Osteoporosis

The word osteoporosis means porous bones. It is a condition in which the bones become very thin, brittle, and weak. It leads to increased chances of fracture. Patients with this condition have weak bones, and small stresses like bending over or coughing with force can cause the bone to break. The fractures related to osteoporosis are mostly related to the hip, wrist, and spine. Bone is also a living tissue that is broken and constantly repaired over time. A person of any age can be affected by osteoporosis, but Asian and white women are at an increased risk of getting affected by the condition. Especially women who are in their phase of menopause. Generally, osteoporosis progresses without any symptoms and occurrence of pain. 

Osteoporosis is generally considered a silent disease. But, you may notice some of the following signs in the body if you are suffering from osteoporosis. 

1. Change in body posture.
2. Losing height by about an inch or more. 
3. Fracture In bone with very minimal stress over the bone.
4. Feeling of constant pain in the lower back.
5. Lung capacity is also decreased due to the compression in the disk. As a result, the patients may have shortness of breath. 

The process of renewal in the bone is constant and regular. The bones are degraded at a slower rate than the generation of the bone in an individual’s early 20s. The person reaches the peak of bone density when the person reaches the age of 30. After crossing the age of 30, the generation rate of bone becomes lesser than the rate of its degradation. As a result, the bone density decreases with time and age. It eventually leads to a decrease in the bone density of the person. The main cause of osteoporosis is decreased bone density in older age.

1. Age: the risk of developing osteoporosis increases after the completion of the mid 30 age.
2. Sex: Men and women are affected by osteoporosis. But, the women are more affected because of the decreased bone density due to the pregnancy and the menopause.
3. Level of sex hormone: the regeneration of the bone becomes harder when the estrogen level of the person is decreased.
4. Ethnicity: White and Asian people are at a higher risk of developing osteoporosis.
5. Genetics: You are at increased risk for developing osteoporosis if you have a family history of this condition.
6. Lifestyle: People with a sedentary lifestyle, excessively consuming alcohol and using tobacco are at increased risk for developing weak bones.  
7. Diet: Dietary factors such as eating disorders (restricting diet), low calcium diet and poor mineral absorption due to gastrointestinal surge may also increase risk of osteoporosis. 
8. Hormones: Reduced level of sex hormones, especially in women after menopause contributes to weak bones. Further, overactive thyroid gland or intake of high amounts of thyroxine medications to treat underactive thyroid gland may cause weak bones.  
9. Medications: Medications for treating gastric reflux, seizures, cancer, and immunosuppressants may also interfere in bone metabolism. Steroids also affect the process of bone formation. 
10. Medical conditions: Certain medical conditions, such as celiac disease, cancer, rheumatoid arthritis, liver disease, kidney disease, inflammatory bowel disease, and multiple myeloma also increase risk of osteoporosis.

Disease Progression

Stage 1: The very first stage of osteoporosis is during the 20s when the rate of bone loss and rate of bone gain is equal. 

Stage 2: There are no symptoms developed in the body at this stage. But at this stage, the rate of bone gain is less than the rate of bone loss. Therefore, the degrading bone density can be detected by the tests. 

Stage 3: If you have stage 3 osteoporosis, it is officially osteoporosis. You might experience the signs and symptoms of osteoporosis. 

Stage 4: It is the most severe stage of osteoporosis. It is the stage where you may start noticing the loss of bone. 

1. For diagnosing osteoporosis, the doctor will ask for a full medical history of the patient. 
2. The doctor may also order some tests to determine the bone density of the patient. The bone density is measured by a machine that determines the level of the minerals in the bone by using x-rays. Bone mineral density (BMD) tests are also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans.
3. In the case of women, the doctor will look at their age and then consider whether the women have reached menopause or not.
4. The doctor may also ask you to see if you have broken your bones in adulthood.
5. The doctor may also ask about the medicines that you are taking. Some medicines like corticosteroids also tend to weaken your bones if used for long.
6. The doctor will also inspect your spine to check if it is curved normally or is there any kind of abnormality. In case of osteoporosis, the spine of the affected person tends to be curved forwardly. This abnormally curved spine may cause the spine fracture in case of osteoporosis.

The treatment of osteoporosis is done based on the bone density of the person. The treatment may include:-

1. Bisphosphonate: This is the most widely used medicine for treating osteoporosis in men and women at a high risk of bone fracture. The side effects of these drugs may include nausea, abdominal pain, and heartburn. However, these are less likely to occur if the medicines are taken properly. 
2. Biologics: These are the second choice drugs after bisphosphonate. They produce similar or better results in increasing bone density in the patient. These drugs are delivered to the patient every six months by using a shot under the skin.
3. Hormone-related therapy: The decreased oestrogen level can also cause a decrease In bone density in women. So, starting estrogen therapy, especially soon after menopause, can help maintain the bone density level during menopause. However, this therapy can also increase the chances of breast cancer in older women. Therefore, it is recommended for younger women.
4. Natural treatment: Several supplements like soy, red clover, and black cohosh are used to promote bone health. These substances help in maintaining the regular bone density of the body. 
5. Bone-building medications: The doctor may prescribe certain medications in patients with severe osteoporosis that include teriparatide (induce new bone growth and given for only two years), abaloparatide (act as anabolic agent for bone and used for only two years) and romosozumab (bone-building medication and used for only one year). 

When the complications associated with osteoporosis become prominent, you must visit an orthopaedic doctor for a better diagnosis and treatment. You must call a doctor if you are experiencing any of the following signs.

1. Change of body posture.
2. Decrease in height. 
3. Experiencing pain in the lower back region constantly.

Complications

The most serious complication of osteoporosis is the fracture of the bones in the hip and spine region. It is so because fractures in these bones may lead to permanent disability for the person. Hip bone fracture is generally caused by a fall and can sometimes result in death within the first year of the condition. The spinal fracture can occur even without any fall.