Osteoporosis

Osteoporosis is a medical condition known colloquially as “bone thinning” or “brittle bones.” The term osteoporosis is derived from the combination of the words “osteo” (related to bone) and “porous” (referring to the porous nature of bones). The World Health Organization (WHO) defined osteoporosis in 1994 as a disease characterized by reduced bone mass, impaired microarchitecture of bone tissue, increased susceptibility to fractures, and a higher risk of bone fragility.

Bone is a living and dynamic tissue composed of calcium and protein, undergoing a continuous process of renewal. During the growth phase, bone formation exceeds breakdown, resulting in increased bone density and strength. However, after a certain age (which varies among individuals), the balance shifts, and bone formation diminishes, leading to a reduction in bone mass. Over time, the weakening of bone tissue occurs gradually, leading to decreased bone density and increased vulnerability to fractures. Common areas of bone loss include the spine, wrists, and hips, which are more susceptible to fractures in older individuals.

The decline in bone mass usually begins around the age of 35. After reaching peak bone mass, women typically experience a loss of approximately 30-50% of their bone tissue, while men experience a loss of about 20-30% over time. Menopause in women acts as an accelerating factor for this bone loss process.

OSTEOPOROSIS TYPES

• Type 1: This type is observed in women aged between 50 and 75. There is a significant loss of bone density in the bone marrow, and fractures in the spine and wrist are more frequent. Hormonal changes are also present.

• Type 2: Commonly seen in individuals over 70 years of age, this type affects both men and women equally. It involves a generalized loss of bone density throughout the entire skeleton, leading to an increased risk of fractures. While it is more prevalent in women during the postmenopausal period, it can occur in men as well and in people of any age due to certain medical conditions. The exact cause of osteoporosis remains unclear, but several factors contribute to its development.

• Aging
• Reduced physical activity
• Decreased estrogen hormone levels
• Use of corticosteroids
• Excessive thyroid hormone
• Excessive alcohol consumption
• Smoking, which exacerbates bone loss.

DETECTING OSTEOPOROSIS

Many individuals are unaware of their bone loss until a fracture occurs, as osteoporosis progresses slowly without causing noticeable symptoms. Initial indications of osteoporosis include height loss, rounding of the shoulders and hips, and back pain. If there is suspicion of the disease, a bone density measurement should be performed.

BONE DENSITY MEASUREMENT

Bone density measurement is a diagnostic procedure that utilizes a device called a densitometer to assess the mineral content within the bone. Typically employing the dual energy X-ray principle, this test measures bone density at the hip, spine, or both regions. It is a relatively quick procedure, lasting approximately 15-20 minutes, and is neither painful nor associated with any known risks.

It is important to note that bone density measurement specifically evaluates the mineral composition of the bone and does not provide information about its microscopic structure. Therefore, it does not offer a precise determination of bone strength. The results of the measurement are compared to the average bone density of individuals in the general population. While the test can indicate the likelihood of fractures, it does not predict the exact timing of such occurrences.

As individuals age, bone density naturally decreases. In many older adults, bone density is lower compared to younger adults. Studies have indicated that approximately 66% of women over the age of 40 exhibit osteoporosis or a predisposition to osteoporosis when compared to their younger counterparts.

Bone density measurements are classified into different categories:

• Normal: Refers to bone density falling below one standard deviation (SD) from the mean in a young and healthy population.
• Low bone mass (osteopenia): Indicates bone density ranging from one to 2.5 SD below the mean in a young and healthy population.
• Osteoporosis: Signifies bone density surpassing 2.5 SD from the mean in a young and healthy population, indicating a 25% higher bone loss compared to individuals with normal bone density. Severe osteoporosis is diagnosed in individuals who not only have osteoporosis but also have a history of fractures.

Why Bone Density Measurement is not a Definitive Diagnostic Method for Osteoporosis;

Bone density measurement alone is not sufficient to provide a conclusive diagnosis for osteoporosis because bone strength is determined by both bone density and the microscopic structure of the bone. The measurement technique can only assess bone density, and a decrease in density does not guarantee the occurrence of fractures in every individual. Moreover, reduced bone density is just one of the contributing factors to increased fracture risk. Other factors such as physical inactivity, poor nutrition, medication use, balance problems, and certain medical conditions can also contribute to bone weakening. While current treatment methods aim to slow down bone loss, they are unable to fully restore the lost bone tissue.

