Osteoporosis is a common condition that can affect any age group but is prevalent in elderly patients. Seventy-five per cent of those over 80 years old are affected by it, however, it is frequently undiagnosed. Whereas osteoarthritis affects only the joints, osteoporosis affects the bones themselves.
The term ‘osteoporosis’ literally means ‘holes in the bone’ as voids develop due to loss in bone mass and density. This makes the bones weak, brittle, soft and liable to fracture.
We reach peak bone mass around the age of 20 years. After this, the rate of loss of bone is greater than production, so there is a natural decrease in bone mass.
In women, the sudden loss of oestrogen hormones at menopause, which are important for depositing bone, causes a surge of bone loss and increases the risk of osteoporosis.
Some patients are also at an increased risk of suffering from osteoporosis if they have a family history of the condition, endocrine problems, poor diet leading to conditions like anorexia, are on certain medications such as steroids or are smokers.
We reach peak bone mass around the age of 20 years. After this, the rate of loss of bone is greater than production so there is a natural decrease in bone mass
The most commonly affected bones are the vertebral bones. This can cause severe back pain and a rounded back with loss of stature. The hip and wrist bones are also frequently affected. In fact, hip and wrist fractures are the most commonly fractured bones among the elderly.
Osteoporosis may cause bone pain but may be totally asymptomatic and only identified when an X-ray is taken after an injury or just incidentally. Quite a significant amount of bone needs to be lost before there are obvious changes on an X-ray; the bones lose their high density, so they appear less white and become thin.
A better way to identify osteoporosis is using a DEXA scan. This involves two low-dose radiation waves which differentially determine the density of bone. The most important value on the DEXA result is the ‘T score’. If this is between 0 and -1.5, it would be a normal scan, -1.5 to -2.5 means one may have osteopenia (an early or lesser form of osteoporosis) and if the T- score is more than -2.5, then there is full-blown osteoporosis.
To prevent this condition, a healthy diet is recommended. This would include an adequate intake of calcium and vitamin D − living in a sun-blessed country like Malta helps in the production of this vitamin. Curtailing the vices of smoking and drinking alcohol is also essential.
The best exercise is weight-bearing, for example, walking 30 to 40 minutes four times a week. Any exercise which impacts forces through the bones helps to stimulate bone deposition. Swimming, although a generally brilliant exercise, is not particularly advised for preventing osteoporosis.
In patients who have developed the condition, the most widely prescribed medications are bisphosphonates such as alendronate. These may be given orally or intravenously and, when taken on a long-term basis, they help decrease the incidence of fractures.
Alistair Pace is a consultant orthopaedic surgeon at St Thomas Hospital, Qormi, St James Hospital, Sliema, and Da Vinci Hospital in Birkirkara.