Osteoporosis is a chronic disease of the skeletal system, in which the bones become weak, brittle, and prone to fractures. The word osteoporosis itself means “porous bone.”
Osteoporosis develops over several years, most often without signs of disease. That is why we often call it a silent epidemic. Today, osteoporosis is one of the leading public health problems in developed countries. Large material resources are spent on treating and caring for patients with osteoporosis. Despite this, even in the most developed countries globally, up to 20% of patients with osteoporosis are treated.
Until recently, osteoporosis was considered a natural aging process. But there is nothing natural about that. Losing height or breaking a bone when climbing stairs or coughing is not a natural process. Furthermore, osteoporosis is not just age-related. Today, osteoporosis is also diagnosed in younger people with certain chronic diseases (more on this later).
Also, until recently, osteoporosis was considered a disease of postmenopausal women. However, one-third of people living with osteoporosis are men (Croatian Osteoporosis Society).
This leads to the division of osteoporosis:
-Primary (postmenopausal and senile)
-Secondary (which, regardless of age, is found in chronic patients either as a result of taking certain medications or lifestyle changes).
Let’s start with a little look at the history of osteoporosis.
Hip fractures have been observed in ancient Egyptian mummies. This indicates that osteoporosis has been around for thousands of years. It was considered an inevitable aging process. Stereotypes from literature, art, and other media encouraged this misconception by portraying the elderly as shaky, insecure, bent, and hunched over, often with a coat of arms on their backs.
In 1830 in France, one doctor noticed that the bones were full of cavities and resembled honeycombs in some people. He noted that such a condition greatly weakens the bones’ strength and structure. Then, for the first time in the literature, such a condition of the bones was described, which was later called osteoporosis. But that French doctor continued his research in another direction. Nothing was known about the causes for a long time. It wasn’t until around 1940 in America at a Massachusetts general hospital that a family doctor discovered an association between estrogen hormone reduction in older women and the onset of osteoporosis. Then begins the era of hormone replacement therapy.
Over the years, discoveries have changed osteoporosis and very complex disease that affects health.
It is never too early and never too late to fight osteoporosis! Namely, building strong bones in youth is just as important as procedures that slow down bone weakening in old age.
Before we begin to describe osteoporosis symptoms, it is necessary to explain the concept of osteopenia.
Osteopenia is a condition of reduced bone mineral density relative to normal values. Some doctors call osteopenia a precursor to osteoporosis (a condition that precedes osteoporosis). Osteoporosis does not develop in all individuals diagnosed with osteopenia (at the densitometry finding), but they are all at high risk for osteopenia to progress to osteoporosis.
Bone mass is built in youth and at the age of sexual maturity. The amount of bone mass stabilizes around the age of 30. After 40 it is gradually lost, approximately 0.5 to 1% per year.
Osteopenia occurs in women after menopause due to the loss of estrogen hormone.
It can also be caused by lifestyles (in both men and women) such as lack of exercise and movement, excessive alcohol consumption, smoking, prolonged use of drugs such as glucocorticoids (in some diseases such as asthma), long-term use of drugs for thyroid disease. Osteopenia can also occur in younger women who are intensely involved in athletics or, for example, marathons and younger women who have problems with proper nutrition (anorexia, bulimia).
Osteopenia should be taken seriously, and you should make efforts to prevent it from progressing to osteoporosis.
The difference between osteoporosis and osteoarthritis
Before describing osteoporosis symptoms, it is also necessary to mention the difference between osteoporosis and osteoarthritis. Osteoporosis is not osteoarthritis! Osteoporosis is a disease that affects the bones, while osteoarthritis affects the joints, i.e., the places where two bones join.
In osteoarthritis, damage to the cartilage serves as a shock absorber between the two joint surfaces, and damage to the cartilage also damages the bone. Then there is pain and restriction of movement in the joints. This is how deformed joints are formed.
Unlike the mentioned visual signs of osteoarthritis, osteoporosis usually occurs “quietly” and is often the first sign of a bone fracture.
Furthermore, it is important to mention that osteoarthritis and osteoporosis conditions can occur simultaneously.
