Osteoporosis, let's talk about bone fragility

By Cristiano Antonino Last updated Jun 4, 2023

Osteoporosis is a disease that makes the bones weak and brittle, so brittle that a fall or even a mild stress such as bending or coughing can cause a fracture

Osteoporosis-related fractures most commonly occur in the hip, wrist or spine

Bone is a tissue that is constantly being broken down and rebuilt.

Osteoporosis occurs when the creation of new bone does not keep pace with the loss of old bone.

It is therefore a systemic skeletal disease, affecting both men and women.

Medication, healthy diet and exercise can help prevent bone loss and/or strengthen already weak bones, thus acting as a preventative against osteoporosis.

Osteoporosis, the symptoms

There are usually no symptoms in the early stages of bone loss.

But, once the bones have been weakened by osteoporosis, symptoms can occur, which vary from person to person:

back pain, caused by a fractured or collapsed vertebrae
loss of height over time
curved posture
bones that fracture much more easily than expected

Diagnosis

Several instruments are used to diagnose osteoporosis
blood tests: (haemochrome with leucocyte formula, electrophoresis of serum proteins, creatinine, parathormone, Vitamin D 25-OH, inorganic phosphate, TSH reflex and calcium, serum telopeptide) allow us to assess the state of bone metabolism and rule out secondary causes of osteoporosis
radiography: generally prescribed when the patient feels pain or in the event of a fracture, it can reveal the presence of osteoporosis (the report will read ‘signs of osteopenia’)
MOC (Computerized Bone Mineralometry): this is the most suitable test for diagnosing osteoporosis, as it allows precise measurement of bone mineral density in the entire skeleton or in skeletal districts particularly prone to bone loss

What treatments are useful in combating osteoporosis

Treatment recommendations are generally based on an estimate of the risk of a bone breaking.

If the risk is not high, treatment will normally not include drugs and will focus on modifying the risk factors.

Bisphosphonates

For both men and women at increased risk of fracture, the most frequently prescribed drugs for osteoporosis are bisphosphonates.

Side effects include nausea, abdominal pain and heartburn-like symptoms.

Intravenous forms of bisphosphonates do not cause stomach discomfort but may lead to fever, headache and persistent muscle pain for up to three days.

Monoclonal antibodies

Denosumab is administered by subcutaneous injection every six months.

Recent research indicates that there may be a high risk of spinal fractures after discontinuation of the drug.

A very rare complication of bisphosphonates is osteonecrosis of the jaw.

This can occur after an invasive dental procedure such as the removal of a tooth.

Hormone replacement therapy

Hormone replacement therapy (HRT) is a drug therapy based on the administration of oestrogen.

After the menopause, when the risk of osteoporosis becomes higher, women produce a low level of oestrogen: with HRT it is possible to mitigate the typical effects of the period (starting with hot flushes) and – at the same time – prevent the onset of osteoporosis in patients who are more likely to suffer from it.

Osteoporosis: risk factors

Bones are in a constant state of renewal: new bone is produced and old bone is broken down.

When one is young, the body produces new bone faster than it breaks down old bone and thus increases bone mass.

After the first 20 years, this process slows down: most people reach peak bone mass by the age of 30.

With advancing age, bone mass is lost faster than it is created.

The likelihood of developing osteoporosis depends in part on the amount of bone mass achieved in youth.

Peak bone mass is somewhat inherited and also varies according to ethnic group.

The higher the peak, the more bones one has ‘in the bank’ and the less likely one is to develop osteoporosis with advancing age.

Risk factors

A number of factors can increase the likelihood of developing osteoporosis, including age, race, lifestyle and medical conditions and treatments.

Some risk factors for osteoporosis are beyond one’s control, including:

gender: women are much more likely to develop osteoporosis than men
age: the older you get, the greater your risk of osteoporosis
race: you are at greater risk of osteoporosis if you are white or of Asian descent
family history: having a parent or sister with osteoporosis puts you at greater risk

Hormone levels

Osteoporosis is more common in people who have too much or too little hormone in their body.

Specifically, lowered sex hormone levels tend to weaken the bone.

In addition, reduced oestrogen levels in menopausal women are one of the strongest risk factors for developing osteoporosis.

Men experience a gradual reduction in testosterone levels with advancing age.

Prostate cancer treatments (which reduce testosterone levels in men) and breast cancer treatments (which reduce oestrogen levels in women) are likely to accelerate bone loss.

