Osteoporosis Symptoms, Diagnosis, And Treatment

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It is a disease characterised by a decrease in bone density and quality. The main danger in bone resorption is the increased risk of bone fracture. Especially hip, spine and wrist fractures are frequently seen.

What Is Osteoporosis?

Bone loss occurs silently and worsens over time. There are usually no symptoms until the first fracture occurs. In people with advanced osteoporosis, a fracture can occur even with a simple bending movement or coughing. As a result of fractures, a serious health problem arises due to the constant pain and the dependence of an independent, self-sufficient person on the help of others. When a fracture of the spine occurs, it may initially be a new onset of severe pain, but over time it can turn into blunt pain and become constant pain.
Osteoporosis affects more than two hundred million people worldwide. One in three women and one in eight men develop osteoporosis.

Bone is a living tissue and is in a continuous cycle of destruction and construction. 8-10 per cent of all our bone tissue is renewed every year. Osteoporosis occurs when there is an imbalance between bone formation and destruction. When bone destruction is more than bone formation, bone resorption occurs and fragility increases.

In order to reach peak bone mass, a healthy diet, adequate calcium and vitamin D intake and physical activity are important. Bone mass generally starts to decrease in men in their 50s and in women in their 40s. Estrogen deficiency after menopause plays an important role in osteoporosis.

What Are The Symptoms Of Bone Resorption?

In the early stages, osteoporosis is usually asymptomatic. For this reason, it is also called “silent disease”. In osteoporosis, symptoms are manifested with fracture formation. A patient with osteoporosis does not need to have a trauma for a fracture to occur.

  • Back pain caused by a fractured vertebra
  • Shortening in height over time
  • Forward-leaning (kyphotic) posture
  • Very easy fracture of the bones

When To Consult A Doctor?

If you have any of the following conditions, you should talk to your doctor about osteoporosis:

  • If you have early menopause
  • If you have long-term use of corticosteroids
  • If you have a family history of hip fracture

What Are The Most Common Causes Of Osteoporosis?

Age-related osteoporosis and osteoporosis after menopause are the most common causes.

What Are The Risk Factors For Osteoporosis?

There are many internal and external factors that affect the quality of bone tissue. Osteoporosis can be seen in everyone, but there is a faster bone turnover in women, especially after menopause.

  • Advanced age
  • Being a woman
  • Being weak
  • Early menopause (natural or surgical)
  • History of prolonged absence of menstruation
  • Eating disorders (especially anorexia)
  • Certain diseases (inflammatory bowel disease, rheumatoid arthritis, lupus, diabetes, hypertroidism, etc.)
  • Certain medications (cortisone use, epilepsy medication, high doses of thyroid hormone, etc.)
  • Low calcium intake
  • Vitamin D deficiency
  • High caffeine intake
  • Alcoholism
  • Inadequate physical activity, immobility
  • Smoking
  • Falls

What Is The Diagnosis Of Osteoporosis?

People with risk factors for osteoporosis should see their doctor and be tested for osteoporosis. All women are advised to be evaluated for osteoporosis within the first 5 years after menopause and have a bone density test. Bone density should be re-evaluated every 2-5 years thereafter.

When evaluating osteoporosis, it is not enough to just do a bone density test. The patient’s risk factors should be evaluated and the presence of other diseases that can lead to osteoporosis should be investigated, and necessary blood tests should be performed. The need to start medication should be decided by evaluating the patient’s 10-year risk of fracture.

The criteria for starting medication in a patient who has had a fracture are different from those in a patient who has not had a fracture. Therefore, the patient’s fracture history is very important. Lateral radiographs of the spine may be required as there is a possibility of silent fracture in our patients.

DEXA (Dual Energy X-Ray Absortiometry) device is used more often as a bone density measurement method. However, in elderly patients, the bone density measurement result may be wrong due to calcification, excessive spinal curvature, fracture, or surgery such as hip replacement. In these patients, bone density measurement by QCT method will give us the correct result.

What Should Be Done To Prevent Bone Resorption?

  • Calcium-rich nutrition starting from the womb
  • Maintaining adequate levels of vitamin D
  • Leading a physically active life

What Is Done In Bone Resorption Treatment?

The main aim of treatment is to prevent fractures, reduce pain and preserve function. Treatment of osteoporosis includes not only medication but also physiotherapy, psychological support and exercise therapy.

  • Adequate calcium and vitamin D intake
  • Tailor-made exercise programmes
  • Medication
  • Calcium and vitamin D
  • Painkillers (in the presence of fracture)

Are There Side Effects Of Drugs Used In Osteoporosis Treatment?

No medication is without side effects. Even when we take a fake drug, side effects such as nausea, vomiting, and abdominal pain are reported. If the complaints observed when we take the drug are observed at a statistically significant level more often than with the fake drug, it is considered a side effect.

The most common medications used in osteoporosis today are bisphosphonates. There are different molecules in this group that are used weekly, monthly, quarterly, and annually. The most common side effects observed with oral use are side effects related to the stomach and intestinal system, flu-like symptoms, delayed fracture healing, impaired kidney function, and decreased blood calcium levels. Rare side effects include the development of jaw osteonecrosis, atrial fibrillation, atypical fractures, and esophageal cancer.

In addition to bisphosphonates, Selective Estrogen Receptor Modulators, Denosumab, and Parathyroid Hormone and Analogs are also used in treatment.

In drug selection, many factors are taken into account, such as the patient’s age, sex, age at menopause, number of births, bone density test results, fracture history, family fracture history, previous diseases and medications used, smoking, and whether they are getting enough calcium and vitamin D in their diet. It is more effective to start treatment with parathyroid hormone and analogs in our patients with two or more fractures and a T score of “-3.5 or lower” as a result of bone density measurement.

What Do You Recommend To Prevent Bone Resorption?

Primary prevention of osteoporosis requires a diet that is sufficient in calcium, vitamin D, and protein to allow our bones to develop fully during the growth period, as well as regular physical activity that puts stress on the bones. This will help to support reaching peak bone mass.

In secondary prevention, we need to maintain our peak bone mass and prevent its loss by living an active life, avoiding excessive alcohol, coffee, and smoking, continuing to get enough vitamin D and calcium, and ensuring that other medications and hormones are used at the appropriate dose, if any.

Physical activity is important not only for reaching peak bone mass, but also for preventing falls and fractures by increasing personal conditioning, flexibility, and strength.

Finally, What Should We Say About Osteoporosis?

We should never forget that it is cheaper and more effective to learn to protect ourselves from getting sick. Instead of going to the doctor with the question “I’m so worried, do I have this?”, the question we should ask is “What do I need to do to continue my health today?”. If we adapt this to osteoporosis, what we need to do today is consume enough vitamin D and calcium and be physically active.

In addition to this, all individuals with various diseases and medication use, all individuals with risk factors for osteoporosis in their family history, and all women who have gone through early menopause or are in menopause should see a doctor for bone density testing.

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