An Overview On Osteoporosis

Overview

Bone is a living tissue that is made up of minerals (calcium mainly), bound together by strong collagen minerals. The main function of the bone is to provide support and shape for the body. 
Osteoporosis also known as ‘porous bone’ is a condition characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and an increased risk of fracture.

Types Of Osteoporosis:

• Primary Osteoporosis: Occurs when there is no underlying disease, is age related calcium loss from the bones , and occurs due to deficiency of some hormones in the body.
• Secondary Osteoporosis: Occurs due to some underlying disease or due to chronic intake of certain medications. 

Risk Factors For Osteoporosis

• Chronic steroid intake (>3 Months)
• Chronic alcoholic and smoker
• Sedentary lifestyle 
• Low calcium and vitamin D intake. 
• Low BMI (body mass index)/Low body weight
• Postmenopausal status 
• Positive family history of osteoporosis.
• Underlying diseases including autoimmune diseases (like Rheumatoid arthritis, Ankylosing spondylitis, SLEetc), malabsorption disorders (like Inflammatory bowel disease, Coeliac sprue).
• Patients who are on long-term medications, which include steroids, antiepileptic medications, proton pump inhibitors drugs, anti-cancer medications, thiazolidinedione, etc.
• Patient who underwent major gastrointestinal surgery.
• Hormone deficiency- Includes low estrogen levels, low level of testosterone, etc.

Symptoms Of Osteoporosis

Usually, it is an asymptomatic condition, until complicated by fracture. 
Symptoms are:

• Gradual loss of height over a period of time due to reduction in vertebral height
• Back pain due to vertebral fractures 
• A stooped posture.
• Fracture in any bone even after trivial trauma 

Diagnosis Of Osteoporosis

Clinical suspicion should arouse when risk factors for bone weakness is present. This is characterized by low bone mass which is detected by Bone Mineral Density (BMD) assessment. The Gold standard for BMD assessment is DEXA (Dual Energy X-Ray Absorptiometry) scan, with a T-Score at any site in DEXA Scan of less than 2.5 confirms the presence of Osteoporosis. A clinical diagnosis of Osteoporosis can also be made when any patient has sustained a fragility fracture (fracture resulting from trivial trauma).  

Treatment for Osteoporosis

Treatment for osteoporosis includes:

• Lifestyle modification: 
  • Regular weightbearing, muscle strengthening , and posture exercises for at least 30 mins per day.
  • Smoking cessation
  • Avoidance of heavy alcohol use
  • Counseling on fall prevention
• Pharmacologic therapy:
  • Adequate calcium (~1200mg/day) and Vitamin D (~800 Units per day) intake
  • Bisphosphonates like alendronate, ibandronate, risedronate,  and zoledronate
  • Anabolic agents like Teriparatide, Abaloparatide and Romosozumab.
  • Denosumab

Prevention Of Osteoporosis

Although not preventable, but the occurrence and subsequent fractures can be reduced by approximately 40-60% by modifying the risk factors and pharmacologic therapy. Risk factor modification includes:

• Avoid smoking and drinking alcohol
• Maintain a healthy weight
• Exercise regularly
• Maintain a healthy lifestyle
• Bone strengthening exercises
• Balance training
• Calcium and vitamin D supplements