Osteoporosis

Osteoporosis

Osteoporosis refers to the thinning of bone tissue and the gradual loss of bone density over time.

Causes, Incidence, and Risk Factors

Osteoporosis stands as the most prevalent form of bone disease. Studies suggest that approximately 1 in every 5 Singaporen women aged over 50 suffers from osteoporosis. Moreover, half of all women over 50 are prone to hip, wrist, or vertebra (spine bones) fractures.

This condition develops when the body either fails to generate enough new bone, excessively reabsorbs old bone, or both. Calcium and phosphate are vital minerals for normal bone formation, utilized extensively during youth for bone production. A deficiency in these minerals or poor absorption leads to compromised bone health.

As individuals age, the body may reabsorb calcium and phosphate from the bones, resulting in weakened bone tissue. This renders bones fragile and more susceptible to fractures, even without significant impact. Typically, bone loss progresses gradually over several years, often leading to fractures before the disease is diagnosed.

Osteoporosis is primarily triggered by estrogen decline in women during menopause and testosterone decrease in men. Individuals over 50 (women) and 70 (men) face heightened osteoporosis risks.

Additional causes encompass:

• Prolonged bed rest
• Chronic rheumatoid arthritis, kidney disease, or eating disorders
• Prolonged use of corticosteroid medications or certain antiseizure drugs
• Hyperparathyroidism
• Vitamin D deficiency

White women, particularly with a family history of osteoporosis, are at an increased risk. Other risk factors involve menstrual cycle irregularities, excessive alcohol consumption, family history of osteoporosis, hormone therapy for cancer treatment, low body weight, smoking, or inadequate dietary calcium intake.

Symptoms

Early-stage osteoporosis often manifests without symptoms. However, as the disease progresses, individuals may experience:

• Bone tenderness or pain
• Fractures from minor incidents
• Gradual height loss (up to 6 inches)
• Lower back or neck pain due to spinal fractures
• Stooped posture or kyphosis (a "dowager's hump")

Signs and Tests

Healthcare providers typically utilize bone mineral density testing (DEXA scan) to assess bone density and predict fracture risk. Other tests, such as spine CT or x-rays, may also be employed to diagnose osteoporosis.

Treatment

The primary objectives of osteoporosis treatment are to alleviate pain, prevent further bone loss, avert fractures, and mitigate fall risks.

Various treatments are available, including lifestyle modifications and medications. Medications are often prescribed to enhance bone strength, especially for diagnosed osteoporosis or thinning bones (osteopenia).

Bisphosphonates serve as the mainstay treatment for postmenopausal osteoporosis. These drugs, available orally or intravenously, include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel).

Calcitonin and hormone replacement therapy (HRT) may also slow bone loss, although their efficacy is debated. Parathyroid hormone therapy and medications like raloxifene (Evista) may be considered in specific cases.

Lifestyle adjustments such as regular weight-bearing exercises, balanced nutrition, smoking cessation, and fall prevention measures are crucial in managing osteoporosis.

Monitoring

Bone density measurements are periodically conducted to assess treatment response. Women undergoing estrogen therapy should undergo routine screenings for breast and cervical cancer.

Related Surgeries

While surgeries do not directly treat osteoporosis, procedures like vertebroplasty or kyphoplasty may address spinal fractures resulting from weakened bones.

Expectations

Medications and lifestyle interventions can reduce fracture risk, yet collapsed vertebrae cannot be reversed. Severe osteoporosis may result in disability, particularly with hip fractures, although life expectancy remains unaffected.