At a Glance:
2. What are osteoporosis symptoms?
3. What are the symptoms and stages of osteoporosis?
4. What are the causes of osteoporosis?
5. What are the types of osteoporosis?
6. What are the risk factors for osteoporosis?
7. What are the complications of osteoporosis?
8. When to seek medical help for osteoporosis?
9. Which doctor treats osteoporosis?
10. How to diagnose osteoporosis?
11. What is osteoporosis treatment?
12. Is follow-up required for osteoporosis treatment?
13. How to prevent osteoporosis?
14. Which foods should be avoided with osteoporosis?
15. Living with osteoporosis and managing it
16. What is the prognosis for osteoporosis?
Losing some height, especially after the age of 40, is normal due to loss of muscle mass. However, a significant height loss can signal osteoporosis, a serious medical condition that people over the age of 50 should be aware of. It develops slowly and weakens the bones as it progresses. Unfortunately, it is not accompanied by any symptoms until the later stages when the bones are too weak to support the body. This may cause fractures in the hip or spine, a stooped posture, and even a significant loss of height!
The bone is regularly broken down and replaced by the body. With osteoporosis, the rate at which new bone is produced fails to keep up with the rate at which it is lost, leading to weak bones. Therefore, patients with osteoporosis are prone to fractures due to brittle bones.
It is more common in women, especially after menopause. To prevent the risk of developing osteoporosis, it is essential to build strong bones before 25-30 years of age when the peak bone density is reached. Consuming adequate levels of calcium helps immensely in the process.
Bone density or bone mineral density (BMD) defines the amount of bone mineral present in the bone tissue. People with low bone density have porous bones, which are fragile and prone to breaking.
Bone density test helps to determine if a person has osteoporosis. The results are given in the form of T-scores, which compares the person’s BMD with that of a healthy 30-year-old adult. The following are the ranges:
Though older women are the most vulnerable, the damage due to osteoporosis tends to begin early in life. There are generally no early signs of osteoporosis. Once the bones have been weakened, the patient may experience low bone density symptoms such as:
Old bone is constantly broken down and reabsorbed (by osteoclasts) and new bone (generated by osteoblasts) takes its place. Before osteoporosis develops, the body goes through a midpoint, wherein the bones are in between healthy and osteoporotic. While they are weak, they don’t break easily. This stage is called osteopenia or pre osteoporosis.
Early stages of osteoporosis rarely exhibit visible symptoms, while the bone loss symptoms in the later stages are more prominent. Osteoporosis progresses through the following stages as we age:
By the age of 30, peak bone density is achieved. At this stage, the rate at which new bone is formed and deposited matches the rate at which the bone is broken down. Osteoporosis begins during this state of equilibrium.
Symptoms: It has no visible symptoms.
Between the ages of 30-35, the bone breakdown occurs faster than the rate at which new bone is deposited, leading to a loss in bone density. Bone mineral density test may be able to detect low BMD.
Symptoms: Though detectable signs are rare, some people may notice receding gums, weak and brittle nails, or weaker grip strength.
From the ages of 45-55, especially in post-menopausal women, bones become extremely fragile. Even simple movements like tripping or bending forward may place enough stress on the bones to break them. Most cases of osteoporosis are identified in this stage due to the visible symptoms.
Symptoms: The person may experience pain in the back or neck (osteoporosis back pain) or/and suffer fractures from minor movements or falls.
Without intervention, osteoporosis may progress into the fourth and last stage. Along with fractures, there may be an increase in pain and the occurrence of deformities in the spine of other areas. The patient may have difficulty performing daily tasks such as sitting down on a chair, climbing the stairs, etc.
Symptoms: The person may lose height or develop a stooped back. Often known as dowager’s hump, it happens due to the compression of the vertebrae, which causes a curve in the spine.
Bone renews continuously; as old bone is reabsorbed by the body, new bone replaces it. Some osteoporosis causes are:
This may occur due to:
Bone production requires two essential minerals — calcium and phosphate. Thus, the intake of calcium should be sufficient for not only bone formation but also to drive other body processes. Bones become weak and brittle in the absence of sufficient calcium and can break easily.
Up until the 20s, bone mass is high since the body produces new bone faster than it absorbs old bone. Peak bone mass is reached by the age of 30, and the process slows down, making people who don’t have adequate levels of bone mass more prone to osteoporosis.
The lack of hormones like estrogen (in women) and androgen (in men) can cause osteoporosis. Since menopause is accompanied by lower estrogen levels, older women may develop osteoporosis.
