Osteoporosis: Brief Introduction

Overview

Low bone mass, micro-architectural degeneration of bone tissue that causes bone fragility, and an elevated risk of fractures are all symptoms of osteoporosis, a systemic skeletal condition. It is the most frequent cause of a broken bone in older people.  The vertebrae in the spine, the forearm bones, and the hip are among the bones that frequently shatter. There are often no signs before a shattered bone occurs. Bones may become so fragile that they can shatter spontaneously or under light force.

A lower-than-average maximal bone mass and greater-than-average bone loss might be the causes of osteoporosis. Because of decreasing amounts of oestrogen after menopause and testosterone following "andropause," bone loss accelerates. Alcoholism, anorexia, hyperthyroidism, renal illness, and surgically removing the ovaries are a few conditions or therapies that might result in osteoporosis. Certain anti-seizure drugs, chemotherapy, proton pump inhibitors, selective serotonin reuptake inhibitors, and glucocorticoids are among the drugs that speed up bone loss. Other risk factors include smoking and insufficient exercise.

Symptoms

The major effect of osteoporosis, which has no symptoms in and of itself, is an increased chance of bone fractures. Osteoporotic fractures are categorized as fragility fractures because they happen in circumstances where healthy individuals would not typically break a bone. Fragility fractures commonly occur in the wrist, hip, rib, and vertebral column.

Fractures

Osteoporosis frequently manifests as fractures, which can be disabling.  Fractures from osteoporosis are frequently to blame for acute and persistent pain in the elderly, which can result in severe impairment and early mortality. These fractures could not even show any symptoms.  The wrist, spine, shoulder, and hip are the joints most frequently fractured by osteoporosis. Sudden back discomfort, sometimes accompanied by radicular pain (shooting pain brought on by nerve root compression), and infrequently spinal cord compression or cauda equina syndrome are signs of a vertebral collapse (also known as a compression fracture). A stooped posture, loss of height, and persistent discomfort as a result of many spinal fractures reduce mobility.

Risk of Falls

Aging is related with a higher chance of falling. Skeletal injury in the wrist, spine, hip, knee, foot, and ankle can result from these falls. Impaired vision from a variety of conditions, such as glaucoma and macular degeneration, balance issues, mobility problems, dementia, and sarcopenia all contribute to the risk of falling (age-related loss of skeletal muscle). Collapse (transient loss of postural tone with or without loss of consciousness) (transient loss of postural tone with or without loss of consciousness).

Complication

Osteoporosis not only increases the risk of breaks and fractures but can also result in additional consequences. Osteoporosis-related bone fractures can cause disability and potentially raise the risk of mortality following the injury. 

Osteoporosis is thought to have a condition called depression. Due to decreased physical activity, people with osteoporosis lose their independence and run the danger of becoming lonely. This will make it harder to control health problems.

Risk Factors

You can divide risk factors for osteoporotic fracture into non-changeable and (possibly) modifiable categories. Moreover, osteoporosis is a known side effect of some illnesses and conditions. Although the use of drugs that raise the risk of osteoporosis may often be inevitable, pharmaceutical usage is potentially adjustable. There is no link between caffeine and osteoporosis.

Nonmodifiable

The most significant risk factors for osteoporosis include old age (in both men and women), female sex, and oestrogen shortage following menopause or surgical removal of the ovaries. In contrast, a decline in testosterone levels in males has a similar (but less apparent) effect.

While osteoporosis affects people of many ethnicities, those with European or Asian heritage are more likely to develop the condition.

Potentially Modifiable

Alcohol consumption in excess: Despite the possibility that small amounts of alcohol may be advantageous (additional alcohol consumption is associated with an increase in bone density, though this association has not been proven to be causal), chronic heavy drinking (additional alcohol consumption of more than three units per day) almost certainly increases the risk of fractures.

Vitamin D Deficiency

Inadequate levels of vitamin D in the blood are a problem for the elderly everywhere. Greater synthesis of parathyroid hormone (PTH) is linked to mild vitamin D deficiency.  PTH causes bone loss by accelerating bone resorption. Although PTH has a negative correlation with bone mineral density, serum 1,25-dihydroxycholecalciferol levels have a favorable correlation with bone mineral density.

Smoking

Several studies have linked smoking to worse bone health, but the underlying causes are still unknown. Smoking tobacco is a known risk factor for osteoporosis and has been hypothesised to impede osteoblast function. Smoking also accelerates the onset of menopause, lowers body weight, and increases the breakdown of exogenous oestrogen, all of which diminish bone mineral density.

Malnutrition

Nutrition plays a significant and intricate function in the upkeep of healthy bones. Low dietary calcium and/or phosphorus, magnesium, zinc, boron, iron, fluoride, copper, and vitamins A, K, E, and C have all been identified as risk factors (and D where skin exposure to sunlight provides an inadequate supply). One danger factor is too much salt. Excessive blood acidity is a recognised opponent of bone and may be caused by nutrition. Low protein consumption has been linked to both reduced bone mineral density in older people and lower peak bone mass during youth, according to certain studies. Protein is one of the reasons of dietary acidity, however others have cited decreased protein consumption as a benefit. Omega-6 to omega-3 polyunsaturated fat imbalance is yet another known danger factor.

Underweight

Although physical stress triggers bone remodeling, being inactive can result in considerable bone loss. Weight-bearing activity can help people reach their maximal bone mass throughout adolescence, and research has found a highly significant link between bone and muscular strength.  Overweight individuals have a decreased risk of osteoporosis.

