Pathophysiology of osteoporosis
The bone can be divided into two parts: the cortical bone and the trabecular bone .
Cortical bone is usually present on the surface of long bones – such as the tibia, which is in the leg – and on the surface of flat bones, such as the patella, of the knee. The trabecular bone, on the other hand, usually stays inside the structure.
Most of the bone mass is formed by trabecular bone, which is composed of trabeculae (thin irregular structures of bone tissue). This part undergoes renewal much more frequently than the cortical bone.
This renewal occurs through two types of cells: osteoclasts and osteoblasts . Osteoclasts are responsible for reabsorbing bone tissue that is old or damaged.
Osteoblasts reconstruct tissue with bone matrix , the base material of bones, composed mainly of collagen, and then mineralization takes place, in which calcium and phosphate stiffen the bone.
Normally, production is balanced with bone resorption. However, in people with osteoporosis, there is an imbalance in this process and the bones do not regenerate quickly enough. This makes the bone porous and fragile.
Types of osteoporosis
There are a few different types of osteoporosis. Are they:
Senile osteoporosis
Senile osteoporosis is age-related. The reduction in bone mass begins to appear near the age of 50 and progresses as time passes, culminating in the disease near the age of 70.
In general, the main cause is the reduction in the production of a particularly active form of vitamin D, which is essential for the absorption of calcium in the intestines.
The result of this reduction is the difficulty for the bones to mineralize with calcium, which is what gives the bone rigidity. With the lack of mineralization, the bones gradually become more fragile over the years.
The lack of vitamin D also increases bone resorption, the procedure responsible for the reduction or degradation of bone, and then the body regenerates it.
That is, when vitamin D is lacking, the bone renewal process is unbalanced and bone mass falls.
Approximately 15% of people aged 60 years old have senile osteoporosis, and that number rises to 70% in people over 80 years old.
Postmenopausal osteoporosis
Women are 3 times more likely to develop osteoporosis and this difference is related to menopause.
One of the main regulators of bone renewal balance is estrogen , the female hormone. It is also present in men, but to a lesser extent.
At the end of a woman’s reproductive period, the amount of estrogen in her body is reduced, resulting in minimal hormone after menopause, which is the last menstrual period.
Without estrogen, the bone renewal cycle is unbalanced and there is an acceleration of the bone tissue reabsorption process, but regeneration does not follow this rhythm.
The result is that, over the years, the bone becomes more porous and fragile.
The risk of fractures in the wrists increases dramatically 10 years after menopause. The spinal fracture rate is also elevated after 15 years and the hip fracture rate is higher after 70 years of age.
Secondary osteoporosis
Secondary osteoporosis is a type of osteoporosis that is caused indirectly by a condition or external agent, such as cancer or the use of medications that affect the bone turnover cycle.
Various conditions and chemicals can cause secondary osteoporosis.
Osteoporosis in men
Osteoporosis is more common in women due to the hormonal change that happens after menopause.
In addition, men have a lower peak of bone mass and the loss of bone mass occurs more slowly, usually at a later stage in life. Despite this, men are not immune to the disease.
In addition to secondary causes, men also experience reduced vitamin D production, which is even more pronounced than that of women, with age. This makes it more common for your bones to be more fragile due to the lack of calcium absorption.
Read more: Lack of vitamin D can cause disease and health risks
Causes of osteoporosis
The causes of osteoporosis are varied. Among them are:
Advanced age
The main cause is old age, as it reduces the production of vitamin D by the kidneys and affects everyone. Vitamin D is necessary, among other things, for the absorption of calcium in the intestine.
Calcium, in turn, is used to mineralize newly regenerated bone. In the absence of calcium, the bone may become malleable and less resistant.
Over the years, this reduction in calcium affects all bones, reducing the resistance of the skeleton as a whole and causing osteoporosis.
Menopause
Also related to age, menopause – the last menstrual period, which marks the end of the female reproductive period – is accompanied by reduced production of the hormone estrogen.
This hormone is essential for the balance between bone resorption and bone regeneration, and when it is lacking, resorption is faster.
Over the years, with regeneration failing to keep up with resorption, the bone becomes more porous and less resistant, resulting in osteoporosis.
Hormonal causes
Diseases that affect hormone production, such as hypothyroidism , can cause secondary osteoporosis. Hormonal changes can cause an imbalance in the bone renewal cycle, causing porosity and fragility of the bones.
Multiple myeloma
Multiple myeloma is a cancer of the plasma cells, which are produced in the bone marrow.
This disease causes osteoclasts, cells responsible for bone resorption, to increase their rhythm, while osteoblasts, which regenerate bones, do not.
The result of this is the rapid loss of bone strength. Fractures in the vertebrae caused by low exertion are one of the possible signs of multiple myeloma due to secondary osteoporosis.
Leukemia
Like multiple myeloma, leukemia affects a cell produced in the bone marrow, where osteoblasts and osteoclasts are also formed.
Blood cell cancer can alter the dynamics of bone turnover, causing secondary osteoporosis.
Absorption problems
Problems with food absorption, especially minerals such as calcium and phosphorus, can cause bone fragility. These substances are essential for the bone mineralization process, as it gives them rigidity and resistance.
