General Health

Osteoporosis: Brittle bones in women

The word ‘osteoporosis’ means ‘porous bone.’ Osteoporosis is a condition usually identified in postmenopausal and perimenopausal women in which the bones become brittle and weak with reduced bone mass and strength— so brittle that a fall or even mild stresses such as coughing or bending over can cause a sudden and unexpected fracture, most commonly occurring in the hip, wrist or spine. Due to microstructural bone deterioration, there is an increase in bone fragility.

Bone is living tissue that is in a constant state of renewal- constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone lags behind the loss of old bone. When you’re young, the body makes new bone faster than it breaks down the old bone thereby increasing your bone mass. After the early 20s, bone turnover slows down, and most people reach their peak bone mass by age 30. With advancing age, bone mass is lost faster than it’s created.

Osteoporosis affects women and men of all races; however, Asian and White women, particularly older women past menopause, are most prone to develop the condition. A healthy diet, medications, and weight-bearing exercises can help prevent bone loss and strengthen bones that are already weak.

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Symptoms and signs

Osteoporosis is usually asymptomatic in the initial stages; however, once the bones have weakened, symptoms such as lower back pain (caused by collapsed or fractured vertebra), a stopped/ forward hunch posture (loss of height), shortness of breath (reduced lung capacity due to compressed disks), easy fracture of bones may be observed.

Risk factors

  1. Sex. Osteoporosis is much more common in women than men.
  2. Age. The risk of osteoporosis increases with advancing age.
  3. Race. Asian and White women are at an increased risk of osteoporosis.
  4. Family history. Having a parent or sibling with osteoporosis increases your risk, particularly if your father or mother had a hip fracture.
  5. Body frame size. Women and men with small body frames are at an increased risk of osteoporosis since they might have less bone mass to draw from as they age.
  6. Sex hormones. Reduced levels of sex hormone levels tend to weaken bone. The drop in estrogen levels in women at menopause is a strong risk factor for osteoporosis. Treatments for prostate cancer in men that lower testosterone levels and treatments for breast cancer in women that lower estrogen levels in women could accelerate loss of bone.
  7. Thyroid hormones. Hyperthyroidism with elevated thyroxine (T3, T4) levels or lower TSH levels can lead to loss of bone.
  8. Other glands. Osteoporosis has also been associated with overactive adrenal glands and parathyroids.
  9. Low calcium intake. Low calcium intake contributes to reduced bone density, early bone loss and increased fracture risk.
  10. Eating disorders. Being underweight with severe restrictions in food intake can weaken bones in women and men.
  11. Gastrointestinal surgery. Surgery performed to decrease the size of your stomach or to eliminate a part of the intestine for weight loss and/or gastrointestinal disorders (including bariatric surgeries) could limit the surface area for absorbing nutrients such as calcium. Steroids and other medications
  12. Prolonged use of steroids. Long-term use of oral or injectable corticosteroids such as cortisone and prednisone can interfere with bone-remodelling.
  13. Other medications. Osteoporosis has been associated with medications used to prevent/ manage seizures, gastric reflux, cancer and transplant rejections.
  14. Associated medical conditions: The risk of osteoporosis is greater in people with medical problems such as celiac disease, inflammatory bowel disease, hepatic or renal diseases, cancer, multiple myeloma and rheumatoid arthritis.
  15. Lifestyle habits. Lifestyle factors can contribute to an increased risk of osteoporosis. Lifestyle habits include people with long sitting hours or lack of physical exercise. Increased alcohol consumption i.e., two drinks a day (or more) and tobacco use may contribute to osteoporosis.

Diagnosis, Prevention and treatment

Osteoporosis is usually diagnosed using bone mineral density (BMD) tests, X-rays, computed tomography (CT) and dual-energy x-ray absorptiometry (DEXA) coupled with the individual’s medical history, identification of risk factors and clinical signs and symptoms.

Regular exercise (especially weight-bearing and strength-training exercises) and good nutrition are important for keeping the bones healthy. Exercises that make your muscles work against gravity (such as jogging, aerobics, walking and weightlifting) are best for strengthening bones. In addition, balance exercises such as tai chi can reduce your risk of falling especially as you get older.

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium per day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70. Rich sources of calcium include low-fat dairy products, dark green leafy vegetables, kale, broccoli, dried figs, canned salmon or sardines with bones, and soy products, such as tofu, and orange juice and calcium-fortified cereals. If dietary calcium is inadequate, calcium supplements may be taken.

Vitamin D improves the absorption of calcium and improves bone health. Dietary sources of vitamin D include salmon, cod liver oil, and trout. Many types of cereal and milk are fortified with vitamin D. Most people need at least 600 IU of vitamin D per day. That recommendation increases to 800 IU a day after age 70. Vitamin D supplements can be considered for individuals at high risk of osteoporosis.

Bisphosphonates (e.g alendronate, ibandronate, risedronate and zoledronic acid) are commonly prescribed for osteoporosis. Alternative medications include denosumab, hormone (estrogen)-replacement therapy, raloxifene and bone-building medications such as teriparatide, abaloparatide and romosozumab.

Author

Pooja Toshniwal Paharia

Dr. Pooja Toshniwal Paharia is a Consultant Oral and Maxillofacial Physician and Radiologist, M.DS (Oral Medicine and Radiology) from Mumbai. She strongly believes in evidence-based radiodiagnosis and therapeutic regimens for benign, potentially malignant, or malignant lesions and conditions either arising from the oral and maxillofacial structures or manifesting in the associated regions.

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