Osteoporosis is one of those diseases that affect millions of people around the world, but to which no one pays the attention it deserves.
It is truly unfortunate how disastrous this can be for people’s lives, but at the same time, it is something that can be avoided as long as measures are taken on time.
What is osteoporosis?
Osteoporosis is a systemic bone disease. It is characterized by reduced bone mass and altered bone microarchitecture, leading to reduced bone strength and increased risk of fractures.
It is a disease of bone metabolism that threatens both women and men.
Osteoporosis is an extremely serious health problem due to the fact that it is associated with increased levels of morbidity and mortality among people and attempts to treat it around the world cost an insane amount of money.
Epidemiological data show that in industrialized countries, between 9 and 38% of women and between 1 and 8% of men over the age of 50 suffer from osteoporosis.
How does osteoporosis occur?
Our bones, like our heart or muscles, are a specific type of tissue. As long as we are alive, every tissue in the human body is in a constant cycle of processes of decay and construction.
Once fully formed, bones undergo two very important processes – modeling and remodeling.
In modeling, only one of the following two things occurs within a given surface:
- bone formation;
- bone resorption.
The formation of bone tissue is also called ossification or osteogenesis. In this process, cells called osteoblasts lay a new layer of material to build bone.
In contrast to the formation, the resorption of bone tissue is a process in which cells called osteoclasts destroy bone tissue, thus releasing minerals present in the tissue into the blood.
Remodeling, in turn, is a process involving the same processes of formation and resorption, but it does not just happen one or the other, but together, sequentially within a surface.
These processes are usually in different proportions depending on our age. In the early years, somewhere around 18-20 years of age, the processes of bone formation dominate. After our 20th anniversary, for about 10-20 years, the formation and resorption are in approximate balance and from then on the resorption begins to take control.
It is the resulting accumulation of the resorption process over time that leads to a reduction in the mass and density of the bones, which when it reaches a certain level of density, we call osteoporosis.
Risk groups and factors
Unfortunately, no one is insured against osteoporosis, but some are more at risk than others.
The most at-risk group is menopausal women. The reason for this is mainly the fact that at the onset of menopause, the secretion of the hormone estrogen stops.
Estrogen is extremely important for bone metabolism in both women and men. Hormone deficiency significantly increases the production of osteoclasts, which are the main drivers of the resorption process.
Estrogen levels are not the only factor influencing the risk of developing osteoporosis.
Other risk factors are:
- glucocorticoid therapy;
- presence of previous bone fractures;
- presence of previous fractures of the femur in the family;
- alcohol consumption;
- presence of certain diseases:
- Rheumatoid arthritis;
- Osteogenesis imperfecta;
- Hypogonadism or early premenopause;
- Chronic malnutrition;
- Poor absorption of certain nutrients;
- Chronic liver and kidney diseases.
A number of scientific data suggest a possible link between the presence of metabolic syndrome and osteoporosis, but the data is still conflicting. Work is also underway to determine the relationship between genes, the immune system, and the disease.
Although women are the main group of people at increased risk of osteoporosis, the disease is often very common in men. According to an NHANES report, between 3 and 6% of men suffer from osteoporosis, and between 28 and 47% suffer from osteopenia (reduced bone mass prior to osteoporosis diagnosis).
The risk in men is again related to both the above risk factors and hormonal levels – in addition to the hormones estrogen and testosterone. With age, estrogen and testosterone levels in men decrease by about 1% per year.
A number of scientific studies have shown that the incidence of osteoporosis in men over the age of 65 who have low testosterone levels (less than 200 ng/dl) is twice as high as in men with normal testosterone levels. higher than 400 ng / dl) (12.3% vs. 6%).
An even higher incidence of the disease was observed in men with low estrogen levels (less than 10 pg/ml) and in those with normal ones (higher than 20 pg/ml) – 15.4% vs. 2.8%.
Why is osteoporosis dangerous?
Due to lower bone mass and density, the main problem with osteoporosis is the increased risk of bone fractures.
Younger readers are probably wondering what can be so dangerous about breaking a bone, but to get a good idea of the problem, we need to put ourselves in the place of an older person, over 55-60 years old.
The majority of elderly people are generally immobilized in general and even simple movements such as getting out of bed or walking are difficult for them.
In most adults, the risk of falling is extremely high – over 50%. In the presence of osteoporosis, any fall can lead to a serious fracture. One of the most common fractures in osteoporosis is that of the thighs and hips. With such a fracture, most older people become unable to take care of themselves and must be taken care of by another person.
Fractures can be so dangerous that, according to the available hip fractures, they increase the risk of death in the next 1 year by between 8 and 36%.
The presence of a fracture in the hips and thighs increases the risk of future fractures by 2.5 times.
