Osteoporosis – beyond fragile and brittle bones

Oh Lord!

‘Oh Lord! My back hurts so much!’ is a common complain of most grandmothers. But when one day, they fall from a chair or a few stairs, and their bones get fractured, they are diagnosed with osteoporosis.

Osteoporosis is a bone disorder, where pores are formed within the bone. It is usually diagnosed only after a fracture. Post-menopausal women are more prone to this condition, but older men can also have osteoporosis. The parts of the body like hip, wrist or spine are more prone to such fractures.

How does a person develop osteoporosis?

Our body has a mechanism of regenerating itself; different structures of the body regenerate at a different pace. Bone cells regenerate almost immediately, but for a complete bone to regenerate, it takes nearly 10 years. The bones undergo a continuous process of regeneration (replacing old bone with new bone) throughout life. The rate of formation of new bone is faster than removal of old bone. This continues till the bone mass and bone strength reaches its maximum. However, after the age of 30, the rate of formation of new bone becomes slower than the removal of old bone. As a result, bones become weak or porous and can easily break or fracture from a fall or minor bumps.

How do I know I have osteoporosis?

In the early stages of bone loss, one may have no indications of this condition. However, once the bones get weakened by osteoporosis, the following signs and symptoms may occur:

  • A loss of height of morethan two inches or stooping over

  • A back pain caused by a fracture

  • High levels of calcium or alkaline phosphatase in your blood

  • Bone mineral density results showing a T-score of -2.5 or less

  • Vitamin D deficiency

  • Difficulty getting up from a chair

  • Joint or muscle pain

What are my chances of developing osteoporosis?

There are various factors which may increase your risk of developing osteoporosis, including:

  • Family history of disease

  • Body mass index (BMI) of 19 or less

  • Deficiency of hormones

  • Prolonged use of certain medications used to treat diseases like asthma or lupus

  • Lack of physical activity, smoking and drinking excessive alcohol

How is osteoporosis treated?

Osteoporosis can be treated by taking supplements or taking a balanced diet consisting of minerals like calcium or phosphorous and vitamin D, exercise, hormonal replacement therapy and preventing falls that may result in fractures.The risk of falls can be reduced by taking care while going downstairs and sitting or rising from a chair or ground. Care should also be taken while walking on uneven surface or slipperysurfaces like in washrooms.

Medications canalso be prescribed to prevent further bone loss and to increase bone strength. These medications may include bisphosphonates (used for post-menopausal women at high risk of fracture), raloxifene, romosozumab and denosumab.

How is osteoporosis prevented?

Osteoporosis can be prevented by taking certain measures such as the following:

  • Having a balanced diet consisting of calcium and vitamin D

  • Performing regular weight bearing exercises

  • Avoiding cigarette, intake of sodium, alcohol and caffeine

  • Taking supplements for calcium and vitamins

Can deficiency of hormones lead to osteoporosis?

Hormones like estrogenand progesterone protect bones by helping bone cells to form a new bone. However, during menopause, the estrogen levels decrease sharply, and the new bone formation is reduced. This increases the risk of osteoporosis.

Can menopausal hormone therapy prevent osteoporosis? Is it safe?

Menopausal hormone therapy is also known as post-menopausal hormone therapy or hormone replacement therapy. It is usually given as a treatment to relieve symptoms of menopause and to address long term consequence like osteoporosis. The hormones used in this therapy are synthetic hormones (estrogen and progestin) which are similar tonatural estrogen and progesterone but not identical.

Synthetic estrogen alone can increase risk of endometrial cancer in early menopause women. However, a combination of estrogen and progestin eliminates this risk and the therapy can be used safely in these women. Menopausal hormone therapy may cause breast cancer or stroke, but these risks are rare and are outweighed by the benefits of this therapy. Nevertheless, it is essential to talk your doctor and check whether you are a good candidate for this therapy.

I am a 56-year-oldwoman and my doctor has suggested bone density test (BMD).What is this test meant for?

A bone density test is recommended to measure the bone mass; it helps to know your bone health. The most widely used BMD test is dual energy x-ray absorptiometry or DXA test to confirm osteoporosis, detect risk of fracture,or to check the progress of the treatment given to the women with osteoporosis.

The scan is safer than normal X-ray test and doesn’t expose an individual to higher levels of radiation. It is performed in the commonly affected areas likeyour wrist, spine and hip.

What is FRAX score?

FRAX refers to fracture risk assessment tool. This tool is designed to assess the risk of fractures in patients with osteoporosis. It is developed by considering the individual patient risk factors.