Osteoporosis is a disease that occurs because of lessening bone density. This lessening happens slowly and progressively for years without any signs or symptoms. That is why osteoporosis often said as a silent disease. The symptoms will show up when the disease becomes worse, such as bone fracture, hunch back, losing body height, and back pain.
About 80 % of osteoporosis patients are women. It has a correlation with the fact that women are having menopause that cause them losing estrogen, a hormone with a function to save calcium to the bone. But men can also suffer from osteoporosis. One of five men above 50 year-old suffers from this disease.
Causes and Risk Factors of Osteoporosis
What is the actual cause of osteoporosis? Some factors play role in causing this disease. Here are they:
1. Postmenopausal osteoporosis. This happens because of decrease of estrogen, the main gonad hormone in a woman which has a function to store calcium to the bone.
2. Senile osteoporosis, possibly because of lack of calcium intake during life. It has a correlation with age and imbalance of bone destruction and formation.
3. Secondary osteoporosis, caused by other medical condition or by drug induced. Osteoporosis may be caused by chronic kidney disease, hiperparathyroidism, long use of corticosteroids, barbiturates, etc. Alcohol abuse and smoking may worsen osteoporosis.
4. Juvenile idiopathic osteoporosis, a kind of osteoporosis with unknown cause. It attacks children and teenager with normal hormone level and function, normal vitamin and no exact cause of bone fragility.
These are the risk factors:
1. Woman. It has a correlation with the decrease of estrogen (start from age 35) and menopause.
2. Age. The older you are, the bigger the chance of having osteoporosis.
3. Race. The white and the Asian have the highest risk. It is commonly because of the low consumption of calcium of Asian women. African and Hispanic have lower risks.
4. Family history of osteoporosis. If one of your relatives has an osteoporosis you have to be careful. Osteoporosis attacks people with specific bone character, such as same bone structure in a family.
5. Bad lifestyle, includes:
- Excessive consumption of red meat and soft drinks. Both of them contain phosphor that may stimulate the secretion of parathyroid hormone which causes release of calcium from bone to blood.
- Caffeine and alcohol. They may cause bone fragile and damaged. Urine of one consuming caffeine or alcohol contains more calcium that comes from bone destruction. Besides, caffeine and alcohol is toxic which inhibit formation of bone mass.
- Lazy doing sport. One who is lazy to move or to do sport will cause inhibition of osteoblastic process. Movements and sports are good stimulation to bone formation. Lazy to move will also decrease bone density.
- Smoking. Nicotine can stimulate bone resorption. It also decreases estrogen level and activity.
- Low blood calcium level. It will cause the body to secrete hormones that cause the blood takes calcium from other parts of the body including the bones.
6. Drug consumption. Corticosteroids used by asthma and allergic patients may inhibit bone formation. Heparin and anti-seizure drugs may do the same. Consult to your doctor before using this kind of drug.
7. Thin and tiny. This body posture tends to make body lighter. Bones are diligent to form cells if they are pressed by heavy bodyweight. So, thin and tiny people have the higher risk to suffer from osteoporosis.
How to Diagnose Osteoporosis
If someone, for example a 70 year-old lady has shown a symptom of osteoporosis such as bone fracture, the diagnosis of osteoporosis will be confirmed based on the signs and symptoms she has been experienced. The physician will also ask whether she has the risk factors of osteoporosis. Then he/she will do some physical examination and an x-ray examination. Other examinations may be needed to know another possibility of the fracture.
Early Screening of Osteoporosis
I have mentioned above that osteoporosis is a silent disease, so if you want to know whether you have this illness or not, you have to do a screening test. The test has a goal to know the density of the bone and to know how big the risk of having the disease is.
Here are some screening tests to diagnose osteoporosis earlier:
1. DXA (Dual-energy X-ray Absorptiometry) densitometer. It is a gold standard to diagnose osteoporosis. This examination is painless and can be conducted within 5 to 15 minutes. It is a useful diagnosis and screening test. It can be used to confirm a doubtful diagnosis. It is useful for a woman who has a high risk of osteoporosis and for a patient in a therapy who needs an accurate assessment.
2. USG (Ultrasonography) densitometer. This is the common device to screen an osteoporosis. The result of this test is being ranged called the T score:
- > -1: good bone density
- -2.5 to -1: osteopenia (less bone density)
It is cheaper and more practical and also painless.
Therapy of Osteoporosis
Therapy and medication of osteoporosis has a goal to increase bone density, to lessen extra-fracture, and to control the pain. To determine the best therapy includes multidisciplinary aspects. A team from surgery department, internal department, obstetric and gynecology department will be involved. A clinical nutritionist should also be consulted.
The therapy will be given appropriate with the patient’s need. If there is a bone fracture the doctor will examine whether it needs a surgical treatment or a splinting. After that, the patient should take physiotherapy to rehabilitate the bone ability.
The pharmacological treatment will be needed to prevent another fracture. This can be given to the patient who has not experienced fracture but has osteoporosis, for example from a screening. Here are the drugs:
1. Biphosphonate. This drug is useful to prevent bone damage, to restore bone mass, and to increase bone density especially of the back and the hip. Drugs include in this group are risendronate, alendronate, pamidronate, chlodronate, zoledronate (zoledronic acid), and ibandronic acid.
2. Selective estrogen receptor modulator (SERM). It is a kind of hormone replacement therapy for a postmenopausal woman. It is effective to decrease bone turnover and to slow the resorption of bone mass. An example of SERM is raloxifene.
3. Vitamin D metabolites that is calcitriol and alpha calcidol. They have ability to help body absorbing calcium.
4. Calcitonin. This drug is suggested to someone who had spine fracture with pain. This drug can be injected or can be given by nasal spray.
5. Strontium Ranelate. This drug improves bone formation by activating osteoblast and by forming collagen and also decrease bone resoprtion by lowering osteoclast activity.