Osteoporosis: Prevention and Treatment

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Table of Contents

Risk Factors of Osteoporosis
Etiology and Pathophysiology of Osteoporosis
Clinical Manifestations
Diagnostic Tests
Treatment Options
Pharmacological
Non-Pharmacological
Preventive Measures
Conclusion
References

Osteoporosis is defined as a bone condition when the body loses too much bone or does not produce enough for sustainable well-being. As a result of this condition, the bone matter becomes weaker as time goes on and thus increases the risks of breaking from falls. In the most severe cases of osteoporosis, patients can experience the breaking of bones because of such minor accidents as hitting bumps or sneezing. In this paper, the condition will be reviewed from different perspectives. The risk factors, etiology, pathophysiology, clinical manifestations, diagnostic tests, treatment options, and preventative measures of osteoporosis will be discussed in detail.

Risk Factors of Osteoporosis

The bone matter is in a continuous state of renewing itself, which means that its old cells break down while new ones are made. When people are young, these cells renew themselves quicker, thus making the bone stronger and less susceptible to breaking. The peak of gaining bone mass usually occurs in the middle of the ’20s. With age, the regeneration of bone matter slows down thus contributing to the loss of bone mass because the cells break down faster than they are created. Therefore, there is a direct connection between how much bone mass has a person developed during their young age (Delaisse, 2014). The higher the bone mass associated with the peak of its development, the more bone will be retained for the rest of the life. If there is not enough bone mass, the higher is the likelihood of osteoporosis development as time goes by.

There are multiple categories of risk factors that can initiate the development of osteoporosis. Among unchangeable risks, sex, age, race, family history, and body frame size are the most likely to influence the condition’s development (Delaisse, 2014). For instance, women have more likelihood of getting osteoporosis compared to men. As already mentioned, the older one gets, the higher the risks of osteoporosis are. When it comes to race, individuals of Asian descent and whites are more likely to get osteoporosis as well as those whose siblings have been diagnosed with the disease in the past. Moreover, one’s body frame size may affect the loss of bone matter, and individuals with smaller body frames lose their bone mass quicker.

Hormone levels have also been linked to the increased risks of osteoporosis. For instance, lower sex hormones contribute to the loss of bone mass. Menopausal women or those treated from breast cancer whose levels of estrogen drop face an increased likelihood of getting osteoporosis (Maeda & Lazaretti-Castro, 2014). Regarding men, the levels of testosterone may drop with age or due to treatments for prostate cancer, subsequently contributing to the loss of bone matter. In people with thyroid problems, the production of high numbers of the thyroid hormone contributes to the lower number of bone cells. Furthermore, when people take a lot of hormonal medication to treat an underactive thyroid, they can risk losing bone cells.

Lifestyle preferences including dietary factors have also been linked to the risks of getting osteoporosis. The low intake of calcium, eating disorders, and gastrointestinal surgery can contribute to the loss of bone mass. Calcium-rich foods and supplements are usually prescribed to reduce the risk factors for osteoporosis (Reid, 2014). The restriction of dietary choices due to such issues as food disorders has been shown to contribute to osteoporosis occurrence. Poor lifestyle habits such as alcohol abuse, tobacco smoking, and sedentary life increase the risks of osteoporosis. Because of this, eliminating unhealthy habits and being more active is often recommended.

Etiology and Pathophysiology of Osteoporosis

Osteoporosis is defined as a health condition characterized by skeletal fragility and the reduced mass of the bone associated with the deteriorating bone tissue, thus increasing the risks of fracture. The pathophysiology of osteoporosis is linked to the under-development of bone mass as well as overall skeletal components of fragility (Maeda & Lazaretti-Castro, 2014). In addition, the condition is characterized by extra-skeletal factors that consequently lead to fractures. The strength of the bone is determined not only by its mass but also by such factors as the shape and the size of the bone, its mineralization, turnover, and architecture. Due to the multifactorial pathophysiology of osteoporosis, there is a recommendation for having an all-encompassing approach and multifaceted prevention.

