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Osteoporosis

Maison Bramel and Hailey Miller

Lincoln University

June 27, 2022

Osteoporosis can be defined as a condition when a persons bones become less dense. In return, this makes the bones fragile and weak which most commonly leads to fractures and other complications. Osteoporosis is a common condition many people have heard of. Because our bones are “ever-changing proteins” they are not as strong as we think they are. Osteoporosis is normally diagnosed using DEXA, or Dual Energy X-Ray Absorptiometry, BMD (bone mineral density tests) are the most accurate way of diagnosing a patient with this condition. In most cases this condition is asymptomatic until a person suffers a fracture.

There are many ways to help prevent osteoporosis. Some examples are taking Calcium and Vitamin D supplements, physical exercise, and certain medications. Medications used to treat Osteoporosis include Raloxifene, Teriparatide, Abaloparatide, Estrogen, and more. Some complications can occur after a person fractures a bone. These complications include, but are not limited to, trouble breathing, pneumonia, blood clots, and possible post surgery infections.

Though osteoporosis is commonly seen in older women, there are other risk factors that can lead to it as well. Some of these risk factors include getting older, being small and thin, having a family history of osteoporosis, certain medications, and white or Aisian women. More risk factors that are not commonly thought of include alcohol use, tobacco use, and even depression. Some diseases leave us at a higher risk for osteoporosis such as hyperthyroidism, diabetes, and inflammatory bowel disease.

Osteoporosis may not seem like a major threat at first, but it is important for patients to understand how common it is and how to take care of themselves if diagnosed with it.

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Osteoarthritis and Osteoporosis: What Is The Difference?

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Pneumonia, breathing issues caused from stooped posture, blood clots, hospital acquired infections from surgery

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Emily is a 65-year-old woman who is in pretty good shape. The last thing she suspects is that she has osteoporosis. However, one day she is walking around the garden, trips, falls, and breaks her hip. This is called a fragility fracture. It's the breaking of a bone in a person with osteoporosis, a break that wouldn't have otherwise occurred in a healthy person who has fallen from a standing height or lower. Unless specifically looked for, the first clue to osteoporosis is often-times a fragility fracture just like Emily's.

Emily's doctor will carefully assess her family history for any evidence of osteoporosis and ask her questions about her lifestyle. How much does Emily exercise? Too little exercise is not good. What does she eat? A low calcium diet increases the risk for osteoporosis. Does she smoke? Tobacco use may lead to weak bones. Does she drink alcohol? Regular consumption of alcohol increases the chances of osteoporosis. Does she have back pain? This may be a sign of osteoporosis. Emily's answers will help lay the foundation for not only diagnosing osteoporosis but determining how it should be treated in her unique case.

In addition to getting Emily's history, the doctor will also perform a physical exam to figure out:

Emily's current height

How her current height compares to prior records of her height

If she has a hunchback appearance

The latter, as well as diminished height, can be signs of osteoporosis.

If the doctor suspects Emily has high levels of thyroid hormone or lowered levels of sex hormones, then he will order a blood test to confirm this and treat that as necessary, as either will predispose to osteoporosis.

While all of these questions and measurements help provide clues to osteoporosis, the only accurate way to scientifically diagnose osteoporosis is to perform a bone mineral density (BMD) test. This is a painless test where Emily lies down on a table and two x-ray beams, which have different strengths to their beam, are aimed at Emily's bones. This helps figure out how dense Emily's bones are compared to a healthy 30-year-old that has the same sex and race as her.

Osteoporosis leads to a decreased bone mineral density and to a hunchback appearance, called kyphosis.

Prognosis

After all the questions, physical exam, and tests, it's beyond a doubt that Emily has osteoporosis. The prognosis for a patient with osteoporosis depends on many factors. This includes the underlying cause of the person's osteoporosis, their age, sex, ethnic background, how well they follow their doctor's orders, and if they have any other concurrent diseases. For example, people whose osteoporosis is caught very early can be treated with anti-osteoporotic medication, and thus lessen their chances of a fragility fracture.

