Osteoporosis is a bone disorder affecting more women than men, where the bones become fragile and susceptible to frequent fractures of the spine, wrist and hip. In this disorder, the bone density decreases with advancingn age. Osteoporosis literary means porous bones – osteo- meaning bones and -porosis meaning porous. Osteoporosis, and resulting fractures are one of the most debilitating diseases for women after menopause. Women are unaware that they are living with osteoporosis, until their bones become so brittle or weak that they cannot withstand a small bump or a fall and land up having a hip fracture or collapsed vertebrae.
According to the World Health Organization (WHO), osteoporosis is considered to be the second most global health care problem after cardiovascular disease. Several clinical studies have revealed that woman aged 50 years have a similar risk percentage of dying from hip fracture as that from breast cancer.
About 44 million people in the United States are at a risk of developing osteoporosis, which is a leading cause of fractures for 1.5 million people annually. As far the worldwide statistics is concerned, it has been estimated that hip fractures due to osteoporosis affects about 1.6 million people annually, which is expected to reach 6.3 million by the year 2050. The countries to be affected the most by osteoporosis are Sweden, Iceland, Norway, Denmark and USA.
Proper knowledge and understanding of bone formation is important for understanding the disease process (pathophysiology) of osteoporosis. Bone is a living tissue that undergoes constant renewal process in two stages namely resorption and formation. Simply this means that new bone is being constantly laid down while old bone is removed and this is ongoing. The imbalance that occurs in these two processes leads to osteoporosis where more bone is removed than laid down. The two processes can function optimally only when there is sufficient and constant supply of minerals.
The process of resorption involves the breaking down of the old bones by cells known as osteoclasts. The process of formation, as the name suggests is the stage wherein new bones are formed by cells known as osteoblasts. During infancy, childhood and early stages of adulthood new bones are formed and very littlel is discarded. During this period, the bones acquire maximum mass and strength. After the age of 30 years, there is more of resorption, that occurs at a fast rate and a decrease in bone density and strength is observed. Osteoclasts requires just few weeks for bone resorption, whereas osteoblasts takes several months for formation of new bones. Thus, as age advances osteoporosis sets in due to increase in the process of resorption.
Estrogen deficiency has as strong link to development of osteoporosis. Its deficiency can result in an imbalance of the two processes that finally leads to more resorption and less of bone formation. Osteoporosis can also occur due to long term use of medications that cause loss of bone mass. Calcium, vitamin D and parathyroid hormone play an active role in maintaining the bone homeostasis. In conditions where there is low calcium intake through diet or poor intestinal calcium absorption due to disease, it can result into secondary hyperparathyroidism. This in turn leads to osteoporosis.
A number of risk factors have been identified in osteoporosis. Not every person with these risk factors will develop osteoporosis.
Older women are more susceptible to osteoporosis compared to their younger counterparts.
Thin bodied women and those with small bones are more likely to suffer from osteoporosis.
Onset of menopause at an early age can cause loss of bone tissue which can lead to osteoporosis.
Smoking, drinking and lack of physical exercise make women more prone to development of osteoporosis.
Poor eating habits and diets that do not supply enough of calcium are other predisposing factors for osteoporosis.
Research has shown that genes play a pivotal role in development of osteoporosis. The variations in the genetic factor of chromosome 20 in post menopausal women have more chances of having decreased bone tissue.
Osteoporosis is referred to as the ‘silent disease’ as most of the time the loss of bone tissue occurs with no obvious symptoms in the early stages. During the advanced stage the symptoms include :
- Pain in joints due to bone tenderness
- Decreased height
- Neck pain and pain in the lower back region because of fractures of the spinal column
- Development of ‘kyphosis’ which means a curved or bent posture, also referred to as Dowager’s hump.
Bone mineral density (BMD) tests are non-invasive, painless and safe. This test achieves the following :
- Measures bone density of the spine, wrist and or hips.
- Provides insight into the degree and stage of osteoporosis.
- Detects low bone density before a fracture.
- Monitors the effectiveness of treatment in between intervals.
Complications of osteoporosis include :
- Hip and wrist fractures
- Difficulty walking
- Permanent disability
- Compression fractures of the spine
- Collapsed vertebrae
- Spinal deformities
Based on the guidelines provided by the American College of Physicians, the treatment of osteoporosis revolves around the following objectives.
- Providing relief to the patient by controlling the pain.
- Prevention of fractures.
- Calcium and vitamin D supplements for bone strength.
- Slow down and eventually arrest loss of bone tissue.
- Modification in lifestyle factors.
- Change in dietary habits.
- Muscle strengthening exercises.
Osteoporosis treatment includes three broad categories:
Supplements of calcium and vitamin D are the cornerstone of any therapy for osteoporosis. Several osteoporotic medications such as bisphosphonates, estrogen, parathyroid hormone and raloxifene need to be administered. Oral analgesics (painkillers) can be given when required in order to provide relief from pain. Moist hot packs and transcutaneous nerve stimulation are helpful to ease aches and pains associated with osteoporosis.
Surgical procedures do not treat osteoporosis itself but the complications of the disease. Vertebroplasty and kyphoplasty may be carried out to manage and treat painful osteoporotic vertebral compression fractures.
Foods rich in calcium should form the major part of the diet. Calcium and vitamin D rich foods help in effective management and treatment of the disease as well.