Bone is an active tissue that changes because of the influence of such factors as age, lifestyle choices, and hormonal changes. The process of bone remodeling starts with the resorption of the matter associated with the conversion of the quiescent bone surface into a resorptive one (Delaisse, 2014). When the bone’s surface receives signals to its osteoblasts and osteoclast, osteocytes initiate the process of bone restoration. The entire process is sustained with the help of calciotropic hormones (estrogen, calcitonin, 1,25-dihydroxy vitamin D, and PHT), cytokines (interleukins 1, 6, 11), and colony-stimulating factors. When the supply of these factors is not enough for the healthy remodeling of the bone matter, individuals lose bone mass and thus are more likely to be diagnosed with osteoporosis.

Clinical Manifestations

In most cases, patients diagnosed with osteoporosis at the early stages may not feel any symptoms. Once the bone matter becomes weaker and the body cannot retain the recommended amount of bone, some signs can include back pain associated with a collapsed or fractured vertebra. Other symptoms include the gradual loss of height over some time, an easy occurrence of bone fractures, as well as a stooped posture. It is recommended for patients to contact a health provider in cases when they have undergone early menopause or were prescribed to take corticosteroids for a long period. Also, people should be attentive to the risks of osteoporosis in cases when their parents had hip fractures as adults.

Osteoporosis is not diagnosed usually until a person fractures his or her bones. This is a problem because many patients who have not experienced any symptoms may wrongly believe that they do not have osteoporosis. However, patients with pain in their back or joints may suspect osteoporosis without really having it. Therefore, appropriate diagnosis procedures are necessary to address this issue as well as reduce the occurrence of fractures through administering appropriate medications and improving the lifestyle overall.

Diagnostic Tests

Before administering any diagnostic tests, a doctor will review a patient’s medical history as well as to inquire about the occurrence of adult fractures among his or her family members. The next step is conducting a bone mineral density (BMD) test because X-rays do not measure the density of bones but can help in identifying fractures. Dual-energy X-ray absorptiometry (DXA) is the most common BMD test that uses low-radiation X-rays that can detect the levels of bone loss. Usually, spine and hip bone density are measured while in some instances doctors may choose to measure the density of an entire skeleton (Liu et al., 2015). Different BMD tests that target specific areas in patients’ bodies include single-energy X-ray absorptiometry targeting wrists or heels, dual photon absorptiometry targeting hips, the spine, or an entire body, single-photon absorptiometry targeting wrists. Quantitative Computed Tomography (QCT) targets the hips and the spine, peripheral QCT targets the forearm, and Quantitative ultrasound targets fingers or heels through the use of sound waves.

As a result of these diagnostic tests, patients get a reference measurement for determining whether they have osteoporosis or not (see Table 1). Usually, osteopenia is evident when the t-score is in the range between 1 and 2.5. The table below shows the correspondence between t-test scores and the severity of osteoporosis:

Severity of Condition	Bone Mass Density (Hip) T-score
Normal	-1 or above
Osteopenia	lower -1 and higher than -2.5
Osteoporosis	-2.5 or lower
Severe osteoporosis	-2.5 or lower + fracture

Table 1. Osteoporosis classification (Self-generated).

Based on the t-test results presented above, doctors conclude whether patients require just dietary and lifestyle changes to address osteopenia or need to be prescribed complex medication for osteoporosis. Importantly, in the absence of fractures but high t-test scores, it does not mean that patients will have them in the future if they implement appropriate measures to address their condition. Radiological assessments of Bone Turnover Markers (BTM) have also been used for measuring the extent of osteoporosis. This test measures bone resorption markers, bone formation markers, as well as markers of osteoclast regulatory proteins (Shetty, Kapoor, Bondu, Thomas, & Paul, 2016).

Treatment Options

The treatment of osteoporosis encompasses both pharmacological and non-pharmacological options. The combination of the two methods has shown to be the most efficient because the disease is complex and thus requires several factors to be addressed. Importantly, the treatment is usually targeted to cater to the unique needs of different patients as well as the reasons that caused the condition’s development in the first place.

