Osteoporosis

Affecting nearly 55 million people in North America alone, osteoporosis is among the most common chronic musculoskeletal disorders in the US and worldwide. This condition causes the bones to become brittle and weak, increasing the risk of fractures and disability.

Osteoporosis is a “silent” disorder, meaning that its symptoms are not immediately noticeable or outwardly visible, making this condition difficult to diagnose and treat. Often, you may only receive a diagnosis after a fracture or when your bone structure has been irreversibly compromised.

However, you no longer need to live with chronic pain and recurring fractures. With adequate lifestyle changes and a combination of various therapies, you can regain control over your health. Learn more below.

What Is Osteoporosis?

The word “osteoporosis” comes from the Greek terms for bone (“osteon”) and small opening passageway (“poros”). This medical term describes a condition that causes the bones to lose mass and become brittle and weak.

To understand how osteoporosis develops, it is important to clarify that bones are not static but dynamic and living bodies that change constantly through what’s known as “bone metabolism.”

Bones are made up of minerals (such as calcium) held together by collagen fibers and protected by an outer shell known as cortical bone. At a microscopic level, this structure gives bones a honeycomb-like appearance, allowing them to remain strong and flexible.

The active tissue that makes up bones constantly changes and renews itself throughout life. Cells called osteoclasts break down old tissue and regulate the rate at which bone mass is lost. At the same time, cells called osteoblasts produce new bone material.

The speed at which bone is formed and broken down (resorption) changes throughout life:

• Childhood and Adolescence: During development, new bone material forms quickly and at a high rate. Bones reach peak density by the time a person is 25-30 years old.
• Adulthood: To maintain balance, the adult skeleton produces bone at the same rate at which bone mass is lost. The skeleton is completely renewed every 7-10 years.
• After Age 40: Bone material breaks down faster than it can be replaced. In women, 10-20% of bone mass is lost during the first 5-6 years of menopause. With aging, everyone experiences some bone mass loss.

However, in some people, the rate at which bone mass and minerals break down is much faster than the rate at which they are replaced.

This causes bones to lose density, and the holes in the “honeycomb” structure become much larger. This results in bones that are brittle, more fragile, and prone to fracture. In people with osteoporosis, a broken bone can be caused by minimal stress, such as coughing or bending.

This disease develops without symptoms, and most patients only receive a diagnosis of osteoporosis when investigating the cause of a bone fracture.

Every year, osteoporosis causes over 2 million broken bones, but 80% of patients are not screened for this disease. However, learning more about this bone condition and finding adequate treatment is essential to safeguard your musculoskeletal health.

Types of Osteoporosis

Although osteoporosis is more common in aging individuals, it can affect anyone. There are different types of osteoporosis, depending on the symptoms it causes and the demographic it affects. Let’s look at them below.

Primary Osteoporosis

Primary osteoporosis is the most common form of this condition. Primary osteoporosis is subdivided into senile osteoporosis and menopausal osteoporosis, depending on whether it is triggered by age-related bone mass loss or hormonal changes (such as those occurring during menopause). It is estimated that 1 in 2 postmenopausal women may have osteoporosis to some extent.

If the cause of primary osteoporosis is unknown, this condition is known as idiopathic osteoporosis.

A person’s bone mass throughout life determines the risk of developing primary osteoporosis in later life. Still, factors such as diet, health, physical exercise, and lifestyle may also have an impact. Primary osteoporosis is commonly diagnosed in individuals aged 60 and over.

Secondary Osteoporosis

Secondary osteoporosis is a severe and progressive loss of bone mass caused by another underlying disease. It can occur at any age. Medical conditions that can cause secondary osteoporosis include leukemia and hormonal disorders such as hyperthyroidism.

Some medications can also speed up the loss of bone density. These include high-dose corticosteroids (when taken regularly, orally or inhaled), hormone replacements, and some cancer treatments.

Osteogenesis Imperfecta

Also known as brittle bone disease, osteogenesis imperfecta is a rare genetic or heritable disease that causes bones to break easily and without obvious cause. This condition is often seen in newborns and can lead to severe complications, including a shortened lifespan. Only around 1 in 20,000 people is affected by osteogenesis imperfecta.

Idiopathic Juvenile Osteoporosis

Idiopathic juvenile osteoporosis is a rare condition that affects children and young adults, usually within the development period (8-14 years old). Although it is more common in individuals with a history of being overweight in childhood, there is no known cause or cure for this disease.

Where Does Osteoporosis Commonly Occur

Any bone in the body can be affected by osteoporosis, and the condition may start without causing fractures for several years. However, some bones are more prone to breaking than others.

In particular, osteoporotic fractures tend to occur in the wrists, hips, spinal bones (vertebrae), and knees. These bones or joints are usually load-bearing or exposed to constant stress, which makes them more likely to break.

If you experience a fracture in any of these bones, your doctor may prescribe a diagnostic test to assess your bone mass density and identify the signs of osteoporosis.

Diagnostic Procedure

Although osteoporosis is hard to detect until a bone breaks, there are diagnostic tests that can give an accurate diagnosis. Let’s explore the methods a doctor might use to determine your bone density:

• Evaluating the Risk Factors: A doctor will begin by assessing your risk factors for osteoporosis, such as age, gender, underlying conditions, and medical history. They may also ask about past fractures, medications you are taking, and your lifestyle, including diet, exercise, and alcohol use.
• Physical Examination: During a physical exam, the doctor will look for signs that your bones have low density. These signs include changes in posture, loss of height, balance problems, and unusual gait. The doctor might also assess your muscle strength and check for muscle atrophy.
• Bone Density Test: One of the most effective tools for diagnosing osteoporosis is a bone density test. This is typically done using a test called dual-energy X-ray absorptiometry (DXA). DXA uses X-rays to measure the mineral density of bones that are prone to fractures, such as the hip, spine, wrist, and knee. This test is painless and non-invasive.

If you believe that you are at risk of osteoporosis, it is important to consult your healthcare provider and undergo the necessary tests. Despite the guidelines provided by the U.S. Preventive Services Task Force, at-risk patients are seldom tested for this condition. As shown by a 2022 study, only 20% of at-risk women were screened for osteoporosis 2 years before a fracture.

Ways to Reduce the Risk of Osteoporosis

Some risk factors for osteoporosis, such as genetics and sex, cannot be changed. However, you can do many things throughout your life to reduce the risk of developing low bone mass density.

These include:

• Leading an active lifestyle and following a diet rich in calcium and vitamin D throughout your life.
• Considering supplements or increasing the levels of calcium and vitamin D in your diet.
• Working with a specialized physical therapist to understand how to keep your musculoskeletal system healthy as you age.
• Practicing strength training as well as weight-bearing and balance exercises.
• Limiting alcohol and tobacco consumption.

Working with a specialized lifestyle counselor and nutritionist can help you understand how to lower the risk of developing osteoporosis.

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