Osteoporosis

The course of the disease can be described as insidious as it does not show symptoms until a fracture occurs. The most serious osteoporotic fractures are those of the head and neck of the femur. In the first three months after the fracture, complications occur in 40% of cases and the mortality rate from them is 25%. In addition to morbidity, the cost (social, psychological, economic) of the fracture due to possible disability is frightening.

From the above, it is easy to see that osteoporosis is among the group of diseases in which prevention is of paramount importance. Treatment of established osteoporosis can reduce the risk of fracture, but is unlikely to fully restore bone quality and strength.

There are two important concepts for understanding the course of osteoporosis: the highest density that the bone acquires throughout the person’s life (Maximum Bone Density) and the rate at which it is lost with age. The age at which Maximum Bone Density is achieved (i.e. when the bone has the greatest strength) is not known with certainty, but is usually placed in the third decade of life for most people. The higher the Maximum Bone Density at this age, i.e. the denser and stronger the bone is then, the stronger it will remain, proportionally always, at the age of 60 or 70. The rate of loss is increased mainly in women after menopause, when the protective effect of estrogen ceases.

Studies in monozygotic twins have shown that the height of Maximum Bone Density is determined to a percentage of 60-70% genetically. The remaining 30-40% is determined by environmental factors, such as diet, exercise, habits, diseases and medications. Professor Charles Dent’s statement that “senile osteoporosis is a pediatric disease” reflects how important it is to obtain the highest possible Maximum Bone Density at a young age for the best possible bone condition later in life.

People at increased risk of developing osteoporosis are mainly women with menopause (natural or after surgery) before the age of 45 as well as people with thyroid disease, people undergoing treatment with glucocorticoids or heparin and women with prolonged absence of menstruation, hypothalamic etiology. These people should undergo an assessment of the risk of developing osteoporosis. The best test we have is the measurement of bone density with DEXA. This is a simple and painless test with low cost and minimal radiological burden for the person. The diagnosis of osteoporosis (or its precursor condition called osteopenia) is then made by statistical comparison of the patient’s measurements with measurements from the general population, of the same sex, young (t-score) or the same age (z-score).

Osteoporosis prevention focuses on three main axes:

• Nutrition. Adequate intake of calories, calcium from dairy products, and vitamin D is required. These two elements (calcium and vitamin D) are essential for maintaining proper bone density and structure. Reducing alcohol consumption is also recommended, while it has not been clarified whether reducing caffeine and salt consumption helps or not.
• Exercise. It is recommended to exercise at least 3 times a week for 30 minutes. Walking is an excellent exercise option. In any case, the type of exercise should not be such that it predisposes to falls and injuries. The benefits of exercise last for as long as the person exercises. Excessive exercise, on the other hand, can lead to suppression of the function of the hypothalamus and thus increase the risk of developing osteoporosis.
• Quitting smoking. Smoking has been shown to accelerate bone loss and for this reason, quitting is strongly recommended for people at increased risk of developing osteoporosis.