Osteoporosis definition | osteoporosis causes | osteoporosis symptoms | osteoporosis treatment

Osteoporosis is a condition of atrophy of the bones characterized by a reduction in the mass of bones per unit volume. Osteoporosis is the most common metabolic bone disease that occurs with advancing age.

Normal bone structure is maintained by the continuous bone breakdown (by osteoclasts) and new bone formation (by osteoblasts) with advancing age there is more bone resorption than formation, collapse, and fracture, especially of vertebrae are common, causing pain and decrease in height

Causes/etiology:

• Osteoporosis may occur due to a combination of low calcium intake and hormonal physical and circulatory factors.
• Bed rest and immobilization increase calcium resorption from the weight-bearing bones and urinary and stool calcium excretion. Aged immobilized patients rapidly develop osteoporosis while exercise and physical therapy prevent its progress.
• Deficiency of estrogen, removal of ovaries, smoking, alcohol, excess phosphorus intake, and sedentary habits produce osteoporosis.
• Lactose increases absorption of intestinal calcium and phosphorus so lack of intake of lactose may cause decreased calcium absorption.
• Excessive use of corticoids is another risk factor.

Bone loss may also occur due to the following conditions, diseases, and/or medical procedures -

• Endocrine disorders:

• Premature menopause
• Thyrotoxicosis
• Irregular periods
• Cushing’s syndrome
• Diabetes
• Hyperthyroidism
• Hyperparathyroidism

• Mental illness:

• Eating disorders
• Depression

• Autoimmune disorders:

• Ankylosing spondylitis
• Lupus
• Multiple sclerosis
• Rheumatoid arthritis (RA)

• Gastrointestinal disorders:

• Inflammatory bowel disease (IBD)
• Celiac disease
• Weight loss surgery

• Cancer:

• Prostate cancer
• Breast cancer

• Blood disorders:

• Sickle cell disease
• Multiple myeloma
• Leukemia and lymphoma

• Neurological disorders:

• Parkinson’s disease
• Stroke
• Spinal cord injuries
• multiple sclerosis

• Some other conditions and diseases:

• Poor diet, including malnutrition
• Weight loss
• Organ transplants
• Chronic obstructive pulmonary disease (COPD)
• Chronic kidney disease
• Polio and post-polio syndrome
• Scoliosis
• Liver disease

Classification:

Osteoporosis can be classified into four categories - 

1. Localized osteoporosis - This may result from local inflammation and immobilization of parts of the body, mainly due to prolonged bed rest, immobilization of the parts of the body. This may result in decreasing osteoblastic activity and increasing osteoclastic activity, which in turn results in osteoporosis.
2. Generalized osteoporosis - here, the process of osteoporosis is widely spread in the skeleton. It is simply a normal feature of aging of the skeleton, which mainly occurs after menopause in females and after 65 years in males mainly due to estrogen and androgen deficiency.
3. Juvenile osteoporosis - it is a very rare case where spontaneous remission takes place after puberty.
4. Endocrinal osteoporosis - after prolonged steroid administration nitrogen balance gets depleted resulting in failure to form bone matrix. In the case of hyperthyroidism, acromegaly, loss of calcium in urine may be a possible cause. In hypogonadism, particularly in females, it may also cause.

Clinical manifestations:

• Severe pain
• Loss of weight
• Bones get brittle
• Loss of teeth
• Radiological findings include - 
• thinning in the bone cortex
• loss of bone density
• changes in the shape of the vertebrae

Prevention and treatment:

• The most effective time to prevent is childhood when adequate calcium intake and exercise should be enforced. It is necessary to have peak bone mass during adolescence as this reduces the chances of osteoporosis later in life.
• Diet should contain calcium rich foods. Following foods can be included in the diet as these are rich in calcium - 

1. Calcium-fortified cereals and orange juice
2. Canned salmon or sardines with bones
3. Dark green leafy vegetables
4. Low-fat dairy products
5. Soy products like tofu

Recommended Dietary Allowances (RDA) of calcium.

• Diet should contain vitamin D rich foods as this vitamin improves the body's ability to absorb calcium 
• Daily exposure to sunlight should be maintained.
• Physical activity and exercise should be encouraged.
• Cigarette smoking, alcohol consumption should be avoided as they are associated with bone formation.
• Excessive consumption of tea, coffee, phytate, oxalate should be avoided as they are associated with Decrease calcium absorption.
• If needed treatment with sex hormone can be given.