteoporosis take after menopause. Other types of estrogen and hormone therapy may help.
Certain alterations to lifestyle can reduce the risk of osteoporosis.
Calcium and vitamin D intake
Calcium is essential for bones. People should make sure they consume enough calcium daily.
Adults aged 19 years and above should consume 1,000 milligrams (mg) of calcium a day. Women who are over 51 years of age and all adults from 71 years onward should have a daily intake of 1,200 mg.
Dietary sources include: Dairy foods such as milk, cheese, and yogurt, green leafy vegetables, such as kale and broccoli, fish with soft bones, such as tinned salmon and tuna, fortified breakfast cereals
If a person’s calcium intake is inadequate, supplements are an option.
Vitamin D also plays a key role in preventing osteoporosis as it helps the body absorb calcium. Dietary sources include fortified foods, saltwater fish, and liver.
However, most vitamin D does not come from food but from sun exposure, so doctors recommend moderate, regular exposure to sunlight.
Other ways to minimize the risk are:
• Avoiding smoking, as this can reduce the growth of new bone and decrease estrogen levels in women
• Limiting alcohol intake to encourage healthy bones and prevent falls
• Getting regular weight bearing exercise, such as walking, as this promotes healthy bones and strengthens their support from muscles
• Exercises to promote flexibility and balance, such as yoga, which can reduce the risk of falls and fractures
Bone fractures, particularly in the spine or hip, are the most serious complications of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury.
In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up your spine (vertebrae) can weaken to the point of collapsing, which can result in back pain, lost height and a hunched forward posture.
Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.
Treatment aims to: Slow or prevent the development of osteoporosis, maintain healthy bone mineral density and bone mass, prevent fracture, reduce pain, maximize the person’s ability to continue with their daily life.
Anyone concerned that they may be at risk of osteoporosis should ask their doctor about screening.
Written by: Chinonye Machie