Symptoms of osteoporosis
Bone loss develops painlessly over several years. There are no visible signs or symptoms in the early stage of the disease, even with a large loss of bone structure.
The most common first sign of osteoporosis is a bone fracture at the regular daily activity or at a minor fall or exertion, such as lifting a lighter load, with compressive vertebral fractures occurring with symptoms: back pain, loss of body height, and hunched posture.
Although the main causes of back pain are muscle tension and arthritis, if you have been diagnosed with osteoporosis, such pain can also be associated with osteoporosis and requires a detailed medical examination.
Osteoporosis often remains unrecognized for a long time because, as it has already been said, it is a disease without characteristic symptoms and typical pain.
So insidious back pain and fatigue are mostly ignored, while this should actually raise suspicion of osteoporosis, especially in old age.
Primary osteoporosis occurs as a result of a specific process. However, the direct cause is not recognized. At the same time, secondary osteoporosis (which is less common) occurs due to a known cause, which is mostly a chronic disease or long-term use of certain medications.
The two most common forms of primary osteoporosis are postmenopausal osteoporosis and age-related osteoporosis.
Both forms can be present in the same person.
Postmenopausal osteoporosis occurs during or after menopause (as the name suggests). As the concentration of the sex hormone estrogen decreases, so does the disease.
In most women, menopause begins around the age of 50. The hormone estrogen is important in building bones, so by reducing its concentration, the bone becomes more porous.
Estrogen depletion can occur several years before menopause.
Entering menopause with low bone mass (osteopenia) can lead to osteoporosis’s faster formation. Therefore, the onset of menopause is the last minute to take active measures to prevent osteoporosis if measures are not started earlier. By the age of 70, women lose up to 50% of their bone mass.
All people lose bone mass with age, the process of building bones slows down, and decomposition speeds up or stays the same. The inner structure of the bone weakens, and the outer thins. It is a natural phenomenon of aging, but if too much bone mass is lost (which is not natural), age-related osteoporosis occurs. This condition usually appears at the age of 75. Age-related osteoporosis in women is often associated with postmenopausal osteoporosis.
Secondary osteoporosis is caused by other diseases, medications that can speed up bone breakdown, and some surgical procedures. It is important to mention here that men also have osteoporosis (we will write about this later), most often a secondary form of osteoporosis.
The causes of secondary osteoporosis are diseases of endocrine disorders such as. Lack of sex hormones increased parathyroid hormone levels, adrenal gland diseases, type I diabetes, and digestive tract diseases. Crohn’s disease, lactose intolerance, liver disease, rheumatoid arthritis, amenorrhea (absence of menstruation), prolonged immobility due to illness, or excessive physical activity such as. In younger athletes.
Drugs such as secondary osteoporosis include corticosteroids, anticonvulsants, thyroid medications, gastric medications, some hormone inhibitors (for the treatment of tumors), and surgical procedures caused by organ transplantation, gastric and upper gastrointestinal surgery.
Other causes should be considered when determining osteoporosis’s exact condition and prognosis: bone structure, lifestyle, habits, gender, and age.
Densitometry in the detection of osteoporosis
What is densitometry?
Densitometry measures the amount of bone tissue in a particular part of the body, usually in the lower spine, hip, forearm, or heel bone.
Doctors use densitometry to assess the risk of fractures and whether treatment is needed.
What does densitometry show?
Densitometry of any bone can predict the overall risk of bone fracture. The amount of bone tissue measured is often called “bone density.”
Bone density varies in humans, as does height, for example, but the lower the bone density, the greater the fracture risk. Densitometry is a much more effective method for determining bone density than X-rays, although some use ultrasound instead.
What is the densitometry of certain parts?
Densitometry of certain parts is a much more convenient method for some patients. Hip densitometry, for example, better predicts hip fracture, but some patients cannot be adjusted to the position to perform that examination.
Forearm densitometry is fast and accurate but cannot be performed in people who have previously had fractures of the wrist or suffer from some types of arthritis.
