Osteoporosis is a common chronic disease in which the bone loses its mass, leading to fragile bones and changes in lifestyle.
In this article, you will find questions that are frequently asked by most of the patients and their answers directly by a doctor. But before that, there will be a brief introduction to the topic in which fundamental terms are going to be described for you to have a better understanding of it.
By the hand of a doctor, you will acquire critical insights about Osteoporosis, its symptoms, complications, amongst other topics. And you will find answers to questions like “What is the life expectancy of a person with Osteoporosis?”
What is Osteoporosis?
Osteoporosis is a bone disease characterized by low bone mass and gradual changes in the bone tissue. This may lead to a consequent increase in bone fragility and susceptibility to fracture as well as other diseases like Osteogenesis imperfecta, also known as brittle bone disease. In normal conditions, the bone has cells that are constantly changing themselves through two different processes. These are bone formation and bone resorption, and they are in perfect balance, though it is a process that takes time; the bone resorption degrades old bone cells and gives the necessary nutrients for the bone formation that creates new cells.
However, in osteoporosis, a misbalance between the processes of bone formation and bone resorption causes mass loss. Due to various causes, the bone resorption process accelerates, causing excessive bone degradation. Therefore the bone formation accelerates giving birth to immature new bone cells that do not have the necessary strength leading to bone fractures.
It is a disease that can affect women and men; it is most common in postmenopausal women and older men. Nonetheless, it is essential to define that there are two types of osteoporosis.
Primary Osteoporosis, it can be juvenile affecting children or young adults or idiopathic, including Postmenopausal Osteoporosis and Senile Osteoporosis.
This disease is the most common metabolic disease affecting over 200 million people worldwide. 1 out of 3 women over age 50 will experience an osteoporotic fracture, as well as 1 out of 5 men. Approximately 10% of women aged 60 and 20% of women aged 70 suffer from osteoporosis. Overall, osteoporosis has a 4 to 1 female to male ratio.
What are the stages of osteoporosis?
Osteoporosis staging depends on bone health, which is measured by the Bone Mineral Density (BMD), the T-Score, and the Z-Score. The T-Score is the BMD of the patient in comparison to the BMD of subjects who are at their peak BMD. This score is traditionally used as an entry criterion for major clinical trials in which the fracture risk reduction is above 50% in 3 years for most of the therapies. The Z-Score is the BMD in comparison to patients of the same age and sex; however, this is used in premenopausal women, men younger than 50 years, and children.
- Normal: BMD values within 1 Standard Deviation (SD); T-Score greater or equal to -1.
- Low Bone Mass (Osteopenia): BMD values between 1 and 2.5 SD; T-Score between -1 and -2.5.
- Osteoporosis: BMD values higher than 2.5 SD; T-Score equal or below -2.5.
- Severe Osteoporosis: BMD values greater than 2.5 SD in patients who have experienced one or more fractures; T-Score equal or below -2.5 in patients who have experienced one or more fractures.
It is essential to know that with each SD reduction in BMD, there is an increase in the risk of fracture that goes from 1.5 to 3 times. This is due to a decrease in bone remodeling (bone resorption and formation) effectiveness with each stage of the disease. These stages apply for any cause of osteoporosis, whether it is postmenopausal osteoporosis, aging, or endocrine disorders like excess of parathyroid hormone (hyperparathyroidism).
What happens to your body when you have osteoporosis?
Menopause triggers osteoporosis most of the time in women or aging as well for men. However, this is often a silent disease because bone loss occurs without symptoms. It becomes clinically apparent when a fracture occurs.
After menopause, women will experience a decrease in levels of a hormone called “estrogen.” It is responsible for the development of the female body and the secondary sexual characters. However, estrogen also helps to reduce bone resorption and increase bone formation. Estrogen exists in male bodies too; it intervenes in the sexual maturation, cholesterol metabolism and helps in bone strength. When levels of estrogen fall, the bone resorption accelerates, and the bone formation becomes slower, leading to immature bone cells and fragility fractures.
After aging, men will also experience a decrease in estrogen and testosterone, which may lead to osteoporosis and fractures. The most common fractures are:
- Vertebral Fractures also called Spinal Fractures (two-thirds of them are painless)
- Hip Fractures
- Wrist Fractures
- Forearm fractures
- Shoulder fractures
In order to make a diagnosis of this disease, the doctor will ask for a test, the Bone Density Scan. The Bone Density Scan is the standard test to measure the Bone Mineral Density. Women older than 65 years and men over 70 years should have a bone density scan, as well as postmenopausal women over 50. People who have had an adult age fracture and are above 50 years old also should do a bone density scan.
