Osteoporosis: Symptoms and treatment of osteoporosis

What do you know about osteoporosis? This report will probably answer all your questions.

Osteoporosis affects bones’ structure and strength and increases fractures’ risk, especially in the spine, pelvis, and wrist. This disease is more common in postmenopausal women, But smoking and a low diet also increase the risk. Usually has no apparent symptoms, but the spine’s weakening can lead to flexion and bone pain. An X-ray scan called DEXA is used to diagnose this problem. Treatment includes medications to prevent or reduce bone density loss, and dietary adjustments include taking more calcium, magnesium, and vitamin D. (Osteoarthritis Symptoms, Prevention, And Treatment)

Outbreak status of osteoporosis

Worldwide, osteoporosis causes more than 9.8 million fractures annually. It is estimated that approximately 200 million women worldwide have osteoporosis. It is predicted that by 2050, compared to 1990, the rate of pelvic fractures due to osteoporosis will increase by 310% in men and 240% in women. In the world, 50,000 pelvic fractures were reported in 2010, and this number is projected to reach 62,000 by 2020. Osteoporosis and osteopenia are common problems among the world over the age of 30. The increase in this disease’s trend in recent years indicates a critical health problem worldwide. However, due to the lack of coordination between different studies’ results, it is impossible to accurately estimate this disease’s prevalence in high populations. Osteopenia is something like the middle stage of healthy bones and bones with osteoporosis or the precursor stage of osteoporosis. In osteopenia, the bones are weaker than usual; But they are not yet strong enough to break as easily as osteoporosis.

What is osteoporosis?

Osteoporosis occurs when bone density decreases, and the body no longer produces as much bone as it used to. This problem can affect both men and women; however, it is more likely to occur in postmenopausal women due to a sudden decrease in estrogen, a hormone that naturally protects against osteoporosis. As the bones become weaker, they are more likely to break due to a fall or even a small blow.

Osteoporosis means porous bone; The bones become weaker, and fractures’ risk increases, especially in the pelvis, spine, and wrists. Bone tissue is always being rebuilt, and new bones are replacing old, damaged bones. In this way, the body maintains the bone structure and density. Bone density is around 25 to 30 years old. After about 35 years, the bones begin to weaken. As we age, the amount of bone breakdown occurs more than it builds up, and if this process is excessive, the result is osteoporosis.

Signs and symptoms of osteoporosis:

The movement of bone tissue towards osteoporosis is slow. Often there are no physical symptoms, and a person may not even realize they have the problem until they break after a minor accident or fall or even a sneeze or cough. Fractures of the spine can lead to changes in posture and curvature of the spine.

Causes and risk factors for osteoporosis:

Several risk factors for osteoporosis have been identified. Some of them are modifiable, but some of them cannot be avoided.

Age: The risk of osteoporosis increases after age 35, especially after menopause

Decreased sex hormones: Decreased levels of the hormone estrogen seem to make bone proliferation difficult. Hormonal balance is an essential issue in building bone in adulthood and maintaining bone strength in adulthood. For example, regular menstrual periods for girls and young women are needed to achieve the genetic potential for maximum bone mass. Women with irregular periods (excluding pregnancy or breastfeeding) should consult a doctor. The sooner action is taken, the more significant the impact on reducing the risk of osteoporosis.

Ethnicity: Whites and Asians are more susceptible to osteoporosis.

Bone structure: The risk is higher in long or narrow bones.

History of a fracture: A person who has experienced a fracture before is more likely to develop osteoporosis, especially after the age of 50.

Eating disorders such as anorexia nervosa or bulimia nervosa

Excessive alcohol consumption

Low levels of calcium, magnesium, and vitamin D as a result of dietary factors, absorption problems, or the use of certain medications

Genetic factors: Having a family member with fractures and osteoporosis means that a person is more likely to develop osteoporosis. If a person’s parents lose more than two and a half centimeters in height or become bent, this could signify that the family has a genetic predisposition to osteoporosis. Having a family history of bone fractures in the pelvis or spine is another factor. Some people have a high genetic predisposition to osteoporosis. There are probably several genes that increase the risk of developing this disease. Genetic predisposition to osteoporosis is passed from parents to children. A person’s genetics determines the highest bone density. If a person has a high genetic predisposition to osteoporosis, that person’s peak bone density may be below average. On the other hand, if a person has strong bones, this is an essential factor determining a person’s chances of having strong bones. Of course, if a person has a genetic predisposition to osteoporosis, it is possible to reduce the disease’s risk or severity through strategies.