Pharmacological

Bisphosphonates are the most common medications that patients with osteoporosis are being prescribed. They include such prescription medications as alendronate, risedronate, ibandronate, and zoledronic acid. Alendronate targets the quick breakdown of bone matter and the increase of its thickness. Risedronate targets the same condition characteristics as alendronate while also being used for preventing osteoporosis that has been caused by taking steroid medications. Ibandronate has been approved for treating osteoporosis among postmenopausal women (Maeda & Lazaretti-Castro, 2014). Zoledronic acid is a medication that targets much more complex conditions apart from osteoporosis. For instance, it is prescribed for treating cancer that spreads from one organ to the bone (Liu et al., 2015). It should be mentioned that hormonal medications are used for addressing osteoporosis. Estrogen-based treatments have been prescribed for menopausal women for improving their bone health; however, they have been shown to have some negative side effects. When prescribing hormonal medications, it is important to weigh-in the benefits and threats about each patient.

Non-Pharmacological

Non-pharmacologic treatment of osteoporosis has been associated with enhancing the quality of one’s health and lifestyle by making positive behavioral choices. Patients diagnosed with the condition must be given information about the risks of the condition’s exasperation associated with making unhealthy life choices. For instance, individuals are recommended to eliminate smoking and alcohol use as well as encouraged to establish a calcium- and vitamin D-rich diet. Regular exercise programs are advised for retaining bone matter and slowing down its destruction. Alternative methods of treating osteoporosis are also commonly used. For instance, with the help of nuclear magnetic resonance (NMR) therapy, bone mineral density has been shown to increase significantly in a year (Krpan, Stritzinger, Lukenda, Overbeck, & Kullich, 2015).

Preventive Measures

The prevention of osteoporosis can be implemented during both childhood and adulthood. Children and adolescents are recommended to follow a nutritious diet that includes adequate amounts of calcium, proteins, and vitamin D. The peak bone mass is usually recommended to be increased by at least 10% to reduce the risks of osteoporosis in adulthood by 50% (Lewiecki, 2018). For adults, the same dietary advice is given for maintaining adequate bone mass. Adults should avoid malnutrition, and eating disorders in particular, which is why seeking psychological help is needed if nutrition has been undermined by mental instabilities. In addition to sustaining a healthy diet, adults are recommended to avoid heavy alcohol drinking and tobacco smoking (including second-hand). Overall, maintaining high bone mass is the target of preventive osteoporosis measures, and both diet and exercise can help in attaining this goal.

Conclusion

Osteoporosis is a complex condition, the symptoms of which do not manifest immediately, thus presenting some challenges for both patients and healthcare providers. However, by taking steps to establish a healthy lifestyle, patients of all ages can reduce the risks of osteoporosis occurrence. Apart from improving the overall health through exercise and a nutritious diet, pharmacological treatments are also available, especially in regards to elderly patients.

References

Delaisse, J. M. (2014). The reversal phase of the bone-remodeling cycle: cellular prerequisites for coupling resorption and formation. BoneKEy Reports, 3(561), 1-8.

Krpan, D., Stritzinger, B., Lukenda, I., Overbeck, J., & Kullich, W. (2015). Non-pharmacological treatment of osteoporosis with nuclear resonance therapy (NMR-therapy). Periodicum Biologorum, 117(1), 161-165.

Lewiecki, E. M. (2018). Osteoporosis: Prevention and treatment. In L.J. De Groot, G. Chrousos, & K. Dungan (Eds.), Comprehensive endocrinology book. Web.

Liu, M., Guo, L., Pei, Y., Li, N., Jin, M., Ma, L., … Li, C. (2015). Efficacy of zoledronic acid in treatment of osteoporosis in men and women-a meta-analysis. International Journal of Clinical and Experimental Medicine, 8(3), 3855-3861.

Maeda, S. S., & Lazaretti-Castro, M. (2014). An overview on the treatment of postmenopausal osteoporosis. Journal for the Brazilian Society of Endocrinology and Metabolism, 58(2), 162-171.

Reid, I. R. (2014). Should we prescribe calcium supplements for osteoporosis prevention? Journal of Bone Metabolism, 21(1), 21-28.

Shetty, S., Kapoor, N., Bondu, J. D., Thomas, N., & Paul, T. V. (2016). Bone turnover markers: Emerging tool in the management of osteoporosis. Indian Journal of Endocrinology and Metabolism, 20(6), 846-852.

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