Osteoporosis is a common chronic disease characterized by a decrease in bone mass and an alteration of the bone structure, resulting in an increase in fractures with minimal or no trauma. These are bone fragility fractures or osteoporotic fractures.
Bone is a living tissue that is constantly changing through the action of multiple cells. Some of these cells destroy the bone, known as osteoclasts, and then others form it, called osteoblasts. In this way, old bone is replaced by healthy bone. Osteoporosis occurs when bone destruction exceeds bone formation.
The importance of calcium
Calcium is one of the elements necessary for bone formation. If we do not have enough calcium and vitamin D, or if the body does not absorb it sufficiently, it can become fragile and have a greater predisposition to break.
Osteoporotic fractures can have serious repercussions and even high mortality. They occur in any part of the skeleton, although there are some more frequent locations, such as the wrist, vertebrae, hip, pelvis, humerus, clavicle and ribs.
The incidence of osteoporosis is increasing.
Bone mass is a measure of the bone’s content of certain minerals, mainly calcium and phosphorus. Bone mass decreases progressively in women after menopause, causing one in three women over the age of 50 to suffer an osteoporotic fracture, compared to one in five men. This risk of osteoporotic fractures also increases with age.
Unfortunately, despite the importance of these fractures, only a small number of patients are screened for osteoporosis and initiate appropriate treatment to prevent them.
The number of people affected by osteoporosis is increasing, mainly due to the increasing age of the population. A World Health Organization (WHO) study has estimated that 30% of white women will suffer from osteoporosis by the age of 75, based on femoral neck bone density in densitometry.
Morbidity and mortality of bone fragility fractures
Most bone fragility fractures are associated with an increased risk of mortality. This increased risk is sustained over 5 years for most fragility fractures and for hip fractures for more than 10 years. With the passage of time, this risk decreases progressively, but will always be higher than that of the population that has not suffered these fractures.
Morbidity is a statistic defined as the number of people affected by a fragility fracture in a given space and time. It is necessary to bear in mind that the morbidity associated with these fractures is important, since it is one of the causes of chronic pain, disability and a significant deterioration in the quality of life of the patients.
On the other hand, these fractures are frequently associated with respiratory alterations and limitations of mobility in the extremities. In addition, having suffered a fragility fracture is a risk factor for new fractures, and the greater the number of fragility fractures, the greater the risk of further fractures.
Symptoms of osteoporosis
The most common symptoms of this pathology are:
- Pain: traditionally it has been said that osteoporosis causes pain when fractures appear. A certain degree of pain is accepted due to small fractures that are not visible on X-rays and that appear in some locations, such as the vertebrae, producing chronic back pain. The presence of old fractures that alter the normal functioning of the joints will also produce arthrosis, which causes pain.
- Appearance of fractures: they occur more and more in the event of minor blows or even without them. As mentioned above, they appear most frequently in the wrist, vertebrae, hip, humerus, pelvis and ribs.
- Deformity of the body: people with osteoporosis lose height (up to 15 cm) and, as the vertebral flattening appears, they notice a curvature of their back. This is called kyphosis. Sometimes it is so striking that it alters the capacity of the thorax and breathing.
Osteoporosis Risk Factors
According to the recommendations of the National Osteoporosis Foundation of the United States, all women and men 50 years of age or older should be clinically evaluated for the presence of so-called risk factors to determine the need for bone densitometry. Those with a higher number of risk factors will have a higher risk of fragility fracture.
The risk factors can be divided into 9 groups:
1. lifestyle-related: low calcium and vitamin D intake, high consumption of caffeine, salt and alcohol or being on treatment with antacids (gastric protectors) containing aluminum. In addition, lack of physical activity, immobility, smoking, propensity to fall and thinness also play a role.
2. Genetic factors: genetic diseases such as cystic fibrosis, hemochromatosis, homocystinuria, osteogenesis imperfecta, glycogenosis, Marfan and Ehler-Danlos syndrome and porphyrias.
