What is Osteoporosis?

Osteoporosis is a bone disease characterized by reduced bone strength resulting in an increased risk of fractures with minimal trauma. Bones are normally in a process of constant “renewal” (bone metabolism). Specialised bone cells, called osteoclasts, degrade the older bone, which is replaced by new bone produced by other specialized cells, called osteoblasts. Disruption of this process leads to osteoporosis.

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What are the causes?

• .Age is one of the most important risk factors.

The older we get, the higher the risk of osteoporosis. This is because as we get older the process of continuous bone renewal declines and the predominance of degradation over new bone synthesis prevails. On the contrary, at a young age, new bone synthesis predominates over degradation, which peaks in the 3^rd decade of life, when we acquire our peak bone mass.

• Female gender is also a risk factor for osteoporosis,

both because women abruptly lose their oestrogens during menopause and because men gain more bone mass.

• Caucasian race increases the risk of fracture.
• A positive family history also increases the risk of fracture. An important risk factor is the presence of osteoporosis in the family, especially the presence of hip fracture in the parents.

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• Low body weight is a risk factor for osteoporosis.
• Endocrine diseases, such as hyperthyroidism, hypogonadism (low oestrogen in women, low testosterone in men), vitamin D deficiency, and hyperparathyroidism, are possible causes of osteoporosis and fracture.
• Diseases such as celiac disease, inflammatory bowel disease, multiple myeloma and rheumatoid arthritis are also causes that lead to osteoporosis.
• Low calcium intake with food, but also
• various drugs such as corticosteroids, oestrogen-blocking treatments for breast cancer, testosterone-blocking treatments for prostate cancer, antiepileptic medications.
• while smoking,
• alcohol abuse, and
• the sedentary lifestyle

are also important risk factors.

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What are the symptoms and signs?

• Asymptomatic
• Back pain
• Loss of height
• Fracture
• Deformity of the spine (hunchback)

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Which are the complications of Osteoporosis?

• Vertebral and
• hip fractures are the most common complications, leading to
• disability and
• a reduction in the quality of life.

Hip fractures usually occur after a fall and in addition to the disability are also associated with

• an increased risk of death within a year of the fracture.

On the other hand, vertebral fractures can occur automatically and lead to

• significant pain,
• loss of height and even in
• spinal deformity, the well-known “hunchback”.

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How is Osteoporosis diagnosed?

Osteoporosis is diagnosed either clinically (presence of a fracture with minimal trauma) or by measuring bone density (DEXA scan). In either case, a physical examination and history taking are required.

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What is Osteopenia?

Osteopenia is low bone mass, and is also diagnosed by measuring bone density. Osteopenia can lead to osteoporosis and can, if risk factors co-exist, predispose to fracture.

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Osteoporosis prevention

Prevention of osteoporosis is clearly preferred to its treatment, because in osteoporosis, apart from bone loss, there is also destruction of the bone microarchitecture, which is largely irreversible. The prevention of osteoporosis begins in childhood and especially in adolescence, where bone is synthesised with the aim of achieving peak bone mass, and continues into adulthood, with the aim of minimising bone loss. Six are the keys to preventing osteoporosis:

• A healthy diet with an adequate intake of protein, fruits, vegetables and legumes.
• Maintaining a normal body weight as lower than normal weight predisposes to bone loss and fractures, and we now know that above normal weight also predisposes to fractures of the upper limbs and wrists.
• Calcium through the consumption of low-fat dairy products, vegetables and some fish. Calcium is a key structural material of bones and makes them dense and strong. Menopausal women lose calcium in their urine every day. In the first 5 years after menopause, women who do not receive oestrogen replacement therapy lose about 5% to 8% of their bone mass.
• Vitamin D, through sun exposure. Vitamin D is primarily synthesized in the skin when it is exposed to the sun’s ultraviolet radiation (UVB). Few foods contain adequate vitamin D. Vitamin D helps calcium absorption, increases bone mass and improves balance. In addition, it appears to have multiple beneficial effects on various body systems.
• Exercise as the bones, like muscles, when exercised become stronger and denser.
• Quit smoking & excessive alcohol consumption as both these two habits are associated with reduced bone mass and increased risk of fracture.
• Pharmacological treatment. In most cases, medications to prevent osteoporosis are not prescribed. However, in some cases, such as in patients being treated with glucocorticoids for another disease, or in patients with osteopenia and a very high risk of fracture, pharmacological therapy may benefit them and reduce their risk of fracture. These decisions are always individualised.

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How is Osteoporosis treated?

/ / / Lifestyle Modifications

The following lifestyle changes in patients with osteoporosis help to limit bone loss and include:

• Measures to prevent falls by controlling vision, using appropriate footwear, controlling the home environment, treating postural hypotension, treating vitamin D deficiency, and physiotherapy.
• Calcium through consumption of low-fat dairy products, vegetables and some fish. Calcium is a key structural material of bones that makes them dense and strong. Menopausal women lose calcium in their urine every day. In the first 5 years after menopause, women who do not receive oestrogen replacement therapy lose about 5% to 8% of their bone mass.
• Vitamin D, through sun exposure. Vitamin D is primarily synthesized in the skin when exposed to the sun’s ultraviolet radiation (UVB). Few foods contain adequate vitamin D. Vitamin D helps calcium absorption, increases bone mass and improves balance. In addition, it appears to have multiple beneficial effects on various body systems.
• Exercise for osteoporosis as bones, like muscles, when exercised become stronger and denser.
• A healthy diet with an adequate intake of protein, fruits, vegetables and legumes.
• Maintaining a normal body weight as lower than normal weight predisposes to bone loss and fractures, and we now know that above normal weight also predisposes to fractures of the upper limbs and wrists.
• Quit smoking & excessive alcohol consumption as these two habits are associated with reduced bone mass and increased risk of fracture.

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/ / / Pharmacological Treatment

Treatments for osteoporosis are divided into:

• those that prevent bone loss, anti-osteoclastic and in the
• anabolic therapies, which regenerate the bone.

The first category includes:

• bisphosphonates,
• the monoclonal-antibody inhibitor of RANKL Denosumab,
• the selective oestrogen receptor modulators raloxifene and bazedoxifene, and
• hormone replacement therapy with oestrogen/progesterone.

The anabolic agents include:

• Teriparatide, which is an analogue of parathyroid hormone.
• Abaloparatide, which is an analogue of parathyroid hormone.
• Romosozumab, which is a monoclonal Antibody; Sclerostin Inhibitor.

Patient selection for a certain drug should be done carefully to make sure that they meet the requirements for the class of medicine they will receive. Patients should also be followed by their endocrinologist, who will check on the progress and success or failure of the therapeutic option and the existence of possible side effects.

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