Osteoporosis

Cause

From the thirty-fifth year of life, the body will slowly break down more bone than is created. This results in osteoporosis. There are a number of factors that increase the risk of getting osteoporosis:

• In women: menopause. After menopause, the body produces less female hormones. These hormones just ensure that the breakdown of bones is inhibited. So after menopause, the body breaks down bones more rapidly, so that they become brittle. Especially women who have been in menopause before their forty-fifth year of life, are at increased risk of osteoporosis.
• Too little exercise. Exercising stimulates the creation of bone tissue.
• Calcium shortage. Calcium is a major component of bones. Dairy products are high in calcium.
• Vitamin D shortage. Vitamin D is necessary for absorbing calcium from the blood and to build it into the bones. Daylight ensures that the body produces vitamin D.
• Smoking and excessive alcohol consumption.
• Particular medications. Corticosteroids (strong anti-inflammatory drugs, such as prednisone) and thyroid hormone are known to disrupt the balance between bone development and bone breakdown.
• Certain diseases. Various stomach, bowel and thyroid conditions are known to increase the risk of osteoporosis. Even when a person has had an eating disorder at younger age, he or she can have osteoporosis later in life, because due to the malnutrition, the bones have not been built up for a long time.

Symptoms

Osteoporosis itself has no symptoms. However, there is a higher risk of breaking a bone, for example when falling. Especially wrist and hip fractures are common in people with osteoporosis. The vertebrae may collapse, causing the patient to be smaller and walk crooked. It’s rare that a patient has pain from osteoporosis, but collapsed vertebrae can sometimes cause pain or loss of function.

Diagnosis

Osteoporosis is usually discovered after a fracture. The diagnosis can only be made with certainty with the aid of a special X-ray, in which the density of bones is measured. This is not visible on a normal X-ray.

Treatment

Generally, the patient is only given medications for osteoporosis if the density of the bones has significantly decreased. Some of the drugs that can be prescribed are:

• Biphosphonates. These prevent the breakdown of bones by binding the calcium into the bones.
• Strontium ranelate. This drug stimulates bone creation and inhibits breakdown.
• Selective Estrogen Receptor Modulators (SERMs). These drugs imitate the effects of the female hormone estrogen. They are therefore only suitable for women. SERMs inhibit bone breakdown, but they can also cause hot flashes as side effect.
• Parathyroid hormone. This hormone stimulates calcium absorption by the intestines and the production of new bone cells. This drug is prescribed only if other medications don’t help.

Prognosis

Osteoporosis is a major cause of disability in the elderly. Hip or vertebral fractures due to osteoporosis can reduce mobility or impede breathing. Some forms of osteoporosis can be cured, but if the disease is caused by aging, it cannot be reversed. Osteoporosis is rarely seen as a cause of death.

Considerations

People can do a lot of things themselves to improve the balance between bone development and bone breakdown. Moreover, one can also take measures to prevent falling and accidental bone fractures:

• Eat or drink enough dairy products. The advice is to take four servings of dairy per day. A serving of dairy is, for example, a glass of milk, a bowl of yoghurt or a slice of cheese.
• Keep exercising. Exercise stimulates bone development. In addition, an active life ensures keeping reaction speed and balance on level, so a person is less likely to fall.
• Get regular daylight. Daylight stimulates the production of vitamin D, needed for strong bones. Every day fifteen minutes of sunlight on a white skin is enough. If a person, for whatever reason, is not able to go outdoors regularly, has a dark skin or is wearing a veil, he or she can use vitamin D pills.
• Prevent falling. One can easily trip over loose mats, cords or other debris. Also be careful with slippery surfaces. Resources can be requested in case of reduced mobility.

Facts

• The term ‘osteoporosis’ is derived from the Greek words osteon (bone) and poros (opening).
• The prevalence of osteoporosis is 0.2%.
• Women are at higher risk of having osteoporosis than men. One in three women older than 60 years suffer from osteoporosis. In men over 60 years this is one in seven.
• The disease especially occurs later in life.