What are some of the complications of having osteoporosis?
Amongst the complications, there are fragility fractures. These fractures occur as a result of a low-energy force that is insufficient to break a healthy bone. The most dangerous fractures are hip fractures and vertebral/spinal fractures.
Hip fractures are the most dangerous of all, and it carries elevated mortality. The one-year mortality rate estimates are in the range of 14% to 36%. These fractures often result from a fall, and these patients present groin pain and pain with hip motion. Hip fractures represent a radical change in patient’s quality of life as they may never fully recover; moreover, they are associated with immobility, which in the end produces pressure ulcers.
Vertebral fractures mostly occur in asymptomatic patients. In severe osteoporosis, the vertebra weakens to a point where simple activities like lifting light objects or changing postural positions may lead to a break in the bone. However, if symptomatic, the patient will experience acute pain in the back that may lead to chronic disease. The chronic course of this condition turns to be a debilitating ailment that severely limits function, leading to back instability. This kind of fractures makes the patients prone to develop respiratory infections in the future, which may lead to further death. Studies suggest that regardless of an individual bone density test results, having one vertebral fracture increases the risk of subsequent vertebral fractures.
What are the symptoms of severe osteoporosis?
Although osteoporosis is a silent disease, when it is severe, it may carry various symptoms due to low bone density. Continuous damage to the bone leads to fragility fractures when least expected, and some of them may be asymptomatic as well. Nonetheless, if you are within the group of risk (Women over 50 years, postmenopausal, or men above 50 years old), the following symptoms may happen.
- Bone fractures (hip fracture, wrist fracture, and vertebral fracture, amongst others).
- Posture changes.
- Immobility or limited functionality. (Due to hip and/or vertebral fractures)
- Shortness of breath (Disk compression and vertebral fractures decrease lung capacity).
- Height loss.
- Pain in the lower back.
What is the life expectancy of a person with Osteoporosis?
The life expectancy of a person with osteoporosis is widely variable as it depends on the stage, which could be severe osteoporosis or osteopenia; it also depends if they are receiving treatment. Having a female to male ratio 4:1, the postmenopausal women have a considerable risk of developing osteoporotic fractures due to a significant decrease in peak bone mass. These fractures may lead to further complications as 1 out of 3 women after 50 years old may suffer from a fracture. It is important to remark that the general population is not aware of this disease and its possible complications, as well as the medical staff’s lack of the necessary awareness and knowledge on osteoporotic fractures. With the combination of these factors, it is no surprise that it remains an underdiagnosed disease.
The hip fracture, if not treated on time, may carry an important mortality risk. Most deaths occur within the first 3 to 6 months following the event, of which 20% to 30% causally relates to the fracture event itself. That is why the physician must explore why the hip fracture happened in the first place and what other diseases the patient has.
However, if receiving treatment, the life expectancy of a 50-year-old man can be around 18 years, and of a 75-year-old man, estimates are an average of 7.5 years. For women, the life expectancy of a 50-year-old woman is about 27 years, and of a 75-year-old woman is approximately 14 years. It is important to emphasize that the causes of death of the patients include pulmonary causes, cancer, and cardiovascular diseases. Although the cause of death is not directly the bone disease itself, it may help to develop further complications that will increase mortality.
How many people will break a bone due to osteoporosis?
Osteoporosis is one of the most common diseases amongst people over 50 years old will carry an increased risk factor for fractures. Estimates are that 1 out of 3 women will experience an osteoporotic fracture and 1 out of 5 men. After reaching this critical age in life, it is essential to practice prevention and be careful with the surroundings and the things in the house to prevent a fall. A weakened bone can fracture after a fall, which may lead to a decrease in life quality and may limit functionality.
The most common fractures include hip fractures, wrist fractures, vertebral fractures, and forearm fractures. However, there are other fractures like rib fractures, tibia fractures, and femoral neck fractures that may not be so common but should be treated carefully and quickly.
Older people should be taken care of, especially if they suffer from mental disorders like dementia. Mental disorders are associated with a higher risk for bone fractures due to the unpredictability of the disease. Families play a significant role in prevention as they are the first line in the protection and care of the patients.
What are the treatment options for osteoporosis?
