د. قيس
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Osteoporosis:
Osteoporosis happens when bone density decreases and the body
stops producing as much bone as it did before.
It can affect both males and females, but it is most likely to
occur in women after
, because of the sudden
, the hormone that normally protects against
osteoporosis.
As the bones become weaker, there is a higher risk of
a
during a fall or even a fairly minor knock
.
Fast facts on osteoporosis:
Osteoporosis affects the structure and strength of bones and
makes fractures more likely, especially in the spine, hip, and
wrists.
It is most common among females after menopause, but
smoking and poor diet increase the risk.
There are often no clear outward symptoms, but weakening of
the spine may lead to a stoop, and there may be bone pain.
A special x-ray-based scan, known as DEXA, is used for
diagnosis.
Treatments include drugs to prevent or slow bone loss,
exercise, and dietary adjustments, including
extra
What is osteoporosis?
"Osteoporosis" literally means "porous bones." The bones
become weaker, increasing the risk of fractures, especially in
the hip, spinal vertebrae, and wrist. Bone tissue is constantly
being renewed, and new bone replaces old, damaged bone. In
this way, the body maintains bone density and the integrity of
its crystals and structure.
Bone density peaks when a person is in their late 20s. After
the age of around 35 years, bone starts to become weaker. As
we age, bone breaks down faster than it builds. If this happens
excessively, osteoporosis results.
Causes and risk factors:
A number of risk factors for osteoporosis have been identified.
Some are modifiable, but others cannot be avoided.
Unavoidable factors:
Age: Risk increases after the mid-30s, and especially after
menopause.
Reduced sex hormones: Lower estrogen levels appear to make
it harder for bone to reproduce.
Ethnicity: White people and Asians are more susceptible than
other ethnic groups.
Bone structure: Being tall (over 5 feet 7 inches) or slim
(weighing under 125 pounds) increases the risk.
Genetic factors: Having a close family member with a diagnosis
of hip fracture or osteoporosis makes osteoporosis more likely.
Fracture history: Someone who has previously experienced a
fracture during a low-level injury, especially after the age of 50
years, is more likely to receive a diagnosis.
Diet and lifestyle choices:
orthorexia
tobacco smoking
excessive alcohol intake
low levels or intake of calcium, magnesium, and
to dietary factors, malabsorption problems, or the use of some
medications
inactivity or immobility
Weight-bearing exercise helps prevent osteoporosis. It
places
Drugs and health conditions:
Some diseases or medications cause changes in hormone levels,
and some drugs reduce bone mass.
Diseases that affect hormone levels include
hyperparathyroidism, and Cushing's disease.
who receive hormone treatment (HT) may be at higher risk of
osteoporosis. However, using anti-androgens for a year before
starting HT may reduce this risk. Transgender men do not
appear to have a high risk of osteoporosis. More research is
needed to confirm this.
Conditions that increase the risk
COPD
some autoimmune diseases, such as
Medications that raise the risk
glucocorticoids and corticosteroids, including prednisone and
prednisolone
thyroid hormone
anticoagulants and blood-thinners, including heparin and
warfarin
protein-pump inhibitors (PPIs) and other antacids that adversely
affect mineral status
some vitamin A (retinoid) medications
thiazolidinedione, used to treat
, as these
decrease bone formation
some immunosuppressant agents, such as cyclosporine, which
increase both bone resorption and formation
aromatase inhibitors and other treatments that deplete sex
hormones, such as anastrozole, or Arimidex
some chemotherapeutic agents, including letrozole (Femara),
used to treat
, and leuprorelin (Lupron) for
Glucocorticoid-induced osteoporosis is the most common type
of drug-induced osteoporosis.
Signs and symptoms:
Bone loss that leads to osteoporosis
. There are
often no symptoms or outward signs, and a person may not
know they have it until they experience a fracture after a minor
incident, such as a fall, or even a cough or sneeze.
Commonly affected areas are the hip, a wrist, or spinal
vertebrae.
Tests and diagnosis:
A doctor will consider the patient's family history and their risk
factors. If they suspect osteoporosis, they will request a scan, to
measure bone mineral density (BMD).
technology known as
dual-energy X-ray absorptiometry (DEXA) and bone
densitometry.
Combined with the patient's risk factors, DEXA can indicate the
likelihood of fractures occurring due to osteoporosis. It can also
help monitor response to treatment.
Two types of device can carry out a DEXA scan:
A central device: A hospital-based scan measures hip and spine
bone mineral density while the patient lies on a table.
A peripheral device: A mobile machine that tests bone in the
wrist, heel, or finger.
