Strong Bones, Strong Life: Stop Osteoporosis Before It Starts!
The density of bones declines with aging. This is normal. However, some persons experience a greater drop than others. If bone density falls below a certain level, this is known as osteoporosis. World Osteoporosis Day
Reduced bone density raises the risk of fracture. However, bone density alone has limited importance. As a result, you should not be concerned just with the bone density value, nor should you restrict yourself excessively for fear of fracturing bones. There are numerous measures that can be used to keep bones stable or prevent osteoporosis complications. Learn how with TheKnowHow.
World Osteoporosis Day : What are Symptoms of Osteoporosis?
Osteoporosis itself is hardly noticeable. It often only becomes apparent when a bone fracture occurs.
Osteoporosis is the most common cause of spinal vertebral bone fractures. These fractures can cause the spine to collapse notably, lowering the body’s height. When standing next to a relative or a friend, you may feel smaller than usual. This could be a first warning sign. Vertebral fractures can cause back pain, which normally subsides after a few weeks. However, many people do not even notice such fractures.
Vertebral fractures can exacerbate the spine’s natural curvature (kyphosis). If many vertebrae shatter over time, it can cause a stooped posture or a “hump” in the upper section of the spine.
Other typical locations for osteoporosis fractures are the wrists and hip (femoral neck). Fractures, particularly of the femoral neck, can have serious consequences. They mainly occur in people over the age of 80 and sometimes lead to a need for nursery care.
Even stumbling falls might result in fractures in osteoporosis patients. Bones can also break as a result of heavy or inappropriate loads, such as lifting a heavy grocery bag. Experts refer to such bone fractures as “fragility fractures”.
World Osteoporosis Day :What Causes Osteoporosis ?
Bones contain an inner skeleton of fine bone beams (trabeculae). This skeleton is structured like a hard sponge and is called spongiosa. The stability of the bones also depends on the shape and density of the skeleton and the mineral content. Mineral content can be measured by measuring bone density.
Osteoporosis occurs when many of the spongiosa are lost: the cavities become larger, and the bone becomes less stable.
Bone density normally increases in girls until about the age of 15 and in boys until the age of 20. It then reaches its highest level and remains there until around the age of 30. After that, bone density slowly decreases.
However, our bones are not built like a stone, they are living organs. Everyday, our bones are rebuild ad adjusted to their needs. Cells which deconstruct bone material in case of minimal injuries are called osteoclasts. Their counterpart cells, osteoblasts, build up new bone structure. To build new stable bone mass, the mineral calcium needs to enter the bone with the support of vitamin D and a hormone from our parathyroid glands.
Usually, both deconstruction and reconstruction of our bones balance each other out. This permanent rebuilding ensures that bones are solid, stable and appropriate for our daily movements. Some hormones such as estrogens support the osteoblasts, some other like our stress hormone cortisol or thyroid hormone supports osteoclasts.
Daily physical activity is the major trigger for renewing bones – if we don´t move, our bones get more and more week.
In women, bone loss accelerates from around the age of 50 because the bone-protective female sex hormone estrogen levels drop during the menopause. When the hormonal protection is lost, bone is lost more quickly.
Malnutrition at older age reduces calcium intake, less time spent outside under sunlight enhances vitamin D deficiency. Therefore, osteoporosis becomes more and more frequent in older age.
Can We Influence Major Risk Factors of Osteoporosis?
We can´t stop aging and cannot influence genetic susceptibility. But the main risk factors for osteoporosis we can influence are
- Low body weight (in relation to height):
- Calcium deficiency (low consumption of milk products)
- Vitamin D deficiency (low exposure to sun)
- Lack of exercise (sedentary life-style)
- Smoking
- Regular alcohol consumption
Medication for some diseases may also induce osteoporosis, such as
- Prolonged use of corticosteroid treatment, e.g. for asthma, COPD or rheumatoid arthritis
- Lithium, e.g. for psychiatric diseases
- Antiepileptic’s
- Anti-hormone treatment of breast cancer
- Prolonged use of antacids, e.g. for chronic gastritis, after hospitalization
In some cases, other medications are available to minimize the use. If this is not possible, co-medication can be chosen to reduce the risk of osteoporosis.
