Osteoporosis is a condition in which bone mass decreases and the internal structure of the bone changes, leading to bones becoming fragile and easily fractured, even from minor accidents.
Nature of Bone Mass Accumulation and Loss
Human bones gradually accumulate from birth, reaching peak bone density around the age of 30. After that, bone mass starts to decline. Bone strength depends on both the size and density of the bones, which are influenced by mineral content such as calcium and phosphorus. Low mineral content can lead to weaker bones.
Bone Turnover
Bone turnover is a natural process where bones are constantly broken down and rebuilt, taking around 2-3 months for each cycle. However, as people age, bone resorption exceeds new bone formation. This is particularly evident in women after menopause (around age 50), where bone loss is significantly greater compared to men of the same age, by approximately 5-10 years. After this point, bone loss occurs at a similar rate for both men and women.
Risk Factors for Osteoporosis:
- Gender: Women are at higher risk than men.
- Age: Bone density decreases after age 30.
- Body Size: Individuals with a small and thin body frame have lower bone density compared to those with an average body frame.
- Diet: Consumption of caffeine, such as coffee or other caffeinated drinks, accelerates bone loss.
- Behavior: Smoking and alcohol consumption contribute to reduced bone density.
- Medications: Use of certain drugs, such as steroids, can increase the risk of osteoporosis.
How to Determine if You Have Osteoporosis?
According to the World Health Organization (WHO), osteoporosis diagnosis is conducted by measuring bone density using Dual-energy X-ray Absorptiometry (DEXA), typically available in large medical centers. Bone density is assessed using a T-Score:
- T-Score of -1 and above: Normal
- T-Score between -1 and -2.5: Osteopenia (low bone density)
- T-Score of -2.5 or below: Osteoporosis
The lower the T-Score, the higher the risk of fractures. However, the risk of fractures also depends on other factors. Therefore, physicians consider these risk factors along with bone density measurements when deciding on osteoporosis treatment.
Risk Assessment and Treatment Considerations
The WHO has developed the FRAX tool to assess the risk of fractures. It takes into account factors such as age, gender, weight, height, smoking, alcohol consumption, steroid use, history of fractures, parental history of hip fractures, and diseases that can cause osteoporosis (e.g., diabetes, hyperthyroidism, rheumatoid arthritis). These factors, combined with the T-Score from bone density measurements, help calculate the 10-year probability of fractures, allowing physicians to choose appropriate treatment options for osteoporosis.
Painless Osteoporosis Symptoms
Osteoporosis is a “silent” disease that does not show painful symptoms but significantly increases the risk of fractures, even with minimal trauma. Fracture-prone areas include the wrist, hip, and spine. In older adults, spinal fractures may lead to back pain and a stooped posture even with minor impact.
Diagnosis of Osteoporosis:
- Bone Density Scan: Measures bone density in areas prone to fractures, such as the wrist, spine, and hip, compared to standard values.
- Biochemical Bone Markers: Blood tests to evaluate bone formation and resorption balance. If bone formation is significantly lower than resorption, bones become thin and fragile.
Prevention and Treatment of Osteoporosis
- Non-Drug Treatments:
- Adequate Calcium Intake: Include foods rich in calcium such as milk, yogurt, cheese, small fish, dried shrimp, shrimp paste, kale, moringa leaves, sesbania flowers, tofu, red beans, and black sesame.
- Weight-Bearing Exercise: Engage in exercises like walking, jogging, Tai Chi, or dancing 2-3 times a week for 30 minutes each time.
- Avoid Smoking and Alcohol: Reduce caffeine-containing drinks (e.g., tea, coffee) as they reduce calcium absorption in the intestines. Avoid steroid use.
- Drug Treatments:
- Calcium and Vitamin D Supplements.
- Hormone Therapy.
- Calcitonin.
- Bisphosphonates.
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