Osteoporosis: Types, Causes, Signs and Treatment

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osteoporosis

OVERVIEW

Osteo means ‘bone’ and porosis means ‘porous’. Osteoporosis is a term used to describe porous bones. Osteoporosis is an acquired condition that is characterized by a reduced mass of bones leading to fragile bones. Reduced mass causes bone weakness and susceptible to fractures. Osteoporosis is due to a variety of insults example vitamin deficiencies, metabolic diseases, diseases related to the gastrointestinal tract, and Miscellaneous. The Hallmark of osteoporosis is reduced bone mass leading to loss of bone. Once enough bone is lost susceptibility to fractures increases.

Types

Primary:

primary osteoporosis is the most common type and is associated with aging. It is President it in women mostly in the postmenopausal state due to a drop in estrogen levels in postmenopausal women. Estrogen level when decreased causes exacerbation of bone loss. Women are at high risk of osteoporosis due to increased aging and postmenopausal state.

Secondary:

Due to insults to bone due to metabolic disease, drug intake, or vitamin deficiencies.

Causes of Osteoporosis

  • Endocrine Causes:

    • Hyperparathyroidism
    • Hypothyroidism
    • Hyperthyroidism
    • Diabetes type1
    • Pituitary gland tumors
    • Addison’s disease
    • Carcinomas
  • Gastrointestinal Diseases:

    • Malnutrition
    • Malabsorption
    • Vitamin C deficiency
    • Vitamin D deficiency
  • Drugs:

    • Anticoagulants
    • Anti-seizure drugs
    • Alcohol
    • Corticosteroids
  • Miscellaneous:

    • Immobilization
    • Pulmonary disease
    • Anemia

Risk Factors

  • Age: osteoporosis occurs mostly as the age advances.
  • Sex: postmenopausal women are at high risk.
  • Race: osteoporosis occurs most in Asians
  • Small body frame: one is at higher risk of osteoporosis if he or she has a small body frame
  • Genetic predisposition: if there is a family history of osteoporosis the person is more at risk of developing this condition, one or more family members may be affected.
  • Thyroid diseases: both Hyperthyroidism and hypothyroidism can cause loss of bone mass resulting in osteoporosis.
  • Parathyroid disease: parathyroid gland is involved in calcium metabolism and subsequently affects bone mass if the disease of the parathyroid gland occurs.
  • Alcohol intake: increased amount of alcohol intake can cause osteoporosis.
  • Malabsorption: Malabsorption occurs due to various GIT conditions for example celiac disease and gastrectomy.
  • Malnutrition: when is at a higher risk of osteoporosis when his diet is deficient in nutrition or at times of high demand. women when lactating or chronic diseases for example cancers can also predispose to malnutrition and subsequently osteoporosis.
  • Vitamin deficiencies: diet lacking in vitamin C and D can alter calcium metabolism and cause osteoporosis.

How Hormonal Levels In Women Influence?

Osteoporosis is common in postmenopausal women due to hormonal influences as the level of estrogen decreases, acceleration of bone loss occurs. bone loss of 35% to 50% can occur after 2 to 20 years. It appears that postmenopausal drop in estrogen level causes inflammatory reactions in the body that suppress osteoblast which is bone-forming cells and increase osteoclast activity which causes bone resorption.

Pathogenesis

Bone mass peaks during adulthood. the greater the peak bone mass the greater the delay in osteoporosis in later life. Bone is formed by cells called osteoblasts. It forming cells form new bone while other types of cells called osteoblasts form bone resorption and proper modeling of bones. When bone resorption occurs more compared to bone formation the bone mass decreases and results in osteoporosis. The beginning of osteoporosis in both men and women occurs in the third or fourth decade of life as bone resorption is more than bone formation with 0.5% bone loss per year. Each year 1.2 million Americans experience bone loss and annual Healthcare costs related to osteoporosis in the US exceeds 20 billion dollars.

Signs and Symptoms

Signs and symptoms depend upon which bones are involved osteoporosis can cause

  • bone fractures
  • loss of height
  • the thoracic and lumbar vertebra are most commonly affected and results in vertebral fracture
  • kyphoscoliosis that is bending of the vertebra can occur which can cause respiratory function compromise
  • bone fractures can cause pulmonary embolism due to fat embolism formation
  • pneumonia
  • femoral, pelvis, spine fractures can cause death

How to Diagnose?

Osteoporosis is difficult to diagnose because it is asymptomatic initially when bone mass is decreasing and is announced with a fracture. Your doctor will take your history and perform general examination with special attention to bones. He may check your bone tenderness pain and can ask you to get various tests done, some of the test to diagnose osteoporosis are:

  • X-ray: may show thinning of bones and reduced bone mass. It is not visible on X-ray until 40% of bone mass is decreased.
  • Biochemical tests: serum levels of calcium, phosphorus, and alkaline phosphate can tell about the bone mass.
  • Dual energy absorptiometry: energy absorbed by bones is detected
  • DEXA scan: typically measures bone density in the spine and hips. It takes only 5-20 minutes to perform the DEXA scan. Patients are exposed to radiation and results are then evaluated.
  • CT scan bones: computed tomography helps in the detailed examination of bones which are not visible on X-ray

    Treatment

Dietary changes: a diet rich in calcium, vitamin D, vitamin C is taken along with pharmacological therapy for the treatment of osteoporosis.

Pharmacological treatment

  • bisphosphonates
  • calcitonin
  • estrogen
  • denosumab
  • Parathyroid hormone analog

Prevention

Prevent Osteoporosis a Complete Guide

Osteoporosis can be prevented by taking a diet rich in high calcium, Vitamin D, and a regular exercise regime. Exercise should be done at least 5 times a week for 30 minutes. This preventative therapy should be started before age 32 to maximize bone mass. It can also be prevented by quitting smoking and alcohol intake.

What Happens If Osteoporosis Is Left Untreated?

A vicious cycle of bone fragility and bone breakage occurs. Weight-bearing bones which are bones of pelvis and femur are at greater risk of fractures. Bending of the spine can occur resulting in short stature especially in women.

When to Seek Medical Help?

You should seek medical help if your age is more than 60 years and you experience bone pains or fatigue. Bone fractures are most common at this age and mostly involves the spine, femoral neck, wrist, hip, or other weight-bearing joints. Your general practitioner may perform a bone density scan and other diagnostic tests to rule out the cause to treat osteoporosis.

Related Tag: Osteomalacia