Inactivity and inactivity: Exercise that is associated with weight-bearing can help prevent osteoporosis. These exercises stimulate the bones to grow by putting pressure on them.

Medications and Health Problems: Some medications or diseases cause changes in hormone levels, and some cause a decrease in bone mass. Examples of diseases that affect hormone levels are hyperthyroidism, parathyroids, and Cushing’s disease.

Diseases that increase the risk of osteoporosis include cancer, chronic obstructive pulmonary disease (COPD) and chronic kidney disease, some autoimmune diseases such as rheumatoid arthritis and rheumatoid arthritis, and corticosteroids, including prednisone and prednisolone.

Some of the essential medications and compounds that are involved in osteoporosis are:

  • Thyroid hormone
  • Anticoagulants and blood thinners include heparin and warfarin.
  • Proton pump inhibitors (PPIs) and other antacids that affect the body’s mineral status
  • Some antidepressants
  • Some family medicines for vitamin A (retinoids)
  • Thiazide diuretics
  • Thiazolidinediones are used to treat type 2 diabetes because they reduce bone formation.
  • Some immunosuppressive agents such as cyclosporine
  • Aromatase inhibitors and other treatments that kill sex hormones, such as anastrozole or Arimidex
  • Some chemotherapeutic agents, including Femara, are used to treat breast cancer, and lupron, treating prostate cancer.
  • Glucocorticoid-induced osteoporosis is the most common type of osteoporosis caused by medication.

Cigarettes: Many of the health problems caused by smoking are well known. The Centers for Disease Control and Prevention reports that the cost of smoking-related illnesses among Americans reaches more than $ 75 billion each year. Smoking causes heart disease, lung and esophageal cancer, and chronic lung disease. Also, several studies have identified smoking as a risk factor for bone fractures and osteoporosis. The role of smoking as a risk factor for osteoporosis has been discussed for more than 20 years. Recent studies have also shown a direct link between tobacco use and reduced bone density. Of course, analyzing the effects of smoking on bone health is complex. It is difficult to determine whether the decrease in bone density is due to smoking or other risk factors common to smokers.

For example, in many cases, smokers are thinner than others, are more prone to alcohol consumption, have less physical activity, and usually have more deficient diets. Women who smoke go through menopause sooner than women who do not smoke. These factors put many smokers at risk for osteoporosis, in addition to the tobacco they smoke. Also, most studies on the effects of smoking show that smoking increases the risk of bone fractures. Of course, not all studies confirm this, but there is evidence, for example:

  • The more a person smokes, the greater the risk of bone fractures in old age.
  • Smokers who break down need more time to heal and may have more problems during the healing process.
  • Significant reduction in bone density has been observed in older men and women who smoke.
  • Women who smoke often produce less estrogen and reach menopause earlier than non-smokers.
  • Quitting smoking reduces the risk of bone loss and fractures, although this may take longer for people with a long history.

Methods of diagnosing osteoporosis:

All physicians will pay attention to the patient’s family history and risk factors. If they suspect osteoporosis, they will request a scan to determine the bone mineral density (BMD). Bone density scanning uses an X-ray technology called DEXA (or DXA). In combination with information about the patient’s risk factors, DEXA can indicate the possibility of osteoporotic fractures. This technology also makes it possible to monitor the treatment process of patients.

A bone density scan shows that an average and healthy person’s bone density is used as a T scale baseline.

Two types of devices perform DEXA scans:

Central Scanner: A hospital scanner that measures a patient’s pelvis and spine’s mineral density while he or she is lying on a table. A DEXA scan takes about twenty minutes and is painless. An X-ray generator measures the amount of calcium and other bone minerals in a piece of bone. Bone mineral density is determined by how much X-rays pass through that bone.

