Osteoporosis is one of those disorders that can sneak up on you without you even knowing about it. It is a bone disease that results in a decrease in bone mass and density which may eventually lead to an increased risk of fracture.
What are the symptoms of osteoporosis? This disease is difficult to detect because it has no symptoms. The consequence of the disease is an increased risk of fractures, so often it is not even diagnosed until after a fracture has occurred.
Because these fractures happen almost spontaneously (without provoked action such as a fall or an accident which would cause fracture in a healthy adult), they are called fragility fractures. They usually occur in the ribs, vertebral bones of the spine, shoulders, hips, and wrists.
Since osteoporosis is often an age-related disorder, fractures can be debilitating to the elderly and may cause early death as a result of immobility and consequences of the fracture. Sudden back pain may be the result of a collapse of the vertebral spine with multiple fractures. This may lead to a loss of height and/or a stooped posture, along with pain.
If you have been diagnosed with osteoporosis, you have an identification classification known as a T-score or a Z-score. Your bone mineral density (BMD) is compared to that of a healthy, young 30-year-old adult. Here are what your T-scores may look like:
- Normal BMD has a T-score of -1.0 or higher.
- Osteopenia (milder form of disease) has a T-score of between -1.0 and -2.5.
- Osteoporosis has a T-score of -2.5 and lower, which means the bone density is 2.5 steps below that of a healthy 30-year-old man/woman.
When more severe cases of osteoporosis are compared, the Z-score is used which compares the average BMD of people of the same age and sex. This is most often used in comparing premenopausal women, children, and men under the age of 50.
What causes osteoporosis? Women are more likely to get osteoporosis than men because of an estrogen deficiency following menopause, which brings on a rapid reduction in bone density. A decrease in a male’s testosterone may have a similar effect, but to a lesser degree.
Heredity and a family history of bone disease increases a patient’s odds of having osteoporosis, especially if they have already had any kind of fracture during their lifetime.
Other contributing lifestyle risk factors include heavy or chronic use of alcohol, tobacco smoking, vitamin D deficiency, and malnutrition including low dietary calcium and phosphorus.
Some medical disorders can also increase bone loss such as Cushing’s syndrome, hyperparathyroidism, hyperthyroidism, hypothyroidism, diabetes mellitus types 1 and 2, and adrenal insufficiency. People affected with Parkinson’s disease and chronic obstructive pulmonary disease also have a higher risk of osteoporosis.
How is osteoporosis diagnosed? The most effective way of diagnosing this bone disorder is by use of dual-energy x-ray absorptiometry (DXA or DEXA scan). This form of x-ray is able to determine BMD by absorption of bone using two x-ray beams. Women should have a DXA screening by age 65, or younger if the family has a prior history of osteoporosis or osteopenia. Men should have a DXA screening by age 70.
What is the treatment for this bone disorder? Prevention is the best treatment. Because osteoporosis often goes unnoticed until a fracture occurs, it may then be too late to reverse the effects of the disease. Lifestyle modifications at a younger age may help to prevent osteoporosis or limit its effects.
- Limit or avoid use of tobacco smoking.
- Limit or avoid use of chronic alcohol consumption.
- Use resistance exercises to strengthen muscle and bone. Stair-climbing, dancing, tennis, walking, jogging, and weight-lifting all help to build and maintain bone density.
- Use aerobic exercise to help increase or prevent loss of BMD in postmenopausal women.
There are conflicting studies on the use of calcium and vitamin D supplements to prevent osteoporosis. Their use may be overshadowed by the side effects of increased risk of kidney stones and myocardial infarction. Discussion with your physician may help to clarify if the benefits outweigh the risks.
Bisphosphonate medications are used to decrease the risk of future fractures after there has already been a fracture due to osteoporosis. Fracture risk reduction may be from 25 to 70 percent with these drugs, but again side effects may prohibit their use. Using them for short duration (3 to 4 years) may be effective.