Osteoporosis: Prevention and Treatment

To understand osteoporosis, we need first to familiarise ourselves with bone cells. There are two types of bone cells: osteoblasts and osteoclasts. Osteoblasts are responsible for creating new bone, while osteoclasts break down old or damaged bone. These two types of bone cells work in a self-regulating mechanism to maintain bone growth. The skeletal system is one of the most metabolically active organs in the human body. Before the age of thirty, osteoblasts are more active than osteoclasts, resulting in the continuous generation of healthy and sturdy bones. Typically, around the age of 30 to 35, an individual's bone density reaches its peak, which is maintained throughout their lifetime. However, as we age, bone metabolism slows down, and there is a gradual loss of calcium from the tissues, leading to decreased bone density and an increased risk of fractures due to weakened bones. Apart from age, bone density is also influenced by hormones. In postmenopausal women, the decrease in estrogen, which can inhibit osteoclasts, significantly accelerates the loss of bone mass.

Although everyone experiences some degree of bone loss as they age, not everyone will develop osteoporosis to a severe extent. Here are nine high-risk factors for developing osteoporosis:

1. Smoking
2. Being over 50 years old
3. Postmenopausal women
4. Having a family history of osteoporosis
5. Long-term use of corticosteroid medications
6. Rheumatoid arthritis patients
7. Lack of exercise and sunlight exposure
8. Inadequate calcium intake over a long period
9. Being underweight

Many people mistakenly believe that osteoporosis will always cause "widespread bone pain," but in reality, this condition does not typically result in any pain. However, when individuals experience symptoms such as lower back pain, stooped posture, or a decrease in height, it may indicate the presence of spinal deformity, which is a significantly severe situation. As a result, patients who do not undergo regular bone density checks often receive a diagnosis only after a fracture has occurred.

Due to the lack of apparent symptoms, osteoporosis is often referred to as the "silent killer." Individuals over 50 or those at high risk for osteoporosis should undergo bone mineral density (BMD) testing.

Dual-energy X-ray absorptiometry (DXA) is a commonly used instrument for measuring bone density. It is used for diagnosis and monitoring treatment effectiveness. The testing process is similar to getting an X-ray and is straightforward. The doctor will compare your test results to the average bone density of healthy young individuals, resulting in a T-score:

1. Calcium and vitamin D supplements
2. Bisphosphonate drugs

The primary function of bisphosphonate drugs is to inhibit osteoclasts, reduce bone metabolism, and increase bone density. These medications are available in oral and injectable forms. Oral formulations can be taken once daily, once weekly, or once monthly, while injectable formulations can be administered every three months or once a year. Individuals with impaired kidney function are not suitable candidates for these medications.

3. Calcitonin

Calcitonin is a hormone that inhibits osteoclasts and reduces the loss of calcium ions from the bones into the bloodstream. This type of medication can also provide relief for spinal compression fractures caused by osteoporosis.

4. Hormone Therapy

Estrogen helps postmenopausal women slow down bone loss and increase bone density. However, it has been found that these medications can increase the risk of developing breast cancer and endometrial cancer.

5. Selective Estrogen Receptor Modulators (SERMs)

SERMs are medications that selectively target estrogen receptors in the bones to inhibit the action of osteoclasts. Since they do not affect estrogen receptors in the breasts and uterus, they do not increase the risk of cancer.

6. Biologic Agents

Biologic agents are a new generation of osteoporosis medications that reduce osteoclast maturation and promote their death, thereby reducing bone loss. These medications are suitable for more severe cases and are administered by injection every six months.

7. Anabolic Agents

Anabolic agents are synthetic parathyroid hormones that stimulate osteoblasts and promote bone growth. Due to a potential increased risk of bone cancer, it is recommended to use these medications for no more than two years.

Treating osteoporosis is similar to managing other chronic diseases—it requires persistence and following the doctor's instructions. Stopping medication too early can lead to rapid loss of previously gained bone mass, rendering previous efforts futile. Alongside medication, fostering healthy lifestyle habits and dietary practices can also improve the effectiveness of treatment.

Virtus Medical Orthopaedics and Traumatology Specialists