The Silent Disease is the name that is often given to Osteoporosis, as most people don't know they have osteoporosis until it has progressed often to the point of fracture, usually in the hip, wrist or spine. Even when undiagnosed osteoporosis results in a vertebral fracture, the pain is frequently dismissed as general back pain. This lack of awareness can lead to serious illness, deformity, even death.
Osteoporosis alone does not cause back pain. It can, however, weaken the spine to where it is no longer able to withstand normal stress or minor trauma, resulting in vertebral fracture. It is the ensuing fracture that causes pain.
Osteopenia is a condition where bone mineral density is lower than normal, but not low enough to be classified as osteoporosis. While often a precursor to osteoporosis, not everyone with osteopenia will develop osteoporosis. Since a diagnosis of osteopenia puts one at greater risk for osteoporosis, patients are encouraged to seek the advice of their GP's about implementing preventive measures.
Osteoporosis Causes and Risk Factors
Bones are made of complex, constantly changing, living tissue. They are able to grow and heal, and are also susceptible to changes in diet, body chemistry, and exercise levels.
Early in life, more bone is laid down than is removed by the body. People typically achieve peak bone mass by around age 30, after which more bone is lost than is replaced. Too much bone loss leads to osteoporosis.
Both of the two primary types of osteoporosis are far more common in women than men:
Type I osteoporosis (postmenopausal osteoporosis) -generally develops after menopause, when estrogen levels drop precipitously, leading to bone loss - usually in the trabecular (spongy) bone inside the hard cortical bone.
Type II osteoporosis (senile osteoporosis) - typically happens after age 70 and involves a thinning of both the trabecular (spongy) and cortical (hard) bone.
In addition, certain medications and medical conditions can damage bone and lead to what is known as "secondary osteoporosis". Patients being treated for any of the following conditions should discuss the risk of osteoporosis with their physicians:
Endocrine disorders
Marrow disorders
Collagen disorders
Gastrointestinal disorders
Seizure disorders
Eating disorders (such as anorexia or bulimia)
It is important to distinguish between primary and secondary causes of osteoporosis because treatment is often different. To determine the cause, a thorough medical history, physical examination, and appropriate diagnostic tests need to be conducted (see Diagnosing Osteoporosis).
Key risk factors for developing osteoporosis include:
Advanced = age over age 65.
Gender = Women are four times more likely to develop osteoporosis than men.
Heredity = Family history of osteoporosis or fracture on the mother's side.
Personal history = any type of fracture after age 45.
Race = Caucasian and Asian women are at greater risk.
Body type= small-boned women weighing less than 127 pounds.
Menstrual history = Normal menopause increases the risk of osteoporosis and early menopause can exacerbate this risk.
Lifestyle = calcium and/or vitamin D deficiency; little or no exercise (especially weight-bearing exercise); alcohol abuse; smoking; too much cola/soda.
Testosterone deficiency (hypgonadism) = in men.
Why women are at greater risk for developing osteoporosis
Estrogen plays an important part in maintaining bone strength. Starting at about age 30 through onset of menopause, women lose a small amount of bone every year as a natural part of the aging process. When women reach menopause and estrogen levels decrease, the rate of bone loss increases for approximately 8 to 10 years before returning to premenopausal rates.
Osteoporosis Symptoms
Osteoporosis can go undetected for years and fracture is typically the first outward sign. Advanced osteoporosis is potentially disabling, often leading to one or more of the following:
fractures of the spine, wrist or hip
spinal deformity (e.g., lost height, hunched back)
chronic or severe pain
limited function and reduced mobility
loss of independence
decreased lung capacity
difficulty sleeping
Osteoporosis is the leading cause of spine fractures, especially in women over age 50, but only about one third of all spine fractures are diagnosed.
Most osteoporotic spine fractures (vertebral compression fractures) start with sudden back pain, usually after routine activity (lifting or bending) that slightly strains or jars the back. After a month or two, this acute pain is usually replaced by an achy pain (see Diagnosing vertebral compression fractures).
Osteoporosis Prevention
Postmenopausal (Type I) osteoporosis can be significantly influenced by preventive measures. Most of these behaviors are up to the individual and should be started as early in life as possible. For those genetically predisposed to osteoporosis, the following practices are even more important:
Exercise regularly weight-bearing exercises (activities that work one's bones and muscles against gravity) are essential to maintaining bone health.
Ensure adequate calcium intake, Calcium plays a key role in keeping bones strong. Vitamin D is also essential, as it helps ensure absorption and retention of calcium in bones. Calcium and vitamin D requirements vary depending on age and gender.
Eat a balanced, healthy diet Certain foods provide excellent sources of calcium, while diets high in protein and/or sodium increase calcium loss.
Quit smoking - Smoking has a detrimental effect on bone density, leading to greater risk of injury and longer recovery times.
Limit alcohol consumption - While the exact way alcohol affects bone isn't entirely understood, excessive alcohol use has been proven to accelerate bone loss.
Limit intake of colas/sodas - recent research indicates that too much cola or soda can increase the risk of osteoporosis.
Undergo bone density testing - every 1-2 years if you are postmenopausal, over age 65, or have other risk factors. Bone mineral density (BMD) tests indicate normal, low or osteoporotic bone density levels, as well as any increased risk of fracture.
For more information, see How to prevent osteoporosis.
Osteoporosis Treatment
Once osteoporosis has been diagnosed, patient and physician should work together to develop a treatment plan where the goal is to slow bone loss and prevent fractures. Treatment may include:
Education on diet/nutrition - see Food for Thought: Diet and Nutrition for a Healthy Back.
Exercise (if no fracture) - to help maintain bone density and reduce the risk of falls.
Medication - to slow bone loss and prevent fractures. Osteoporosis medications fall into two categories:
medications that slow or stop bone resorption (loss);
medications that increase bone formation.
Treatment for vertebral fractures, which may include:
rest, though long-term rest accelerates bone loss;
rigid back braces to support the spine;
ice/heat and pain medications;
surgery (kyphoplasty or vertebroplasty), which may be necessary in certain situations where the fracture is causing severe pain and/or deformity, or has failed to respond to three months of non-surgical treatment.
Do be positive because even once osteoporosis has been diagnosed, it is possible to slow bone loss, build bone density and prevent fractures. Continually advancing osteoporosis and related fractures are not an inevitable outcome of being diagnosed with osteoporosis.
Terry O'Brien
Back Trouble UK.
<http://www.backtrouble.co.uk> (c)2008
