What is osteoporosis?

Osteoporosis is a disease defined by the loss of bone in relation to normal values ​​for a certain age, sex and race. The prevalence of osteoporosis in Spain among the female population is 24% in women between 60 and 69 years and 40% in women between 70-80 years.

The WHO classifies it for postmenopausal women based on the values ​​obtained in the

• Osteoporosis: T-score –2.5 SD
• Osteopenia: T-score –1 to –2.5 SD
• Normality: T-scores greater than –1 SD

Types of osteoporosis

It is classified into two large groups:

Primary osteoporosis, the most common

• Postmenopausal osteoporosis: women between 50-70 years with vertebral crush or Colles (wrist) fractures
• Senile osteoporosis: in both sexes, although somewhat higher in men from 70 years of age. Increased risk of hip and vertebral fractures
• Idiopathic: in young men and women

Secondary osteoporosis

Cushing's syndrome (including chronic glucocorticoid therapy), hyperthyroidism, hyperparathyroidism, hypogonadism, immobilization, chronic heparin administration, anemia, lymphomas, liver disease, multiple myeloma, and alcoholism.

How is it produced?

Osteoporosis is considered a disease in which bone loss occurs at a higher rate than normal aging. The structure of the bone consequently becomes spongier and more fragile.

Multiple processes that alternate formation and destruction take place inside the bone, involving different aspects: hormonal levels, physical exercise, diet, and toxic habits. In osteoporosis, bone destruction predominates over formation, making this bone "porotic", susceptible to fractures.

An adult person reaches peak bone mass around 35 years of age. It is from here that a slow decline in bone mass begins that lasts a lifetime. This implies that a low calcium intake in childhood and adolescence causes a decrease in bone mass and is a risk factor for developing osteoporosis in old age. The optimal daily doses of calcium vary depending on age, thus a newborn baby up to 6 months of life will require a calcium intake of 400 mg / day, a child of 6-10 years, between 800-1200mg, the adolescents / young adults, between 1200-1500mg, male and female adults between 25-65 years, 1000mg, from 65 years, 1500mg and pregnant women and during lactation, between 1200-1500mg / day.

Postmenopausal osteoporosis is caused by a deficiency of estrogens (female sex hormones) by the ovary. Until menopause, estrogens act as a protective factor for bone.

In senile osteoporosis, there is an alteration of the metabolism and the consequences of aging itself.

Symptoms

It is usually asymptomatic until the fracture occurs. The vertebral fracture presents as an acute pain, dorsal or lumbar with significant physical disability that decreases progressively at 4 weeks.

These fractures, as well as the hip fracture or Colles' fracture (the most frequent), occur with minimal trauma or, in some cases, as a radiological finding.

Diagnosis

The suspicion of osteoporosis is made in different cases: in the face of a fracture after minimal trauma, by a radiological finding or in individuals at high risk of suffering from osteoporosis.

Diagnosis is made by measuring bone content. DEXA is the most widely used procedure today. It is not indicated to carry out indiscriminate densitometry in all postmenopausal women or in all elderly people.

The current criteria to request a DEXA consist of the presence of risk factors for osteoporosis, which are:

• old fractures due to minor trauma from the age of 45
• chronic use of drugs that promote bone destruction
• Postmenopausal women with at least one of the following factors: family history of osteoporosis, early menopause (before 45 years), smoking (> 20 cig / day), low weight (BMI <19) and removal of both ovaries before the physiological menopause
• radiology with suspected bone fracture
• follow-up after starting treatment
• monitoring of chronic use of corticosteroids
• asymptomatic hyperparathyroidism

Laboratory parameters in primary osteoporosis are normal. In cases of suspected secondary osteoporosis, values ​​of vitamin D, liver and kidney function, calcium, phosphorus, thyroid hormones and ESR, as well as 24-hour urine should be determined.

Treatment

The goal of treatment is to strengthen the bone, making it more resistant and thus avoiding subsequent fractures. Those patients at the highest risk of osteoporosis benefit the most from treatment.

Non-pharmacological preventive measures include:

• avoid sedentary lifestyle
• avoid alcohol and tobacco
• balanced diet with adequate calcium intake
• avoid falls

The calcium in the diet is indicated for proper bone formation. In cases of low intakes with food, pharmacological calcium supplements are required.

Vitamin D is synthesized from solar radiation that acts on the skin. It is essential to maintain a balance of calcium in the bone. It is indicated above all in elderly patients who do not go outside and in latitudes with few days of sun. It is administered in the form of medicine at a dose of 800 IU / day.

The establishment of specific treatment for osteoporosis will be carried out according to the patient's risk of suffering a fracture. This risk is observed when the DEXA shows osteoporosis, in very advanced ages, in a history of fractures with minimal trauma, a family history of osteoporosis and in patients at risk of falls.

Current drugs aim to slow down the loss of bone mass and initially increase it in minimal amounts. These include: estrogens, calcitonin, bisphosphonates, and selective estrogen receptor modulators: raloxifene

Treatment of vertebral fracture consists of bed rest for 2-3 weeks, analgesics and muscle relaxants, local heat, and initiation of mobilization as soon as possible. If it does not improve in this time, a corset may help.

What you should know:

• It consists of the loss of bone mass by the bone and affects more women, especially after 60 years.
• It is usually asymptomatic until the fracture occurs (hip or Colles fracture are the most frequent).
• Avoiding a sedentary lifestyle, eating a balanced diet with a good supply of calcium, limiting tobacco and alcohol, and avoiding falls are basic preventive factors.