DEXA test results:
The results of the test are given as a DEXA T-score or a Z-score.
the patient's bone mass with peak bone
mass of a younger person.
-1.0 or above is normal
from -1.0 to -2.5 suggests mild bone loss
-2.5 or below indicates osteoporosis
The Z-score compares the patient's bone mass with that of other
people with similar build and age.
The test is normally repeated every 2 years, as this allows for
comparison between results.
Other tests:
A lateral vertebral assessment (LVA)
an older patient who is more than one inch shorter than they
used to be, or who has
that is not related to another
condition.
osteoporosis. It can be carried out in the primary care setting. It
is less common than DEXA, and the measurements cannot be
compared against DEXA T-scores. Breaks in the spine can lead
to changes in posture, a stoop, and curvature of the spine.
Treatment and prevention:
Treatment aims to:
slow or prevent the development of osteoporosis
maintain healthy bone mineral density and bone mass
prevent fractures
reduce pain
maximize the person's ability to continue with their daily life
This is done through preventive lifestyle measure and the use of
supplements and some drugs.
Calcium and vitamin D
Calcium is essential for bones, and ensuring an adequate
calcium intake is important.
Adults aged 19 years and above should consume 1,000
milligrams (mg) a day. Women aged 51 years and over, and all
adults from 71 years should have a daily intake of 1,200 mg.
Dietary sources are preferable and
dairy produce, such as milk, cheese, and yogurt
green leafy vegetables, such as
fish with soft bones, such as tinned salmon and tuna
fortified breakfast cereals
If a person's dietary intake is not enough, supplements are an
option.
Vitamin D plays a key role, as it helps the body absorb calcium.
Dietary sources include fortified foods, saltwater fish, and liver.
However, most vitamin D does not come from food but from
sun exposure, so moderate, regular exposure to sunlight is
recommended.
Lifestyle factors for preventing osteoporosis:
Other ways to minimize the risk are:
not smoking, as this can reduce the growth of new bone and decrease
estrogen levels in women
limiting alcohol intake, to encourage healthy bones and prevent falls
getting regular weight-bearing exercise, such as walking, as this
promotes healthy bone and strengthens support from muscles
doing exercises to promote flexibility and balance, such as
, as
these can reduce the risk of falls and fractures
For people who already have osteoporosis,
, exercise and fall
in reducing risks and bone loss.
Drug therapy:
and treat osteoporosis include:
Bisphosphonates: These are antiresorptive drugs that slow bone loss
and reduce fracture risk.
Estrogen agonists or antagonists, also known as selective estrogen-
receptor modulators, SERMS), for example, raloxifene (Evista): These
can reduce the risk of spine fractures in women after menopause.
Calcitonin (Calcimar, Miacalcin): This helps prevent spinal fracture in
postmenopausal women, and it can help manage pain if a fracture
occurs.
Parathyroid hormone, for example, teriparatide (Forteo): This is
approved for people with a high risk of fracture, as it stimulates bone
formation.
RANK ligand (RANKL) inhibitors, such as denosumab (Xgeva): This
is an immune therapy and a new type of osteoporosis treatment.
Other types of estrogen and hormone therapy may help.
The future of osteoporosis therapy?
In future, treatment may include
injecting a particular kind of stem cell into mice
reversed osteoporosis and bone loss in a way that could, potentially,
benefit humans too.
Findings published in 2015 suggested that growth hormone (GH) taken
with calcium and vitamin D supplements
fractures in the long term.
Also in 2015, researchers in the United Kingdom (U.K.)
found
that a diet containing soy protein and isoflavones may
offer protection from bone loss and osteoporosis during menopause.
Scientists believe that up to 75 percent of a person's bone mineral
density is determined by genetic factors. Researchers are investigating
which genes are responsible for bone formation and loss, in the hope that
this might offer new ways of preventing osteoporosis in future.
Complications:
As bones become weaker, fractures occur more frequently, and, with
age, they take longer to heal.
This can lead to ongoing pain and loss of stature, as bones in the spine
begin to collapse. A broken hip can be hard to recover from, and the
person may no longer be able to live independently.
It is important to take action to prevent falls among people with
osteoporosis.
removing trip hazards, such as throw rugs and clutter
having regular vision screenings and keeping eyewear up to date
installing grab bars, for example, in the bathroom
ensuring there is plenty of light in the home
practicing exercise that helps with balance, such as tai chi
asking the doctor to review medications, to reduce the risk of dizziness
The United States Preventive Services Task Force
(USPSTF)
screening for all women aged 65 years and over,
and younger women who are at high risk of experiencing a fracture.
Anyone who is concerned that they may be at risk of osteoporosis
should ask their doctor about screening.