Lateral scanning device: A mobile device that examines the bones of the wrist, heel, or fingers This type of device is often available in pharmacies but does not provide an accurate measurement of bone density; however, it is necessary to see a doctor for further tests if the test is positive.

Interpretation of DEXA test results

The results of this experiment are expressed as a T score and a Z score. At T-score, the patient’s bone mass is compared to the maximum bone mass in a young person:

  • Scores of 1- above are standard.
  •  Scores of 1- to 2.5- indicate a slight decrease in bone density.
  •  Scores below -2.5 indicate osteoporosis.

At Z score, a patient’s bone mass is compared to other people’s bone mass of the same structure and age. A Z score of -2.5 or less can indicate a risk factor for osteoporosis.

Other tests to diagnose osteoporosis:

A lateral vertebral evaluation (LVA) test may be recommended for elderly patients who are short (for example, due to a vertebral fracture) or low back pain related to other diseases. An ultrasound scan of the heel bone is another way to assess osteoporosis. This method is less common than DEXA, and its numbers are not comparable to T-scores.

Treatment of osteoporosis

Therapeutic goals:
  • Reduce or prevent the progression of osteoporosis
  • Maintain proper mineral density and bone mass
  • Treatment of osteoporosis
  • Fracture prevention
  • Reduce pain
  • Maximize the ability of the individual to continue daily life
Medication: Medications that can help prevent and treat osteoporosis include:
  • Bisphosphonates: Drugs that reduce the process of bone loss and reduce the risk of fractures.
  • Estrogen agonists (SERMS), such as Avesta: Can reduce the risk of spinal fractures in postmenopausal women.
  • Calcitonin: This drug helps prevent spinal fractures in postmenopausal women and can control pain in the event of a fracture.
  • Parathyroid hormone (such as forte): It is prescribed for people who are at high risk of fractures. This drug stimulates bone formation.
  • RANKL ligand inhibitors (such as denosumab): This is an immunosuppressive drug and a new treatment for osteoporosis.

* Other types of estrogen and hormone therapy can also help.

Prevention of osteoporosis:

Some lifestyle changes can reduce the risk of osteoporosis:

Calcium and Vitamin D Consumption: Calcium is essential for bone health, and getting enough calcium is essential. Adults 19 years of age and older should consume 1,000 milligrams of calcium daily. Women over the age of 51 and all adults 71 years and older should consume 1,200 mg of calcium a day.

Some calcium-rich foods include:

  • Dairy products such as milk, cheese, and yogurt
  • Vegetables such as broccoli
  • Fish with soft bones such as trout and tuna

If an individual calcium intake through diet is not enough, you can use supplementation.

Vitamin D also plays a role in bone health because it helps the body absorb calcium. Dietary sources include saltwater fish, liver, and foods fortified with this vitamin. However, most vitamin D does not come from food but exposure to sunlight, so it is recommended that the person be exposed to moderate sunlight. A daily intake of 800-600 units of vitamin D is needed to increase bone mass for treatment. Prevention of osteoporosis with lower levels of 400-200 units per day is possible. Many multivitamins or calcium supplements also contain vitamin D.

Nutritional or drug interactions:

Some calcium supplements are better absorbed from the stomach, while some are less absorbed. Some foods, such as spinach, rhubarb, and whole grains, may bind to calcium and reduce calcium absorption. Calcium may also bind to some oral drug compounds and prevent them from being absorbed in the stomach. Avoid this problem; calcium supplements should be avoided one to two hours before or two to four hours after taking drugs such as sucralfate, tetracycline, ciprofloxacin, and moxifloxacin. Thiazide diuretics such as hydrochlorothiazide may also increase calcium levels and poisoning.