Therefore, it is crucial to take measures to protect our bones. The most effective approach to managing osteoporosis is to focus on preventing bone loss.

In general, there are simple preventive measures that can help slow down bone loss. These include ensuring adequate calcium intake irrespective of bone density, engaging in regular exercise, avoiding smoking, maintaining an active lifestyle, and minimizing unnecessary medication use.

To Prevent Bone Loss and Reduce the Risk of Fractures:

• Consume sufficient amounts of calcium and vitamin D.
• Refrain from smoking.
• Avoid sudden and excessive weight loss.
• Engage in regular exercise routines.

To Decrease the Risk of Fractures:

• Maintain a consistent exercise regimen.
• Limit alcohol consumption.
• Wear appropriate and slip-resistant footwear.
• Undergo regular eye examinations and utilize corrective eyewear as needed, as visual impairment can contribute to falls.
• Remove potential tripping hazards within the home environment, such as toys and electrical cords.
• When using sleep aids or tranquilizers, ensure you have a companion when venturing outdoors to mitigate the risk of falls due to drowsiness or lack of attention.
• Consult with your healthcare provider to optimize your lifestyle and dietary habits.
• Assess the suitability of hormone therapy, if necessary.
• Evaluate the potential requirement for additional medication treatments.

Osteoporosis (bone loss) – Important Information:

Definition of Osteoporosis: Osteoporosis, also known as bone loss, refers to the condition where the bones become fragile and susceptible to fractures due to a decrease in mineral content and changes in bone structure.

Is Osteoporosis a Recent Discovery?:

With the aging population, osteoporosis has gained recognition and significance as it has been found to impact individuals’ quality of life through increased fracture risk. Factors such as reduced physical activity, longer life expectancy, and societal emphasis on a slender appearance have contributed to the growing awareness and importance of this disease.

Mechanisms of Osteoporosis: Bone is a dynamic organ that undergoes a continuous process of remodeling, involving both bone formation and resorption. In younger individuals, the rate of bone formation matches that of resorption. However, as one ages, the rate of bone resorption surpasses that of formation, leading to a decline in bone mass. In women, the hormone estrogen plays a role in inhibiting bone resorption. During menopause, when estrogen levels decline, bone resorption increases, accelerating the progression of osteoporosis. Insufficient calcium intake, inadequate exposure to sunlight for vitamin D synthesis, and a suboptimal peak bone mass during childhood and early adulthood can also contribute to the development of osteoporosis. Additionally, there is a genetic predisposition to osteoporosis, which can sometimes outweigh the influence of environmental and lifestyle factors.

Menopausal stage that is significant for osteoporosis: The period of the first five years after menopause is characterized by the highest degree of bone loss, while bone loss continues at a reduced rate in the subsequent years.

Comparison between surgical and natural menopause in terms of osteoporosis risk: Women who have undergone surgical removal of the ovaries without hormone therapy, as well as those experiencing early menopause, are at a higher risk of developing osteoporosis.

Potential consequences of osteoporosis: Osteoporosis renders bones more susceptible to fractures, particularly in the hip and spine, resulting in height loss, kyphosis (hunchback), back pain, alteration in the shape and reduced volume of the rib cage. The diminished size of the rib cage can impede normal heart and lung function. Treatment often necessitates surgical intervention, and the healing process may pose challenges. Non-healing fractures can lead to compromised mobility, dependence on others, and further deterioration of bone health.

Methods for diagnosing osteoporosis: Bone mass measurement can be conducted within a short duration, typically lasting 10-15 minutes, without causing pain or discomfort. Osteoporosis can also be identified through plain X-ray imaging as the disease progresses. Regular assessment of bone density is crucial for monitoring disease progression and evaluating treatment efficacy. In addition to bone densitometry, it is advisable to obtain plain X-ray images.

Factors contributing to osteoporosis: Several factors can contribute to osteoporosis, including calcium and vitamin D deficiencies, smoking, excessive alcohol consumption, certain medications, and high caffeine intake. These factors can adversely affect bone-forming cells. Certain medical conditions and a sedentary lifestyle also increase the risk of bone loss.

Groups at higher risk of osteoporosis: Osteoporosis is more prevalent in women compared to men, in individuals with a slender physique rather than those who are overweight, and in individuals with shorter stature as opposed to taller individuals.

The relationship between smoking and osteoporosis: Smoking is detrimental to bone-building cells and contributes to bone loss. There is a direct correlation between the amount and duration of smoking and the loss of bone mass. In women who smoke, menopause tends to occur at an earlier age.

