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Osteoporosis is a disease that reduces the density and mass of the bones, we also talk about bone demineralization, in this disease it is also possible to observe some changes in the architecture of the bone.
The consequence is that the bones tend to become more and more fragile, which can lead to fractures. Osteoporosis is caused by the progressive loss of calcium and other minerals from the bones.1.
This disease, increasingly frequent among the population, in particular due to their aging, can cause serious public health problems and invalidate the patient’s life. The dorsal zone and the hip region (neck of the femur) are the most dangerous and paralyzing for the patient.
The term osteoporosis literally means “porous bones”.
From the age of 35, more bone tissue is destroyed than produced. As a result, we begin to naturally lose bone structure with age.
The problem with osteoporosis is not the disease itself, but the consequences, that is, the risk of fracture.
In osteoporosis, even a small fall can lead to a fracture .
Epidemiology
Statistics by gender and age
Women are generally more affected than men by this disease, especially women after menopause (around the age of 50). From this age, one in three women are affected by osteoporosis.
Women make up about 80% of people with osteoporosis.
However, men over 70 are often affected by the disease. By age 50, about one in seven men is affected by osteoporosis.
Worldwide and country statistics
– It is estimated that 200 million women worldwide are affected by osteoporosis.
– In the United States, in 2020, about 8 million women and 2 million men suffered from osteoporosis2.
Causes
In women, the first cause of osteoporosis is a decrease in the expression of sex hormones (in particular estrogen), since the age of menopause. We then speak of postmenopausal osteoporosis.
In men, osteoporosis is often linked to age. From the age of 70, bones can start to become more fragile. It is likely that this is also related to a hormonal cause, in this case, the decrease in testosterone concentration.
For both men and women, osteoporosis can have a strong hereditary component.
Osteoporosis can also have other causes, often very important, such as:
– an unadapted diet and especially low in calcium (lack of consumption of dairy products) and vitamin D .
– Long-term use (treatment of one year or more) of cortisone-based medication or its derivatives in oral form (in pills). Drugs other than corticosteroids increase the risk of osteoporosis, such as: antidepressants, antiepileptics, antidiabetics, and treatments used during chemotherapy.
Therapies used for rheumatoid arthritis can also weaken the bones.
– Little exposure to the sun (the sun synthesizes vitamin D , which is essential for good absorption of calcium by the intestine).
– Overweight and obesity, high weight puts bones at greater risk, leading to increased risk of osteoporosis.
– The consumption of coffee , tobacco and alcohol is not favorable, as these products can favor osteoporosis.
– Hormonal problems, especially in the thyroid gland. Excess thyroid hormones are known to cause bone loss. Other glands can trigger bone problems, such as the parathyroid gland and adrenal glands.
– Low bone density.
– Certain diseases can increase the risk of being affected by the disease: ankylosing spondylitis, rheumatoid arthritis, diabetes, breast cancer, some diseases that disturb the absorption of nutrients (eg calcium).
– A small body frame . With age, men and women with a small body frame have less bone reserve during osteoporosis.
– Gastrointestinal surgery. Some surgeries that reduce the size of the stomach or intestine, such as a bypass, can decrease the surface area for absorption of certain nutrients, such as calcium (important for preventing osteoporosis).
People at risk
– Women
– Elderly people
– Caucasians and Asians
– People with osteoporosis in their family
– Thin people (thin build)
– Diabetics
– Alcoholics
– Smokers
– People suffering from eating disorder diseases
– Sedentary people
Symptoms
Osteoporosis usually develops silently, without symptoms (asymptomatic), especially during the early years of development. This means that the person is not aware of the evolution of osteoporosis and it is often only after an accident (eg fracture) that the disease will be clearly diagnosed.
The main symptoms of this disease are:
– Fractures in the bone region (generally of the wrist, femur and vertebrae) increasingly frequent. Read: Hip fracture: Increases mortality in older women
– Pain, especially in the back region.
– Decrease in size
– Change in posture, the person becomes arched
Diagnosis
Diagnosis is based on measurement of bone mineral density (BMD). To measure BMD, the doctor uses a scanner that passes through the patient’s body using X-rays.
As we can see in the infographic below, during osteoporosis, bone takes on the shape of a honeycomb matrix. In other words, bone is more porous and has larger holes.
Assessment
tools There are fracture risk assessment tools, which work with an algorithm, such as FRAX (https://www.sheffield.ac.uk/FRAX). This tool, developed in 2008 by the University of Sheffield, in England, makes it possible to assess the risk of hip fracture in 10 years. The use of algorithms such as FRAX can be very useful for both the doctor and the patient, because the diagnosis of osteoporosis is not exact. In other words, it is important to take into account several risk factors (eg age, history of fractures…) before knowing whether or not to start therapy.
Treatments
Osteoporosis treatments may vary depending on the cause and only the doctor will be able to prescribe the best treatment after making a diagnosis.
1. In the prevention of osteoporosis (in particular in postmenopausal women or in other risk groups):
– Hormone replacement increases bone mass, leads to the maintenance of health and quality of life for women. However, it should be used with great care and always under the supervision of a doctor, as it increases the incidence of breast cancer and thromboembolism.
Hormone replacement can be TRH, estrogens and progestogens, with TRH being the most recommended (it reduces the risk of fractures by up to 34%).
