Osteoporosis: Types, Causes, Signs and Treatment

OVERVIEW

Osteo means ‘bone’ and porosis means ‘porous’. Osteoporosis is a term used to describe porous bones. It is a condition in which bone mass and bone quality drop, so bones become fragile and break more easily.

Many things contribute, including aging, menopause, low calcium or vitamin D, some medical conditions and certain medicines. Osteoporosis is usually silent until a bone breaks.

Types

Primary:

Primary osteoporosis is the most common type and is linked to aging. It is especially common in women after menopause, when falling estrogen levels speed up bone loss.

Secondary:

Secondary osteoporosis is caused by another disease, a medicine or a nutritional problem.

Causes of Osteoporosis

• Endocrine Causes:

  • Hyperparathyroidism
  • Overtreated hypothyroidism (too high a dose of thyroid medicine)
  • Hyperthyroidism
  • Diabetes type1
  • Low estrogen or low testosterone
  • Cushing syndrome (excess cortisol)
  • Some cancers

• Gastrointestinal Diseases:

  • Malnutrition
  • Malabsorption
  • Vitamin C deficiency
  • Vitamin D deficiency

• Drugs:

  • Long-term heparin use
  • Certain anti-seizure drugs
  • Heavy alcohol use
  • Long-term corticosteroids

• Miscellaneous:

• • Immobilization
  • Rheumatoid arthritis
  • Anorexia nervosa

Risk Factors

• Age: osteoporosis occurs mostly as the age advances.
• Sex: postmenopausal women are at high risk.
• Race: according to NIAMS, osteoporosis is most common in non-Hispanic white and Asian women. Black and Hispanic women have a lower risk but are still significantly affected.
• Small body frame: one is at higher risk of osteoporosis if he or she has a small body frame
• Genetic predisposition: if a parent had osteoporosis or a hip fracture, your risk may be higher.
• Thyroid diseases: too much thyroid hormone, whether from an overactive thyroid or too high a dose of thyroid medicine, can cause bone loss.
• Parathyroid disease: parathyroid gland is involved in calcium metabolism and subsequently affects bone mass if the disease of the parathyroid gland occurs.
• Alcohol intake: chronic heavy drinking raises the risk of osteoporosis.
• Smoking and inactivity: smoking and a lack of physical activity both raise risk.
• Malabsorption: Malabsorption occurs due to various GIT conditions for example celiac disease and gastrectomy.
• Malnutrition: a diet low in calcium, vitamin D or protein, or excessive dieting, raises the risk. Conditions such as anorexia nervosa and some cancers can also lead to malnutrition and bone loss.
• Vitamin deficiencies: diet lacking in vitamin C and D can alter calcium metabolism and cause osteoporosis.
• Certain medicines: long-term glucocorticoids, some anti-seizure drugs, some breast and prostate cancer hormone treatments, proton pump inhibitors and SSRIs are linked with bone loss.

How Hormonal Levels In Women Influence?

Osteoporosis is common after menopause because estrogen helps protect bone. When estrogen levels fall, bone breakdown speeds up and bone loss accelerates, often starting a year or two before menopause.

Lower estrogen means the cells that break down bone (osteoclasts) become more active than the cells that build bone (osteoblasts).

Pathogenesis

Bone mass peaks in early adulthood. The higher your peak bone mass, the more bone you have in reserve later in life. Bone is built by cells called osteoblasts and broken down by cells called osteoclasts.

When breakdown outpaces formation, bone mass falls, and osteoporosis can develop. Small, gradual bone loss after the peak years is a normal part of aging, and it speeds up in women after menopause.

Signs and Symptoms

Osteoporosis usually has no symptoms until a bone breaks. When signs appear, they can include:

• bone fractures
• loss of height
• the thoracic and lumbar vertebra are most commonly affected and results in vertebral fracture
• a stooped posture (kyphosis), which in severe cases can affect breathing
• sudden back pain from a spinal fracture
• fractures after minor falls, or even from bending, lifting or coughing
• hip fractures, which can lead to serious complications and loss of independence in older adults

How to Diagnose?

Osteoporosis is difficult to diagnose early because it causes no symptoms until 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: can show fractures and thin-looking bones, but regular x-rays are not accurate for diagnosing osteoporosis. Bone loss usually has to be advanced before it shows.

• Biochemical tests: blood and urine tests (such as calcium, phosphorus, vitamin D and alkaline phosphatase) do not measure bone density. They help find other causes of bone loss.

• DEXA scan: dual-energy x-ray absorptiometry (DEXA or DXA) is the standard test. It measures bone density, usually at the hip and spine, using a low dose of radiation, and takes only a few minutes.

• CT scan bones: computed tomography can also measure bone density in some cases, but it uses more radiation and is not the routine test.

  Treatment

Dietary changes: a diet with enough calcium and vitamin D supports bone health and is used alongside medicines when treatment is needed.

Pharmacological treatment

According to MedlinePlus, prescription options include:

• bisphosphonates (the main first option for many postmenopausal women)
• calcitonin (mainly for pain from spinal fractures)
• estrogen or raloxifene in selected women
• denosumab
• Parathyroid hormone analog (teriparatide or abaloparatide)
• romosozumab, for more severe bone loss

Prevention

Prevent Osteoporosis a Complete Guide

You can lower your risk with a diet rich in calcium and vitamin D and regular weight-bearing exercise such as walking, plus strength and balance training. Building strong bones in childhood and early adulthood helps most. Quitting smoking and limiting alcohol also help.

What Happens If Osteoporosis Is Left Untreated?

Bone loss can continue, raising the chance of repeated fractures. Hip, spine and wrist fractures are the most common. Spinal fractures can cause height loss and a stooped back.

When to Seek Medical Help?

Talk to your doctor about bone density testing if you are a woman aged 65 or older, which the U.S. Preventive Services Task Force recommends. Younger women past menopause with risk factors, and men with risk factors, may also need testing.

Seek care promptly after any fracture from a minor fall, or for sudden back pain or height loss. Fractures are common at the spine, femoral neck, wrist and hip. Your doctor can order a bone density scan and other tests to find the cause and decide on treatment.

HP Thoughts: Did you know that there is “juvenile arthritis”? Read more about it in our post: Juvenile Rheumatoid Arthritis.

Related Tag: Osteomalacia

Sources

• Osteoporosis, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
• Osteoporosis, MedlinePlus (U.S. National Library of Medicine)