Definition
Osteoporosis is a chronic disease of bone metabolism during which gradual reduction in bone density and in quality of bone structure is observed, this leading with the passage of time to the bones becoming ever more thin and brittle. This inevitably brings about the risk of bone fractures as their strength and elasticity diminish. In our modern age, osteoporosis has become a major public health concern worldwide, mainly because of the ageing of populations but also for other less studied reasons such as stress, diet and lack of exercise.
Categories
- Primary osteoporosis includes: a) post-menopausal osteoporosis, that is osteoporosis that arises from hormonal causes after menopause due to the progressive reduction in women’s oestrogens b) senile osteoporosis that appears in senior citizens because of the reduced absorption of calcium by the intestine, or limited activity, or long-term use of other medications; c) idiopathic osteoporosis that appears in boys and girls during puberty as well as in young adult men and women; it is of relatively short duration.
- Secondary osteoporosis is induced by a specific condition. Some examples are: Cushing’s disease, because of the increased secretion of the hormone cortisol, hyperparathyroidism due to the increased secretion of the hormone parathyroid hormone, hyperthyroidism from the increased secretion of the hormone thyroxine or from an overdose of thyroxine in patients suffering from thyroid disease, hyperprolactinaemia due to the increased secretion of the hormone prolactin, or long-term use of cortisone preparations and anticoagulants, sickle cell anaemia, multiple myeoloma, prolonged immobilization, etc.
- In men, osteoporosis is mainly on account of hormonal factors such as the abovementioned but also due to reduced secretion of the male hormone testosterone, this being encountered in hypogonadism.
Other risk factors
- Gender: it is more common among women
- Diet: long-term high protein consumption which causes a loss of calcium
- Menarche: Age at a woman’s first menstrual flow
- Over-consumption of alcohol, coffee, tea
- Prolonged use of corticosteroids, anticoagulants and antiepileptic drugs
- Familial predisposition
- Body weight and sudden weight loss that is not followed by a suitable diet
- Smoking
- Excessive exercise in young women athletes / gymnasts
- Anorexia nervosa especially among young girls of reproductive age
- Gastrointestinal such as coeliac disease etc
Symptoms
Typically, osteoporosis is one of the so-called ‘silent’ diseases (i.e. with no or only vague symptoms), progressing gradually over a long period of time without any clinical manifestations. It has also been called “the silent thief” or “sneak thief”. The first clinical manifestations are often pervasive, persistent and mild intensity back pain or low back (lumbar) pains. These are often mistaken for “chills”, so that no diagnosis is made.
- Acute painful episodes due to fractures in the thoracic vertebrae. In these cases, the pain extends long the ribs. Though it does not improve with bed rest, it recedes after 3-4 weeks.
- Once the disease has progressed, movements of the spine are greatly limited and cause pain.
- Progressive deformation of the spine leads to kyphotic deformation (curvature of the thoracic spine, ‘hunchback’). It results in a shortening of the individual’s height that can over time be as much as by 10-20 centimetres.
- Sudden pain in the thoracic or lumbar spine during any normal movement or while lifting a weight is the first clinical manifestation. Clinical investigation and diagnosis of the disease will uncover a compression fracture.
- Intratrochanteric hip fractures and fractures of the femoral neck as well as those of the distal radius or of the proximal end of the humerus. It should not however be forgotten that a significant role in the occurrence of these fractures is played by frequent falls among the aged due to loss of balance control and muscle weakness.
Control – Monitoring
- Bone densitometry (bone density testing) in the region of the spine and/or of the hip, in accordance with the patient’s needs, and counseling by the endocrinologist. It is noteworthy that, since bone mass measurement does not comprise of itself the only reliable indicator of fracture risk available to the patient, the endocrinologist also needs to use other criteria.
- X-ray of the spine and/or of the hip according to the patient’s need.
- Measurement of metabolic factors (bone markers) that will show the rate of bone mass loss as well as those that will contribute to bone remodeling. These markers of bone metabolism at the start aid the endocrinologist in assessing the metabolism of the bone and the risk for increased bone mass loss, while they also help in the early assessment as to whether an osteoporosis therapy would ultimately benefit the patient or not.
- Calculation of the muscle mass and muscle strength of the patient due to the fact that good muscle mass and strength stimulate the growth of new bone tissue.
- Follow-up of height
- Assessment via an algorithm screening (Fracture Risk Algorithm, provided by the International Osteoporosis Foundation, IOF, for each country and race) for fracture risk (FRAX score) in people with a simple predisposition, with osteopenia or with osteoporosis. It must be mentioned that bone densitometry is not always on its own a reliable fracture risk indicator, since patients with osteopenia may suffer a fracture, while those diagnosed with osteoporosis may not.
Treatment
- Correct diet and regular follow-up
- Suitable exercises to heighten muscle strength and stimulate bone formation.
- Choice of the optimal pharmaceutical therapy according the patient’s needs, since there is no ‘one size fits all’ treatment of the disease. It is important to note concerning the treatment of osteoporosis, by contrast to treatment of other chronic diseases, that while a particular medication will produce good results at the start, long-term, i.e. over a number of years, the metabolism of the bone may change resulting in the medication ultimately producing opposite and adverse effects.
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| Reduced bone density and impaired architecture of vertebral osteoporosis (left) compared with normal vertebrae (right) | |
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| Recommended exercises for patients with osteoporosis | |
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| Recommended exercises for patients with osteoporosis |