World Osteoporosis Day : How Frequent is Osteoporosis?
Globally, women are about twice as likely to have osteoporosis as men. Over all age groups, around 23% of women are affected by osteoporosis, and around 11% of men. The highest prevalence (percentage of a population affected by a disease) was detected by the International Azad University in Iran, where 73% of post-menopausal women over the age of 55 years had low bone density, indicating osteoporosis. Paradoxically, despite the intense sunshine in the Middle East and North Africa, deficiencies in vitamin D are widespread among the population. The region’s high temperatures limit time outdoors for many people. Cultural forms of dressing, which include covering major parts of the body, may affect the skin’s absorption of sunlight.
The prevalence of osteoporosis is age dependent, usually developing after the age of 50 and becoming more common with age. However, diseases such as anorexia in childhood and adolescence, celiac disease or other gastrointestinal disorders or severe malnutrition can cause osteoporosis even at a young age.
Contrary to what is often perceived, osteoporosis is not a women’s disease but also affects men. This is especially true in GCC countries. A study at King Fahd Hospital of the University at Alkhobar, Saudi Arabia in 2018 showed that 63,6% of men and 58,4% of postmenopausal women who visited the hospital for measurement of bone density were diagnosed with osteoporosis.
World Osteoporosis Day: How is Osteoporosis Diagnosed?
Osteoporosis is often discovered accidently, such as when the upper body is x-rayed for another reason and vertebral fractures are identified.
Osteoporosis can also be detected when a person falls from a regular height and fractures their bone. In the case of such a fracture, the doctor may usually make the diagnosis following a physical examination and discussion. If osteoporosis has already resulted in a fracture, the disease is known as “manifest” osteoporosis.
What is a DEXA Scan ?
Osteodensitometry can assess whether or not bone density has decreased. This measurement, also called Dual Energy X-ray Absorptiometry (DEXA Scan), evaluates the mineral salt content of bones. A DEXA Scan should be performed by certified trained technicians in the spinal vertebras and the hip. Bone density values are more reliable measured at the hip, because the vertebras can also be changed in old age for other reasons. The result of a DEXA bone density test is called a T-score. A T-score of 0 corresponds to the bone density of a young and healthy adult aged 20 to 30 years.
According to the current definition of the World Health Organization,
- a T score of -1 is considered normal,
- a T-score between -1 and -2.5 as reduced (known as osteopenia), and
- a T-score equal to or less than -2.5 as osteoporosis.
While there are other alternative imaging techniques available using quantitative ultrasound (QUS) and quantitative computed tomography (QCT), DEXA is still the gold standard for the diagnosis of osteoporosis.
The DoH Guideline on the Screening for Osteoporosis : World Osteoporosis Day
is based on a review of several international guidelines and designed to serve as a basic reference on the screening of osteoporosis in the Emirate of Abu Dhabi. It provides guidance on the assessment of fracture risks utilizing the level of risk at which treatment should be considered.
According to DoH, Osteoporosis should be diagnosed
- based on presence of fragility fractures in the absence of other metabolic bone disorders or
- a T-score of –2.5 or lower in the lumbar spine, femoral neck, total hip, and/or 33% (one-third) of the radius bone even in the absence of a prevalent fracture.
A diagnosis of osteoporosis in younger men, premenopausal women and children should not be based on a bone density test result alone. For young population such as children, teens, women still having periods and younger men Z-scores rather than T-scores should be used as the Z-scores compares bone density to what isnormal in someone with similar age and body size. A Z-score above -2.0 is normal according to the International Society for Clinical Densitometry (ISCD).
Osteoporosis may also be diagnosed in patients with osteopenia and increased fracture risk using FRAX® country-specific thresholds. The FRAX® tool has been developed on individual patient models from Europe, North America, Asia and Australia that integrate the region specific risks associated with clinical risk factors as well as bone mineral density (BMD) at the hip (femoral neck). In their most sophisticated form, the FRAX® tool is computer-driven and is available on https://frax.shef.ac.uk/. Several simplified paper versions can be downloaded for office use. The FRAX® algorithms give the 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture).
