Osteoporosis is a condition where the strength of the bones in the body decreases due to bone density and bone quality declining with age and other contributing factors, which increases the risk of fractures.
According to a survey by the International Osteoporosis Foundation, more than 9 million people suffer fractures from osteoporosis each year. ‘The older you get, the higher the risk of fractures.’ Most cases are found in people aged 50 and above. Women are at higher risk than men, and only one in three patients seek medical attention immediately after a new fracture, causing delayed treatment and leading to many complications.
Causes of Osteoporosis
The cause is an imbalance in the bone remodeling process, where bone resorption exceeds bone formation, or abnormal mineralization in the bones, resulting in weak bone structure and fractures. Factors affecting this process include age, hormones, and the use of certain medications such as steroids.
Symptoms of Osteoporosis
Most patients have no symptoms even when osteoporosis is detected or fractures have occurred, leading to delayed diagnosis in early stages. Symptoms usually appear after fractures, such as chronic back pain and loss of height, often caused by fragility fractures from minor accidents.
Diagnosis of Osteoporosis
Diagnosis can be made if the patient has vertebral or hip fractures from minor trauma. Otherwise, bone density is measured using a low-energy X-ray device (DXA Scan), which involves minimal radiation, no contrast injection, and a short examination time. The scan is performed on the spine and hip. A T-score below -2.5 indicates osteoporosis.
In addition to bone density testing, evaluation for other diseases causing osteoporosis is necessary, such as kidney disease, hyperparathyroidism, vitamin D deficiency, and arthritis like rheumatoid arthritis, each requiring different treatments.
Treatment of Osteoporosis
Treatment has two main approaches:
Non-pharmacological treatment includes
- Taking calcium and vitamin D in appropriate doses
- Eating a balanced diet with all five food groups, emphasizing adequate protein intake
- Regular exercise, quitting smoking, and reducing alcohol consumption
- Assessing fall risk and providing appropriate prevention
Pharmacological treatment involves the following steps
The doctor will assess the risk of fractures from osteoporosis to select appropriate medications. These include oral drugs such as bisphosphonates or injections like denosumab and teriparatide. Patients must be evaluated before treatment, including kidney function, calcium and vitamin D levels, and oral health to reduce drug complications. Bone density will be re-evaluated every 1-2 years to monitor treatment response.
Who should be screened for osteoporosis?
Since fractures from osteoporosis may have no symptoms and can occur from minor accidents leading to disability or permanent impairment, early screening helps prevent these complications. Those who should undergo bone density testing include:
- Postmenopausal women
- Elderly individuals
- People with a history of minor fractures
- Those with a family history of osteoporosis
- Individuals taking steroids
- People with decreased height
- Those with unexplained chronic back pain
- Individuals with other risk factors or related symptoms
