Osteoporosis is a generalized disease of the bone, characterized by the decrease of the bone mass and alteration of its microstructure, so that the bones become more porous, it increases the number and the size of the cavities or cells that exist in its interior, And this causes brittleness of the same and increase the risk of fractures.
Bone mass and bone quality, bone fracture factors
In the interior of the bone, throughout the life, numerous metabolic changes, alternating phases of destruction and of formation. These phases are regulated by different hormones, physical activity, diet, toxic habits and vitamin D, among other factors. Under normal conditions, a person reaches a maximum amount of bone mass, what we call "peak bone mass" at 30-35 years. From the moment the peak is acquired, there is a natural loss of bone mass, which is usually slow and lasts the rest of life.
Peak bone mass is perhaps the most important determinant of skeletal health for the rest of life. In the attainment of peak bone mass, genetic factors play a predominant role; To a lesser extent, nutritional factors (essentially calcium intake), hormonal factors (puberty, menopause, gonadal insufficiencies) and the degree of physical exercise are also influenced.
Bone quality refers to those skeletal factors other than bone mass that also play a role in the production of bone fracture. The most important are:
- The shape (length and angulation of the femoral neck) and microarchitecture of the bone (cortical porosity, connection between trabeculae, matrix collagen abnormalities)
- The degree of remodeling
- The damage accumulated in the bone (microfractures by fatigue)
- The mineralization
All these factors are very important in bone strength. However, we do not have objective evidence to measure bone quality in clinical practice.
Symptoms of Osteoporosis
Osteoporosis is called "silent disease," because no symptoms appear until the bone has weakened so much that a fracture occurs, being the most frequent vertebral, hip and wrist, although they can appear in any location. A fundamental characteristic of these fractures is that they occur spontaneously (without previous trauma), or with a slight trauma that would not produce fracture under normal conditions.
Pain occurs when fracture occurs. But it is important to know that some vertebral fractures can occur without symptoms and go unnoticed, being discovered when an x-ray is taken.
Depending on the location of the fracture, other symptoms such as deformity, swelling, nerve compression, vascular rupture, etc. may occur in addition to pain.
Hip fracture is especially important because it requires surgical intervention, hospital admission and implies a loss of quality of life for the patient, even for a short period of time.
Osteoporosis in Menopausal Women
Osteoporosis mainly affects women after menopause, although it can also occur before menopause, or affect men, adolescents and even children, although in these cases it is usually associated with other diseases or their treatments, for example: corticosteroids, Antiepileptics, hyperthyroidism, malabsorption problems or liver diseases; What is known as secondary osteoporosis.
In the case of women, first, their peak bone mass is lower than in men, which adds that when menopause, when the production of female sex hormones by the ovary ceases, in some women Produces a more rapid and rapid loss of bone, and as a consequence postmenopausal osteoporosis appears.
In addition, there are other risk factors such as tobacco and alcohol consumption, low weight, history of family members with osteoporotic fractures or treatment with glucocorticoids, among others, that must be taken into account to assess the risk of fracture in a patient With osteoporosis.
Osteoporosis Can it be prevented?
To prevent osteoporosis and its consequences (fractures) we have 2 pillars of action: hygienic dietary measures and drugs .
As for the hygienic dietary measures, although the peak of each person's bone mass is conditioned mainly by their genetic load, and it is not possible to act on it, it is important to make the young, especially the female population aware of their ingestion in adolescence And youth an adequate amount of calcium. They also perform a correct physical exercise and suppress harmful habits, such as alcohol and tobacco, in order to obtain a good amount of bone mass, that is, the "bone mass peak" is as large as possible, Is going to be the bony capital that is going to have for the rest of the life.
The required amount of Calcium varies with age, with the highest needs in the growth stages and menopause. Menopause requires a calcium intake of 1,000 to 1,500 mg per day. This intake can be made with natural foods rich in calcium (especially milk and its derivatives) or with supplements in the form of medicines (calcium salts). In the latter case there should be a control of your doctor about the amount and the administration schedule.
Similarly, vitamin D is a key substance for bone. The vitamin D content of most foods, with the exception of some fatty fish, is very low; Fundamentally, the contribution of vitamin D to the body is achieved through the skin; If there is a low sun exposure, supplements should be used to ensure daily requirements.
Densitometry, analytical and radiography for the diagnosis of osteoporosis
Although it is a silent disease, rheumatologists today have a wide range of tools for their early diagnosis to adapt the treatment, either to prevent the loss of bone mass or to combat osteoporosis.
Densitometry is the technique used to assess bone mineral density , but this is not enough to reach the diagnosis, since it is also necessary to assess the different risk factors that the patient presents, such as medications taken, family history, toxic habits , Presence of an osteoporotic fracture, body mass index, among the most important.
A basic analysis should also be performed to detect any possible alteration in calcium metabolism, determining calcium, phosphorus, vitamin D, hormone PTH ...
Also, it is very important to determine if there is an asymptomatic vertebral fracture, for which a dorsolumbar spine radiograph should be performed.
There are other complementary tests, which will have to be individualized in each patient.
Treatment for osteoporosis: avoiding fractures
The goal of treating osteoporosis is to prevent fractures from osteoporosis.
Pharmacological treatment for osteoporosis will depend on several factors such as sex, age, severity of the disease, the cause of osteoporosis, clinical history and associated diseases, among others:
- First, there are a series of non-pharmacological measures aimed at correcting nutritional deficiencies, modifying life-threatening lifestyles for the bone (not smoking, not drinking alcohol, exercising adapted to the patient's possibilities), avoiding falls and minimizing Intensity of impact.
- Secondly, an adequate supply of calcium and vitamin D should be obtained, if possible with food, and if this is not enough, with the taking of pharmacological supplements, always under the medical prescription.
- Third, we have drugs that slow down bone loss, and even increase it. Among the most used are bisphosphonates, Denosumab, raloxifene, hormone treatment (estrogen) and parathormone. They have all demonstrated, to a greater or lesser extent, the ability to prevent vertebral, hip, and other long bone fractures.
If all these measures are taken, we will be able to avoid most of the osteoporotic fractures, and with it, the loss of quality of life that a fracture would suffer.