Articles

Osteoporosis

What is it and what are the risk factors commonly associated with it?

Osteoporosis is a progressive reduction in the density of bones causing them to become thin and brittle and therefore easy to break. Bones are continuously broken down and reformed or remodeled. The process is continuous and allows bones to become bigger and stronger as we grow reaching their peak at about the age of thirty, at which point, their density gradually decreases. The bone mass requires an adequate supply of minerals such as calcium and phosphorus to keep its density. If the body is unable to maintain adequate bone formation bones lose their density and become increasingly fragile, eventually resulting in osteoporosis.

There are two types of osteoporosis, postmenopausal and senile; senile simply refers to aging. Postmenopausal osteoporosisis is caused by a lack of estrogen, the main female hormone, which helps to regulate the incorporation of calcium into bone.

Osteoporosis is much more common in women than men, a ratio of about 4:1 and the women most at risk are white, fair-skinned and slim, primarily because they have smaller bones even in their youth and their lower body fat results in the production of less estrogen.

Societal Impact

About 5% of women suffer from osteoporosis whereas men are only affected by senile osteoporosis and generally not until they are over 70.

Symptoms

Because the loss of bone mass is a very gradual process there are no symptoms until a bone fractures or collapses, resulting in severe sudden pain or gradually developing bone pain and deformities. In the long bones of the arms and legs fractures tend to occur at the ends rather than in the middle. In the spinal column vertebral crush (osteoporotic fracture) tends to occur in the middle to lower back resulting in sudden pain, which worsens when standing or walking. Other bones like the hip and wrists may fracture as a result of a fall. Hip fractures are particularly serious because the bones do not heal quickly and can result in a major disability and loss of independence.

Diagnosis

A number of screening tests are available to measure bone density and blood tests measure calcium and phosphorus.

Prevention and Treatment

For obvious reasons, prevention is better than treatment and requires the consumption of adequate amounts of calcium and vitamin D combined with sufficient weight bearing exercise. Drugs called bisphosphonates may be used alone as preventive therapy or, in women, combined with estrogen replacement therapy.