Osteoporosis for Patients

Estándar

This excellent information has been written by Dr. Pilar Aguado, staff member of the Rheumatology Unit at the Hospital Universitario La Paz in Madrid. Dr. Aguado is a specialist in metabolic bone pathology, and this contribution is aimed at patients. I want to express my infinite gratitude for this excellent contribution.

What is Osteoporosis?

Osteoporosis is a disease that affects all skeletal bones, and consists of a decrease in the amount and quality of bone. This makes bones lose strength, becoming more fragile, and vulnernable to easily break spontaneously or after minor injuries.

What is bone mass?

Bone mass is the amount of bone (made up of proteins and minerals, the most important being calcium) in a person’s skeleton and depends on one’s age, race, and sex. Bone mass increases from birth, as the skeleton grows until it reaches a maximum value, known as “peak bone mass”), at 30-35 years. The later the “peak,” the less chance of osteoporosis. It is, therefore important that throughout life, but especially in childhood and youth, adequate amounts of calcium are ingested. Shortly after “peak bone mass” has been reached, a physiological loss of bone will start, which, is usually slow and lasts for the rest of one’s life.

Who can affect osteoporosis?

Although osteoporosis is a disease that mainly affects women after menopause, it can also affect men. The frequency of osteoporosis is very high and is estimated to affect one-third of women between 60 and 70 years. The peak of bone in women is lower than in males (30-50% lower). Also, when menopause starts, the ovary ceases the production of hormones, causing some women to suffer a more accelerated loss of bone mass. This is known as postmenopausal osteoporosis, the most common form of osteoporosis.

Besides menopausal osteoporosis, other types of osteoporosis can occur as a result of endocrine, inflammatory, autoimmune, digestive, pulmonary and hematologic diseases or as a result of taking certain medications, like glucocorticoids.

Why does osteoporosis occur?

It should be clarified that not all women will develop osteoporosis after menopause.

Osteoporosis and its consequence, fractures, are due to a combination of factors called “risk factors.” The more relevant are,

– Age, >65 years or more.

– Family history (parents and siblings) of hip fracture.

– Body mass index (BMI) less than 20 kg / m2. BMI (weight divided by the squared height).

– A prior fragility fracture

– Alcohol abuse (consume more than three units of alcohol a day).

– Smoking

– Treatment with glucocorticoids, some antiepileptic drugs or meds used for breast cancer, such as aromatase inhibitors.

– Some diseases such as rheumatoid arthritis, diabetes, hyperthyroidism, hyperparathyroidism, eating disorder (anorexia, bulimia), renal failure or chronic liver disease and early menopause (before age 42).

– Often falls. Fractures are habitually associated with them.

The more risk factors a person has, the greater is the chance of suffering an osteoporotic fracture.

Being in the period of menopause does not mean you have osteoporosis.

Symptoms

Osteoporosis gives no symptoms unless fractures or microfractures occur. Therefore, most of the times it goes unnoticed. Fractures affect the quality of life because they produce pain, difficulty in performing daily activities and may decrease mobility by losing autonomy. The most common fractures are in the hip or femoral neck, spine, wrist and shoulder. In the spine, the vertebrae are crushed resulting in a loss of height and kyphosis more. A hip fracture usually occurs later, often after 75 years, and is the most severe fracture, because it increases disability and may cause serious complications.

How is osteoporosis diagnosed?

There is a test called “bone densitometry” to measure the bone mass of the skeleton and helps to predict the risk of osteoporotic fracture. The measure of bone mass is performed in the central skeleton (spine and femur). To carry out a “bone densitometry” a particular radiology equipment (dual x-ray absorptiometry, DXA) is used.

Bone densitometry has to be done only when the physician suspects osteoporosis.

When there is back pain, or a decrease of height or increases the back curve, it is useful to perform an x-ray of the spine. Microfractures of vertebrae might be already present.

What can we do to prevent osteoporotic fractures?

A healthy lifestyle is the first choice to prevent osteoporosis.

– Follow a diet with adequate calcium in food. These amounts vary by age, gender and special situations such as pregnancy or breastfeeding. Foods that contain more calcium are milk and dairy products (especially cheese). Some people may not like the milk or not even tolerate it, because of a lack of a substance needed for digestion. In these cases, the intake of calcium in the form of medication (calcium salts) would be recommended by your doctor.

– The contribution of vitamin D. This vitamin is important for the regulation of calcium metabolism. An exhibition of the face, hands and arms to the sun for ten or fifteen minutes a day is usually enough to synthetize in the skin the necessary amount of vitamin D, which allows the intestinal absorption of calcium. The consumption of food rich in this vitamin or a supplement of vitamin D is also recommended.

– Perform physical activity and exercise regularly (walking, dancing, aerobics, gymnastics adequate, etc.)

– Stop consuming alcohol and quit smoking.

– Pay particular attention to the prevention of fractures. Falls or blows no matter how minimal may cause a fracture in osteoporotic patients.

-Have good night-lighting, removing loose rugs, avoid slippery surfaces;  showering is safer than bathing, use a seat in the shower, wear shoes with nonslip soles.

Are there medicines to treat osteoporosis?

Drug treatment should be done under medical supervision, and drug selection should take into account the age, the risk of fragility fracture and the circumstances and patient preferences. Drugs available are bisphosphonates (alendronate, ibandronate, risedronate and zoledronate), raloxifene, bazedoxifene, teriparatide, strontium ranelate and denosumab. These drugs improve bone quality.

How long have you to take medications for osteoporosis?

Osteoporosis is a process that evolves slowly, both in its development and in the improvement with treatment. Therefore, treatments are chronic and last several years. There are no medications for a short period.

Are there support associations for patients with osteoporosis?

Affected people can find support in Associations that help patients (sharing experiences, hearing testimonies, seeking support and advice from professionals and experts on bone diseases).

On the Internet, you will find the most appropriate Association close to your geographical situation.

Pilar Aguado Acín MD

Translation supervised by Forest Neal

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