Osteoporosis: What are signs and symptoms of silent bone disease

Osteoporosis literally means “porous bone.” Porous means full of holes. With aging our bones get thinner. Osteoporosis is a disease in which bones become very weak and brittle. It often develops unnoticed over many years without any symptoms or discomfort until a bone breaks. Because there are no symptoms in the early stages and it progresses quietly, it is often referred to as a silent disease.

These fractures most often occur in the hip, spine, and wrist. Bones are often broken as the result of a fall, although at times people with osteoporosis can fracture their bone even when doing simple household tasks or sneezing, or a sudden movement. Fractures caused by osteoporosis can be life-threatening and a major cause of pain and long-term disability.

World Osteoporosis Day (WOD) is observed every year on 20th October across the world to create global awareness for prevention, diagnosis and treatment of osteoporosis. WOD aims to make osteoporosis and fracture prevention a global health priority.

What is osteoporosis?

Bone is a living tissue. To maintain strength, healthy bones naturally remodel themselves by removing older bones and replacing them with new ones. Osteoclasts degrade old bones and release minerals into circulation in a process known as bone resorption, while osteoblasts form new bones in a process known as bone ossification or osteogenesis. The imbalance between bone resorption and bone ossification causes osteoporosis.

In osteoporosis, bone reabsorption exceeds bone growth. Probability of developing osteoporosis depends partly on peak bone mass attained in youth. Peak bone mass is partly inherited and varies by ethnic group. Peak bone mass is usually attained by age 30. The higher the peak bone mass, the more bone one has “in the bank” and the less likely that one will osteoporosis with aging.

What are the risk factors?

Osteoporosis most often occurs in older women, but men are also at risk. One in three women and one in five men over age 65 will break a bone because of osteoporosis. Apart from age and sex, following are the risk factors for osteoporosis:

• Early menopause
• Being underweight (body mass index below 19)
• Medical conditions associated with osteoporosis, such as rheumatoid arthritis, diabetes, breast or prostate cancer, or certain digestive diseases
• Medications causing osteoporosis, such as longer-term daily use of glucocorticoids (steroids)
• Parental history of hip fracture or osteoporosis
• Sedentary lifestyle
• Smoking and excessive drinking
• Poor dietary intake of calcium and vitamin D
• Previous fracture
• Ethnicity: Caucasian and Asian people are more likely to develop it.

What are the symptoms of osteoporosis?

Although osteoporosis is a silent disease, the following signs and symptoms should be kept in mind:

• Loss of height (getting shorter by an inch or more).
• Change in posture (stooping or bending forward).
• Shortness of breath (smaller lung capacity due to compressed disks).
• Bone fractures.
• Pain in the lower back.

How is osteoporosis diagnosed?

Bone mineral density (BMD) tests are also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans is used to diagnose osteoporosis. These X-rays use very small amounts of radiation to determine how solid the bones of the spine, hip or wrist are.

All women over the age of 65 and all men above 70 years age should have a bone density test. The DEXA scan may be done earlier for women and men who have risk factors for osteoporosis.

How is osteoporosis treated?

The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures.

• Proper nutrition.
• Lifestyle changes.
• Exercise.
• Fall prevention to help prevent fractures.
• Medications.
The treatment should be individualised and tailored to each patient need.

The author is a Consultant Endocrinologist at Global Hospital, Parel, Mumbai. The views expressed are personal.  

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