Osteoporosis

Asya Popova, Atlas

October 20 is the World Osteoporosis Prevention Day. This is a disease in which the bone tissue weakens and becomes brittle. Atlas tells us what increases the risk of osteoporosis and whether it can be prevented.

What is osteoporosis?

Osteoporosis is a condition in which the body loses bone tissue faster than it restores. Bones become brittle and break easily. Compression fractures of the vertebrae, bones of the forearm and femur are most common in osteoporosis.

Osteoporosis occurs in women and men, but most often occurs in older women. After menopause, the level of estrogen (a female hormone that helps maintain bone mass) falls, which increases the risk of developing the disease.

Osteoporosis is usually asymptomatic until a fracture occurs. Compression fractures of the vertebrae and femur can lead to chronic pain, deformity, depression, disability and even death. In addition, half of people with a femoral fracture do not fully recover the ability to walk without assistance, and a quarter need long-term care.

What increases the risk of osteoporosis

Risk factors that we cannot influence:

• Paul. Osteoporosis is more common among women.

• Age. The older a person is, the higher the risk of developing osteoporosis.

• The structure of the body. Small, thin women are at greater risk.

• Ethnicity. White and Asian women have a higher risk.

• Family history. The risk increases if a family member has been diagnosed with osteoporosis or cases of fractures.

Other factors:

• Hormones. Low estrogen levels (absence of menstruation or menopause) increases the risk of osteoporosis in women.

• Low testosterone levels can lead to osteoporosis in men.

• A diet low in calcium and vitamin D.

• Some medications increase the risk of developing the disease.

• Lack of physical activity or prolonged bed rest can lead to weakening of the bones.

• Smoking. Cigarette smoke worsens the condition of bone tissue.

• Alcohol. Excessive consumption of alcoholic beverages (three or more servings per day) can lead to bone loss, which increases fragility.

Also, various diseases are associated with osteoporosis: diabetes mellitus, increased hormonal activity of the thyroid gland (hyperthyroidism), hyperparathyroidism, impaired absorption of nutrients in the small intestine (malabsorption), anorexia and chronic liver diseases.

How to reduce the risk

The most important methods of preventing osteoporosis include diet, exercise and smoking cessation.

Diet. To prevent osteoporosis, it is recommended to consume enough protein and calories. To maintain the processes of formation and preservation of bone density, the body must receive enough calcium and vitamin D.

Experts of the Uptodate database, based on the principles of evidence-based medicine, recommend that women before menopause and men consume at least 1000 mg of calcium per day (food, beverages and supplements). Postmenopausal women should consume 1200 mg of calcium per day. But you do not need to take more than 2000 mg of calcium because of possible side effects.

The main dietary sources of calcium are milk, cottage cheese, yogurt, hard cheese and green vegetables (cabbage and broccoli).

Women who cannot get enough calcium from the diet can use supplements (calcium carbonate or calcium citrate). Calcium doses exceeding 500 mg should be divided into several doses, for example, in the morning and evening.

Men over 70 and postmenopausal women need to consume 800 IU of vitamin D daily. Lower levels of vitamin D are not as effective, and high doses can be toxic. There are no strict guidelines for premenopausal women and young men. They are usually recommended 600 IU of vitamin D per day.

Calcium and vitamin D supplements are usually not enough to prevent age-related bone loss, but they can be useful for older people who have a lack of these substances. Most patients with osteoporosis or at risk of it are prescribed medications or hormone therapy, which slows down bone loss.

Alcohol and smoking. Alcohol can increase the risk of fracture due to an increased risk of falling and poor nutrition, and cigarette smoking accelerates bone loss.

Physical exercise reduces the risk of fractures by increasing bone mass in women before menopause, and also helps maintain bone density after it. An additional bonus: exercise increases muscle mass, which reduces the risk of hip fracture.

How and when to undergo the examination

Most often, tests for measuring bone tissue are used as screening for osteoporosis: quantitative ultrasound of the calcaneus, a test for bone density (densitometry) of the hip and lumbar spine.

Specialists in the prevention of diseases in the United States recommend doing a bone density test for women aged 65 and older, and young women with a high risk of fracture. The advantage of screening for osteoporosis in men has not yet been proven.

The National Osteoporosis Foundation of the USA recommends taking a bone density test for women over 65, men over 70, in case of a fracture after 50 years, people from 50 to 69 years old who have risk factors.

A doctor should calculate the risk factors for a fracture. People from 40 to 70 years old can use the FRAX calculator to estimate the approximate risk. In the BMD cell, you need to select the brand of equipment and record the value of bone mineral density. It is better to discuss the final values with a doctor: in some cases, people at high risk may not meet these criteria.

Sources:

Patient education: Bone density testing (Beyond the Basics). Uptodate. Sep 2017.

What is Osteoporosis and What Causes It? National Osteoporosis Foundation.

Osteoporosis. Medlineplus.

Patient education: Osteoporosis prevention and treatment (Beyond the Basics). Uptodate. Sep 2017.

Osteoporosis. National Health Services. June 2016.

Patient education: Calcium and vitamin D for bone health (Beyond the Basics). Uptodate. Sep 2017.

Osteoporosis: Screening. U.S. Preventing Services. Jan 2011.

Bone Density Exam/Testing. National Osteoporosis Foundation. 

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