Causative & risk factors
Since bone cells need adequate nutrition to grow, a diet deficient in calcium or protein can lead to osteoporosis. Even when the diet is adequate, any condition that hampers the absorption of nutrients into the bloodstream can also reduce the rate of bone formation. These conditions include malabsorption syndromes, gastric surgery etc.
Advancing age is a major cause of osteoporotic bones. As we grow, the bones lose their density and become weaker. Females have a much higher risk of developing osteoporosis especially after menopause. This is because the sudden dip of estrogen in the bloodstream leads to heavy calcium losses.
Hormonal problems such as thyroid and adrenal gland disorders can lead to excessive bone loss, thus putting you at risk of osteoporosis.
Other causes include immobility due to any reason, prolonged use of steroids, leading a sedentary lifestyle and drinking too much alcohol.
These days, inadequate levels of vitamin D in the body, owing to less sun exposure is also responsible for osteoporotic changes.
Clinical presentation (with complications)
In the initial stages, osteoporosis does not produce any symptoms. Some patients may present with severe backache caused due to compression fracture. Since the bones are weakened, even trivial trauma can lead to fractures. The frequent fracture sites for osteoporosis include the spine, wrist and hip.
Investigating a patient for a fracture usually points out to changes of osteopenia in the fractured bone. Subjecting this patient to a bone density scan or DEXA scan reveals the underlying osteoporosis.
Osteoporosis can lead to complications such as kyphosis and loss of height.
Investigations
X-ray of the fractured bone shows osteopenia. A bone density scan will show reduced bone mineral density. DEXA scan is the gold standard test for this purpose. A bone biopsy may be suggested in some cases where the diagnosis is not clear.
Treatment
A diet rich in protein and calcium is advocated to the patient. In addition, calcium supplementation is also recommended. Vitamin D supplementation is also done in order to aid the absorption of calcium. However supplementation with vitamin D in post-menopausal women is controversial since this carries potential of developing cardiovascular disease.
Drug therapy can include androgens, estrogens, calcitonin, biphosphonates or strontium ranelate is advised as per necessity.
An osteoporotic person must undergo weight training or weight bearing exercises to stimulate the formation of new bone.
To prevent osteoporotic changes, one must have a protein and calcium rich diet and exercise regularly. In addition, one must keep smoking and drinking to a minimum level.
Alternative therapies like acupressure and yoga are also beneficial for patients of osteoporosis.
Recent updates
Earlier, bone density scan (specifically DEXA) was used to diagnose cases of osteoporosis. Recently, a new tool called FRAX is being advocated to determine the risk of developing fractures in the future in an osteoporotic person.
Several new drugs are being advocated for the treatment of osteoporosis which include estrogen modulators, raloxifene and odanacatib.