3. Situations of hypogonadism, which is a disorder of the function of the sexual organs or their regulatory mechanisms. Some cases can be ovarian failure, amenorrhea and anorexia nervosa.
4. Endocrinological diseases: Diabetes mellitus, hyperparathyroidism, Cushing’s disease, adrenal insufficiency and thyrotoxicosis.
5. Alterations of the digestive system: weight reduction interventions, malabsorption and diseases of the pancreas, among others.
6. Blood diseases: myeloma, leukemias and lymphomas, hemophilia, etc.
7. Rheumatic diseases: rheumatoid arthritis, lupus, etc.
8. Other diseases: alcoholism, pulmonary emphysema, muscular diseases, epilepsy, renal insufficiency, heart failure, depression, scoliosis, multiple sclerosis, etc.
9. Medications: glucocorticoids, heparin, antiepileptic drugs, cancer chemotherapy, aromatase inhibitors for breast cancer, etc.
On the other hand, it is necessary to calculate the risk of suffering falls, by means of another series of risk factors:
1. Environmental: existence of bathrooms with technical aids, loose carpets, poor lighting, presence of obstacles and slippery areas.
2. Illnesses: anxiety, agitation, cardiac arrhythmias, depression, disability, malnutrition, sedation due to medication, sight and hearing disorders, lack of vitamin D, etc.
3. Muscular causes: spinal kyphosis, poor muscle balance, muscle weakness, etc.
How is osteoporosis diagnosed?
The diagnosis of osteoporosis is given by data from a bone densitometry, which measures bone mineral density. It is measured at different sites of the body, such as the hip, the spine and sometimes the wrist.
A bone densitometry should be done in the following situations:
- Women 65 years of age or older and men 70 years of age or older, even if they have no risk factors.
- Postmenopausal women and men between 50 and 69 years of age, with any risk factors.
- Women during menopause at risk of having fractures (low weight, presence of previous fracture at minimal trauma, decrease in densitometry values despite treatment).
- Adults 50 years of age or older with fractures
- Adults diagnosed with rheumatoid arthritis or under treatment with glucocorticoids.
- Patients diagnosed with osteoporosis to evaluate the evolution of the disease
- Postmenopausal women at the end or discontinuation of estrogen therapy.
In addition, an X-ray of the spine may be performed, which will serve to determine the presence of fractures, and blood and urine tests, to evaluate for other diseases.
Recommendations for patients with osteoporosis
It is essential to maintain a balanced diet, which allows for an adequate intake of calcium and vitamin D. A daily amount of calcium in the diet of at least 1,200 mg is recommended, including supplements. Its consumption during youth ensures the so-called “peak bone mass”, i.e. the maximum amount of calcium that can be reached, maintaining bone health.
Vitamin D plays a key role in the absorption of calcium from the diet and proper bone development, as well as in good muscle activity, reducing the risk of falling. It is recommended to take between 800 to 1,000 International Units per day, for all adults 50 years of age or older, in order to maintain adequate blood levels to perform their functions (30 ng/mL or higher).
On the other hand, physical activity is essential, as it improves balance and muscular endurance, thus preventing falls. Some exercises are highly recommended in osteoporotic patients, such as Tai Chi.
Thirdly, it is extremely important in patients with fragile bones to reduce the risk of falling. For this reason, attention should be paid to the presence of bathrooms that do not have aids, loose carpets, poor lighting, obstacles and slippery areas.
Finally, smoking and excessive alcohol consumption should be avoided, since both aspects weaken the bones, making them more prone to falls.
Pharmacological treatment of osteoporosis
All men and women 50 years of age or older should be treated for:
Hip or vertebral fracture 2.
Densitometry values that correspond to osteoporosis.
Densitometry values corresponding to osteopenia (stage prior to osteoporosis).
There are many medications useful in the treatment of this disease, which should be selected by a specialist in Traumatology, since not all treatments for osteoporosis are valid for all patients.
These medications can be pills or injections. None of them are free of undesirable side effects, so you should consult with your doctor for any different symptoms that appear under the effect of these drugs and before stopping any medication.