Side effects of calcium and vitamin D:

Calcium may cause constipation, nausea, or vomiting. People with kidney stones should check the calcium level in their urine to determine if increased calcium intake leads to kidney stones. The recommended amount of vitamin D should not be exceeded. High doses of vitamin D for long periods can lead to intoxication and symptoms such as weakness, headache, drowsiness, muscle aches, bone pain, and elevated liver enzymes. People with any of the following problems should not take calcium or vitamin D supplements: (Vitamin A; Benefits, Symptoms Of Deficiency, And Sources Of This Vitamin)

  • Allergy to supplements
  • Vitamin D poisoning
  • The increased concentration of calcium in the blood

Estrogen ‌Treatment for the treatment of osteoporosis:

Estrogen is available in the form of oral pills or capsules or as skin tags. Estrogen is part of postmenopausal hormone replacement therapy (HRT). Estrogen is used alone after ovarian resection. For women with uterine fibroids, progesterone is also added to estrogen to reduce uterine wall cancer risk. Women with breast cancer or a family history of breast cancer should not take estrogen. There are other useful options for preventing and treating osteoporosis, and they are being developed to prevent the risks associated with using hormones. The HRT treatment course that postmenopausal women should undergo is questionable due to the increased risk of cancer, stroke, and heart attack.

How does estrogen work? It slows down bone loss and prevents osteoporosis when used after menopause.

People with the following conditions should not use estrogen:

Estrogen sensitivity, estrogen-related cancers such as breast cancer during pregnancy, blood clotting disorders, unusual vaginal bleeding that has not been checked by a doctor

General instructions for using estrogen:

The amount of estrogen used, with or without progesterone, should be at least as effective as the treatment goals during treatment. Oral tablets are usually taken daily; For those who also need progesterone, it may be given as a combination or at different times of the month. Skin patches are used on the abdomen, pelvis, or buttocks. The timing of changing labels depends on the type of label used. Some need to be changed weekly (such as Klimara), and some are changed twice a week (such as a violin).

Side effects of estrogen therapy:

Estrogen may reduce the effectiveness of anticoagulants, such as warfarin. Research by the WHI Institute increases the risk of heart attack, stroke, breast cancer, pulmonary embolism (blood clots in the lungs), and deep vein thrombosis (blood clots in the legs) in postmenopausal women aged 79-50 years who have been treated with compounds for five years. Estrogen and progesterone were present; it was reported. Estrogen may cause breast tenderness, weight gain, fluid retention, gallbladder disease, and vaginal bleeding, along with an increased risk of breast and uterine wall cancers. Estrogen also increases the risk of blood clots and may cause blood clot-related problems such as stroke, heart attack, or thrombophlebitis (inflammation of the veins). If you notice any of the following side effects, you should see your doctor:

Itching, hives, swelling of the face or hands, respiratory problems or other allergic reactions, chest lumps, pressure in the upper and right side of the stomach, vomiting, fever or pain, change in vision, severe headache, bloody cough, chest pain Or the bottom of the foot.

Lifestyle factors that prevent osteoporosis:

  • No smoking
  • Limit alcohol consumption
  • Do regular exercises such as walking because these exercises cause bone health and muscle strength.
  • Do exercises for flexibility and balance, such as yoga, because these activities reduce falls and fractures.
  • For people with osteoporosis, nutrition, exercise, and fall prevention play an essential role in reducing osteoporosis risks.

What is the future of osteoporosis treatment?

In the future, therapies may include stem cell-based therapies. In 2016, researchers found that injecting a specific type of stem cell into mice reversed the process of osteoporosis and bone loss in mice in a way that is thought to be beneficial to humans. Findings published in 2015 show that growth hormone and calcium and vitamin D supplements can reduce fractures’ risk in the long run. In 2015, British researchers found evidence that a diet high in soy protein and isoflavones may protect postmenopausal women from bone loss and osteoporosis. Scientists believe that genetic factors determine up to 75% of a person’s bone mineral density. Researchers are investigating what genes are responsible for bone formation and loss, hoping that they may find new ways to prevent osteoporosis in the future.

Problems with the progression of osteoporosis:

As the bones get weaker, the fractures increase, and as you get older, your recovery will take longer. This can cause constant pain and flexion due to the collapse of the spine. A broken pelvis is challenging to heal, and a person with a fracture may no longer live independently, so it is essential to prevent people with osteoporosis from falling.

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