Osteoporosis and Exercise:

Physical activity has a positive impact on bone mass. In contrast, a sedentary lifestyle or being bedridden can contribute to a decrease in both muscle and bone mass. Engaging in regular exercise is beneficial for individuals with osteoporosis as it helps increase bone mass.

Availability of Calcium in Foods: Is Supplementation Necessary?

Dairy products and food items derived from milk are rich sources of calcium. It is recommended to consume adequate amounts of these calcium-rich foods from childhood onwards. However, in older adults who may have difficulty maintaining a well-balanced diet, calcium supplementation in the form of medication is advised, typically at a daily dosage of 1-1.5 grams. Additionally, supplemental calcium intake may be recommended during menopause and breastfeeding.

The Significance of Vitamin D in Osteoporosis:

Vitamin D plays a crucial role in facilitating the absorption of calcium in the intestines. In its inactive form, vitamin D present in the skin becomes activated upon exposure to sunlight. In cases where there is insufficient exposure to sunlight, vitamin D deficiency can occur, leading to impaired calcium absorption. In countries with limited sun exposure, milk is often fortified with vitamin D. Certain cultural practices, such as fully covering the body with clothing in countries like Saudi Arabia and Iran, can contribute to vitamin D deficiency among women, resulting in the early onset of osteoporosis. Furthermore, limited exposure to sunlight among the elderly, due to reduced outdoor activities, further exacerbates the development of osteoporosis.

Prevalence of Osteoporosis in Men:

While osteoporosis is commonly associated with women, it can also affect men. Male hormones provide some protection against bone resorption; however, approximately 10% of men under the age of 60 experience osteoporosis. Beyond the age of 65, the risk of osteoporosis in men becomes similar to that in women. Individuals with known risk factors should consult their healthcare providers if they experience widespread bone pain to determine if osteoporosis is present.

Reversibility of Bone Abnormalities in Osteoporosis:

Current treatments for osteoporosis may not fully reverse bone abnormalities. However, these treatments can effectively halt further bone loss and, in some cases, promote a certain degree of bone gain. Combining medication with regular exercise helps increase bone mass, and taking preventive measures to reduce the risk of falls significantly decreases the likelihood of fractures.

Common Sites of Fractures in Osteoporosis:

The spine, hip, wrist, and shoulder bones are most susceptible to osteoporotic fractures. Fractures frequently occur in these areas. While wrist and spine fractures are relatively easier to manage, hip fractures carry serious complications, including a higher risk of mortality.

Spontaneous Fractures in Osteoporosis:

In rare instances, individuals with osteoporosis may experience fractures without an apparent cause, such as a fall or trauma. These spontaneous fractures, particularly in the spine, can occur without noticeable symptoms or a specific triggering event.

To prevent osteoporosis in the future, it is advisable to follow these recommendations:

• Ensure a calcium-rich diet from childhood and consider additional calcium supplementation during menopause and old age.
• Engage in regular physical activities like walking, stair climbing, and swimming. Aim for at least 3 days a week of brisk walking for 30-45 minutes.
• Weight-bearing exercises can be beneficial, and if your health permits (e.g., no heart disease), try carrying your own shopping bags instead of relying on assistance.
• Take advantage of sunny days to expose your skin to sunlight and spend time outdoors.
• Avoid smoking, excessive alcohol consumption, and medications known to increase bone loss.
• Discuss with your doctor the possibility of long-term hormone therapy (5-10 years) after entering menopause, if it is suitable for your health.
• Seek guidance from a healthcare professional when taking medications such as corticosteroids, heparin, or antiepileptic drugs that may affect bone metabolism.
• Ensure timely and appropriate treatment for any underlying conditions that impact bone metabolism.

Regarding the treatment of women approaching or experiencing menopause;  it is important to consult with a healthcare provider. Hormone therapy options have evolved, reducing the risk of uterine cancer but still carrying a low possibility of developing breast cancer. Hormone therapy offers protection against heart disease and early dementia. It is crucial to weigh the potential health risks associated with not taking hormone therapy due to concerns about breast cancer, as the risk of dying from a heart attack in women without hormone therapy exceeds the risk of dying from breast cancer.

The primary goals of osteoporosis treatment; encompass preserving or increasing bone mass, preventing fractures, and providing appropriate treatment in case fractures occur.