Osteoporosis is a condition in which the density and quality of bones is reduced, making them weak, brittle and more likely to fracture. There are usually no symptoms of osteoporosis until a bone breaks. Treatment and prevention will normally focus on lifestyle changes and medications to boost bone density.
Osteoporosis is characterized by a decrease in bone mass and strength, so much so that even a relatively minor strain can result in a fracture (fragility fracture). While there is a normal physiological decrease in bone mass with age, in osteoporosis there is more of it due to an imbalance between bone resorption and bone formation.
Many factors influence bone mass and bone loss. One is at greater risk for osteoporosis due to genetic factors, or environmental ones like lack of exercise, immobility, smoking and diet deficient in calcium. It could also result from certain diseases like hypogonadism, endocrine diseases such as pituitary or thyroid disease, and drugs like corticosteroids, anticonvulsants (drugs given in epilepsy), and sedatives.
Symptoms Of Osteoporosis
You may have bone pain and tenderness (that is, pain in bone when pressed gently). If the osteoporosis is due to an underlying disease there could be associated symptoms of that particular disease. However, often, a patient with even advanced osteoporosis is asymptomatic and presents suddenly with a fracture even with minor trauma.
Precipitating factor for vertebral or spinal fractures is often bending over or lifting heavy weights. The trigger for long bone fractures such as in arms and legs is usually a simple fall. Arm and spine fractures are more common in those over 55, but hip fractures are more common in those over 70.
While the symptoms due to the fracture itself depend on the particular bone fractured, there are some general symptoms like marked pain in the region affected, associated with swelling, abnormal movement of the limb or body, crepitus (a peculiar grating or crackling sound when the fractured surfaces of the broken bone rub against one another) or deformity.
Vertebral compression fractures could be asymptomatic initially, though occasionally there could be neck pain or back pain which radiates to ribs and to the abdomen; but as the vertebrae start collapsing, there is a decrease in height of even up to 6 inches. The posture is stooped (dowager’s hump) due to abnormal curvature in spine called kyphosis.
There is no single cause of osteoporosis but there are many risk factors. These include:
- Older age (>50 years)
- Female gender
- Thin build
- Physical inactivity
- Family history of osteoporosis
- Excessive alcohol or caffeine consumption
- Low dietary calcium intake
- Low levels of vitamin D
- Long-term use of some medications eg: corticosteroids, thyroid medications, epilepsy medications
If you have reason to suspect you may have osteoporosis or you just want to rule out such a possibility, then you should undergo what is called bone densitometry. This is the gold standard in diagnosis of osteoporosis, and is usually done with X-rays, also called as dual energy X-ray absorptiometry (DXA or DEXA). This test measures the bone mineral density in certain bones such as the hip, spine and thigh bone.
In addition to detecting the presence and grade of osteoporosis, it also predicts the future susceptibility to fractures. Quantitative ultrasound and CT scanning can also be done. Associated risk factors should be excluded. In fact, if you are over 50, it is advisable that you get your blood levels of calcium and vitamin D checked periodically and if found to be low, get a bone densitometry done.
Prevention and Treatment
You can take several steps to either prevent the occurrence or reduce the severity of osteoporosis by
(1) Exercise: 30 minutes of weight-bearing exercise 3 times a week as per your comfort level increases bone mineral density;
(2) Quit smoking and reduce alcohol intake;
(3) Precautions: Make home environment skid proof, and wear hip protectors if possible;
(4) Drugs: If diagnosed with osteoporosis, then most likely your doctor would prescribe bisphosphonates like alendronate and risedronate (usually taken once a week), and calcium and vitamin D supplements;
(5) Underlying condition: Risk factors like underlying diseases should be treated. Despite these measures, if fracture(s) should result, then they are treated as any other fracture would be.