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Bone is a tissue that provides structural support to our body, protects the soft tissues and is a mineral reservoir. Osteoporosis’ which means ‘Porous bone’ is a bone disease characterized by low mineral density. This condition makes the bone weak, and brittle and increases the risk of fractures due to trivial fall. This is considered to be a silent disease as there are no symptoms in the initial phase until you have fractured a bone. Generally, fractures occur in the areas of the spine, wrist, hip, etc.
Risk Factors:
The factors that increase your risk for the development of osteoporosis include:
Older age: Older people are at a higher risk for osteoporosis due to a decrease in the rate of bone rebuilding, less bone mineral density and low bone strength.
Gender: One in two women aged 50 years and above may suffer a fracture because of Osteoporosis. Women are four times more likely to get osteoporosis compared to men because women have thinner, lighter, and smaller bones and lower production of oestrogen hormone. Oestrogen is an important hormone for protecting bones.
The eating habits such as low consumption of dairy products and also anorexia can make bones weak and brittle and increase your risk of osteoporosis due to nutrient deficiencies.
Early-onset of menopause: Postmenopausal women have a higher chance of osteoporosis and higher fracture risk as menopause causes increased bone resorption and reduced oestrogen production, causing rapid bone loss density in the first 10 years of menopause.
Heredity or family history of osteoporosis: If parents and/or siblings have osteoporosis, you are more likely to develop osteoporosis.
No, or low exposure to sunlight: Sunlight is important for the synthesis of vitamin D. Therefore, vitamin D is also called the sunshine vitamin.
Habits like excessive intake of alcohol, tobacco, coffee, etc. and smoking: These habits inhibit the absorption of minerals which are important for bone strength. Smokers lose bone density faster than non-smokers. Alcoholism reduces bone formation and increases the risk of falling.
Inactive lifestyle: Lack of exercise reduces bone strength and increases the risk of falling.
Medical conditions like autoimmune disorders (rheumatoid arthritis, lupus, multiple sclerosis, etc.), digestive disorders (celiac diseases, inflammatory bowel disease, etc), endocrine disorders (diabetes, hyperthyroidism, hyperparathyroidism, etc), neurological disorders (Parkinson’s disease, multiple sclerosis, etc), cancer, AIDS, and surgical procedures like gastrectomy, gastrointestinal bypass, etc., increase the risk for developing osteoporosis.
Medications like anticonvulsants, glucocorticoids, steroids, etc., over time, may cause bone thinning.
Causes:
It is natural for healthy bones to constantly remodel themselves by removing older bones and build new ones to maintain bone strength. Osteoclasts are cells that break down the old bones and release minerals into the bloodstream by a process called bone resorption, and osteoblasts are cells that create a new bone by a process called bone ossification or osteogenesis. The imbalance between bone resorption and bone ossification causes osteoporosis. In osteoporotic conditions, bone reabsorption is higher than bone formation. This imbalance in skeletal turnover begins after the 30s.
Signs and Symptoms:
Osteoporosis is considered to be a silent disease and does not show any obvious symptoms until you have had a painful fracture. However, one may watch out for the following signs and symptoms:
Early signs of osteoporosis:
Weaker handgrip due to low mineral density in the bones.
Weak and brittle nails could be an indication of weak bone density.
Later-stage symptoms:
Loss of height: Due to spinal compression caused by weak bones, the individual tends to get shorter by an inch or more, over time.
Change in posture: Due to compression fracture of the spine, slight curving of the spine leading to stooping or bending forward (kyphosis) may occur.
Shortness of breath: Weak bone results in a compression fracture of the spine. The vertebra collapses putting pressure on the lungs causing limited lung capacity.
Bone fractures: Due to weak, brittle, or fragile bones, the fracture can occur even with a strong sneeze, cough, or the slightest twisting of the leg.
Pain in the lower back and neck due to compression fractures of the spine caused by osteoporosis.
Treatment:
For the treatment of osteoporosis, either non-operative or operative options are recommended based on the diagnostic investigations of the imaging tests like X-ray, CT scan, MRI, DEXA scan, etc.
Non-operative treatments of osteoporosis:
Depending on the severity of bone loss, treatment recommendations are made that include:
Medications: If the risk of fractures is mild to moderate, medications are recommended that includes:
Bis-phosphonates (anti-resorptive drugs to stop the body from re-absorbing bone tissue).
Monoclonal antibody medications (a form of immunotherapy).
Bone-building medications
Anabolic agents (for the formation of bones)
Hormone-related therapy (hormones like oestrogen, testosterone, etc., may be prescribed to increase bone density).
Lifestyle modifications: The risk of developing osteoporosis and fractures can be reduced by quitting habits like smoking, drinking alcohol, chewing tobacco, etc. Regular exercising, walking, jogging, weightlifting, etc., can strengthen bones.
Dietary modifications: Eat a diet rich in calcium and include good sources of calcium such as dairy products, fish (salmon with bones, sardines), vegetables (kale, broccoli), calcium-fortified products, dried figs, etc.
Supplements: Dietary supplements such as calcium, vitamin D, and other minerals can stop or slow down bone loss.
Operative management of osteoporosis:
In case of severe osteoporosis (bone mineral density (T-score) score of −2.5 or lower) - which is characterized by fragile bones - surgical options are recommended for Osteoporosis treatment only after alternative, non-surgical treatments like bed rest, medications, etc., fail:
Arthroplasty: Osteoporotic knee and hip fractures in elderly people are managed by arthroplasty. Arthroplasty is a surgical procedure that involves the removal and replacement of the affected joints.
Vertebroplasty: This is a minimally invasive procedure that stabilizes the spine and reduces pain. The procedure involves injecting a mixture of bone cement using a hollow needle into the fractured spine. The main goal of this procedure is the prevention of recurrent fractures and reduce pain through aggressive pain control and stabilization of the fractured spine.
Kyphoplasty: In the affected area of the spine, a balloon is inserted via a tube into the fractured spinal area. The balloon is inflated to create space and attain a normal spinal height. A mixture of bone cement is then added to fill the space and stabilize the spine.
Open decompression or fusion surgery, or lumbar laminectomy.
Spinal instrumentation for fracture and deformity: The osteoporotic spine is stabilized by using special implants like screws, rods, pins, plates, etc.
Rehabilitation:
The process of bone healing post-operatively may take several weeks to months depending on the location and severity of fractures. Mild exercising and mild to moderate increase in the activity done gradually can help the healing process.
