1 in 3 women and 1 in 12 men over 50 years of age have osteoporosis. In Spain, every year 80,000 people fracture their hips, 720,000 break a vertebra while 200,000 break their wrists, generating enormous economic costs and suffering for patients. In Europe, an osteoporosis fracture occurs every 30 seconds and the figures are increasing due to the aging of the population and the lack of awareness of this problem by health authorities, doctors and patients. Only 10% of patients with osteoporosis receive treatment.
Osteoporosis is characterized by low bone mass and deterioration in the microscopic structure of bone tissue. The bone becomes more fragile and fractures increase. It is one of the most prevalent bone diseases, together with osteoarthritis, and the second most important health problem after cardiovascular diseases.
Risk factors for osteoporosis
Some of the factors that indicate that a person may suffer from osteoporosis are:
- Sex, women suffer from it more than men.
- Family history
- Menopause before the age of 45
- Fragility fractures before 45 years of age
- Hip fracture
- Low calcium and vitamin intake
- Sedentary lifestyle
- Diseases such as Parkinson’s, rheumatoid arthritis, IDDM or hyperthyroidism
Normal bone and osteoporotic bone
At first the disease progresses without apparent symptoms, which is why it is known as “the silent epidemic”. If it progresses, pain appears, the main symptom of the disease, usually concentrated in the back, hips, wrists or shoulders and, finally, pathological fractures. These occur with minor trauma which, under normal conditions, should not cause a fracture; or without trauma. The main osteoporotic fractures, which should serve as a warning to specialists, are:
- Vertebral fracture. It is the cause of the kyphosis or “hump” of many elderly people.
- Hip fracture. “We come into the world through the pelvis and leave it through the neck of the femur”, says one of our classic text treatises.
- Fracture of the distal extremity of the radius, the wrist.
- The fracture of the proximal extremity of the humerus, the shoulder.
- The periprosthetic fractures. They are those that occur on a prosthesis, hip, knee, shoulder or elbow. They represent an emerging problem due to the large number of prostheses that are implanted and the difficulties in achieving a reliable reconstruction that does not limit the patient’s activity and autonomy. They are difficult to solve, have to be treated by specialists in reconstructive surgery of the knee and hip and involve a huge consumption of resources, much higher than in other types of fractures.
It is important to see a specialist in primary care, rheumatology or traumatology in cases of generalized bone and joint pain.
Prevention of osteoporosis includes measures such as giving up smoking, following an adequate diet (especially calcium and vitamin D), moderate sunbathing, daily exercise and preventing falls.
Osteoporotic vertebrae and proximal femurs
Treatment of osteoporosis
Osteoporosis treatment aims to control pain, stop bone loss and prevent fractures. It can be classified into three types:
- Antiresorptive drugs: the most potent are bisphosphonates. They inhibit the cells that eat the bone.
- Osteoforming drugs: they reduce the incidence of vertebral and non-vertebral fractures by 50 to 65%.
- Dual action drugs: decrease bone resorption and stimulate bone formation. It is important to add calcium and vitamin D to these treatments.
The orthopedic surgeon occupies an excellent observation position. He is the professional who can best assess the need for prophylaxis and is often the first to detect it when treating an osteoporotic fracture, a known risk factor for other fractures.
One of our responsibilities is to inform, raise awareness, stop the epidemic from being silent and treat the complications derived from the disease, promoting multidisciplinary treatment.