Other conditions that lead to osteoporotic bones may include:
Based on the cause of osteoporosis, doctors distinguish between primary and secondary osteoporosis.
It is linked to the aging process, wherein the rate at which bone is lost is linked to changing hormonal levels (due to age) or deficiencies in the body.
As discussed previously, certain medications and medical conditions can also increase the risk of osteoporosis. This is known as secondary osteoporosis, which is caused due to the disruption of bone reformation due to external factors. Diabetes, thyroid problems, etc. can lead to the condition.
There are various factors that can influence your chances of developing osteoporosis. A few are discussed below.
Medical conditions that increase the risk of osteoporosis are:
Long-term use of certain medications such as corticosteroids can affect bone growth. Other medications which are used to treat the following conditions have also been linked to osteoporosis:
Less or more levels of certain hormones can affect bone density. Some of these hormones are:
Certain issues related to one’s diet can also affect bone density.
Certain lifestyle habits can increase the risk of lower bone mass:
Some of the complications of osteoporosis are:
Some cases we recommend seeking medical attention for are:
Doctors will perform a bone density scan to assess whether the pain/fracture is a result of osteoporosis.
There is no particular osteoporosis doctor. It may be treated by doctors from various specialties. For an initial assessment, a person can visit as an orthopedician, endocrinologist, rheumatologist, geriatrician, gynecologist, generalist, internist, orthopedic surgeon, or physiatrist.
The doctor will carefully evaluate the patient’s medical history, family history, and lifestyle habits while checking for osteoporosis. This helps to determine if blood tests are required to check for the levels of calcium, phosphate, testosterone, etc. in the body.
The doctor will request a bone density scan in case osteoporosis is suspected. The specialized test is done with the help of dual-energy X-ray absorptiometry (DEXA). It measures the bone density in the spine, hip, or throughout the body.
The result of the test is derived by comparing the patient’s bone mineral density with two standards:
If the patient’s score is below young normal, it is an indication of osteoporosis and susceptibility to its accompanying risks.
Recommendations for treatment are based on the results of the bone density test through which the risk of breaking a bone in the next decade is derived. If the risk is low, low bone density treatment may not involve medication. Generally, it is aimed at achieving the following objectives:
Medical treatment may employ the use of drugs to improve bone density, stimulate bone growth, regulate hormonal levels, etc.
Other treatments that aim to modify the risk factors for bone loss and falls focus on lifestyle modification. This includes:
Yes, follow-up treatment is required for patients undergoing long-term treatment for osteoporosis.
Patients on various medications may require long-term care and constant review of their response to the medication. This helps to evaluate if continuing treatment is the best option or if it needs to be changed. The patient’s response to medical treatment can also determine if it needs to be stopped completely.
We recommend the following practices to ensure a healthy lifestyle that supports building and maintaining bone density for osteoporosis prevention:
It is also essential to prevent the possibility of falls. Here are some useful tips:
Certain foods can negatively impact bone density. These include:
We recommend reducing or eliminating their consumption from the diets of people who are at risk of or suffer from osteoporosis.
Osteoporosis is a progressive condition and can be managed and treated with the right medication and lifestyle habits. It is, therefore, always recommended to modify your lifestyle and accommodate the changes that osteoporosis brings to it. As we have recommended earlier:
While one cannot reverse osteoporosis, it is possible to curb its effects and prevent fractures.
While osteoporosis cannot be reversed, its progress can be slowed down and contained if it is detected in the early stages and treated accordingly. Patients can increase their bone mineral density with medication, appropriate diet, and regular exercise, and the risk of fractures can be decreased with appropriate environmental modification as well. Thus, it is very important to detect and treat osteoporosis as early as possible. Appropriate measures should also be taken from an early age to prevent osteoporosis.
Osteoporosis is a serious medical condition linked with decreasing bone mass that makes patients prone to fractures. It is especially common in post-menopausal women. If left untreated, it can also lead to a loss of height and stooped posture. Therefore, it is essential to detect and treat osteoporosis early. It can be managed by changing one’s diet, such as consuming a sufficient amount of calcium and vitamin D and by adopting healthier lifestyle habits. Medications can also be given to spur new bone growth, increase bone mineral density, or manage the pain.
About Author –
Dr. Shashi Kanth G, Sr. Consultant Orthopedic Surgeon, Yashoda Hospitals, Hyderabad
He is specialized in arthroscopy, sports medicine, and orthopedics. His expertise includes Lower Limb Joint Replacement Surgery, Lower Limb Arthroscopy, Sports Injuries, Foot and Ankle Surgery, & Management of Complex Trauma.
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