And although falls are the main cause of more serious fractures, depending on the degree of thinning of the bones, even simple things like sneezing or involuntary collision with another person/object can lead to injuries.
For the diagnosis of osteoporosis, bone mineral density (BMD) is most often tested.
Dual-energy x-ray absorptiometry (DXA) is mainly used to study bone density and mass, and the whole body or only certain parts of it can be examined – the femoral neck, the spine (especially the lumbar part), or 33% of the radial bone.
The evaluation of the analysis comes in the form of a T-score. T-score ≤ −2.5 diagnoses osteoporosis, and T-scores between -1.0 and -2.5 diagnose osteopenia. T-score ≥ -1.0 is considered normal bone strength and density.
It is important to note that a T-score diagnosis can only be made in men and women over the age of 50.
Z-score is used for younger men and women. A score of Z-score <-2.0 is considered clinically significant. When using the Z-score, the diagnosis of osteoporosis or osteopenia is not very correct.
A score of Z-score <-2.0 is interpreted as “lower than normal for the respective age”, and a Z-score> -2.0 is interpreted as “normal for the respective age”.
Science is also advancing in the study of certain biomarkers as a means of diagnosing osteoporosis and bone metabolism. Such markers are, for example, markers related to bone formation (osteocalcin, alkaline phosphatase, procollagen type 1 carboxy-terminal propeptide, and procollagen 1 amino-terminal propeptide), as well as those related to bone resorption (resistant to tartaric acid and phosphate-resistant tartrate). type 1 c-terminal part). However, much work remains to be done in this direction.
Prevention and treatment
Osteoporosis is likened to being an invisible disease, mainly because symptoms only appear when things get significantly worse.
The main recommendations of health organizations are to examine people over the age of 50 if they have had a fracture after reaching that age, or all people over the age of 65, regardless of whether they have had fractures.
Osteoporosis is a preventable disease, but the recommendations for research at such a late stage in life unfortunately significantly reduce the possibility of avoiding it.
It is equally important to note the fact that most young people are not sufficiently informed.
Recommendations for the prevention of osteoporosis are also valid for its treatment.
Reduce alcohol consumption
It is recommended to limit alcohol consumption to no more than 2 units per day.
1 unit of alcohol is equal to 10 ml or 8 grams of pure alcohol. Relative to some of the more popular types of alcoholic beverages, 2 units equals about:
- 500 ml of beer;
- 150 ml of wine;
- 50 ml of distilled alcohol (vodka, whiskey, and others).
Smoking significantly increases the risk of osteoporosis and fractures. The risk is highest in current smokers but remains high even in people who have stopped smoking.
Get enough vitamin D and calcium
Although many substances are associated with bone metabolism, vitamin D and calcium deserve special attention.
99% of the calcium in our body is found in the bones, but the mineral also plays a key role in the metabolism of most cells. When we do not get enough through food, our body is forced to increase the levels of resorption in the bones to get the mineral.
The recommended amount of calcium is in the range of 1000 mg/day for both men and women. For people over 70 years of age, the recommendations are slightly higher – 1200 mg/day.
It is not recommended to systematically take larger amounts than 1500 mg, as on the one hand, they do not bring additional benefits, and on the other hand, the long-term safety of higher doses is not completely clear.
Vitamin D is also critical for maintaining healthy bones, with current recommendations in the range of 800-1000 IU / day. It is recommended to be obtained together with calcium, as it is necessary for and improves the absorption of calcium in the intestine , although according to some data the improvement is minimal.
On the other hand, only the combination of vitamin D and calcium, but not both, shows a reduced risk of falling in the elderly, which is particularly important for those diagnosed with osteoporosis.
Taking other supplements
Meta-analyzes have shown that intake of fish oil/omega-3 and soy isoflavones may be beneficial.
Practice resistance training
In principle, any type of sports activity would be beneficial, but for optimal prevention and improvement in pre-existing osteoporosis, resistance training, and functional training are extremely effective as it stimulates bone building. Such are, for example, weight training and if possible they can be performed in a gym, at home or at sports facilities.
The above recommendations are the first that should be taken, but if the result is unsatisfactory, at the discretion of the doctor may resort to medical treatment.
Approved pharmacological options are:
- Estrogen hormone therapy;
- Estrogen agonists or antagonists;
- Tissue-selective estrogen complex;
- Parathyroid hormone;
- Blockade of receptor activator of nuclear factor kappa-B ligand (RANKL);
- Blockade of the sclerostin protein
It is unfortunate that millions of people around the world suffer from a disease that could easily be avoided if one takes at least minimal care and follows a few basic recommendations without waiting for the “knife to rest on the bone”.
Unfortunately, thinking about the future, especially 30-40 years ahead, is not for everyone, but if we want to live well in both youth and old age, such thoughts should be regular, regardless of age.
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