Osteoporosis is a chronic, progressive disease of the skeletal system that can lead to disability. It is characterized by increased bone fragility due to a reduction in bone mineral density, which can lead to osteoporotic fractures. Osteoporosis is preceded by osteopenia, which is a decrease in bone mineral density.
Causes of osteoporosis
In the skeletal system, bone tissue is constantly being made and broken down. Osteoblasts, which make bone, and osteoclasts, which break down bone, are the two types of cells responsible for this. As people get older, the activity of osteoclast cells goes up, but the activity of osteogenic cells doesn’t keep up. Because of this, it leads to a slow loss of bone mass and the growth of osteoporosis. In other words, the natural ways that bones renew and grow are messed up.
Due to the causes causing disorders leading to osteoporosis, the disease is divided into two main types:
Estrogen deficiency in postmenopausal women is the cause. Estrogen is a hormone that makes bone-building cells work and is involved in the metabolism of calcium and phosphorus.
The cause is advanced age and the natural weakening of calcium absorption from the gastrointestinal tract, as well as vitamin D deficiency.
Changes in lifestyle (like eating too much salt, not getting enough calcium and vitamin D, being overweight, or not getting enough exercise), taking certain medicines (like glucocorticosteroids, heparin, or anticonvulsants), and diseases that change bone tissue are all causes.
Osteoporosis signs and symptoms
The disease may stay dormant for a long time and not show any signs for years. Some symptoms are hard to notice. Many people with osteoporosis don’t know they have it until they break a bone.
In addition to fractures, symptoms of osteoporosis may include:
- flattening of the vertebrae causing a rounded back (the so-called widow’s hump ),
- reduction in height by up to several centimeters,
- incorrect posture in the form of a tummy pushed forward,
- pain in the back and spine (strong, sudden may even indicate a fracture of a weakened vertebra),
- abdominal pain – when the ribs press on the internal organs.
The above symptoms indicate advanced osteoporosis. Because osteoporosis does not hurt (in the early stages), we often ignore the first symptoms of the disease.
Risk factors for osteoporosis
Osteoporosis can affect anyone. People with a family history of the disease are more at risk . Both genes and environmental factors increase the risk of developing osteoporosis.
Known risk factors for developing osteoporosis include:
- slim and petite body build,
- hormonal disorders – mainly thyroid disorders and a decrease in sex hormones, especially as a result of menopause,
- age – after the age of 60, we have about 30% weaker bones than around the age of 30,
- abuse of alcohol and beverages with caffeine and smoking – they impair calcium absorption and bone reconstruction,
- a diet containing an excess of animal protein – increases the excretion of calcium in the urine,
- taking certain medications, such as corticosteroids and high doses of thyroxine,
- diseases – causing immobilization, as well as e.g. COPD or hyperparathyroidism.
If you have signs of osteoporosis or are going through menopause, you should have your bones checked. Even a simple X-ray can show changes in advanced cases. Densitometry can find the disease in its early stages. Your doctor or an osteoporosis clinic will tell you where to go for free exams. Dual-energy X-rays (DXA) are used to take pictures for densitometry, which is the measurement of bone mineral density (BMD). Since bone tissue absorbs the radiation in different ways, a clear picture can be made. The test is very sensitive.
Based on the osteoporosis test, you get 3 values:
- absolute bone mass (g/cm 2 ),
- comparison of the patient’s BMD with the highest value obtained in young adults (T-score),
- comparison of the patient’s BMD with the average age-appropriate value (Z-score).
Thanks to densitometry, the doctor can recognize normal condition, osteopenia or osteoporosis:
- normal bone mass : T-score > (-) 1.0
- osteopenia : T-score from (-) 1.0 to (-) 2.5
- osteoporosis : T-score < (-) 2.5 without fractures
- advanced osteoporosis : T-score < (-) 2.5 and existing fracture
Thus, osteoporosis is diagnosed when the T-score, which is a deviation from peak bone mass, falls below (-) 2.5 .
Osteoporosis is treated with pharmacological agents and supplementation, as well as prevention of injuries and falls. It cannot be cured, but the progression of the disease can be stopped. The cure depends on the cause.
The main drugs used to treat osteoporosis are bisphosphonates and calcium, and vitamin D supplementation. Bisphosphonates are organophosphate compounds that inhibit bone resorption and prevent further loss of their mineral tissue.
Denosumab is a human monoclonal antibody whose action is based on binding and inhibiting the RANKL factor, responsible for the formation of osteoclastic cells. Teriparatide is a human parathyroid hormone that stimulates the bone formation process, increases the absorption of calcium in the intestines and improves the synthesis of calcitriol in the intestines. After the end of therapy, the patient takes other drugs, most often bisphosphonates.
Effects of osteoporosis
Osteoporosis is a serious condition that can lead to fractures and bone injuries. Fractures of the femur are the most dangerous, and are most common in people over 50 years of age. It can also lead to disability, chronic pain, kyphosis, reduced height, breathing disorders, and even death. Psychological problems such as depression and withdrawal from social life are also common. It is important to prevent and treat osteoporosis to stop the development of the disease.
The skeleton builds and regenerates throughout life. However, after the age of 30, the repair processes slow down. Since then, bone mass has decreased by about 1% each year. In order to stay ahead of osteoporosis, it should be prevented as early as possible. A proper lifestyle can reduce bone loss by 1/3. To prevent osteoporosis:
- be physically active – by loading your bones moderately, but systematically (e.g. while walking or jumping rope), you stimulate the growth of their mass, besides, you develop the muscles that support the skeleton,
- put on a diet rich in calcium and vitamin D (these ingredients are necessary for building bones); let milk and its products, soy products, legumes, sardines and orange juice enriched with calcium be a permanent part of your menu,
- say goodbye to drastic slimming diets – they cause calcium and vitamin D deficiencies, and thus weaken the bones.