Osteoporosis
What is osteoporosis?
The name osteoporosis comes from "osteo" meaning "bone" and "porosis" meaning "porous". This etymology is explained by the alteration of bone mass and structure. These two aspects reduce bone strength and make the bone weak and fragile. When a bone's strength is reduced and becomes weak and fragile, this increases the risk of fractures. Bone loss occurs silently, asymptomatically.
The most affected population is over 65 years of age, although osteoporosis may occur earlier. After age 50, the number of women with osteoporosis increases significantly; at age 65, 39% of women have osteoporosis; and at age 80, 70% of women have osteoporosis and of that 70%, 60% have had at least one fracture. Contrary to popular belief, men are not spared from this disease, but men are half as likely to have this condition as women.
Making the diagnosis
When a doctor suspects osteoporosis, he/she will often conduct a patient interview (to better understand the patient's symptoms, complaints, and medical history) and analyze the patient's risk factors for osteoporosis. A doctor must also check that there are no other causes for the individual's symptoms and complaints, such as a tumor, trauma, etc.
When a risk for or a history of osteoporosis exists, a doctor will generally prescribe an imaging exam called a "bone densitometry," which will give the individual's Bone Mineral Density (BMD). This exam is usually performed on two areas of the body: the lumbar spine and femur. Depending on the extent of the difference between the individual's BMD score and the normal (also known as the T-Score), a doctor will be able to determine whether the patient's bone density is higher or lower than the bone density of a healthy adult. As a result, a doctor can accurately determine whether an individual has osteopenia or osteoporosis. Osteopenia is when the bone density is lower than a normal healthy adult, but not to the extent of osteoporosis.
Fractures, the main complication of osteoporosis
The most frequent and severe complications are fractures. They most often reach the spine and hips, which are bones that are commonly under pressure to support an individual's weight. Hip fractures, which more often occur after a fall, can lead to disability and even death from post-operative complications (prolonged immobilization).
Fractures can sometimes occur spontaneously, such as when the vertebrae are so weak from bone density loss that they compress and collapse on their own. These fractures often cause severe pain, which may slowly fade away. The succession of these subsidences can lead to a curved back.
Preventable risk factors
Alcohol and tobacco: excessive consumption of these products can increase the risk of fractures.
Vitamin D or calcium deficiency: a diet low in calcium throughout life causes a deficit; vitamin D deficiency may be a result of a poor diet or to little sun exposure. These two deficiencies increase the risk of osteoporosis because calcium is less bound to the bones.
Lack of physical activity (physical inactivity): Physical exercise promotes the creation of strong bones.
Corticosteroids: Corticosteroids taken over periods of more than three months may cause bone degradation, increasing the risk of osteoporosis.
Low weight with lower BMI 19: low weight means low bone mass. The loss of a small amount of bone is serious and it increases the risk of osteoporosis.
Adapt your daily routine when you have osteoporosis
Since an osteoporosis diagnosis results in an increase in risk for fractures, precautionary measures should be taken to mitigate the risk of falling, such as adapting the interior of the home, work, and other often visited areas. Some examples would be to remove rugs, have no high objects, place grab bars in the bathroom, and increase the light throughout the house, especially the hallways.
It is also recommended that individuals diagnosed with osteoporosis adapt their diet by increasing the consumption of foods rich in calcium and vitamin D, such as eggs, cheese, parsley, mussels, and oysters.
What are the osteoporosis prescription treatments?
If the root cause for osteoporosis is identified (hyperthyroidism for example), it is important that the root cause is addressed. In these situations, the doctor may also prescribe medication to address the osteoporosis (see below for classes of osteoporosis drug treatments).
If no cause is identified, the drug treatment is based on several classes:
Bisphosphonates (their name ends with -dronate): decreases bone resorption (degradation), stabilizes bone mass, and increases bone mineral density. The medication must be continued for a minimum of three years.
Raloxifene: an anti-reabsorber. It is more commonly used with women who are under 70, at risk for breast cancer, and who have osteoporosis.
Teriparatide (a form similar to thyroid parathormone): often reserved for severe forms of osteoporosis with at least 2 vertebral fractures. It can be used with patients who have underwent subcutaneous corticosteroid treatment for no more than 18 months.
Strontium ranelate: has a dual action by acting on resorption and bone formation. It can be prescribed as a second-line treatment for women under 80 years of age without a history of phlebitis or pulmonary embolism.
Treatment decisions are made based on various criteria such as fracture history, risk factors, gender and contraindications to treatment.
What is the status of medical research?
In the field of osteoporosis, biotherapies promise significant improvements, particularly with denosumab, an antibody that aims to reduce bone resorption. It is prescribed in an injectable form once every 6 months. It also can be used with other diseases, such as ankylosing spondylitis and rheumatoid arthritis.
Sources: Article written under the supervision of Dr. Florence LEVY-WEIL, Head of Rheumatology Department at the Argenteuil Hospital Center (France).
Published Mar 6, 2018
