Osteoporosis diagnosis, treatment and prevention.

Posted on 24/04/2024

The word ‘osteoporosis’ means ‘porous bone.’ Since the condition weakens bones, having it increases your chance of sudden, unforeseen bone fractures. If you have osteoporosis, your bones are weaker and have less mass. The condition frequently progresses without any warning signs or discomfort, and it is typically not recognized until the weakening bones result in excruciating fractures. The majority of these involve hip, wrist, and spine fractures.Osteoporosis is responsible for more than two million fractures each year, and this number continues to grow.

Cause of Osteoporosis

Bones support and shield the body's vital organs. Calcium and other minerals are also stored in bones. The body breaks down and rebuilds bone when it requires calcium. This procedure, known as bone remodeling, maintains the strength of the bones while supplying the body with the calcium it requires.

You typically gain more bone than you lose up until the age of roughly 30. After age 35, bone mass gradually decreases because bone deterioration outpaces bone formation. You lose bone density more quickly if you have osteoporosis. The rate of bone deterioration increases after menopause.

Diagnosis of Osteoporosis

Bone density scan (DEXA scan)

All women over the age of 65 should have a bone density test. The DEXA scan may be done earlier for women who have risk factors for osteoporosis. Men over age 70, or younger men with risk factors, should also consider getting a bone density test.To determine how dense (or strong) your bones are, a bone density scan uses low dosage X-rays. It may also be referred to as a DEXA scan. Bone density scans are frequently used to identify or gauge your risk of osteoporosis. A bone density scan can detect low bone density more accurately than standard X-rays and is also rapid and painless.

How is it done?

Dual energy X-ray absorptiometry is a form of X-ray that is used to conduct a bone density scan. This is abbreviated as DEXA.While some radiation passes through your body, some is absorbed by bone and soft tissue.The DEXA machine uses specialized detectors to measure the amount of radiation that goes through your bones before being transferred to a computer.

With the use of a bone density scan, you can compare your bone density to that of a young, healthy adult or an adult of the same age, gender, and ethnicity. A standard deviation (SD) score is calculated to represent the difference. It calculates the discrepancy between your bone density and what is predicted. A T score is the variance between your measurement and a young, healthy adult.

A Z score is the variance between your measurement and that of a person your age.
The World Health Organization assigns the following categories to T scores:

Above -1 SD, bone mineral density (BMD) is considered normal. Between -1 and -2.5 SD, BMD is considered mildly diminished compared to peak bone mass (PBM). At or below -2.5 SD, osteoporosis is considered.

Your bone density is lower than it should be for someone your age if your Z score is less than -2. Children and people under 30 who are still developing are typically the target audience for Z scores.

CT scan for hidden bone density information

By using routine CT images to obtain data on bone density, opportunistic bone density screening can assist identify osteoporosis and poor bone density. The spine is the most frequently evaluated area, and CT has the advantage of eliminating confounders that might be troublesome for dual-energy x-ray absorptiometry, such as body size, atherosclerotic calcifications, and degenerative alterations to the spine. Opportunistic bone density testing doesn't include any additional expenses for the patient, radiation exposure, or scanner time.

Treatment of Osteoporosis

Treating osteoporosis involves treating and preventing fractures, and using medicines to strengthen bones.

Bone-building drugs

Your doctor could advise attempting: if you have severe osteoporosis or if the most popular therapies for osteoporosis don't work well enough.

Teriparatide (Bonsity, Forteo) (Bonsity, Forteo). This potent medication stimulates the creation of new bones and is similar to parathyroid hormone. For up to two years, it is administered via daily injection under the skin.

Another medication like parathyroid hormone is abaloparatide (Tymlos). We can to consume this medication only for two years.

Romosozumab (Evenity) . This is the most recent osteoporosis medicine to promote bone growth. It is only effective for one year of treatment and is administered as an injection monthly at your doctor's office.

You will typically need to take another osteoporosis medicine to sustain the new bone growth after stopping any of these bone-building medications.

Hormone-related therapy

Estrogen can help maintain bone density, especially when taken immediately after menopause. However, estrogen medication raises the risk of blood clots, which can lead to strokes, and breast cancer. Therefore, estrogen is frequently utilized for bone health in younger women or in those who simultaneously need to treat menopausal symptoms.

In postmenopausal women, raloxifene (Evista) replicates estrogen's positive effects on bone density while avoiding some of the dangers. This medication can lower the chance of developing some forms of breast cancer. As a side effect, hot flashes are possible. Your risk of blood clots could also rise if you take raloxifene.

An age-associated reduction in testosterone levels in men may be related to osteoporosis. Although osteoporosis drugs have been better studied in males to treat osteoporosis, they are nevertheless advised alone or in addition to testosterone replacement treatment since they can help with the symptoms of low testosterone.

How can we prevent Osteoporosis ?

These recommendations could lower your risk of osteoporosis or breaking bones:

Avoid smoking. Smoking increases the likelihood of fracture as well as the pace of bone loss.

Drink in moderation. Alcohol consumption above two drinks per day may hinder bone growth. Drinking too much alcohol can also make you more likely to trip and fall.

Avoid falling. Check your home for electrical cables, area rugs, and slick surfaces that could cause you to fall, and wear low-heeled shoes with non-slip bottoms. Install grab bars just inside and outside your shower door, keep rooms well-lit, and check that you can easily get in and out of bed.