In osteoporosis, old bone is being reabsorbed faster than new bone is being made, causing the bones to lose density, becoming thinner and more porous. Osteoporosis usually goes unnoticed until there is a bump or fall causing a fracture that usually would not have caused injury. Severe or established osteoporosis is identified when there is a fragility fracture that is generalized, involving major portions of the axial skeleton, or regional, involving one segment of the appendicular skeleton.
Throughout the lifetime, bone is reabsorbed (removed), and new bone is added (formation) to the skeleton. This happens at a fast pace until peak bone mass, or maximum bone density and strength is reached, usually around age 30, after which reabsorption exceeds bone formation. Men have a higher bone density than women, therefore the prevalence of this disease is usual found in women at around age 50, and men at around age 80.
It is recommended by the United States Preventative Services Task Force that women get screened for osteoporosis at age 65.
Vertebral fractures are most common. The person may be not feel pain from the fracture, but the fracture may still result in deformity, reduced pulmonary function, and loss of height.
A bone mineral density (BMD) is the most common method of measuring bone mass. This test measures bone quantity, not quality. The Fracture Risk Assessment (FRAX), which is a questionnaire that signified risk factors for osteoporosis, in combination with the BMD at the femoral neck predict the 10-year probability of a fracture.
See https://www.sheffield.ac.uk/FRAX/tool.aspx
Facts:
- Osteoporosis is most common in women at a rate of 1:2; men at a rate of 1:4.
- It is most rapid in the first years after menopause.
- Approximately 52 million people are affected by it.
- Vertebral fractures are most common.
- Mexican Americans are high risk for osteoporosis at the lumbar spine or femoral neck.
- African Americans are typically low risk. African American women are at risk due to factors such as decreased calcium intake, percentage of lactose intolerance, sickle cell, and lupus.
- White Americans more susceptible to low bone density with age.
- Influenced by genetic factors.
Prevention:
- Calcium and Vitamin D supplement
- Magnesium
- Healthy diet that includes fruits and vegetables
- Regular, moderate weight-bearing exercise
- Muscle strengthening exercise routine
Treatment:
Treatment is focused on maintaining optimal bone function, although prevention is optimal. Pharmacological interventions can be classified into anti resorptive agents that prevent the bone resorption and anabolic agents that help in the new bone formation. Approved anti-resorptive agents in USA include hormone replacement therapy (HRT), bisphosphonates, SERMS, Denosumab. Anabolic agents include Strontium (only available in Europe) and Teriparatide.