What is Osteoporosis?
Osteoporosis is a condition in which the bones lose calcium, causing them to become weak, brittle and at a high risk for fracture. In all healthy people, bone turnover is continuous; bone breaks down over time, but is replaced with new bone tissue. Bone density increases until age 35-40 in women. With aging, bone loss occurs faster than new bone mass is created, resulting in an overall loss and osteoporosis. This process is exaggerated after menopause in women because of the loss of the bone-protective effects of estradiol and other female sex hormones. The use of steroids, anti-convulsants, proton pump inhibitors and other meds can also contribute to this, with glucocorticoid steroids, such as prednisone, being the worst offenders.
Men suffer osteoporosis too, especially if hypogonadal. One of the great pities of modern primary medical care is that this is so often overlooked.
Symptoms of Osteoporosis
In most cases people do not know that they have osteoporosis until they break a bone. Thin bone does not hurt, so there are typically no symptoms in the early stages of osteoporosis. As the condition progresses, symptoms may include:
- Back pain from a collapsed vertebra
- Stooped posture
- Loss of height
Bones affected by osteoporosis may be extremely weak and even everyday activities can result in a fracture. Spinal compression fractures the most common osteoporosis-related injury, can be triggered simply by bending over. The most serious risk for people with osteoporosis is for hip fracture following a fall. Osteoporotic hip fractures associate with a high chance of death in the following year, whether from complications of the fracture, its surgery, or the conditions that led to the break.
Risk Factors for Osteoporosis
While osteoporosis commonly affects people over the age of 60, especially post-menopausal women, there are other risk factors for developing osteoporosis:
- Family history of osteoporosis
- Overactive thyroid
- Low calcium intake
- Eating disorders such as anorexia
- Long-term use of steroids
- Being small and of thin stature
- Being of White or of Asian descent
- Smoking and heavy alcohol use
Osteoporosis is diagnosed after a review of symptoms, complete medical history and physical exam. An X-ray study (“bone density test”) can show the degree of bone loss. Having a history of fractures that are out of proportion to the trauma suffered also makes the diagnosis. Blood testing helps determine the progress and underlying cause of osteoporosis. It is crucial to differentiate osteoporosis from the bone loss of such diseases as hyperparathyroidism, chronic vitamin D deficiency and renal insufficiency, because these different disorders have differing natural histories and therapies.
Treatment of Osteoporosis
We are in an era of rapid advancement in the therapy of osteoporosis. Twenty years ago our only meds were sex hormones, calcium and vitamin D. We now have a dozen therapies, two of which can restore lost bone and thus reverse the osteoporosis. The choice of therapy is neither simple nor quick, as the patient’s current condition, the progressive nature of her bone loss, her other meds and diagnoses all need to be taken into careful account. For these reasons, Dr. Howe needs to see a patient for consultation and for careful follow-up when treating osteoporosis.
Treatment often includes medication to reverse, slow or stop bone loss. All of these will reduce the risk of fracture; Dr Howe attempts to give the therapy that will give the most benefit. People with osteoporosis are advised to eat a diet rich in calcium and vitamin D, as well as to exercise regularly to increase muscle and bone strength.