Osteoporosis happens when bone density decreases and the body stops producing as much bone as it did before.
It can affect both males and females, but it is most likely to occur in women after menopause, because of the sudden decrease in estrogen, the hormone that normally protects against osteoporosis.
As the bones become weaker, there is a higher risk of a fracture during a fall or even a fairly minor knock.
What is Osteoporosis?
“Osteoporosis” literally means “porous bones.” The bones become weaker, increasing the risk of fractures, especially in the hip, spinal vertebrae, and wrist.
Bone tissue is constantly being renewed, and new bone replaces old, damaged bone. In this way, the body maintains bone density and the integrity of its crystals and structure.
Bone density peaks when a person is in their late 20s. After the age of around 35 years, bone starts to become weaker. As we age, bone breaks down faster than it builds. If this happens excessively, osteoporosis results.
Signs and symptoms of Osteoporosis
Bone loss that leads to osteoporosis develops slowly. There are often no symptoms or outward signs, and a person may not know they have it until they experience a fracture after a minor incident, such as a fall, or even a cough or sneeze.
Commonly affected areas are the hip, a wrist, or spinal vertebrae.
Breaks in the spine can lead to changes in posture, a stoop, and curvature of the spine
Causes and risk factors of Osteoporosis
A number of risk factors for osteoporosis have been identified. Some are modifiable, but others cannot be avoided
Non-modifiable risk factors include:
- Age: Risk increases after the mid-30s, and especially after menopause.
- Reduced sex hormones: Lower estrogen levels appear to make it harder for the bone to reproduce.
- Ethnicity: White people and Asians are more susceptible than other ethnic groups.
- Bone structure: Being tall (over 5 feet 7 inches) or slim (weighing under 56 kgs) increases the risk.
- Genetic factors: Having a close family member with a diagnosis of hip fracture or osteoporosis makes osteoporosis more likely.
- Fracture history: Someone who has previously experienced a fracture during a low-level injury, especially after the age of 50 years, is more likely to receive a diagnosis.
Diet and lifestyle choices
Modifiable risk factors include:
- eating disorders, such as anorexia or bulimia nervosa, or orthorexia
- tobacco smoking
- excessive alcohol intake
- low levels or intake of calcium, magnesium, and vitamin D, due to dietary factors, malabsorption problems, or the use of some medications
- inactivity or immobility
Weight-bearing exercise helps prevent osteoporosis. It places stress on the bones, and this encourages bone growth.
Drugs and health conditions
Some diseases or medications cause changes in hormone levels, and some drugs reduce bone mass.
Diseases that affect hormone levels include hyperthyroidism, hyperparathyroidism, and Cushing’s disease.
Conditions that increase the risk include:
- chronic kidney disease
- some autoimmune diseases, such as rheumatoid arthritis and ankylosing spondylitis
Medications that raise the risk include:
- glucocorticoids and corticosteroids, including prednisone and prednisolone
- thyroid hormone
- anticoagulants and blood-thinners, including heparin and warfarin
- protein-pump inhibitors (PPIs) and other antacids that adversely affect the mineral status
- some antidepressant medications
- some vitamin A (retinoid) medications
- thiazide diuretics
- thiazolidinediones used to treat type 2 diabetes, as these decrease bone formation
- some immunosuppressant agents, such as cyclosporine, which increase both bone resorption and formation
- aromatase inhibitors and other treatments that deplete sex hormones, such as anastrozole, or Arimidex
- some chemotherapeutic agents, including letrozole (Femara), used to treat breast cancer and leuprorelin (Lupron) for prostate cancer and other conditions
Glucocorticoid-induced osteoporosis is the most common type of drug-induced osteoporosis.
Prevention of Osteoporosis
Certain alterations to lifestyle can reduce the risk of osteoporosis.
Calcium and vitamin D
Calcium is essential for bones, and ensuring an adequate calcium intake is important.
Adults aged 19 years and above should consume 1,000 milligrams (mg) a day. Women aged 51 years and over, and all adults from 71 years should have a daily intake of 1,200 mg.
Dietary sources are preferable and include:
- dairy products, such as milk, cheese, and yogurt
- green leafy vegetables, such as kale and broccoli
- fish with soft bones, such as tinned salmon and tuna
- fortified breakfast cereals
If a person’s dietary intake is not enough, supplements are an option.
Vitamin D plays a key role, as it helps the body absorb calcium. Dietary sources include fortified foods, saltwater fish, and liver.
However, most vitamin D does not come from food but from sun exposure, so moderate, regular exposure to sunlight is recommended.
Calcium and vitamin D Tests
Do check your calcium and vitamin d level from the blood. Any abnormality or variation should be consulted with your family doctor.
Lifestyle factors for preventing Osteoporosis
Other ways to minimize the risk are:
- not smoking, as this can reduce the growth of new bone and decrease estrogen levels in women
- limiting alcohol intake, to encourage healthy bones and prevent falls
- getting regular weight-bearing exercise, such as walking, as this promotes healthy bone and strengthens support from muscles
- doing exercises to promote flexibility and balance, such as yoga, as these can reduce the risk of falls and fractures
For people who already have osteoporosis, nutrition, exercise, and fall prevention play a key role in reducing risks and bone loss.
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Osteopenia vs Osteoporosis
Osteopenia is sometimes confused with osteoporosis. Although both conditions are related to bone density, they are not the same thing.
Osteopenia involves below normal levels of bone density. Osteoporosis is considered more serious than osteopenia because the extent of the bone loss is more severe.
Osteoporosis leaves bones fragile, which can lead to bone fractures even from minor falls. It can also lead to stooped posture, loss of height, and a collapsed vertebra.
Both osteoporosis and osteopenia are very common.
It is important to understand that people with osteopenia are at an increased risk of developing osteoporosis.
Osteomalacia vs Osteoporosis
Osteomalacia is a weakening of the bones. Problems with bone formation or the bone-building process cause osteomalacia.
This condition isn’t the same as osteoporosis. Osteoporosis is a weakening of living bone that is already formed and being remodelled.
Bone Density Test
A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. Doctors recommend a bone density test of the hip and spine by a central DXA machine to diagnose osteoporosis. DXA stands for dual energy x-ray absorptiometry.
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