There are various options for osteoporosis treatment; this includes a pharmacological therapy or a supplementation therapy for prevention. Now, who should be considered for pharmacological treatment? Women with postmenopausal osteoporosis and men over 50 years with the following conditions:
- A hip or a vertebral fracture.
- Determination of fractures when the T-Score is below -2.5 at the femoral neck, total hip, or lumbar spine.
- Low bone mass (T-score between -1.0 and -2.5 at the femoral neck or lumbar spine)
- The 10-year probability of a hip fracture greater than 3% or a 10-year probability of a major osteoporosis-related fracture over 20%.
Older people are at high risk of developing fractures and so will derive substantial benefits from treatment. The main goals in the pharmacological therapy are:
- Prevention of fractures by improving bone strength and bone health.
- Relieve symptoms of fractures and skeletal deformities.
- Maintain normal physical functions.
The choice of therapy should take into account several factors like the potential adverse effects as polypharmacy is already common in older people. Most of the osteoporosis drugs are designed to decrease bone resorption, and they are known as antiresorptive agents. These antiresorptive agents include the following osteoporosis medications:
- Bisphosphonates (Alendronate, Risedronate, Ibandronate and Zoledronic Acid)
- Strontium Ranelate.
All of these agents have an increase in bone mass, but only alendronate, risedronate, zoledronic acid, and strontium ranelate decrease both vertebral and hip fractures. Sadly, the optimal duration of the treatment is still unclear, but bisphosphonates can maintain bone density for at least two years after treatment withdrawal. On the other hand, other treatment effects wear off soon after discontinuation, so the physician should consider alternative treatments. Here are some recommendations for the bisphosphonates treatment:
- Review of BMD after five years of oral therapy or three years of intravenous therapy.
- Continue for up to a further five years if there are new fragility fractures, increased risk, vertebral fracture history, or a T-Score below -2.5.
- Considerate a drug holiday for 2-3 years if T-Score is over -2.5, and there are no risk factors involved.
Supplementation therapy includes Calcium and Vitamin D as they reduce the risk of fractures and lead to optimal bone health. Patients with pharmacological treatment should as well consume calcium and vitamin D to help the bone healing process. Besides, its consumption must continue during the bisphosphonates drug holiday too.
However, before initiating a supplementation therapy, estimating the dietary intake of calcium is necessary. Therefore, calcium supplements can be added up to vitamin D supplementation. Calcium requirements increase among older persons; recommendations are a daily intake of 1000mg/day for men with ages that go from 50 to 70 and 1200 mg/day for women over 50 years and men over 70 years. Nonetheless, for optimal absorption, the amount of calcium should not exceed 500-600 mg per dose. Excess intakes may lead to kidney stones, cardiovascular diseases, and strokes.
How much Vitamin D should you take if you have osteoporosis?
In order to maintain bone health, the diet should contain calcium supplements. However, Vitamin D is necessary for adequate calcium absorption. The recommendations for Vitamin D dietary are 600 IU/day (15 micrograms) until the age of 70, and after the 70 years, it rises to 800 IU/day (20 micrograms).
Nonetheless, patients with osteoporosis must visit their physician. They need to calculate the Vitamin D intake and deficiency in order to indicate an assertive supplementation treatment. Vitamin D excessive levels may cause non-specific symptoms like anorexia, weight loss, and palpitations. Similarly, it can also raise blood levels of calcium, leading to calcification of blood vessels and tissue, with subsequent damage to the heart and kidneys.
How does osteoporosis affect daily life?
Living with osteoporosis is somehow life-changing because that means that you have to protect your bones. Most of the patients with the diagnosis are very careful in their lifestyles as well as their families. Patients with fractures may be in pain or with a limitation in functionality, which means they cannot move willingly, they can also be in bed with nursing care if the fracture is very complicated. If patients are cautious, they can live a long time without any of the complications. Osteoporosis patients should make the following recommendations:
- Reduce alcohol intake, as it is a factor that has damaging effects over bones. Alcohol toxicity events may also lead to falls and bone fractures.
- Limit your caffeine intake as there is a demonstrated correlation between caffeine and fracture risk.
- Maintaining physical activity such as aerobic exercises, strength exercises, and postural exercises may improve balance and muscle strength. These exercises will ultimately reduce the risk of falls.
- Patients should prevent falls. Measures should be taken in house and work. Removing tripping hazards like rugs and electrical wires should be done.
Do you have risk factors for this condition?
This tool is an osteoporosis symptoms checker. It will help you to determine how likely it is for you that you have this condition. It is free, and it would take a few minutes.