Patients with osteoporosis have weak, brittle bones that are at risk of breaking easily. Osteoporosis literally means “porous bones” and is the result of several modifiable factors, such as diet and exercise and non-modifiable factors such as age, sex, and race. Bones, like other tissue in the body, are self-renewing—up to a point. In a healthy person, old bone tissue is used up and worn out, but the old bone tissue is replaced with new bone tissue. Advanced age and other factors can harm this cycle of rebuilding. As people age, their bones are not rejuvenated as vigorously. The result is a thinning of the bone which becomes more vulnerable to injury. A patient with severe osteoporosis may break a bone by doing a very light activity such as simply bending over or even coughing. A broken hip bone is one of the most common and devastating outcomes of this condition. Prevalence of Osteoporosis According to the International Osteoporosis Foundation, approximately 200 million people across the world suffer from osteoporosis. Osteoporosis is more common than heart attack, stroke, or cancer. In the United States, 44 million people have osteoporosis or low bone density. Anywhere from 24-50% of women and 7.5% men over age 50 have osteoporosis.

Before talking about what causes osteoporosis, let’s look at the functions of bones. Bones serve as a large reservoir of calcium and to support the skeletal system. Bones are constantly regenerating as a way to get rid of old bone tissue and strengthen the bones with new bone tissue. It is estimated that the skeleton is completely replaced approximately over 4 years. Bone building, known as “remodeling” is the process of resorption and formation. Resorption : In resorption old bone is eaten up by the body (osteoclasts) and calcium, phosphorus, and collagen type 1 are in released into circulation. Osteoblasts are created when the parathyroid hormone stimulates the Osteoblasts, who in turn signal the monocytes and macrophages to differentiate into osteoclasts. Resorption takes days to weeks. Bone formation : is when osteoblats lay down new bone tissue called osteoid, which is made up of of type 1 collagen and other proteins. In order for the new bone tissue to grow strong, the osteoblasts deposit calcium and phosphorus (this step depends on the amount of calcium and phosphorus available, which is why it is important that we get enough calcium in our diet.) Bone formation takes months. Osteoporosis Causes Osteoporosis occurs when more bone is being broken down than built up. This can occur due to estrogen deficiency, steroid use, etc. There are two types of osteoporosis; primary and secondary.

Unmodifiable Risk Factors for Osteoporosis: Things you can’t do anything about Over age 50 Caucasian or Asian race Dementia Female gender/ postmenopausal women Women are at a much greater risk for osteoporosis than men.  The loss of sex hormones in the body is the most common cause of osteoporosis. Women experience a decline in estrogen, the female sex hormone, when they undergo menopause. This means that women who have undergone menopause are much more likely to develop osteoporosis. Family history of Osteoporosis Broken bones or height loss Decline in testosterone Men can and do occasionally develop osteoporosis for the same reason: A decline in testosterone, the male sex hormone, results in bone loss. As they age, men lose testosterone more gradually than women, and that protects many men from developing osteoporosis. However, the treatment for prostate cancer depletes testosterone, making patients with prostrate cancer at higher risk for bone loss. Chronic health conditions that effect bone formation/resorption People with small frames Are at greater risk for this condition because they have less bone tissue to begin with. Modifiable Risk Factors for Osteoporosis : Things you can change to lower your risk Low Calcium intake and Vitamin D Calcium deficiency has been implicated in the development of osteoporosis.

Early signs of Osteoporosis In its early stages, osteoporosis is likely to be asymptomatic. That means many people will not know they have it without the benefit of testing. Osteoporosis often goes diagnosed until a fracture or injury occurs, because low bone mass does not cause pain. A hallmark sign of osteoporosis are fractures that occur easily Common fracture site include the vertebrae, wrist, femur, and ribs. Other reasons for pain in osteoporosis include secondary causes such as cancer. If a patients with low bone mass is presenting with bone pain and there are no fractures to be seen, the provider should rule out other causes of bone pain. Late signs of Osteoporosis Fractures Back pain can be a warning sign. It might be the result of a collapsed or broken spinal vertebra precipitated by bone loss. Dowager’s hump (or hump back) of the thoracic spine that occurs with multiple vertebral compression fractures. Loss of height: Getting shorter is an almost infallible sign of bone loss. Because the bones have lost their density. Height loss > 4 cm in 10 years is significant! Scoliosis Low extremity strength, balance, gait, and postural reflexes Red Flags Multiple fractures Fatigue Easily Bruising Generalized pain Gait abnormalities Height loss > 4 cm in 10 years Complications   include fractures, falls, pulmonary embolism, pain, decrease in quality of life, lost work days, disability, collapse of vertebrae secondary to compression fracture, recurrent fracture, death!

The USPSTF recommends screening for osteoporosis in Women aged 65 years or older and Younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors Men Concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men Re-screening There are no current guidelines on the value of rescreening women whose initial screening test did not detect osteoporosis is to improve fracture risk prediction The World Health Organization recognizes three classes of bone loss Osteopenia is the term used for minimal bone loss which is still clinically significant. Osteopenia is diagnosed if the bone mineral density test shows a bone loss standard deviation of -1 to -2.5. Patients with osteopenia are deemed up to 250 percent more likely to experience a bone fracture than a healthy person. Osteoprosis: A bone loss of greater than -2.5 is diagnosed as osteoporosis. Severe osteoporosis is diagnosed if the bone loss is -2.5 or greater and at least one fracture has occurred that is related to bone loss.