Osteoporosis: What you need to know about this "silent disease"

Ageing and osteoporosis present challenges in Fracture healing and fixation in the elderly. Osteoporosis is a condition characterized by weakened and brittle bones, increasing the risk of fractures even from minor falls or everyday activities. It develops when the creation of new bone doesn’t keep up with the loss of old bone mass, leading to decreased bone density and structural changes. Often called a “silent disease,” many people don’t realize they have osteoporosis until a fracture occurs.Bone healing can be affected by ageing bone, osteoporosis, mechanical environment after fixation and medications.SymptomsIn the early stages, osteoporosis often presents no noticeable symptoms. However, as bone loss progresses, individuals may experience: * Back pain: This can be caused by fractured or collapsed vertebrae. * Loss of height over time: Compression fractures in the spine can lead to a gradual decrease in height. * Stooped posture (kyphosis): The spine may curve forward due to weakened vertebrae. * Bones that break more easily than expected: Fractures can occur from minor bumps or falls, most commonly in the hips, wrists, and spine.These warning signs of osteoporosis can include: Loss of height Back painFatigue and generalised body acheCauses and Risk FactorsSeveral factors can increase the likelihood of developing osteoporosis: * Age: Bone density naturally decreases with age, particularly after menopause in women due to declining estrogen levels. Women after 50 and men after 60 generally have osteoporosis. * Family history: Having a parent or sibling with osteoporosis increases your risk. * Body size: Individuals with smaller body frames tend to have lower bone mass. * Race: White and Asian women have a higher risk. * Low calcium intake: A lifelong deficiency in calcium contributes to lower bone density and increased bone loss. * Vitamin D deficiency: Vitamin D is essential for calcium absorption. * Certain medical conditions: These include hormonal disorders, autoimmune diseases, and gastrointestinal disorders. * Medications: Long-term use of corticosteroids and some other medications can affect bone health. * Lifestyle factors: * Sedentary lifestyle: Lack of weight-bearing exercise weakens bones. * Smoking: Tobacco use is detrimental to bone health. * Excessive alcohol consumption: High alcohol intake can interfere with bone formation. * Eating disorders: Severely restricting food intake and being underweight weakens bones. * Gastrointestinal surgery: Procedures that reduce stomach size or remove part of the intestine can limit nutrient absorption, including calcium.PreventionPreventing osteoporosis involves adopting healthy lifestyle habits throughout life: * Maintain a balanced diet: Ensure adequate intake of calcium and vitamin D through foods like dairy products, leafy green vegetables, fatty fish, and fortified foods. * Engage in regular exercise: Weight-bearing exercises (e.g., walking, jogging, dancing) and strength-training exercises help build and maintain bone density. * Maintain a healthy weight: Being underweight increases the risk of bone loss. * Avoid smoking: Quitting smoking is crucial for bone health. * Limit alcohol consumption: Drink in moderation, if at all.DiagnosisOsteoporosis is typically diagnosed through a bone density scan called a DEXA (dual-energy X-ray absorptiometry) scan. This low-radiation X-ray measures the mineral density of your bones, usually at the spine and hip.Blood test includeCalcium, phosphorus, alkaline phosphatase and parathormoneTreatmentTreatment for osteoporosis aims to prevent fractures and slow down bone loss. It may involve: * Lifestyle modifications: Adopting the preventive measures mentioned above. * Calcium and vitamin D supplements: To ensure adequate intake. * Medications: * Bisphosphonates: These drugs slow down bone breakdown. * RANKL inhibitors: Denosumab is an antibody against the receptor activator of nuclear factor-kappa B ligand (RANKL). Through osteoclast inhibition and decreasing bone resorption, denosumab has been shown to reduce the risk of hip, non-vertebral, and vertebral fractures. * Selective estrogen receptor modulators (SERMs): These drugs have estrogen-like effects on bone.*Sclerostininhibitors: Romosozumab is a humanized monoclonal antibody against sclerostin that isused to treat osteoporosis in postmenopausal women. These patients are at an increased risk of fracture and often have a history of osteoporotic fractures, multiple risk factors, or cannot be prescribed other medications to treat osteoporosis. Cardiac evaluation is required prior to starting this medicine * Anabolic agents: These medications help to rebuild bone. * Fall prevention strategies: To reduce the risk of fractures. * Pain management: Medications and therapies to alleviate pain from fractures. * Physical therapy: To improve strength, balance, and posture. * Surgical procedures: Depending on the site of fractures and criticality Conservative or operative options are takenHow factors interplay to affect bone healing is complex and the cause for union, delayed or non-union is often multifactorial, in osteoporosis drugs like teriparatide may expedite fracture healingIt is essential to consult with your doctor for proper diagnosis and a personalized treatment plan for osteoporosis.Dr Vasudev N Prabhu, Senior Consultant Orthopaedic and Joint Replacement Surgeon, Apollo Hospitals, Sheshadripuram, Bengaluru