Osteoporosis

The osteoporosis It is a disease that some authors have defined as a true epidemic; a silent epidemic that involves numerous personal and social costs, mainly derived from its main consequence: bone fractures. This disease affects a considerable number of individuals (it is estimated that in Spain there are approximately three million people with osteoporosis), being more frequent among the elderly and the elderly. The most feared consequence of osteoporosis is fracture and, secondarily, dependence, forming a social-health and economic problem of the first magnitude.

Osteoporosis is a disease where there is a progressive loss of bone mass that, together with alterations in the microarchitecture of the bone, causes greater fragility, less resistance to forces, and therefore an increased risk of fractures, which are They can occur with minimal trauma or even spontaneously.

The causes and risk factors for the development of osteoporosis are:

• The aging. In itself, it implies a reduction in bone mass by slowing down the metabolism itself. Likewise, sarcopenia, the loss of skeletal muscle mass, implies a reduction in bone as it supposes a less stimulation of the bones with movement.
• Menopause. The decrease in the amount of estrogen produced in the ovaries is drastically reduced after menopause. This hormone is necessary to maintain an optimal level of calcium in the bones.
• Poor calcium intake. Especially after menopause there is a greater loss of calcium in the urine. If the amount eliminated is not replaced correctly, there will be an imbalance, which will facilitate a rapid decrease in bone mass and therefore the appearance of osteoporosis.
• Hydration and mineralization. The low intake of water and minerals in many cases causes bone mass to decrease. It is not only necessary the contribution of calcium in the diet, but its balance provided with magnesium and phosphorus as the main minerals.
• Inadequate diets. Related to different problems, which will cause an imbalance in the intake of macro and micronutrients.
• Prolonged immobilization. The way to be able to generate bone is to continue with an active life and an appropriate musculature, which stimulates the formation and strengthening of bones. This accommodation of habits, together with many diseases and ailments of old age that force the elderly population to remain bedridden or for long periods of inactivity, exacerbates the problem of osteoporosis.
• Little exposure to the sun and liver or kidney disorders. All of them are causes of a decrease in the acquisition, metabolism and action of vitamin D, basic for the fixation of calcium in bone tissue and for its formation.
• Drugs. As you get older, the need to use medications for long periods of time or chronically increases. Many of them produce as an adverse effect the loss of bone mass, such as corticosteroids used in the treatment of chronic diseases. Other drugs that can promote bone loss are diuretics and certain anticonvulsant drugs.
• Use of tobacco and alcohol. A higher frequency of osteoporosis has been observed when the consumption of these substances occurs.

Osteoporosis is an asymptomatic disease in the early stages, while in the advanced stages it appears:

• Bone pain or tenderness
• Fractures with little or no trauma.
• Loss of stature
• or cervicalgias due to fractures of the bones of the spine.
• Stooped posture or kyphosis.

Diagnosis

The diagnosis of osteoporosis is made indirectly through radiological methods, since the direct histological study of a sample of bone tissue through a biopsy is outside of routine clinical practice.

Radiological methods are very diverse but can be summarized in the usefulness of conventional bone and bone radiographs. Conventional radiography has a low sensitivity in detecting this process, since a loss of at least 30% of bone mass is necessary to detect osteoporosis in certain bones. Bone densitometry is a specific technique that allows the measurement of bone mineral density. It confirms and diagnoses osteoporosis, and with it it is possible to follow patients in their evolution and their response to treatments.

There are numerous biochemical tests determined in routine analyzes that study the metabolic state of the bone and that are especially useful in secondary osteoporosis.

In osteoporosis, prevention is essential, even before entering the third age, to avoid the evolution of the disease towards advanced stages and difficult to solve. For this it is recommended:

• Do appropriate exercises and according to each person. In these, it is necessary to combine aerobic exercises together with some light impact exercises, to stimulate the incorporation of calcium in the bone matrix, reduce bone destruction and increase the formation of new bone.
• Sunbaths. They help to form vitamin D in the skin, essential in the metabolism of calcium, taking into account the precautions of not undergoing long exposures at hours of maximum sunlight and high temperatures and ensuring good hydration.
• Adequate nutrient intake. In particular, ensure the intake of calcium in the diet, as well as proteins and other nutrients such as magnesium and phosphorus.

The goals of osteoporosis treatment are:

• Control the pain associated with the disease.
• Slow or stop the process of bone loss.
• Prevent fractures with medications that strengthen the bone.
• Minimize the risk of falls that could cause fractures.

There are different treatments for osteoporosis, including lifestyle changes and a variety of medications. Medicines are used to strengthen bones when:

• Osteoporosis has been diagnosed through a bone density study.
• Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred.

Bisphosphonates are the main drugs used to both prevent and treat osteoporosis in postmenopausal women.

Bisphosphonates taken by mouth include alendronate, ibandronate, and risedronate, which are usually taken once a week or once a month.

Calcitonin comes as a nasal spray and an injection. It is a drug that slows the rate of bone loss and relieves bone pain.

The main side effects of calcitonin are nasal irritation in the aerosol form and nausea in the injectable form.

estrogens are hardly used anymore to prevent osteoporosis. They are not approved to treat postmenopausal women with osteoporosis because they carry an unacceptable increased risk of gynecologic malignancy.

Teriparatide, a derivative of parathyroid hormone, is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered to be at high risk for fractures. The drug is administered through daily subcutaneous injections and can be given at home by the patient herself.

raloxifene is used for the prevention and treatment of osteoporosis. raloxifene can reduce the risk of spinal fractures by almost 50%; however, it does not appear to prevent other fractures, including those of the hip. The most serious side effect of raloxifene is a small risk of blood clots in the veins of the legs (deep vein thrombosis) or in the lungs (pulmonary embolism).

Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis, both by increasing bone mass and by reducing the risk of falls. Some of the recommended exercises are:

• Weight-bearing exercises: walking, light running, tennis, dancing.
• Resistance exercises: free weights, weight machines, rubber bands for stretching.
• Balance exercises: tai chi, yoga
• Riding an exercise bike.
• Use rowing machines.

You should consume at least 1,200 milligrams of calcium a day and 800 to 1,000 international units of vitamin D. If these amounts cannot be assured, both calcium and vitamin D supplements will be recommended. They are foods rich in calcium:

• Cheese and other dairy products.
• Green leafy vegetables, such as spinach and kale.
• Low fat milk.
• Salmon.
• Sardines (with thorns).
• Tofu (bean curd).