She came for her annual gynecological checkup. There was a plaster cast over her right arm. “What happened to your arm?” I asked. “I slipped and fell in the bathroom and fractured my wrist. After investigations, the doctor told me that I suffered from osteoporosis,” she answered.
L, a 52-year-old teacher had been menopausal for the past 2 years. She was thin and petite. Her mum also had a hip fracture when she was in her 50s. Osteoporosis is a serious bone-thinning disorder. The bones become so weak and brittle that a slight fall or mild trauma may cause a fracture. It is often referred to as the ‘silent disease’ because the patient usually has no symptoms until he or she has a fracture.
How does osteoporosis happen?
Bone is a living tissue that is constantly in the stage of renewal. New bone is formed and old bone is broken down and replaced. When we are young, the process of bone building is faster than that of bone loss and our skeleton remains healthy and strong. Bone mass peaks by the age of 30. Thereafter, the mass declines gradually with age as new bone formation cannot keep up with the loss of old bone. Bones thus get thinner and osteoporosis results.
Osteoporosis may develop depending partly on how much bone mass we attained in our youth. Peak bone mass is also somewhat inherited. The higher the peak bone mass, the less likely osteoporosis will develop as we age.
What are the symptoms of osteoporosis?
Typically, there are no symptoms. Sometimes, backache may occur from a minor fracture or collapse of the vertebrae. A “dowager hump” or a stooped posture may be obvious and the patient may notice getting shorter with time.
What are the risk factors?.
There are many risk factors. They include:
- Gender. Women are much more likely to develop osteoporosis than men.
- Age. The older you are, the greater your risk of osteoporosis.
- Race. Asian women are more prone to osteoporosis. There are also some ethnic variations
- Family history of osteoporosis
- Body frame size. Small body frames have a higher risk of osteoporosis
- Hormonal factors: post-menopausal women and patients with an overactive thyroid gland are more likely to develop osteoporosis.
- Diet: A diet low in calcium
- Medications: Long-term use of oral or injected steroid medications
- Medical conditions: chronic kidney or liver diseases.
- Excessive alcohol consumption and smoking.
How is osteoporosis diagnosed?
The bone density is usually measured by running a scanning machine using low levels of X-rays over the body of the patient. The proportion of mineral in the hip and spine bones is then calculated.
Complications of osteoporosis
Serious complications such as hip or spine fractures may be life threatening.
Prevention and treatment
Good nutrition especially calcium and vitamin D intake and regular weight bearing exercise are essential in keeping the bones healthy throughout life. Treatment using oral medications such as bisphosphonates and injection such as Monoclonal antibody are effective in improving the bone density and reducing the chances of bone fractures.
L was prescribed oral medication for her condition. She told me that she was lucky to have had only a wrist fracture and not a hip or spine fracture. “I am more aware of my bone health now,” she said as she was leaving my consultation room.