Melomed Articles

27 August 2019 - Dr. Zaraina Solomons

Osteoporosis: Love your bones, Protect your future. Steps to Prevention.

As we exit the month of August after paying homage to women on Women's day, we enter the month of October.  In addition to focusing on breast cancer awareness another topic highlighted this month is World Osteoporosis Day celebrated on the 20 October. 

Millions of people worldwide suffer from Osteoporosis which is a disease characterized by bone breakdown or loss. According to the WHO this systemic disease results in low bone mass and deterioration of the architecture of bone which increases the risk of developing fractures. These fractures tend to involve the wrists, spine, hips and pelvis. Osteoporosis should not be confused with Osteoarthritis. The latter is a form of arthritis where there is wear and tear of the cartilage resulting in joint disease.  

More than 10 million people are affected by the disease and each year it contributes significantly to the rate of fractures (broken bones) of the back, wrists and hips. More women are affected than men and it is the leading cause for fractures in post- menopausal women and the elderly. Women are the more affected demographic due to: 
  • Inherently smaller and thinner bone structure compared to men.
  • Natural bone loss with age due to increased longevity
  • Natural of bone mass following menopause with decreased levels of oestrogen which acts in a protective capacity for bone. 

  • Bones are organs that consist of calcium and other minerals. Bone is constantly being renewed or turnover. This process occurs from childhood into young adulthood and the body is able to replenish the cells that die hence bones remain strong. In patients with osteoporosis there is a mismatch in the degree of bone breakdown versus the degree in which it can be replaced. This increases the likelihood of thinner more brittle bones with an increased propensity to break with pressure or a fall. It is often called the silent disease' as bone loss occurs without any warning signs. 
    The other major associated risk factors for the development of osteoporosis are as follows:
    • Dietary insufficiencies such as lack of Calcium and Vitamin D which has been implicated in the development of weak bones. Certain conditions that result in lack of nutrient intake such as Anorexia Nervosa confers a higher risk for Osteoporosis. 
    • A lack of exercise or inactive lifestyle can predispose to Osteoporosis. High impact exercises can help build and maintain bone mass. 
    • Cigarette smoking and excessive alcohol consumption can increase the risk for Osteoporosis. Chronic alcoholism is associated with low bone density, impaired bone cell activity and issues with metabolism that reduce bone health. 
    • Medications used for chronic conditions such as steroid therapy, certain epileptic medication and anti- cancer medication can predispose to development as well. 

    Most patients are unaware that they have the disease as they remain symptomless until they have a fracture. Fractures affecting the vertebra can result in serious problems and results in the following symptoms:
    - Sloping of the shoulders with a curve in the spine resulting in a hunched posture.
    - Height loss 
    - Back pain 

    These fractures can happen during day-to-day activities like climbing stairs, lifting objects, or bending forward when you have osteoporosis.

    In addition to the above symptoms your doctor will consider screening you for osteoporosis if the following criteria are met:
    - Over the age of 65
    - Younger than 65 with multiple risk factors. 
    The diagnosis of osteoporosis can be easily made via a DEXA scan which specifically looks at your bone density. This imaging modality uses low doses of radiation and is a fast and painless procedure.  

    In the setting of Osteoporosis, prevention is key. This involves building strong bones during childhood and teen years as its important to prevent it later on. To ensure this one needs to address risk factors individually. If the diagnosis of Osteoporosis is made your doctor will start you on a combination of bisphosphonate therapy with calcium and Vitamin D supplementation with yearly monitoring to escalate therapy based on repeated bone scans. 


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