Osteoporosis is a condition characterised by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis means “porous bones.
When the balance between breakdown and rebuilding is disturbed – for example, by hormonal changes or dietary changes – the bone may lose some of the minerals that contribute to its density and strength. A condition of diminished bone density is called osteopenia. When a significant loss in bone density occurs, such that the bone is markedly weakened and susceptible to fracture, the condition is termed osteoporosis.
Bone mass (bone density) decreases after 35 years of age, and bone loss occurs more rapidly in women after menopause. About half of women 50 and older will have an osteoporosis-related fracture in their lifetime.
Types of Osteoporosis:
- Primary- or age-related osteoporosis
This refers to osteoporosis developing without any apparent cause. It is much more common in women but can also be seen in men, particularly in older men.
This refers to bone loss due to another disease. It affects both men and women and may be due to several different disorders including rheumatoid arthritis, hyperparathyroidism, Cushing’s disease, chronic kidney disease, multiple myeloma, or drugs such as anti-epileptics, glucocorticoids, or lithium.
Causes of Osteoporosis:
- Low Calcium Diet
- Lack of Physical Activity
- Family History: If someone in your family has or had osteoporosis, you are more at risk
- Gender: Women are simply more likely to develop osteoporosis
- Ethnicity: White and Asian people are more likely to be affected
Osteoporosis is called a “silent disease”. It can be present without any symptoms for decades because osteoporosis doesn’t cause symptoms until bone fractures. Back pain, caused by changes in the vertebrae, may be the first sign that something is wrong.
Testing & Diagnosis:
Testing may be done to screen for bone density loss or to evaluate bone status when a person has an unexpected bone fracture and may be used to monitor osteoporosis therapy for effectiveness. Diagnostic imaging, a non-laboratory test, is used in the Bone Mineral Density test, the primary screening and diagnostic test for osteoporosis.
Blood calcium levels – this test is usually normal in osteoporosis but may be elevated with other bone diseases.
Vitamin D – deficiencies can lead to decreased calcium absorption
Thyroid tests – such as T4 and TSH to screen for thyroid disease
Parathyroid hormone (PTH) – to check for hyperparathyroidism
Follicle-stimulating hormone (FSH) – to check for menopause
Testosterone – to check for deficiency in men
Protein electrophoresis – to identify abnormal proteins produced by a certain type of cancer (called multiple myeloma) that can break down bone
Alkaline phosphatase (ALP) – to test for increased levels that may point to a problem with the bones
Bone markers are blood and urine tests that may sometimes be ordered to help evaluate and monitor the rate of bone resorption and formation. They are not used for diagnosis.
Tests measuring bone loss
Bone resorption tests tell about the rate of bone loss. They can be checked before treatment and again after treatment to see if the rate of bone loss has decreased. They include:
C-telopeptide (C-terminal telopeptide of type 1 collagen (CTx))
Urinary collagen type 1 cross-linked N-telopeptide (NTX)
Tartrate-resistant acid phosphatase (TRAP) 5b
Bone sialoprotein (BSP)
Tests measuring bone formation
Bone formation tests tell about the rate of bone production. As with bone turnover tests, they may be checked before the start of treatment and periodically after treatment to see if bone formation has increased. They include:
Bone-specific alkaline phosphatase (ALP)
Osteocalcin (bone gla protein)
P1NP (Procollagen Type 1 N-Terminal Propeptide) and C-terminal (C1NP)
The best treatment for osteoporosis is prevention. While preventive measures cannot eliminate every case of osteoporosis, regular weight-bearing exercise (such as walking and resistance training), eating foods rich in calcium and vitamin D (and supplements as needed), quitting smoking, and moderating alcohol consumption can all help reduce the risk.
The variety of treatments is available, including antiresorptive medications and bone forming (anabolic) medications to help inhibit bone resorption, increase bone formation, maintain bone mass, and reduce the number of fractures people affected by or are at increased risk of osteoporosis.