Osteoporosis is a silent condition causing bones to become porous and weak, primarily due to aging, menopause, and hormonal imbalances, but it can be effectively managed and prevented through proper nutrition, vitamin D, exercise, and medical treatments.

Osteoporosis is a silent condition causing bones to become porous and weak, primarily due to aging, menopause, and hormonal imbalances, but it can be effectively managed and prevented through proper nutrition, vitamin D, exercise, and medical treatments.

Osteoporosis is a silent condition causing bones to become porous and weak, primarily due to aging, menopause, and hormonal imbalances, but it can be effectively managed and prevented through proper nutrition, vitamin D, exercise, and medical treatments.

Our bones are not completely solid like cement. They have small pores within them to make them strong without adding extra weight. These pores become large in osteoporosis, causing the bone to become weak and leading to early fracture. The most common cause of osteoporosis is old age in both men and women. However, sudden withdrawal of estrogen in women during menopause causes exaggerated bone changes during ensuing years, leading to early osteoporosis.

There are several other hormonal causes that can lead to osteoporosis, even in younger individuals. These include hyperparathyroidism (due to elevated PTH levels), severe hyperthyroidism, hypogonadism (low estrogen in women and low testosterone in men), cushing's syndrome (caused by steroid use or hormonal imbalance), and osteogenesis imperfecta (a condition where people are born with weak bones). Additionally, severe vitamin D deficiency (which causes osteomalacia), as well as chronic liver and kidney disorders, can result in weak bones and an increased risk of fractures."

What are the common symptoms?

Symptoms of osteoporosis can be very silent sometimes ; only detected during check up. But sometimes it can be severe enough to fracture and then be diagnosed as osteoporosis. An elderly person can have vertebral fractures due to osteoporosis, leading to chronic back pain, which is commonly misdiagnosed as vertebral disc problems. Some of the patients may present with progressive loss of height or forward bending while walking.

Some of the patients can have fractures with trivial injuries which would normally not cause any fracture.

What are the risk factors for osteoporosis?

Risk fractures can be divided into modifiable and non-modifiable ones.

Modifiable: 

*Low calcium intake and vitamin D deficiency

*Low physical activity- poor muscles leads to poor bones

*Smoking and excess alcohol consumption

*Prolonged immobilisation

*Long term steroids and hormonal issues 

Non-Modifiable:

*Female sex 

*Increasing age 

*Family history and Genetic predisposition

*Previous fragility fracture

*Early Menopause

How does osteoporosis develop?

It is a common perception that bone is like an iron rod with no activity within it. However, bone, unlike cement or iron, is metabolically active. There is a constant breakdown of bone followed by the laying down of new bone layers at microscopic levels, according to the strain endured and strength required, to keep the bone healthy and fit. Medically, we call it osteoclastic activity (old bone breakdown) followed by osteoblastic activity (new bone formation). If the breakdown is more than formation, then we have osteoporosis. This depends on variables such as age, hormonal imbalance, strain, immobility, etc.

Can osteoporosis be treated?

Osteoporosis can be treated both medically and non medically. Non- Medical intervention include: 

*Strenght training- good muscles lead to strong bones. Peak bone strength is usually achieved by 30 years

*Good nutritional intake of calcium and micro-nutrients

*Sun exposure and vitamin D

*Fall preventive measures- falls lead to fractures, so by preventing falls we are preventing fractures

Medical Interventions

*Vitamin D and Calcium Supplementation- especially in post menopausal women

*Bone strengthening medications

* Bisphosphonates - like Zolendronic acid, Ibandronate, etc. It reduces breakdown

*Teriparatide- daily injections given for around 18 months. It increases new bone formation

* Denosumab- Injection given subcutaneously once in 6 months. More effective than bisphosphonates.

Medical treatment is based on the underlying patient physiology and BMD (Bone mineral density), which can be assessed by a DXA scan

How can osteoporosis be prevented?

Osteoporosis can be prevented through healthy nutrition, adequate calcium, and vitamin D intake. Equally critical are at-home fall-prevention measures, such as placing non-slip mats in bathrooms, keeping nightlights on so the elderly can navigate safely, and eliminating uneven flooring or unnecessary steps.

Maintaining a healthy lifestyle and ensuring timely diagnosis and treatment of underlying conditions—such as hyperthyroidism, hypogonadism, and Cushing's syndrome—can help prevent the disease. Additionally, early screening for low bone mass using a DXA scan is crucial for preventing advanced osteoporosis and fractures.

The author is a consultant endocrinologist at KMC Hospital Mangalore. 

 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.

TAGS