Osteoporosis is a metabolic bone disease characterized by low bone mass and disruption of bone microarchitecture. As a result, bones become fragile and are prone to fracture with minimal trauma, such as descending a stair.
Which are the risk factors for osteoporosis?
Heredity: family history of low trauma fractures
Absence of menses for more than 6 months
Low calcium intake
Vitamin D insufficiency
Low body weight
Absence of physical exercise
Excessive alcohol intake
Long – lasting use of medications (corticosteroids , high-dose thyroxine, antiepileptics )
Signs and symptoms of osteoporosis
At the beginning osteoporosis is a “silent” disease, as it is not associated with symptoms. Later on, if a vertebral fracture occurs, it may incur back pain or leg pain, if the fractured vertebra compresses the nerve routes. Furthermore, vertebral fractures may decrease body height or may lead to cyphoscoliosis (bending of vertebral spine). The most severe osteoporotic fracture is hip fracture, which usually requires surgical replacement of the hip joint and is associated with high mortality and long rehabilitation periods, compromising the quality of life.
How do we diagnose osteoporosis?
The preferred screening method of osteoporosis is the bone densitometry with DEXA (measurement of bone mineral density, BMD). BMD is assessed mainly in two parts of body, more specifically in the lumbar spine and in the hip. According to the instructions of World Health Organization, the T – score index is used to evaluate the BMD of postmenopausal women. T-scores are calculated by comparing the measured BMD with the average BMD of healthy young women. T- score values above -1 indicate normal bone mass. Values between -1 to -2,5 indicate low bone mass (osteopenia) and values below -2.5 indicate osteoporosis. Furthermore, the existence of one or more osteoporotic fractures in combination with T- score lower than -2.5 demonstrate established osteoporosis. The evaluation of BMD in men and premenopausal women is done with the Z- score index, which compares the measured BMD with the average BMD of the same gender and age.
How will I prevent osteoporosis?
The most important step against osteoporosis is prevention. Menopausal women should adopt healthier dietary habits, consuming high amounts of dairy products. If not feasible, supplementary calcium should be administered, so that daily intake is 1500mg.
The calcium content of dairy products is:
1 glass of milk: 300mg
1 yogurt: 300mg
100gr of white goat’s cheese: 500mg
100gr yellow cheese contains: 800mg
Furthermore, each menopausal woman should ensure adequate intake of vitamin D. Skin production usually is not sufficient, especially during winter. Supplementary vitamin D in a daily dose of 800IU is recommended for every postmenopausal woman.
Quit of smoking, restriction of caffeine and alcohol-containing drinks and increase of physical activity are also helpful in preventing osteoporosis. Walking, playing tennis, jogging, dancing are effective in preventing bone loss.
Medical management of osteoporosis is divided in two categories:
A. Drugs that reduce bone absorption: denosumab, Bisphosphonates, selective estrogen receptor modulators (SERMS), strontium ranelate, hormone therapy, calcitonin
B. Medicines that increase bone formation: PTH analogues, strontium ranelate
It is worth mentioning that the most important step for the management of osteoporosis is the early diagnosis and its prevention. If the patient has a fracture the possibility of having another is very increased. In this case, medication is used for the stabilization of the disease and not for its cure, since the damage in bone quality cannot be restored.