Osteoporosis
Background
Osteoporosis is a condition in which the bones become less dense and more likely to break. A broken bone is often the first indication of osteoporosis. Any individual over the age of 50 with a broken bone should be evaluated for osteoporosis. The wrist, shoulder, hip, and vertebral column are the most likely locations for fractures to occur. Vertebral fractures can cause a stooped posture, loss of height, and shooting pain from a compressed nerve. require bed rest and increase the risk of developing potentially life-threatening complications such as a blood clot (DVT) in the legs as a result.
An individual’s bone density normally peaks around 30 years of age. Bone density begins to decrease with further aging. Osteoporosis is diagnosed when a person’s bone density falls 2.5 standard deviations below the normal bone density of a healthy person (i.e the average bone density of someone in their early 30’s). Osteopenia is considered a precursor to osteoporosis and occurs when a patient’s bone density falls 1.0-2.5 standard deviations below normal bone density.
The rate of decrease in bone density often determines whether a person will develop osteoporosis during their lifetime. As a result, increasing age is the most important risk factor for the development of osteoporosis. Decreases in estrogen after menopause is associated with a rapid decrease in bone density. Falling testosterone has a similar but less severe effect. Vitamin D deficiency, smoking, and excessive alcohol consumption are also factors that increase the risk of developing osteoporosis. In addition, there is often a hereditary disposition for the development of osteoporosis s a positive family history is a significant risk factor. Osteoporosis can develop in female endurance athletes as a part of the female athlete triad (osteoporosis, disordered eating, amenorrhea). Chronic kidney disease can also lead to osteoporosis.
Diagnosis
The diagnosis of osteoporosis is made by measuring bone mineral density with a specially calibrated x-ray machine called a dual energy x-ray absorptiometry scan or DVA scan (this was previously known as a Dexa scan). Several biomarkers can also be detected in the blood that may indicate bone loss.
Treatment
Prevention is the simplest form of treating osteoporosis. Smoking cessation and limiting alcohol intake will both decrease the risk of osteoporosis. Bone health can also be maintained with adequate nutrition.
Weight-bearing exercises and activities improve muscle strength and promote bone strength.
Medications such as bisphosphonates have been shown to stabilize or improve bone density and decrease the risk of a second fracture.
Physical therapy can be helpful for those with osteoporosis. Physical therapy can correct posture, improve functional movement, and decrease the risk of falls.
It is important for patients to work closely with their primary care provider or an expert in osteoporosis management to develop a coordinated approach to preventing the development of osteoporosis -or having a coordinated approach to treating osteoporosis if it has already occurred.
Edited March 13th, 2021