Osteoporosis: Symptoms, Tests and Treatment

Osteoporosis: Symptoms, Tests and Treatment

Osteoporosis is a condition characterized by weakened bones that are more susceptible to fractures. Often called a "silent disease," osteoporosis typically has no symptoms until a fracture occurs. With an estimated 50 million Indians affected, understanding osteoporosis — its risk factors, screening, and treatment — is critical for preventing debilitating fractures.

What Is Osteoporosis?

Osteoporosis means "porous bone." Healthy bone has a dense, honeycomb-like structure. In osteoporosis, the holes in this honeycomb become larger and more numerous, reducing bone density and strength. This makes bones fragile and more likely to break from minor falls or even from coughing or bending.

A 2020 study in The Lancet estimated that osteoporosis affects 200 million women worldwide, with 1 in 3 women and 1 in 5 men over 50 experiencing an osteoporotic fracture.

Risk Factors

Non-modifiable:

• Age (risk increases after 50)
• Female gender (women lose bone faster after menopause)
• Family history of osteoporosis or fractures
• Ethnicity (Caucasian and Asian women at higher risk)
• Early menopause (before 45)

Modifiable:

• Low calcium and vitamin D intake
• Sedentary lifestyle
• Smoking
• Excessive alcohol consumption
• Long-term corticosteroid use
• Low body weight (BMI < 18.5)
• Eating disorders
• Hyperthyroidism
• Malabsorption conditions (celiac, IBD)

Symptoms

Osteoporosis is often asymptomatic until a fracture occurs. Warning signs include:

• Loss of height (more than 2 cm)
• Stooped posture (kyphosis)
• Back pain (from vertebral fractures)
• Fractures from minor falls (hip, spine, wrist)
• Receding gums (jaw bone loss)

Common fracture sites: Hip, spine (vertebral), wrist (Colles'), and shoulder.

Diagnosis: The DEXA Scan

The gold standard for diagnosing osteoporosis is the DEXA (Dual-Energy X-ray Absorptiometry) scan, which measures bone mineral density (BMD). Results are expressed as T-scores:

• Normal: T-score ≥ -1.0
• Osteopenia (low bone mass): T-score between -1.0 and -2.5
• Osteoporosis: T-score ≤ -2.5
• Severe osteoporosis: T-score ≤ -2.5 with fragility fracture

The WHO recommends DEXA screening for:

• Women 65 and older
• Men 70 and older
• Postmenopausal women under 65 with risk factors
• Men 50-69 with risk factors
• Anyone with a fragility fracture
• Anyone on long-term corticosteroids

Treatment

1. Calcium and Vitamin D

• Calcium: 1000-1200 mg/day (from diet + supplements)
• Vitamin D: 800-1000 IU/day (target level 30-50 ng/mL)

2. Bisphosphonates (First-Line Medications)

• Alendronate, risedronate, ibandronate, zoledronic acid
• Reduce fracture risk by 40-70%
• Must be taken on empty stomach with water; remain upright for 30-60 minutes

3. Other Medications

• Denosumab: Monoclonal antibody, given as injection every 6 months
• Teriparatide: Parathyroid hormone analog, builds new bone (for severe osteoporosis)
• Raloxifene: SERM for postmenopausal women
• Calcitonin: Less effective, used for pain relief after fractures

4. Lifestyle Modifications

• Weight-bearing exercise (walking, dancing, resistance training)
• Fall prevention (home safety, vision correction, balance training)
• Quit smoking and limit alcohol
• Adequate protein intake (1.0-1.2 g/kg/day)

Prevention

• Build peak bone mass before age 30 (adequate calcium, vitamin D, exercise)
• Maintain bone health throughout life
• Regular weight-bearing exercise
• Avoid smoking and excessive alcohol
• Get adequate calcium and vitamin D
• Screen at-risk individuals

Conclusion

Osteoporosis is a silent disease that causes devastating fractures. The good news is that it is preventable and treatable. Building strong bones early in life, maintaining adequate calcium and vitamin D, regular weight-bearing exercise, and appropriate screening can significantly reduce fracture risk. If you are over 50 or have risk factors, talk to your doctor about a DEXA scan.

References:

• Kanis, J.A., et al. (2019). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International, 30(1), 3-44.
• Compston, J., et al. (2019). UK clinical guideline for the prevention and treatment of osteoporosis. Archives of Osteoporosis, 12(1), 43.
• Black, D.M., & Rosen, C.J. (2016). Clinical practice. Postmenopausal osteoporosis. The New England Journal of Medicine, 374(3), 254-262.
• Cummings, S.R., & Melton, L.J. (2002). Epidemiology and outcomes of osteoporotic fractures. The Lancet, 359(9319), 1761-1767.
• Riggs, B.L., & Melton, L.J. (1986). Involutional osteoporosis. The New England Journal of Medicine, 314(26), 1676-1686.