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Osteoporosis

Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry. The term "established osteoporosis" includes the presence of a fragility fracture. It is a medical condition that affects the bones, causing them to become weak and fragile and more likely to break (fracture).

Common form of osteoporosis:
 

1) Primary Osteoporosis:

Type I: It is also called as postmenopausal osteoporosis.
Type II: Type II or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1.

2) Secondary Osteoporosis:

Secondary osteoporosis may arise at any age and can affect men and women equally.
This form results from chronic predisposing medical problems or disease, or prolonged use of medications such as glucocorticoids, when the disease is called steroid induced or glucocorticoid-induced osteoporosis.

References:
www.cdc.gov
www.who.int
www.nlm.nih.gov
www.youtube.com
Merck Serono - Bone and Joint Health

 

The content of this module has been validated by Dr S. Y. Kothari, Retd. Special DGHS, Ministry of Health and Family Welfare, Government of India on 18/3/2015
 

Osteoporosis develops slowly over several years. Sometime a minor fall or sudden impact can cause a bone to fracture. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.

Symptoms include:

  • Joint pain
  • Swelling
  • Loss of height and stooped posture.
  • Disfigurement
  • A curved upper back (dowager's hump).
  • Debilitation

Reference: www.nhs.uk

Osteoporosis may be caused due to decrease in density of bones.

Risk Factors:
 

Women
Women are at greater risk of developing osteoporosis than men. This is because changes in hormone levels can affect bone density. Female hormone estrogen is essential for healthy bones. After the menopause, the level of estrogen in the body falls, and this can lead to a rapid decrease in bone density.

Men
In most of the men who develop osteoporosis, the cause is unknown. However, there is a link to the male hormone testosterone, which helps to keep the bones healthy. Men continue to produce this hormone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone.

Diseases of the hormone-producing glands There are increased chances of Osteoporosis by hormone-related diseases, including:

  • Hyperthyroidism (overactive thyroid gland)
  • Disorders of the adrenal glands, such as Cushing's syndrome
  • Reduced amounts of sex hormones (oestrogen and testosterone)
  • Disorders of the pituitary gland
  • Hyperparathyroidism (overactivity of the parathyroid glands).

Other things thought to increase the risk of osteoporosis and broken bones include:

  • Family history of osteoporosis
  • A low body mass index (BMI) of 19 or less
  • Long-term use of high-dose corticosteroid treatment (widely used for conditions such as arthritis and asthma), which can affect bone strength
  • Heavy drinking and smoking
  • Rheumatoid arthritis

Reference: www.nhs.uk

Osteoporosis is often diagnosed after the weakening of the bones has led to a fracture. Diagnosis can be made on suspicion when patient approaches a doctor for any other reason or x-ray is done otherwise and bones appear weak.

Conventional radiography
Conventional radiography is used either alone or in conjunction with CT or MRI, for detecting complications of osteopenia (reduced bone mass preosteoporosis). However, radiography is relatively insensitive to detection of early disease and requires a substantial amount of bone loss (about 30%) to be apparent on X-ray images. The main radiographic features of generalized osteoporosis are cortical thinning and increased radiolucency. Involvement of multiple vertebral bodies leads to kyphosis of the thoracic spine, leading to what is known as dowager's hump.

Dual-energy X-ray
Dual-energy X-ray absorptiometry (DXA) is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old) healthy adult women reference population. This is translated as a T-score.

Biomarkers
Chemical biomarkers are a useful tool in detecting bone degradation. The enzyme cathepsin K breaks down type-I collagen protein, an important constituent in bones. Antibodies recognizes the resulting fragment, called a neoepitope, as a way to diagnose osteoporosis. Increased urinary excretion of C-telopeptides, a type-I collagen breakdown product, also serves as a biomarkers for osteoporosis.

Reference: www.nhs.uk

Lifestyle
Tobacco smoking and high alcohol intake have been linked with osteoporosis. Cessation of smoking and moderation of alcohol intake are commonly recommended.

Nutrition
Vitamin D and calcium supplements together can result in preventing fractures. However, there is an increased risk of myocardial infarctions and kidney stones with excess of these supplements.

Medications
Bisphosphonates are useful in decreasing the risk of future fractures. Teriparatide (a recombinant parathyroid hormone) has been shown to be effective in treatment of women with postmenopausal osteoporosis.

Regular exercises: Regular exercise is essential. Adults are advised to workout for at least 30 minutes, five times a week. Weight bearing exercises are beneficial.

Healthy eating: Calcium and Vitamin D are essential for healthy bones. No smoking, No excess consumption of alcohol.

  • CREATED / VALIDATED BY : NHP CC DC
  • LAST UPDATED ON : Sep 16, 2015

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