Excessive amounts of thyroid hormone can also cause bone loss.

Dietary factors

Osteoporosis is more likely to occur in people who have:

a low calcium intake: a lifelong calcium deficiency plays a role in the development of osteoporosis. A low calcium intake contributes to decreased bone density, early bone loss and an increased risk of fractures;
dietary problems: severely restricting food intake and being underweight weakens bone in both men and women;
gastrointestinal surgery: surgery to reduce the size of the stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium.

Steroids and other drugs

Long-term use of oral or injected corticosteroid drugs, such as prednisone and cortisone, interferes with the bone reconstruction process.

Osteoporosis has also been associated with drugs used to combat or prevent

convulsions
gastro-oesophageal reflux
cancer
transplant rejection

The risk of osteoporosis is higher in people who have health problems such as:

celiac disease
inflammatory bowel disease
kidney or liver disease (especially cholestatic)
cancer
lupus
multiple myeloma rheumatoid arthritis

Finally, certain bad habits can increase the risk of osteoporosis

sedentary lifestyle: people who spend a lot of time sitting have a higher risk of suffering from osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for bones, but walking, running, jumping, dancing and lifting weights seem to be particularly beneficial;
excessive alcohol consumption: regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis;
tobacco use: the exact role of tobacco in osteoporosis is unclear, but its use has been shown to contribute to bone weakness.

Complications

Bone fractures, particularly in the spine or hip, are the most serious complications of osteoporosis.

Hip fractures are often caused by a fall and can lead to disability and even an increased risk of death within the first year after the injury.

In some cases, vertebral fractures may occur even if the person has not fallen.

The bones that make up the spinal column (vertebrae) can also weaken to the point of crumpling, causing back pain, loss of height and a forward bent posture.

Osteoporosis – how to prevent it

A good diet and regular exercise are essential for maintaining healthy bones throughout life.

Protein

Protein is one of the building blocks of bones.

However, there is conflicting evidence on the impact of protein intake on bone density.

Most people get a lot of protein in their diet, others get too little.

It has nothing to do with how much meat one eats: vegetarians and vegans can get enough protein in their diet if they intentionally look for adequate sources such as soy, nuts, legumes, seeds for vegans and vegetarians and dairy products and eggs for vegetarians.

Older people, however, tend to consume less protein and therefore require supplementation.

Body weight

Being underweight increases the possibility of bone loss and fractures, but it is also known that excess weight increases the risk of fractures.

Therefore, maintaining an appropriate body weight is good for your bones as well as your health in general.

Calcium

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium per day.

This daily amount increases to 1,200 milligrams when women turn 50 and men 70.

Good sources of calcium include:

low-fat dairy products
dark green leafy vegetables
canned salmon or sardines with bones
soya products such as tofu
cereals fortified with calcium
orange juice

Total calcium intake, from supplements and diet, should not exceed 2,000 milligrams per day for people over 50 years of age.

Vitamin D

Vitamin D improves the body’s ability to absorb calcium and improves bone health in numerous ways.

People can get some of the vitamin D they need from sunlight, but this may not be a good source if you live in high latitudes, are housebound, regularly use sunscreen or avoid the sun because of the risk of skin cancer.

To obtain enough vitamin D to maintain bone health, it is therefore recommended that adults between the ages of 51 and 70 take 600 international units (IU) and 800 IU daily after the age of 70 through food or supplements.

People without other sources of vitamin D and especially with limited sun exposure may need a supplement.

Most multivitamin products contain between 600 and 800 IU of vitamin D.

Up to 4,000 IU of vitamin D per day is safe for most people.

Exercise

Exercise can help build strong bones and slow bone loss.

Exercise benefits your bones no matter when you start practising it, but you will get the most benefit if you start exercising regularly when you are young and continue throughout your life.

Ideally, strength training exercises should be combined with weight-bearing and balance exercises.

Strength training helps strengthen the muscles and bones of the arms and upper spine.

Exercises under load, such as walking, jogging, running, climbing stairs, jumping rope, skiing and high-impact sports, mainly affect the bones of the legs, hips and lower spine.

Finally, balance exercises such as tai chi can reduce the risk of falling, especially with advancing age.

Swimming, cycling and exercising on machines can provide a good cardiovascular workout, but do not improve bone health.

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