Definition
Osteoporosis is a disease characterized by tinning of the bones due to loss of calcium and bone proteins. Osteoporosis makes the bones very fragile and can cause "pathological" fractures, which result from very slight efforts, like caught for example.
Osteoporosis can occur
in any age, but it is most common in older adults. It affects both men and
women. However postmenopausal women are at highest risk. Osteoporosis is also
current in people who take steroids.
Causes
The bones as every other tissue are constantly undergoing process of renewal- old bone elements are being destructed and replaced by new ones. When there is a domination of the bone mass elimination process over the bone production, bone density diminishes, causing firstly osteopenia, which than progresses into osteoporosis, if risk factors persist.
The bones as every other tissue are constantly undergoing process of renewal- old bone elements are being destructed and replaced by new ones. When there is a domination of the bone mass elimination process over the bone production, bone density diminishes, causing firstly osteopenia, which than progresses into osteoporosis, if risk factors persist.
Risk factors
►Sex: women suffer more that osteoporosis than men, especially after menopause
►Age: bone density decreases after the age of 35, so the risk of osteoporosis increases after this age
►Family history of osteoporosis
►Race: osteoporosis affects more people from the white and the Asian race. Africans are relatively protected from osteoporosis since their bone mass is higher.
►Bad eating habits such as low food (and therefore calcium) intake, anorexia or malabsorption syndromes such as celiac sprue
►Unhealthy lifestyle- the low physical activity weakens the muscles and the bones. In addition the lack of sufficient sun exposure disturbs the metabolism of vit.D, which is as necessary for the bones as calcium is.
►Smoking and alcoholism: although the exact mechanisms remain unclear, it is being proved that both alcohol and tobacco decrease bone density
►Use of medications: osteoporosis is associated with long-term use of corticosteroids, some cancer drugs, as well as drugs preventing transplant rejection
►Chronic diseases like rheumatoid arthritis, or genetic disorders of the connective tissue like Marfan syndrome, osteogenesis imperfecta
►Hormonal misbalance: the decrease in estrogen levels in postmenopausal women is one of the major predisposing factors for osteoporosis as estrogens have protective role, concerning the bones. Testosterone also play role in bone mass formation, so men with hypogonadism are threatened by osteoporosis, too. Other hormonal disorders such as hyperthyroidism could also affect bone density, due to the increased bone metabolism. Hyper production of parathormone from the parathyroid glands on the other hand increases the calcium blood level, by extracting calcium from the bones, which decreases bone density.
►Sex: women suffer more that osteoporosis than men, especially after menopause
►Age: bone density decreases after the age of 35, so the risk of osteoporosis increases after this age
►Family history of osteoporosis
►Race: osteoporosis affects more people from the white and the Asian race. Africans are relatively protected from osteoporosis since their bone mass is higher.
►Bad eating habits such as low food (and therefore calcium) intake, anorexia or malabsorption syndromes such as celiac sprue
►Unhealthy lifestyle- the low physical activity weakens the muscles and the bones. In addition the lack of sufficient sun exposure disturbs the metabolism of vit.D, which is as necessary for the bones as calcium is.
►Smoking and alcoholism: although the exact mechanisms remain unclear, it is being proved that both alcohol and tobacco decrease bone density
►Use of medications: osteoporosis is associated with long-term use of corticosteroids, some cancer drugs, as well as drugs preventing transplant rejection
►Chronic diseases like rheumatoid arthritis, or genetic disorders of the connective tissue like Marfan syndrome, osteogenesis imperfecta
►Hormonal misbalance: the decrease in estrogen levels in postmenopausal women is one of the major predisposing factors for osteoporosis as estrogens have protective role, concerning the bones. Testosterone also play role in bone mass formation, so men with hypogonadism are threatened by osteoporosis, too. Other hormonal disorders such as hyperthyroidism could also affect bone density, due to the increased bone metabolism. Hyper production of parathormone from the parathyroid glands on the other hand increases the calcium blood level, by extracting calcium from the bones, which decreases bone density.
