Osteoporosis: The silent bone eater

This is because women start off with a lower peak bone mineral density than their male counterparts and also lose bone mass at a much faster rate, especially during the years immediately following menopause. 

Most cases of osteoporosis in females are primary. This means that no contributory disease is present and that the condition is most likely to be due to post-menopausal oestrogen deficiency. Oestrogen is important in the regulation of a woman’s reproductive cycle, but also maintains bone strength such that, when the levels of this hormone fall after menopause, the rate of bone loss increases. 

On the other hand, causes of secondary osteoporosis include hyperthyroidism, diabetes mellitus, alcoholism, coeliac disease and rheumatoid arthritis, amongst others. Steroid use is also a risk factor for the development of osteoporosis.  

The recommended investigation for diagnosing osteoporosis is the DEXA bone density scan. This compares the patient’s bone mineral density with that of a young healthy adult. A T-score of -1 or greater is normal, while a score between -1 and -2.5 indicates that the patient is at risk of developing osteoporosis. Osteoporosis is diagnosed when the T-score is -2.5 or worse. Post-menopausal women are advised to undergo a bone density scan every 2 years, especially if they have already been diagnosed with osteoporosis. 

Osteoporosis is a ‘silent condition’, meaning that patients won’t experience any symptoms unless a bone is fractured, however there are still things that can be done to prevent and treat this condition. Some risk factors, such as a positive family history of osteoporosis, are non-modifiable, but others are. Both women who are osteoporotic, as well as those at risk, can benefit from certain lifestyle changes such as smoking cessation, reduced alcohol consumption, adequate intake of calcium and vitamin D, and weight-bearing exercises. It is also important to educate patients with osteoporosis on how to make their home safer by eliminating any hazards that could increase their risk of falling.

In addition to lifestyle changes, pharmacological measures are available for the treatment of osteoporosis.   The first line drugs are the bisphosphonates such as Zoledronic acid which is commonly used to treat or prevent osteoporosis in patients taking steroids for a longperiod of time.   Zoledronic acid is injected into the vein for 15 minutes once a year.   For those who are intolerant to bisphosphonates, strontium ranelate is used.  In post-menopausal women, hormone replacement therapy (HRT) can be used to prevent (not treat) osteoporosis.  The problem with HRT is that it increases the risk of breast cancer so raloxifene is preferred which acts similarly to HRT but has a lower breast cancer risk.  In the case of males, testosterone shots may help in hypogonadal men.   

No matter your age, it is never too early to start fighting the battle against osteoporosis. Having a good balanced diet and exercising from a young age can boost your bone mineral density to its peak, thus helping to keep osteoporosis at bay.