How About Early Detection Screening for Everybody?
In some countries, doctors provide bone density measurements as an individual health service. The measurement aims to diagnose osteoporosis at an early stage. However, a screening examination in healthy and low-risk individuals can have more disadvantages than benefits. If the measurement reveals low bone density but no osteoporosis, the result has no therapeutic relevance. However, it can be unsettling and may cause people to move less out of fear of fracturing a bone. In this scenario, early identification may potentially be harmful, as decreased physical activity is a key risk factor for osteoporosis and falls.
Osteoporosis Treatment: Which One is Right for Me?
Osteoporosis is still not entirely curable. However, treatment can significantly enhance clinical outcomes and quality of life. When it comes to osteoporosis medication, there is no one-size-fits-all treatment. Understanding your options begins with knowing what’s available.
Some medications can help to postpone the progression of the disease. Newer medications can also significantly stimulate bone formation. Treatment options may vary between women and men, between high-risk or low risk for fractures. Furthermore, guidelines distinguish between women before or after menopause. It is important to talk to your experienced doctor. Ask for available options specifically in your situation with all the pros and cons.
To get an overview, we explain the different classes of medications below.
Basic Pillar: Calcium, Vitamin D, Proteins! ; World Osteoporosis Day
To build solid well mineralized bone mass, our body needs calcium. Osteoporosis medication can only work successfully if the daily calcium intake is ensured. The required daily dose of calcium is ideally achieved through dairy products, such as milk, yoghurt, or cheese. Calcium supplementation is appropriate if the dietary intake is below 800 mg/day. In general, 800-1200 mg of elemental calcium daily (diet plus supplement) are suggested.
You don´t know how much calcium is in your daily food? The IOF calcium calculator tool can be used to for an accurate calculation.
Calcium can only enter the bone in the presence of vitamin D. Usually, 30 to 60 minutes exposure of face and arms to the sun per day is sufficient for the body to produce enough vitamin D. However, patients with osteoporosis might have acquired a vitamin D deficiency over a long period of time. Therefore, when osteoporosis medication is initiated, vitamin D supplementation is most often required. Your doctor will check your vitamin D level and recommend the appropriate dosage.
While calcium and vitamin D is important for healthy bone as well as an effective osteoporosis treatment, don´t use supplements without advice from your doctor. An overdose of calcium over a longer period may bear the risk of kidney stones or atherosclerosis.
World Osteoporosis Day: Bisphosphonates
To slow bone breakdown, many doctors first turn to one particular class of drugs. If someone has a very low T-score, doctors typically start with the bisphosphonates.
There are several bisphosphonates to choose from, such as:
- pills, such as alendronate, ibandronate, or risedronate, taken daily, weekly, or monthly, for a period of around 5 years
- injections of ibandronate, given once every three months, for 3 to 5 years.
- intravenous infusion of zoledronic acid, given once a year, for a maximum of three years.
Oral bisphosphonate pills need to be taken before breakfast sitting or standing upright for 30 to 60 minutes to protect the esophagus from irritation. If this is difficult for elderly patients, of in case of gastrointestinal problems like reflux, patients may be put on an injection or infusion of these drugs, which works about as well as the oral versions.
Bisphosphonate drugs may have side effects, one of which is osteonecrosis (bone death) in the jaw, especially after dental infections, extractions, or implantations. Though these concerns are real, they are more common in people taking intravenous bisphosphonates to treat cancer that has spread to the bones, or in patients who are on long-term, high-dose bisphosphonates.
Doctors acknowledge that the risk of these side effects also increases with long-term use of bisphosphonates. Therefore, most patients take these drugs for about five years. The good news is that the bone-protective benefits continue even after you stop taking bisphosphonates.
Raloxifene
Raloxifene, a selective estrogen receptor modulator (SERM), is known for its role in breast cancer treatment, but serves double duty in treating osteoporosis, too. It works by binding with estrogen receptors around the body to produce estrogen-like effects, one of which is to decrease bone turnover. For women with osteoporosis of the spine, raloxifene reduces the risk of vertebral fractures. The main side effects are hot flashes, muscle pain, and an increased risk of blood clots in the leg (deep-vein thrombosis). Raloxifene is not approved for treatment of male osteoporosis patients.