Symptoms
Osteoporosis develops slowly during years, even decades. In most of the cases osteoporosis first sign is an osteoporotic fracture, which is characterized by severe pain. The localization of the pain depends on the localization of the fracture. It could occur in any bone, but most common places are the vertebras, the hip and the wrist. Multiple spine fractures may lead to chronic low back pain, postural change with formation of hump or decrease in height due to the compression of the vertebras.
Osteoporosis develops slowly during years, even decades. In most of the cases osteoporosis first sign is an osteoporotic fracture, which is characterized by severe pain. The localization of the pain depends on the localization of the fracture. It could occur in any bone, but most common places are the vertebras, the hip and the wrist. Multiple spine fractures may lead to chronic low back pain, postural change with formation of hump or decrease in height due to the compression of the vertebras.
Complications
►Fractures: osteoporotic fractures differ from trauma fractures since they could appear while exercising even the slightest pressure on the bone. They also take longer to heal, causing prolonged disability and decreased quality of life.
►Pneumonia: this complication may occur after prolonged bed rest after a osteoporotic fracture, especially in elderly patients with decreased immune system strength.
►Pulmonary embolism: decreased physical activity due to fractures or chronic pain may lead to the formation of blood cloths in the leg veins and their dissemination in the lungs. This is a serious complication manifesting with sudden difficulty to breath and increased heart and breathing rate, which requires emergency medical help.
Diagnosis
Osteoporosis could be revealed trough routine X-ray. But X-ray changes appear only when at least 30% of the bone density is being lost, which makes X-ray inappropriate method for early diagnosis. Bone density is being measured with dual-energy X-ray absorptiometry scan (DXA, also known as DEXA) and it is than being compared with normal bone density. This test is precise, easy to perform and exposes the patient to minimal radiation.
►Fractures: osteoporotic fractures differ from trauma fractures since they could appear while exercising even the slightest pressure on the bone. They also take longer to heal, causing prolonged disability and decreased quality of life.
►Pneumonia: this complication may occur after prolonged bed rest after a osteoporotic fracture, especially in elderly patients with decreased immune system strength.
►Pulmonary embolism: decreased physical activity due to fractures or chronic pain may lead to the formation of blood cloths in the leg veins and their dissemination in the lungs. This is a serious complication manifesting with sudden difficulty to breath and increased heart and breathing rate, which requires emergency medical help.
Diagnosis
Osteoporosis could be revealed trough routine X-ray. But X-ray changes appear only when at least 30% of the bone density is being lost, which makes X-ray inappropriate method for early diagnosis. Bone density is being measured with dual-energy X-ray absorptiometry scan (DXA, also known as DEXA) and it is than being compared with normal bone density. This test is precise, easy to perform and exposes the patient to minimal radiation.
Treatment
►Medications that stop bone loss and increase bone strength, also known as bisphosphonates are the medications of first choice
►Medication that increase bone formation are also available on the market and are recommended if patients do not respond well to bisphosphonates
►Hormone-therapy with estrogens or testosterone is also an option. Since estrogens increase the risk of blood clots formation, endometrial or breast cancer, they should be prescribed with caution.
►Medications that stop bone loss and increase bone strength, also known as bisphosphonates are the medications of first choice
►Medication that increase bone formation are also available on the market and are recommended if patients do not respond well to bisphosphonates
►Hormone-therapy with estrogens or testosterone is also an option. Since estrogens increase the risk of blood clots formation, endometrial or breast cancer, they should be prescribed with caution.
Prevention
Prevention consists of changing the lifestyle in order to minimize the influence of the risk factors. Patients should therefore be advised to quit smoking, reduce alcohol use, be physically active during the day, eat enough diary, fish, fruits and vegetables to supply the organism with calcium and vit D.
Osteoporosis is a disease with huge social impact, so it should not be underestimated. As for every other condition prevention is very important as osteoporosis consequences are hard to deal with.
Prevention consists of changing the lifestyle in order to minimize the influence of the risk factors. Patients should therefore be advised to quit smoking, reduce alcohol use, be physically active during the day, eat enough diary, fish, fruits and vegetables to supply the organism with calcium and vit D.
Osteoporosis is a disease with huge social impact, so it should not be underestimated. As for every other condition prevention is very important as osteoporosis consequences are hard to deal with.
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