A bone to pick with osteoporosis

Here's everything you need to know about stress fractures and cracks in the bone. Make sure it’s not osteoporosis, writes Dr Aditya Premkumar

Osteoporosis is defined to be the “decrease in the microarchitectural quality of bone.” Simply put, it means that the strength of the bone is lost. This is due to the decreased formation of new bone that doesn’t sufficiently replace the old bone. This causes the bone to be weaker and less resistant to forces and stress, which in turn leads to higher rates of fractures while performing normal activities.

Osteoporosis can affect men and women of all races, especially Asians and whites. It most commonly results in fractures of the pelvis, spine and wrist. Even a simple action of coughing or bending can result in a fracture of the spine. One of the problems with osteoporosis is that it occurs behind the scenes. The patient will also not present with a classical history of trauma, but in most cases, they will present with a single or multiple episodes of trivial trauma that generally should not cause a bone to break. With regard to osteoporotic vertebral fractures, most commonly the patient might present with intermittent back pain that might progress to a stooped posture and decreased height if there are multiple vertebrae involved. These are known as compression fractures of the spine.

Risk factors

Females have a higher risk than males

Older age

Family history

Low body weight

Lower sex hormones

Premature menopause

Hyperthyroidism

Overactivity of parathyroid or
adrenal glands

Dietary issues

Low calcium intake

Gastrointestinal surgery

Eating disorders

Prolonged steroid intake

Medical conditions

Kidney or liver disease

Celiac disease

Inflammatory Bowel Disease

Cancer

Rheumatoid arthritis

Sedentary lifestyle

Excessive alcohol consumption

Smoking

Complications

Fractures of the hip, pelvis, or wrist leading to disability.

Fractures of the spine leading to decreased breathing capacity or strength.

Evaluation

To confirm osteoporosis, your doctor will have to accurately review medical history, rule out secondary causes and do a clinical examination. An x-ray of the lumbosacral spine and pelvis will be sufficient to confirm, as well as a bone densitometry test. This is more commonly known as a DEXA scan, which is a painless non-invasive test that uses x-rays to determine the density of bone. This is most commonly done over the spine, pelvis and wrist. Based on the results of this test, the appropriate treatment can begin.

Prevention

One of the best ways to prevent osteoporosis is to ensure your dietary intake of calcium and Vitamin D is sufficient. Adequate weight-bearing exercises such as walking, jogging and climbing stairs, resistance exercises using dumbbells, elastic bands and resistance-producing machines such as the treadmill, cross trainer or stair climber also help to “load the bone” thereby increasing bone formation and production. Be sure to consult with a doctor before starting a new type of exercise or diet.

Treatment

There is no single cure for osteoporosis but based on the results from your evaluation, your doctor will implement a multifaceted plan consisting of medication, physiotherapy and lifestyle changes. All these measures will aim to slow the breakdown of bone in the body, increase the formation and production of new bone and help in the strength and protection of the bones.
(The author is an orthopaedic surgeon.)