Training for Endurance Events

Heavy training loads can result in reduced bone density and an elevated risk of osteoporosis in female endurance athletes. The female athlete trifecta, which includes amenorrhea from hard exercise and the suppression of menstruation, may be the reason of this phenomenon. The issue is less apparent for male athletes, and while some research have found that elite male endurance athletes had poor bone density, other studies have found that leg bone density has grown.

Diagnosis

Bone mineral density measurements and traditional radiography can also be used to diagnose osteoporosis (BMD). Dual-energy X-ray absorptiometry is the most used technique for calculating BMD.

 

The diagnosis of osteoporosis necessitates investigations into possibly modifiable underlying causes, which may be done using blood testing. This is in addition to the discovery of aberrant BMD. Investigations for cancer that has metastasized to the bone, multiple myeloma, Cushing's disease, and other above-mentioned reasons may be carried out depending on the possibility of an underlying issue.

Conventional Radiography

Conventional radiography is helpful for the differential diagnosis of osteopenia, for follow-up exams in particular clinical settings, such as soft tissue calcifications, secondary hyperparathyroidism, or osteomalacia in renal osteodystrophy, as well as for detecting complications of osteopenia (reduced bone mass; pre-osteoporosis), such as fractures. Nevertheless, radiography is not very sensitive to early illness identification, and it takes a significant amount of bone loss (approximately 30%) for it to be visible on X-ray pictures.

Dual-Energy X-ray

For the diagnosis of osteoporosis, dual-energy X-ray absorptiometry (DEXA scan) is regarded as the gold standard. A diagnosis of osteoporosis is made when the bone mineral density is 2.5 standard deviations or less than that of a reference group of young, healthy adult women (30–40 years old). The equivalent of this is a T-score.

Biomarkers

Chemical indicators can help identify bone deterioration. The cathepsin K enzyme degrades type-I collagen, a crucial component of bones. Osteoporosis can be identified using pre-made antibodies that can identify the resultant fragment, also known as a neoepitope. As a biomarker for osteoporosis, increased urine excretion of C-telopeptides, a byproduct of type-I collagen breakdown, is also useful.

Prevention

The potential modifiable risk factors are in many ways the opposite of how lifestyle might prevent osteoporosis. Smoking cessation and moderate alcohol use are frequently advised as measures to help prevent osteoporosis since they have been connected to the disease. 

Following a gluten-free diet reduces the chance of developing osteoporosis and boosts bone density in patients with celiac disease.

The diet must provide appropriate calcium intake (of at least one gramme per day), and it is advised to measure vitamin D levels and take certain supplements as needed.

Nutrition

Research on the advantages of calcium and vitamin D supplements have shown inconsistent results, maybe because the majority of trials lacked participants with low dietary intakes. According to a USPSTF review from 2018, there is insufficient proof that taking calcium and vitamin D supplements on a regular basis (or taking both supplements at once) will lower the risk of developing an osteoporotic fracture in male and female adults living in the community who have no known history of vitamin D deficiency, osteoporosis, or a fracture. As there does not seem to be a difference in fracture risk, the USPSTF does not advise postmenopausal women to take low dosage supplements (less than 1 g of calcium and 400 IU of vitamin D).

Osteoporotic fractures are also at risk due to vitamin K insufficiency. Vitamin K is necessary for the gamma-glutamyl carboxylase (GGCX) gene to function. Variations in bone metabolism and BMD might be caused by functional polymorphisms in the gene. Osteoporosis can also be treated with vitamin K2, and variations in responsiveness to vitamin K therapy across individuals may be explained by GGCX polymorphisms.

Physical Exercise

Just a small body of research supports the idea that exercise helps to maintain bone health. There is some evidence that regular exercise may help postmenopausal women maintain healthy bone density and result in a 4% absolute reduction in the incidence of bone fracture. Exercises involving weight bearing have been proven to trigger an adaptation response in the skeleton. Exercise that involves weight bearing protects bone density by promoting osteoblast activity. Increased bone activity and weight-bearing activities begin at a young age to avoid bone fragility in adults, according to a position statement.  Swimming and cycling are not regarded as weight-bearing activities. Both have a detrimental impact on bone density, and neither helps slow down bone loss as people age.

Physical Therapy

Due to poor postural control, muscular weakness, and general deconditioning, people with osteoporosis are more likely to fall. Maintaining functional actions like walking and standing requires postural control. Vertebral fractures, which are frequent in persons with osteoporosis, may cause postural weakness that can be effectively treated with physical therapy. Balance training, postural improvement, trunk and lower extremity muscle strengthening activities, and moderate-intensity aerobic exercise are all part of physical therapy treatment strategies for persons with vertebral fractures.  Regaining natural spine curvatures, boosting spine stability, and enhancing functional performance are the objectives of these therapies.  By the use of home exercise regimens, physical therapy interventions were also created to reduce the pace of bone loss.

Journal of Orthopaedics Trauma Surgery and Related Research

Journal of Orthopaedics Trauma Surgery and Related Research is high impact peer reviewed international journal that publish the articles which are freely accessible. The journal aims to disseminate the exciting updates in the scope of Orthopaedics, traumatology, arthritis, arthroplasty, bone research, fractures and surgeries, Osteoporosis, Osteonecrosis, Osteosarcoma, rheumatoid arthritis, bone cancer, orthodontics, bone fragility, bone grafting, bone metastasis, spine surgery and articles that are of emphasized interest to orthopaedic surgeons or physicians.

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