Spine densitometry sometimes gives false results in people over the age of 60 or in too thin or fat people.
How often do you need to do densitometry?
A single test is sufficient for most people to assess fracture’s future risk. Repeated densitometry may be needed after two to three years if a new treatment decision is needed.
Densitometry is performed every two to three years in people receiving corticosteroid therapy.
So reduced bone density is always osteoporosis?
No, some other conditions can cause decreased bone density and cause fractures. These include osteomalacia (vitamin D deficiency), some glands’ overactivity, some digestive disorders, brittle bone disease (osteogenesis imperfecta), and some inherited conditions that cause fractures in childhood.
It is important to find these problems because they require different treatments.
Diet and nutrition for osteoporosis
In addition to bone structure, calcium plays a vital role in the proper functioning of muscles, heart and nerves, and normal blood clotting. It is found in every cell of our body, although about 99% of total calcium is found in our bones, which serve as a storehouse of calcium in the body.
It is said to “unlock the door to calcium” because it maintains the calcium concentration in the blood and increases the absorption of calcium from the small intestine. Suppose there is not enough vitamin D, the concentration of calcium in the blood decreases. The sun plays the most important role in the supply of vitamin D. Under the sun’s influence, about 90% of the required amounts of vitamin D are produced in the body. Experts recommend exposing the face, shoulders, and arms to sunlight for 10-15 minutes two to three times a week, regardless of the season.
It is present in most foods such as meat, poultry, fish, eggs, dairy products, hazelnuts, legumes, cereals, and cereals. Phosphorus is important for the normal development and function of bones and tissues. In the last 20 years, e.g., in the United States, dietary phosphate intake increased by more than 15% due to increased consumption of foods with additives and carbonated beverages (unhealthy phosphates are formed).
They are the building blocks of bones and are important for tissue structure and regeneration. They are needed for fracture healing and the immune system’s normal functioning. The recommended daily amount is 44 grams for women and 56 grams for men. That means 56 grams = 2 large cups of milk and 150 grams of meat.
Useful tips to increase calcium intake
Use the knowledge of which foods are rich in calcium in your daily diet, and try to add at least one meal of foods rich in calcium to each meal.
Three meals a day will provide you with at least 900 mg, compared to a daily requirement of 1200 to 1500 mg.
a) A serving of 2 cups of soup with milk (maybe soy) will provide you with at least 300 mg of calcium
b) Oatmeal with 1 DCL of milk will provide you with 150 mg of calcium
c) Plain yogurt (2 DCL) contains an average of 450 mg of calcium;
d) One cup of cooked green vegetables (kale, spinach, red cabbage) contains 200 mg of calcium
e) By adding 3 mg of ground almonds to salads or stews, you will provide an additional 50 mg of calcium
f) Most soy dishes contain a lot of calcium:
g) One cup contains about 260 mg of calcium;
h) solid tofu contains 860 mg of calcium per ½ cup;
Foods rich in calcium
a) Yogurt, usually low fat (1 cup, 480 mg calcium, 140 kcal);
b) Soy milk (1 cup, 250 mg calcium, 80 kcal);
c) Milk usually (1 cup, 300 mg calcium, 150 kcal);
d) Swiss cheese (30 g, 270 mg calcium, 110 kcal);
e) Mozzarella (30 g. 205 mg calcium, 115 kcal)
f) Tofu (½ cups, 860 mg calcium, 180 kcal);
Fish and seafood
a) Sardines in a can (85 g (6 sardines), 325 mg of calcium, 177 kcal);
b) Salmon (85 g, 180 mg calcium, 120 kcal);
a) Orange juice (1 cup, 300 mg calcium, 105 kcal);
b) Papaya (1 medium, 70 mg calcium, 120 kcal);
a) Soy (1/2 cup, 230 mg calcium, 125 kcal);
b) Kale (½ cups, 130 mg calcium, 30kcal);
c) Spinach (½ cups, 120 mg calcium, 20 kcal);
d) Cabbage (ice cups.115 mg calcium, 25 kcal);
e) Beans (½ cups, 100 mg calcium, 80 kcal);