The skeleton is made up of bones, which provide support and shape to the body. They protect our internal organs from external injury. Together with the muscles, strong bones enable the body to move freely.
One of the most common bone-related problems that affect women is known as Osteoporosis. This is a condition where the bone density decreases, resulting in fragile bones. Osteoporosis leads to porous bones which are compressible. Therefore, a person suffering from osteoporosis is at a greater risk of fractured bones, especially in the hips, spine, wrists and ribs. In women, bone mass typically decreases after 35 years of age, and bone loss occurs more rapidly in women after menopause.
Causes and Risk Factors of Osteoporosis
The factors that increase the risk of developing osteoporosis are:
• Reduced sex hormones: Lesser quantities of hormones, particularly, estrogen in case of women and androgen in case of men, inhibit bone production.
• Age: The risk of osteoporosis is directly proportional to the age, especially after the 30s and the post-menopausal period in women.
• Body structure: Being excessively thin or tall can increase the risk of osteoporosis.
• Genetic factors and family history: Having a close family member with a diagnosis of hip fracture due to osteoporosis doubles the risk of the person suffering from this condition. Other inherited disorders such as osteogenesis imperfect and skin diseases like Marfan syndrome may also be responsible.
• Alcohol and Tobacco: Excessive alcohol intake and smoking weakens the bone structure.
• Malnutrition: Low levels of essential nutrients such as calcium, magnesium and Vitamin D, can aggravate the risk of osteoporosis.
• Immobility: Being immobile for extended periods of time and not exercising regularly deprives your bones of vital movements needed to strengthen the bones and the joints.
• Hyperparathyroidism: It refers to a condition wherein the parathyroid gland produces excessive quantities of parathyroid hormone. This in turn causes too much calcium to be removed from the bones, weakening them.
• Medications: Long-term use of medicines such as heparin, which is a blood-thinner, anti-seizure medicines and oral corticosteroids such as prednisone can also cause osteoporosis.
• Gender and Ethnicity: Women are at a greater risk of developing osteoporosis than men, especially in the later ages. Also, whites and Asians are more prone to this condition.
Signs and Symptoms of Osteoporosis
• Bone loss develops slowly and often there are no symptoms or signs of an impending osteoporosis. A person may be unaware about it until he/she experiences a fracture due to an unrelated incident such as a fall or sometimes even a cough or sneeze.
• Back pain caused due to changes in the vertebrae is often the first sign.
• Pain in a particular location due to an osteoporotic fracture is a common symptom. A dull pain in the bones or muscles, especially low back pain or neck pain is also a symptom.
• Sudden onset of sharp pains that does not spread to other areas which lingers for a few months.
• A stooped posture resulting in a loss of height due to spinal fracture is a tell-tale sign of osteoporosis.
• Fractures at hips or wrist fractures due to a fall can sometimes reveal this condition.
What tests do doctors use in the diagnosis of osteoporosis?
First, a healthcare professional will consider the patient’s detailed medical and family history in order to ascertain any risk for this disease.
Blood tests may be done to measure the levels of calcium, vitamin D, magnesium and other hormones like testosterone or estrogen in the body and assess the thyroid and kidney function.
A Bone Mineral Density (BMD) test can measure the bone density in different parts of the body and can detect osteoporosis before a fracture actually occurs. This test can also monitor the effects of treatment and help determine the rate of bone loss. The results of the BMD test is compared to two standards, known as “age-matched” and “young normal”. The age-matched reading compares the person’s BMD to that of the expected levels of bone density of a person of same age, sex and size. The young normal reading compares the person’s bone density to that of a healthy adult of the same gender.
Bone density scanning uses a technology known as Dual-energy X-ray Absorptiometry (DEXA) to indicate the likelihood of occurrence of fractures due to osteoporosis. The DEXA measures the density of bone at the spine, hip or the whole body.
The results of a DEXA test are given as a T-score, which compares the patient’s bone mass to the peak bone mass of a younger person. A score of -1.0 or above is considered normal, and a range of -1.0 to -2.5 indicates a mild bone loss and a score of -2.5 or below indicates osteoporosis.
Single-energy X-ray Absorptiometry (SXA) uses a smaller X-ray machine to measure the bone density at the heel, kneecap and the shins.
A Lateral Vertebral Assessment (LVA) may be done in case of older patients or for those suffering from back pain unrelated to another condition.
Another method involves an ultrasound scan of the heel bone to assess for osteoporosis.
Treatment for Osteoporosis
The treatment for osteoporosis focuses on slowing down or preventing the development of this disease and aims to maintain a healthy bone mass and bone mineral density. It involves treating and preventing fractures, minimising the pain and maximising the person’s ability to carry on his/her daily activities. The treatment measures include:
Drugs: Biphosphonates are antiresorptive drugs that slow down bone mass and reduce the risk of fractures. Biphosphonates may increase the risk of jaw bone destruction or cause gastrointestinal problems such as ulcers in the esophagus and acid reflux.
Selective Estrogen Receptor Modulators (SERMs): Estrogen antagonists like Raloxifene can reduce the risk of spine fractures in post-menopausal women. It is used less than other medications due to concerns about the risk of cancer, blood clots, stroke and heart disease.
Diet: A balanced and nutritious diet with sufficient intake of calcium and vitamin D helps increase bone mass. Green leafy vegetables contain magnesium which maintain good bone quality, and fish such as salmon and tuna contain vitamin D which help in absorption of calcium.
Lifestyle changes: These include quitting smoking, limiting alcohol consumption and exercising regularly. All these measures can help in preventing as well as treating osteoporosis.