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    Osteoporosis

    Overview
    Risk Factors
    Symptoms
    Diagnosis
    Prevention
    Treatment Options
    Where to Seek Treatment
    Singapore General Hospital
    Contributed by Dept of Orthopaedic Surgery

    Overview


    Osteoporosis is a condition that causes thinning and weakening of bones. Brittle bones are more prone to fractures. These fractures may happen even with very minimal trauma. Although any bone can be affected, the fractures typically occur in the hip, spine and wrist.

    Worldwide, 200 million women suffer from osteoporosis and a woman’s risk of hip fracture is the same as her combined risk of developing breast, uterine and ovarian cancer. In Singapore, the number of osteoporosis - related hip fractures in women over 50 years is 8 times more than that of breast cancer cases.

    Who is at risk?

    Although women 50 years or older are most at risk for osteoporosis, younger women and men can also be affected.

    Peak bone mass is attained by the age of 30. After that, bone mass gradually decreases. In pregnant and lactating women, the pace of bone loss will temporarily increase if the increased calcium demands of pregnancy or breastfeeding are not met by increased dietary intake of calcium. In women, there is also a significant decrease of bone mass in the immediate period following the onset of menopause. 


    Risk Factors


    Risk factors can be divided into those that can be changed and others that cannot.

    Risk factors that cannot be changed

    • Age - The risk for osteoporosis increases as one gets older
    • A woman who has gone through menopause - After menopause, the body produces less estrogen, estrogen protects the body from bone loss
    • Family history of osteoporosis or osteoporosis-related fractures
    • Slender body frame (small bone structure)
    • Race - A person of Caucasian or Asian ancestry is more at risk
    • Low bone mass or osteopenia
    • Previous fracture following a low level trauma, especially after age 50

    Risk factors that can be changed

    • Smoking - Don’t smoke as smoking causes bone loss and early menopause
    • Excessive alcohol consumption - Excessive amounts of alcohol not only reduce bone formation, it also affects the body’s ability to absorb calcium
    • Sedentary lifestyle

    Other causes of osteoporosis

    • Medications: Using some medications long term can damage bone. These include corticosteroids to treat chronic conditions such as asthma, rheumatoid arthritis etc, medications
      that lower sex hormones, some anti-seizure medications and sometimes thyroid hormone when prescribed in high doses. Talk with your health care provider about the medications you take
    • Other causes: Various conditions can interfere with calcium absorption and contribute to bone loss. These include liver or kidney disease, diabetes, hyperthyroidism (overactive thyroid), Cushing’s disease (in which the body produces excess cortisol) and conditions like anorexia nervosa

    Symptoms

    Osteoporosis is called the ‘silent disease’ because bone loss occurs without symptoms and is painless. The condition often is not detected until it is quite advanced. Some signs in the advanced stages may include:

    • Fracture of the hip, spine and wrists
    • Back pain
    • Loss of height over time

    Diagnosis

    Osteoporosis can be detected through a Bone Density Test most commonly done using a DEXA scan. The test can determine if you have osteoporosis by measuring the bone mineral density or bone strength at the hip and spine.

    The test is quick and painless and is similar to having an x-ray taken but uses much less radiation.

    Who should be tested?

    • Early menopause before 45 years
    • Had previous fracture from fall
    • Immediate family member with osteoporosis
    • Thin or underweight
    • Frail as a result of long term illness
    • Women with conditions associated with osteoporosis such as rheumatoid arthritis
    • Prolonged use of corticosteroids or thyroid medication

    Prevention

    Engage in regular weight-bearing exercise

    Do so at least 3 times a week, but it is important to avoid exercise that can injure weakened bones. Patients who have not exercised before or suffer from medical problems should consult their doctor first.

    Diet

    Get enough calcium, vitamin D and phosphorus either through food or supplements. An adult under 50 needs 1,000 mg of calcium daily. Adults over 50 need over 1,200 mg of calcium daily.

    Vitamin D is needed by the body to absorb calcium. Vitamin D can either be obtained through the skin from exposure to sunlight or through diet. An adult under 50 years needs 400-800 IU of Vitamin D daily while adults over 50 needs 800-1000 IU of Vitamin D daily.

    If you have difficulty getting the calcium and vitamin D that you need from your diet, you can take supplements.


    Treatment Options

    Although there is no cure for osteoporosis, several treatments are available that can prevent further bone loss and improve bone strength. This can significantly reduce the risk of fractures. Medication, exercise and nutrition all play a role in treatment.

    Medication

    Currently most of the approved osteoporosis medications are known as ‘antiresorptive’ agents because they stop resorption (or depletion) of bone mineral from bones. Medicines that can stimulate bone formation are also available. Your physician can help you decide which treatment is best for you.

    If you are diagnosed with osteoporosis, your physician may recommend one of the following medications:
    Bisphosphonates that include agents like Alendronate (Fosamax®), Risedronate (Actonel®), Ibandronate (Bonviva®) and Zoledronic Acid (Aclesta®). Selective Estrogen Receptor Modulators such as Raloxifene, Nasal Calcitonin (Miacalcin®), the newer agent Strontium (Protos®) that may have a double action of stopping bone resorption and stimulating bone formation or the anabolic (bone forming) medication Teriparatide (Forteo®) that is given as a daily injection. It is important to note that the choice of drug therapy can be complex. Your treatment will be tailored for you.

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