Bones undergo a dynamic process known as bone remodelling. This continuous process involves bone-formation and bone-reabsorption. During childhood and adolescence, bone-formation occurs at a higher rate than bone-reabsorption.
Osteoporosis is a condition where the bone is weakened due to reduced bone mass—from higher rate of bone-reabsorption than bone-formation—thus affecting its structural integrity. This causes osteoporotic patients to have an increased risk of developing fractures.
Osteoporotic fractures can occur anywhere. However, the most common areas affected are the wrist, hip, and spine. While wrist and hip fractures due to osteoporosis almost always result in the patients seeking medical treatment, spinal compression fracture are often perceived as normal back pain. As osteoporosis have no symptoms until a fracture has occurred, it is important to note that a compression fracture on one vertebra is an indicator that the patient is susceptible to more fractures. Hence, it is important to seek medical help to manage the condition.
Osteoporosis can affect men and women regardless of race. However, some studies indicate that women (especially those past menopause) are at a higher risk of developing the condition.
While osteoporosis does not manifest any symptoms especially in the early stages, symptoms and signs can be observed especially if the bones have become very weak. Some of the symptoms that are likely to manifest can include:
- Sudden sharp pain, especially made worse by activities that puts weight on the area
- Stooped posture
- Bone fractures that occur more easily
- Back pain (often secondary to a collapsed or fractured vertebra)
Several factors can significantly increase a person’s likelihood of developing osteoporosis. This can include lifestyle choices, medical conditions, race, age, and treatments, among others.
Risk factors that are beyond one’s control include:
- Age – the older one gets, the greater is the risk of developing the condition.
- Sex – women are more likely to develop osteoporosis compared to men.
- Race – those who are of White or Asian descent are more at risk of developing the disease.
- Size of body frame – individuals with smaller body frames are at a higher risk compared to their larger counterparts as they have less bone mass especially as they age.
- Family history – having someone in the family (siblings or parents) with osteoporosis can put one at a greater risk of developing the condition.
- Excessive alcohol consumption – consumption of more than two alcoholic drinks on a daily basis can increase the risk of osteoporosis.
- Sedentary lifestyle – those who spend more time sitting than being active have a higher risk of developing the disease.
- Tobacco use – while tobacco’s exact role in the development of the condition is not clearly understood yet, studies have shown that tobacco use can contribute to weak bones.
Osteoporosis is more common in people who have:
- Eating problems – individuals with anorexia are at a higher risk of the disease. Since people with anorexia have low food intake, the amount of calcium and protein ingested is significantly reduced.
- Low intake of calcium – calcium deficiency is identified as one of the major causes of osteoporosis. Low calcium intake can also result to increased fracture risks, bone loss, and diminished bone density.
- Gastrointestinal surgery – a bypass will limit the surface area available to facilitate nutrient absorption, including calcium.
Medications and Steroids
Long-term use of both injections and oral corticosteroid medications (i.e. cortisone and prednisone) has been known to interfere in the bone-rebuilding process. Osteoporosis has also been linked with medications used to combat other medical conditions such as:
- Transplant rejection
- Gastric reflux
Bone fractures (especially in the hip and spine) are considered two of the most serious complications of the condition. Hip fractures often occur due to falls. In some cases, it can result in disability and sometimes death—often from postoperative complications—in older adults. In some instances, spinal fractures can develop even without triggers. If the vertebrae (the bones that make up the spine) become severely weakened, it can crumple. This results in pain and a hunched forward posture.
Information from a bone density test is often taken into account before the doctor provides likely treatment recommendations. If the risk is low, treatment approach might just focus on lifestyle changes and modifying risk factors. However, in cases that need further treatment, the attending doctor will likely refer the following specialists:
- Physiatrist – treats muscle, bone, and nerve problems that affects movement
- Orthopedic doctor – can cast and repair broken bones
- Physical or occupational therapist – teach exercises and other means so patient can recover faster and resume routine activities
Depending on the location of the fracture, different techniques are used to restore mobility and function of the affected area. Some conditions require rest and recuperation while others might need corrective surgery. In the case of a compression fracture (broken vertebra in the spine), pain medication is often prescribed. Exercises, rest, and maybe a back brace (for the muscle spasms) might also be recommended while healing. However, if the pain is severe and persistent, patients might become likely candidates for:
- Kyphoplasty – a balloon device is inserted into the vertebra that is fractured. This is done to restore the shape and the height of the vertebra. Once removed, the device will leave a small cavity that will be filled with special bone cement.
- Vertebroplasty – bone cement is injected into the spine in order to stabilize it. Apart from alleviating pain, the procedure also helps ensure further bone fractures are minimized.
For individuals with hip fractures, treatment will depend on key factors like the severity of the break, the patient’s overall health, and the location of the hip fracture. Possible treatment options can include:
- Total or partial hip replacement
- Surgical repair using plates, nails, or screws
- Exercises to help build strength and facilitate better movement
For wrist fractures, the best treatment will be dependent on the location of the break. Given the right protection, some wrist fractures can heal on its own. In most cases, simple remedies such as a splint or cast and exercises for the wrist, hand, and forearm would suffice.