Teriparatide
Teriparatide and the new abaloparatide are synthetic versions of parathyroid hormone that dramatically improve bone density and strength. They can reduce the risk of fractures significantly in the spine and other bones. They are a reasonable option for someone – either female or male – with very low bone density and vertebral fractures. Doctors usually limit this particular treatment to around two years. A switch to a bisphosphonate is then required to maintain the increased bone density. Patients on teriparatide or abaloparatide need to give themselves a daily injection.
World Osteoporosis Day: Denosumab
Denosumab is a monoclonal antibody given as a twice-yearly injection. It prevents bone-dissolving osteoclast cells from forming. Denosumab may be an option if a female or male patient cannot tolerate bisphosphonates. Once started, patients usually stay on this therapy indefinitely because if stopped, bone resorption will accelerate.
World Osteoporosis Day: Romosozumab
Romosozumab is another monoclonal antibody currently approved for postmenopausal women with severe osteoporosis. It is usually considered after a woman has had a fragility fracture. It acts by blocking sclerostin, a protein that inhibits bone formation. The medication is injected once a month and should only be taken for one year, because its bone-making activity wanes after 12 months. New studies show, that one year of treatment with romosozumab followed by one year of alendronate reduces fracture risk more than two years of alendronate therapy alone.
Strengthen Your Bones: Physical Action Required!
Many osteoporosis patients mistakenly think exercise will lead to fracture. In fact, though, using your muscles helps protect your bones. Certain types of exercise strengthen muscles and bones. Other types can improve balance, which can help prevent falls.
Exercising if you have osteoporosis means finding the safest, most enjoyable activities for you based on your overall health and amount of bone loss. There’s no one-size-fits-all prescription. Consult your health care provider before starting any exercise program for osteoporosis. Find out together what exercises are safe for you.
Types of activities which are often recommended for people with osteoporosis are
- Strength training exercises, especially those for the upper back.
- Weight-bearing aerobic activities, like walking.
- Flexibility exercises.
- Stability and balance exercises.
Strength training : World Osteoporosis Day
Strength training includes the use of free weights, resistance bands or your own body weight to strengthen muscles, tendons and bones. Strength training is especially helpful to build back muscles that are important for posture. It also can help support bone density.
You should tailor your strength training to your ability and level of comfort, especially if you have pain. It is worthwhile to talk to a physical therapist or personal trainer who has experience working with people with osteoporosis. They can help you develop a strength-training routine. They also can help you learn to use proper form and technique to prevent injury and get the most from each workout.
Weight-bearing aerobic activities
Weight-bearing aerobic activities involve doing aerobic exercise on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics, elliptical training machines, stair climbing and gardening.
These types of exercise work directly on bones in the legs, hips and lower spine to slow bone loss and support bone rebuilding.
Swimming and cycling have many benefits, but they don’t provide the weight-bearing load that bones need to slow bone loss. However, if you enjoy these activities, do them. Just be sure also to add weight-bearing activity as you’re able.
Flexibility exercises : World Osteoporosis Day
Moving joints through their full range of motion helps keep muscles working well. Stretches are best performed after muscles are warmed up. For example, it’s good to stretch at the end of an exercise session or after a 10-minute warm-up. Stretches should be done gently and slowly, without bouncing.
Avoid stretches that flex the spine or require bending at the waist. Ask your health care provider which stretching exercises are best for you.
Stability and balance exercises
Efforts to prevent falls are especially important for people with osteoporosis. Stability and balance exercises help muscles work together in a way that makes falls less likely. Simple exercises that improve stability and balance include standing on one leg and movement-based exercises such as tai chi.
Talking to Your Doctor About Your Bone Health
If you’re worried about your bone health and think you might be at risk of osteoporosis and broken bones, it’s important to talk to your doctor. You might be worried about wasting your doctor’s time. You might use the osteoporosis risk checker of the Royal Osteoporosis Society UK. Don´t hesitate to make an appointment to discuss your bone health when you feel, you might be of risk. World Osteoporosis Day
Your health matters!
