Osteoporosis Overview and Types

Osteoporosis

• Definition: A progressive systemic skeletal disease, characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures.
• Osteoporosis causes bones to become weak and brittle, making them prone to fracture from a fall or mild stresses like bending or coughing. Common fracture locations are the hip, wrist, or spine.
• It is a severe, chronic, progressive disease that is clinically silent, and is the most common metabolic bone disease.
• Osteoporosis affects all races and sexes, yet white and Asian women, particularly those past menopause, have the highest risk.
• Imbalance in bone cell function can also contribute to osteoporosis. It is referred to as the "silent epidemic" of the 21st century.

Types of Osteoporosis

• Primary osteoporosis includes idiopathic osteoporosis (in children and young adults, with unknown causes) and involutional osteoporosis (in both men and women, more related to aging).
• Involutional osteoporosis is further divided into type I, or postmenopausal osteoporosis (mainly affecting women aged 51 to 75, characterized by rapid bone loss), and type II, or senile osteoporosis (occurring in those over 75, characterized by a loss of trabecular and cortical bone associated with aging).
• Secondary osteoporosis accounts for less than 5% of cases, stemming from an underlying disease or medication. Postmenopausal osteoporosis is the most frequent kind.

Symptoms of Osteoporosis

• Early stages typically show no symptoms.
• Later stages may manifest as back pain (from a broken or collapsed bone in the spine), loss of height over time, hyperkyphosis (increased outward curvature of the spine causing neck pain), and easy bone fractures. Osteoporosis-related breaks can result in vertebral fractures, and a decrease in height, as vertebral fractures and hyperkyphosis can result in a decrease in height of about 10-20 cm, approximately.

Risk Factors of Osteoporosis

• Unchangeable risks include sex (women more prone), age (risk increases with age), race (white and Asian women at higher risk), and family history of osteoporosis.
• Changeable risks include smaller body frame size (related to less bone mass), inadequate calcium intake contributing to diminished bone density, early bone loss, and increased risk of fracture, eating disorders leading to underweight and weakened bones, gastrointestinal surgeries removing nutrient absorption surfaces (like calcium), and medication use (e.g., corticosteroids and other medicines).

Hormone Levels and Osteoporosis

• Hormones can play a role in osteoporosis risk. Lowered sex hormones weaken bones, especially estrogen loss during menopause in women, impacting bone density. Certain treatments for cancers (e.g., prostate or breast cancer) reduce testosterone or estrogen levels, accelerating bone loss.
• Thyroid problems (hyperthyroidism) can also contribute to bone loss. Individuals taking too much thyroid medication or those with overactive thyroid glands may experience increased bone loss.

Dietary Factors and Osteoporosis

• A lifelong low calcium intake is a significant osteoporotic factor. Individuals with eating disorders or significant dietary restrictions or deficiencies in calcium, fruits, vegetables, and low-fat dairy products have increased risk of osteoporosis.
• Gastrointestinal surgeries that reduce the gut's nutrient absorption, such as bariatric surgeries, limit the intake of calcium and may contribute to osteoporosis.

Medical Problems and Osteoporosis

• Certain medical conditions increase osteoporosis risk, including diabetes mellitus (types I and II), celiac disease, inflammatory bowel disease, kidney or liver disease, and rheumatoid arthritis.

Lifestyle Choices and Osteoporosis

• A sedentary lifestyle is linked to an increased osteoporosis risk.
• Excessive alcohol intake, smoking, and other risk factors are associated with an increased fracture risk with increased osteoporosis.

Complications of Osteoporosis

• Fractures caused by minimal trauma are the significant consequence of osteoporosis and lead to pain, disability, reduced quality of life, and significant health risks. Hip fractures, particularly, are associated with higher mortality and lengthy hospitalizations.

Assessment of Osteoporosis

• Measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is the major method for osteoporosis assessment.
• Vertebral fracture assessment is also important, as these fractures frequently occur without symptoms and are significant osteoporosis predictors. Vertebral fractures should also be considered in high-risk individuals.

Pharmacological Treatment for Osteoporosis

• Bisphosphonates (e.g., alendronate) and intravenous zoledronate are common forms of osteoporosis treatment, considered cost-effective.
• Hormone replacement therapy (HRT) and calcitriol (vitamin D3) are other treatment options.

Non-Pharmacological Management of Osteoporosis

• Healthy diets emphasizing calcium and vitamin D are useful for managing osteoporosis.
• Regular weight-bearing and muscle-strengthening exercises are particularly crucial for improving bone density and preventing fractures.
• Smoking cessation and alcohol reduction are also important steps for osteoporosis management.

Sarcopenia

• Sarcopenia is a geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass, along with decreased muscle strength, and physical function.
• This reduces an individual's ability to perform daily tasks and increases the risk of falls and fractures.
• Sarcopenia is often concomitant with osteoporosis and increases the associated health risks and complications.

Diagnosis of Sarcopenia

• The European Working Group on Sarcopenia in Older People (EWGSOP) outlined criteria, including measurement of low muscle mass, strength, and physical performance in older adults.

Pathophysiology of Sarcopenia

• Aging impacts the skeletal muscle's homeostasis, resulting in an imbalance between anabolic and catabolic processes in protein production.
• Decline in muscle fiber size and number, infiltration of intramuscular and intermuscular fat, and diminished satellite cells are all contributing factors to muscle loss associated with sarcopenia.

Management of Sarcopenia

• Non-pharmacological interventions include exercise (especially resistance training) and proper nutrition (with an emphasis on adequate protein intake, vitamin D, sufficient antioxidants, and long-chain polyunsaturated fatty acids).
• Nutritional and exercise interventions are effective and affordable sarcopenia progression prevention.

Assessment Tools

• The Short Physical Performance Battery (SPPB) is a method for assessing functional mobility, including balance, lower extremity strength, and walking capacity using standardized methods of assessment.