Osteoporosis

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Osteoporosis

What is osteoporosis?

Osteoporosis is a condition where the bones in the body become fragile overtime. Because of the frailness of these bones, they are more susceptible to breaking even with minor injuries. It may also cause problems with prolonged healing from the fracture. Many times osteoporosis will go unnoticed as there are no clear signs or symptoms of the disease. This also puts the person with the condition at increased risk of abrupt and unexpected fractures.

Who can develop osteoporosis?

Over 50 million Americans are diagnosed with osteoporosis. It is more common in seniors- particularly women. This is because during menopause, women lose bone faster over the course of a few years. Men and women do not begin to lose bone at the same rate until around the age of 65. Also, it is believed that men initially have higher bone densities than women. Certain ethnicities such as Asians and Caucasians are also more prone to this condition. 

Where is the difference between osteoporosis versus osteopenia?

Osteopenia is a condition between normal bones and osteoporosis. After the age of 50, 1 in 3 people are at risk for osteopenia. If your healthcare provider diagnoses you with osteopenia, this means you may still have time to take the appropriate steps to prevent osteoporosis and further bone loss.

Where does osteoporosis occur?

This disease can occur in any bone. History of fractures due to osteoporosis usually occurs in the:

  • Hips
  • Wrists
  • Spine

Causes

What is the cause of osteoporosis?

It is believed that osteoporosis develops once the spongy bone, also known as trabecular bone, forms larger holes. This makes the inside of the bone more fragile and brittle, which can easily fracture. Early on in life, bone growth occurs at a greater rate to bone loss. But after the age of 35, we begin to lose bone mass more than what is developed. With osteoporosis, bone loss is at a much higher rate significantly, weakening the bones.

What are the risk factors for osteoporosis?

Older women tend to develop osteoporosis more than younger populations or men. Here are other risk factors associated with the development of osteoporosis:

  • Genetics- There is some evidence that some people are more susceptible to developing osteoporosis if there is a family history of the disease.
  • Hormones- Lower levels of estrogen or testosterone can cause the development of brittle bones. People with a history of early-onset menopause or have had surgeries to remove their ovaries prior to menopause may also be more susceptible to osteoporosis.
  • Trauma-  If there is a history of broken bones after the age of 50, this may place you at a higher risk of developing this disease.
  • Vitamin deficiency-  There is evidence that deficiencies in calcium or vitamin D may cause osteoporosis.
  • Physical activity-  People who are less physically active or bedbound have a higher propensity for osteoporosis. 
  • Medications- use of certain medications like long-term steroid use may cause weakness in the bones.
  • Body type-  People with more petite or smaller frames pose a higher risk for breaks due to fragile bones.
  • Smoking-  Smokers are also known for having weaker bones due to a reduction in calcium absorption.
  • Alcohol- The more an individual drinks alcohol a day, the more they are at risk for osteoporosis. It is recommended no more than one drink a day to decrease chances of developing. 
  • Medical conditions-  Diseases that interfere with hormone levels may place someone at greater risk for osteoporosis. Some examples include thyroid issues, organ transplants, celiac disease, or eating disorders.
  • Gastric surgeries- procedures performed to alter the size of the stomach or intestines may place some at higher risk for osteoporosis as there will be less absorption of certain vitamins.

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Symptoms

What are the symptoms of osteoporosis?

There are not a lot of signs or symptoms associated with osteoporosis. For many people, the only evidence that they may be suffering from this condition is after they have broken a bone. Some other symptoms that may be suspicious for osteoporosis are:

  • Notice getting shorter in height
  • Back pain
  • Shortness of breath
  • Improper posture (hunched over spine)

What complications are associated with osteoporosis?

Major injuries to vital bones, such as the spine and hips, are a huge concern with osteoporosis. Hip fractures particularly may cause disability. This type of injury can be quite debilitating and has a high mortality rate.

Diagnosis

How is osteoporosis diagnosed?

Osteoporosis is diagnosed by licensed healthcare providers once completing a history and physical examination. Once your physician suspects osteoporosis, additional testing may be recommended to confirm the diagnosis.

Are there any diagnostic tests that can be performed to confirm osteoporosis?

Currently, it is recommended that bone density testing, known as DEXA scans, be done after the age of 65 in women and after the age of 70 for men to determine if there are any signs of the bones weakening in the body or for those who may be at risk of developing osteoporosis. This test is helpful with determining your risk of developing a fracture and if you are already suffering from osteopenia versus osteoporosis.

Treatment

Can osteoporosis be prevented?

There are some known things that can be done to help prevent the development of osteoporosis by maximizing your peak bone mass as a young adult. This involves:

  • Exercise- being active and exercising regularly helps to strengthen and maintain bone strength and health.
  • Diet-  eating a healthy, well-balanced diet filled with vitamin D and calcium may help with the prevention of osteoporosis. 
  • Reduce alcohol intake-  this is helpful in reducing the risk of falls and developing osteoporosis

What are treatment options for osteoporosis?

Unfortunately, preventative measures may not be enough to combat osteoporosis. Medications may be needed. Treatment for osteoporosis usually involves strengthening the weakened bones and preventing further bone loss.

Here are the different types of medications currently available for osteoporosis: 

  • Hormone therapy- treatment used for the maintenance of bone density in both men and women. Most common ones used for osteoporosis are:
  1. estrogen 
  2. testosterone
  3. raloxifene (Evista)
  4. Calcitonin-salmon (Fortical and Miacalcin)
  • Bisphosphonates- helpful with preventing the body from reabsorbing bone and acts as a preventive measure of further bone loss. The most common type of treatment for osteoporosis and can be used by both men and women. Examples include:
  1. alendronate (Fosamax and Binosto)
  2. Ibandronate (Boniva)
  3. risedronate (Actonel and Atelvia)
  4. zoledronic acid (Reclast, Zometa)
  • Biologics- used when traditional treatments have failed. This is a subcutaneous injection provided to help prevent future fractures. An example is:
  1. Denosumab (Prolia, Xgeva) 
  • Anabolic agents- helpful with making new bones. Mostly the last resort when everything else has not been successful. Examples include:
  1. romosozumab-aqqg (Evenity) 
  2. teriparatide (Forteo) 
  3. abaloparatide (Tymlos) 

Other treatment options include:

  • Supplements- there are several dietary options available that are over the counter for the management of osteopenia or osteoporosis. Soy, vitamin K-2, and calcium have all been shown to be beneficial in the prevention of osteoporosis, however, more research is needed. Supplements should always be reviewed with your healthcare provider as there are many supplements on the market that are not regulated or that may interfere with certain medications. Different supplements may work better than others or for other people, but our specialists at TeleMed2U may be able to give you guidance.
  • If you are looking for calcium supplements for your bones, you may want to consider:
  1. https://theralogix.com/products/calmag-thins-calcium-magnesium 
  2. https://theralogix.com/products/isorel-whole-soybean-extract-supplement
  3. https://theralogix.com/products/thera-d-vitamin-d-supplement
  4. https://theralogix.com/products/theracal-bone-health-supplement 

If you have experienced abrupt fractures, especially from minor injuries, you may have osteoporosis. Our providers at TeleMed2U are always available to help order diagnostic tools that may give clearer answers to why you are prone to injury and better ways to prevent future falls and complications.

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Zenon Andreou studied medicine at University College London, graduating in 2006. His postgraduate training was in hospitals in and around London and he trained for four years in Otolaryngology before completing his training in General practice

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