In cases where the osteoporosis is caught very late, after a fracture has already occurred, things are trickier. The thing is, osteoporosis itself will not kill Emily. However, she is at risk of dying from various complications that arise as a result of broken bones. These complications include:

Pneumonia, an infection of the lungs

Breathing disorders that arise from the stooped posture people with osteoporosis have

Blood clots, especially those in the deep veins of the legs

Hospital acquired infections as a result of surgery to fix a fracture

Even if Emily does not suffer from any of these complications, her quality of life may be greatly diminished as a result of her hip fracture. She may have serious life-long pain from the fracture, an inability to get around very well, and an increased risk of getting another fracture.

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Calcium consumption, exercise, tobacco or alcohol consumption, have they been experiencing back pain

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When a fracture occurs that would not have occurred in a healthy person who had fallen from a standing or lower position.

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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Most individuals do not realize they have this disease until they have a minor incident that causes a fracture.

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Osteoporosis is the scientific name for a disease in which bones become weaker, more fragile, and brittle, predisposing an individual to more cracks and fractures. This should not be confused with a similar sounding condition called osteopetrosis. The latter is a rare, inherited disorder that also predisposes a person to a greater risk of fracture as a result of over-hardening of the bone as opposed to the weakening of it. In any case, osteoporosis is a pretty famous condition, one that even a caveman who was out of the dark enclave for even a day would have heard of.

While men, cavemen or otherwise, can be affected by this condition, it's more common in women, especially post-menopausal women. Besides advanced age and sex, there are other factors that influence someone's likelihood to develop osteoporosis. Drinking alcohol, smoking, leading an inactive lifestyle, soda, and many other factors, such as metabolic diseases or other medical conditions, can predispose an individual to developing osteoporosis.

Why Does Osteoporosis Occur?

While the risk factors are many, the reason why osteoporosis occurs boils down to something like this. We tend to think of our bones as this hard and rigid structure. The reality is that they only become super hard and almost weapon-like after death. While you are alive, your osseous tissue, or the strong connective tissue that forms your bones, isn't as hard or unchangeable as you might think. That's because bone is an ever-changing state of proteins, cells, and hydroxyapatite, which is bone mineral that is comprised of calcium and phosphate.

While the mineral gives our bones their famous rigidity and strength, it's a protein called collagen that gives our bones a bit of flexibility. I sometimes like to think of this combination as a medieval flail. The ball is like a molecule of a really hard mineral of bone and the chain is like the stringy portion of bone that's attached to it. While the chain gives the weapon some flexibility, the ball at the end of the chain is hard enough to kill someone. That's sort of how bone is structured as well. It's a balance of strength and flexibility.

Additionally, I mentioned that cells play a part in our bones. These cells, called osteoblasts and osteoclasts, are responsible for shifting around, repairing, and modifying our bone as we live our lives. That's why bone is truly alive and ever-changing as we live and change ourselves! In short, osteoclasts consume bone and osteoblasts build bone. You can think of the osteoclasts as the construction workers that come by a road and begin to tear it apart, while the osteoblasts would be the crew that comes in afterwards to rebuild it.

In osteoporosis, either too little formation of bone or too much removal of bone occurs as a result of external factors, be it genetic or environmental. A specific but generalized example of one way this imbalance can occur can be seen in post-menopausal women. Estrogen is a hormone found in men and women that kills off osteoclasts to prevent the removal of too much bone. After menopause, the levels of estrogen in women rapidly decrease, allowing the osteoclasts to live longer and remove more bone.

This, therefore, leads a woman's bones, especially after menopause, to become weaker, more fragile, and more porous. That's how we get the name for this disease; 'osteo-' means bone and '-porosis' implies that something is porous.

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We see a lot of elderly hip fractures from ground falls due to this disease. The image on the left is affected by osteoporosis, it is less dense. 

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Calcium and Vitamin D supplements
Exercise
Bisphosphonates (prescription that slows bone destruction by causing osteoclasts to reabsorb bone)

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Dual energy x-ray absorptiometry. A test performed to evaluate bone density. Used to diagnose osteoporosis or identify future risk for development.

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This is due to the decline in estrogen levels. Estrogen helps prevent the formation of too many osteoclasts which break down bone.

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RF: genetics, decline with age, being small and thin (less stress on bones to promote strengthening), being a white or asian female, certain medications can disrupt bone building