– Calcium . Except for medical exception, such as during pregnancy, the recommended daily intake (RDI) of calcium for women between 19 and 50 years old is 1000mg and for women over 50 years old it is 1200mg. The RDA for calcium for men aged 19 to 70 years is 1000 mg and for men over 70 years is 1200 mg years. You can consume calcium through your diet (eg dairy products, green leafy vegetables, calcium-fortified foods) or as a dietary supplement.
In the United States, women over 50 and men over 70 should consume at least 1200 mg of calcium daily.
– Vitamin D , also known as vitamin D3 (whose daily consumption should be 400 IU and even 800 IU or 1,000 IU for many doctors), to be obtained from food (fish), with moderate exposure to the sun with chewable vitamin D tablets (possibly combined with calcium).
– MSRES or selective estrogen receptor modulators (eg raloxifene), indicated in postmenopausal women.
– Exercises: Studies show that the regular practice of exercises, mainly aerobic ones, is important for the maintenance of bone mineral density and for the treatment of osteoporosis.
– In women after menopause, the use of hormones such as estrogen can prevent osteoporosis, reducing fractures (for example, of the hip). However, beware of a slight increase in the risk of breast cancer caused by these hormone therapies for some women. Your doctor can help you find out whether hormone replacement therapy is appropriate or not.
2. In the treatment of osteoporosis (curative, once osteoporosis is confirmed):
– Bisphosphonates increase bone mass in the femur and spine (alendronate, etidronate, risedronate, ibandronata), they must be taken in the form of tablets once a week or a month (depending on the medicine).
Bisphosphonates help inhibit bone destruction, preserve bone mass, and increase bone density, as reported by the Mayo Clinic . It is estimated that bisphosphonates reduce the risk of fracture by between 30 and 50%, depending on the type of fracture. Side effects of bisphosphonates can include gastrointestinal effects (eg, stomach upset). In very rare cases (1 to 4 cases in 10,000 people), bisphosphonates may increase the risk of hip and jaw fracture.
– Calcium and vitamin D3 (whose daily consumption of vitamin D3 should be 400 IU or even 800 IU or 1,000 IU for many doctors), to be used in chewable tablets, powder or effervescent tablets.
– Calcitonin decreases bone resorption (a thyroid hormone): to be used in nasal spray or in the form of ampoules, but using it requires a lot of care. In recent years, calcitonin has been less indicated for the treatment of osteoporosis (especially post-menopause), mainly because of some side effects. If used, it is advisable to use a low dose and for a short period of time.
– Fluoride salts (eg, sodium fluorate) are not a good option, as despite increasing bone mass they do not reduce the incidence of fractures, they provide poor quality bone that is not very resistant.
– In severe cases: possible use of parathyroid hormone (PTH), a hormone that favors the construction of bone tissue, can be prescribed by the doctor.
– Denosumab. It is a medicine of biological origin used in osteoporosis and also indicated for bone metastases. Denosumab has a subcutaneous injection presentation.
Interesting observation: with an adapted treatment against osteoporosis, the risk of fractures is halved.
In the United States, on April 9, 2019, the FDA (drug regulatory authority) authorized the marketing of romosozumab (romosozumab) under the brand name Evenity®. Romosozumab is a monoclonal antibody from the group of sclerostin inhibitors for the treatment of osteoporosis in postmenopausal women. It promotes bone formation and, to a lesser extent, also inhibits bone resorption. Effects are based on binding to the glycoprotein sclerostin, which inhibits osteoblast function, differentiation, proliferation and survival. The drug is injected subcutaneously once a month. The maximum duration of therapy is 12 months. Among the most common possible adverse effects are joint pain and headache. Results from a clinical trial indicate an increased risk of serious cardiovascular events on romosozumab.
Alternative treatments
The best natural way to prevent and therefore delay the onset of osteoporosis is to eat foods rich in calcium (cheese, milk, certain vegetables) and drink mineral water that is also rich in calcium. The aim is to have a daily intake of 1’000 mg (1gr) of calcium or more (up to 1’500 mg).
It is also important to ingest a sufficient amount of vitamin D (vitamin D3), as it allows good absorption of calcium in the intestine. In general, in spring and autumn, normal exposure to the sun (20 minutes from time to time) allows sufficient vitamin D synthesis (the sun activates vitamin D synthesis in the skin). In winter and other periods of poor sun exposure, it is strongly advised to have a diet rich in vitamin D which is found in fish or egg yolk.
Tips
Eat calcium-rich foods such as dairy products: milk, butter, cheese, yogurt or certain vegetables (broccoli, fennel)
– Drink plenty of mineral water, as it is rich in calcium .
– Practice sports (running, etc.) or exercise (walking), as this has a beneficial effect on reducing and delaying osteoporosis.
A Spanish scientific study, carried out by the Camilo José Cela University, showed that jogging ( running ) made it possible to increase bone density or, at worst, the level of the calcaneus, as demonstrated in this research work. Spanish scientists have also shown that the more kilometers one travels, the more bone health improves.
According to this research, certain sports practices, such as weightlifting, running or high jumping, qualitatively strengthen the bones and, particularly, the mineralization density. This study was published in the February 2016 issue of the European Journal of Applied Physiology .
– If you suffer from osteoporosis, be very careful about falls, take precautions to avoid them (use suitable footwear, have good posture, avoid slippery floors, etc.) !
– Perform the movements correctly and adopt good posture, especially in the back. Poorly executed exercises can exacerbate symptoms. If possible, call a professional to guide you.
– Avoid smoking and drinking alcohol to excess.
News:
– 5 Tips for Strong Bones
– Calcium Supplements Don’t Strengthen Bones
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