What is Osteoporosis?

Osteoporosis literally means pores (or holes) in bones. It is a bone disease wherein the bone density of the body decreases below the normal for that age. Usually occurring in post-menopausal women, it is further compounded by the fact that at the same time the body produces new bone very sparsely.

Though occurring in both men and women, Osteoporosis is much more common among women after their menopause. This is because, with menopause, oestrogen (the hormone that primarily prevents bones from erosion) suddenly decreases to a great extent.

As the density of bone is decreased to below normal levels, affected people become prone to fractures, even with the slightest of injuries or falls. Bones around the hips, wrists and the spine are most prone to breakage as they are the weight bearing struts. Smoking and poor diet are other risk factors that increase the risk of osteoporosis and Osteopenia.

Why treat Osteoporosis?

Before osteoporosis sets in (pre-menopause), the aim is to build bone mass and slow down bone erosion.

Once osteoporosis sets in, treatment is aimed at

  • Maintaining bone mass
  • Reducing bone and muscle aches and pains
  • Improving quality of life
  • Preventing fractures following simple falls

How and what type of drugs can help in Osteoporosis?

The treatment of osteoporosis is multi-pronged, and involves a combination of lifestyle modification, good nutritious diet, regular exercise and medication. Drugs used today include:

  • Anti-resorptive drugs: most used medication, aimed at preventing further bone erosion, and thereby indirectly improving bone strength.
  • RANKL inhibitors like denosumab (Xgeva), which works as a general anti resorptive as well as an immune therapy for osteopathic diseases
  • Estrogen agonists or selective estrogen-receptor modulators (Raloxifene, Toremifene, Tamoxifen), used around menopause (to restore estrogen levels needed for bone production).
  • Parathyroid hormone analogues (Teriparatide), which is the only true drug that stimulates new bone formation.
  • Calcitonin (Miacalcin, Calcimar) specifically Signs and symptoms of Osteoporosis

In most cases, Osteoporosis is silent disease (symptomless) and takes many years to reach a point where clinical attention is sought. Most of the people do not even understand that they are suffering from Osteoporosis till they actually suffer from a fracture with the slightest of injuries or falls. The condition may sometimes worsen to a level where a fracture can happen even from sneezing or coughing. If these fractures occur in the spine, a permanent change in the posture can be noticed.

What causes osteoporosis and risk factors

The causes of Osteoporosis can be divided into 2 groups:

Unavoidable or Non-modifiable factors

  • Age (technically, after the age of 30, bone density cannot increase, so the aim is to maintain the levels of bone mass)
  • Ethnicity (Asians and Caucasians are most prone)
  • Lower Estrogen level (as in early menopause, or post-uterus and ovary removal)
  • Genetic factors (family history of osteoporosis or fractures following simple falls)
  • Poor bony and physical structure
  • Past history of fractures following simple falls/injury (People aged 50 years and above with a previous history of fractures)

Modifiable risk factors

  • Inadequate diet (Low intake of vitamin D, calcium and magnesium)
  • Malabsorption problems
  • Excessive intake of alcohol
  • Tobacco consumption (oral/smoking)
  • Prolonged inactivity or immobility (years)
  • Diseases like hyperparathyroidism, hyperthyroidism and Cushing’s disease (all affect the hormone levels that regulate healthy bones and lower bone density)

Other risk factors of Osteoporosis

The other risk factors include:

  • COPD
  • Cancer
  • Ankylosing Spondylitis (inflammatory arthritis in large joints and spine)
  • Rheumatoid arthritis (a chronic inflammatory disorder in joints, hands and feet)
  • Chronic kidney disease

Medications which can increase the risk of Osteoporosis

There are certain medicines and health conditions which can worsen Osteoporosis:

  • Corticosteroids and Glucocorticoids (steroid hormones)
  • vitamin A (retinoids)
  • Blood-thinners
  • Antidepressant medication
  • Thiazolidinediones (type 2 diabetes medicines)
  • Thyroid hormone
  • Antacids that mess with mineral status (PPIs)
  • Aromatase inhibitors (breast cancer and gynecomastia treatment)
  • Thiazide diuretics (hypertension and edema medicines)
  • Cancer medicines (chemotherapeutic agents)

How to prevent osteoporosis

Calcium and vitamin D are the most essential components of human bones. If a young adult of 19 years or above consumes calcium less than 1000mg/day then he or she is exposed to greater risk of lower bone density after 30 years of age. For women aged >51, the minimum daily intake should be 1,200mg.

Dairy products are the best source of calcium. This list includes:

  • Fortified breakfast cereals
  • Milk, cheese and yogurt
  • Soft-boned fish
  • Kale, broccoli and other green vegetables

Sources of adequate Vitamin D include:

  • Regular and moderate sun exposure
  • Saltwater fish
  • Fortified foods (Vitamin A, Vitamin B, Vitamin D, Iodine, Iron, Folic acid)
  • Cheese, Egg yolks

Lifestyle changes that help control bone density

  • Quitting smoking can increase the formation of new bone
  • Restriction on alcohol consumption
  • Weight-bearing exercise with muscle strengthening
  • Yoga for enhanced flexibility of the body

All Orthopaedic surgeons recommend regular bone mineral density screening (DEXA scan) especially for women aged 65 years and over.

Content Reviewed By: Dr. Dr Rajeev Thukral