Kidney disease
Diseases that affect the kidneys are related to bone fragility since it is in these organs that vitamin D is produced, a compound necessary for the absorption of calcium in the intestine.
When there is a reduction in vitamin D, the body may find it difficult to mineralize the bones, which results in tissue suppleness and consequent fragility.
Mineral deficiency
When food is deficient in minerals necessary for bone reconstruction, the body may not be able to properly regenerate the structure, which leads to fragility and osteoporosis.
Medicines
Some medications can impair the balance of the bone turnover cycle and thus cause osteoporosis. These drugs include anticonvulsants, antidepressants, some diuretics, some thyroid drugs, among many others.
An osteoporosis caused by drugs is secondary and the withdrawal of the substance usually rebalances bone production. However, it is not always possible to interrupt treatment.
Risk factors
The vast majority of people develop osteoporosis at some point in life, especially at older ages. However, some people are more prone to this and may have osteoporosis earlier.
The main groups and risk factors for the disease are:
Women
Women are the main risk group for osteoporosis, especially after menopause, because of the reduction of an important hormone for bone balance, estrogen. Osteoporosis affects about 3 times more women than men.
Seniors
Age is a major risk factor for the development of osteoporosis. After the age of 50, all people start to have their bone mass reduced and, after a decade or two, osteoporosis can appear. Most people over the age of 80 have the disease.
Kidney disease
Kidney disease can affect the production of vitamin D, which impairs the absorption of calcium in the intestine. This can lead to osteoporosis.
Thyroid disease
Thyroid disease and the drugs used to treat it can affect bone renewal balance and cause osteoporosis. People who suffer from these diseases are at an increased risk of developing the disease.
Smoke
People who suffer from smoking are up to 2 times more likely to develop osteoporosis than those who do not smoke.
Alcoholism
Bone health is affected by alcohol consumption, so alcoholism increases a person’s chance of developing osteoporosis and suffering from the complications caused by the disease.
Family history
Family history of osteoporosis can be a risk factor. Although the disease is not genetic, it can be an indication of how the bone renewal cycle works in your family.
Rheumatoid arthritis
The rheumatoid arthritis is a disease that affects the joints and both she and the medications used to treat it are risk factors for the development of osteoporosis.
Lack of sun
Lack of sunshine is a risk factor for osteoporosis because it is through sunlight that we produce vitamin D, not just through the kidneys. Without vitamin D, calcium absorption is reduced and the bone can become fragile.
Read more: Lack of vitamin D can cause weakening of the bones
Symptoms of osteoporosis
Osteoporosis usually does not show symptoms until a fracture occurs, indicating that the bones may be too weak, but these fractures can take a long time to happen.
However, some signs may indicate that the disease is present. Are they:
Bone pain
Pains or sensitivities in the bones can indicate microfractures or fragility of the tissue. Especially when they appear in the spine, they can indicate fractures of the vertebrae (which are less noticeable and generally do not cause the vertebrae to move).
Hunchback
A hump is a possible indication of osteoporosis. It is not an exclusive sign of this disease, but in this case, it is a curvature of the spine that can happen due to vertebral fractures that were not treated and healed incorrectly.
Fracture with little impact
The main indicator of osteoporosis, and often the first to appear, is a fracture with little impact or sometimes simply due to pressure.
In general, the first bone that is affected by this type of fracture is the wrist, which is usually used to cushion impacts.
Other places that can be affected are the vertebrae, which can suffer from the simple weight of the body.
In addition, the hip and femur may become more sensitive. These bones are usually affected in more advanced stages of the disease and cause greater complications when fractured.
How is the diagnosis made?
The doctor who performs the diagnosis of osteoporosis is the orthopedist , the bone specialist. The diagnosis is made using bone densitometry.
Bone densitometry
Densitometry is an exam that analyzes the density of bones in specific regions of the skeleton and compares them with the expected value for the person’s age and sex.
When density is reduced, it is indicative of osteopenia (reduction in bone mass) and, depending on the level of reduction, osteoporosis.
The equipment uses x-rays to analyze the parts of the skeleton most affected by osteoporosis. They are the femur, the spine, the pelvis and the forearm.
The exception is when the test is done on children, who have their whole body analyzed.
The exam usually lasts close to 15 minutes.
Is Osteoporosis Curable?
In cases where the disease is secondary, when the primary cause is eliminated, the tendency is for the bones to recover. However, when osteoporosis is primary, there is no cure, only treatment for the condition, aiming to avoid fractures and reduce the rate of bone loss.
What is the treatment of osteoporosis?
Osteoporosis treatment seeks to prevent fractures and control bone loss, reducing it to a minimum. Drug treatment can be carried out to achieve these goals.
When the cause of secondary osteoporosis is identified, treatment aims to eliminate it if possible.
Read more: Material restores bones and may replace bone marrow transplant
The main methods of treatment involve:
Vitamin D supplementation
When the patient has reduced vitamin D, supplementation can be indicated so that the necessary amounts of the vitamin are present.
Drug treatment
Drug treatment for osteoporosis can involve two types. The antirreabsortivos that reduce bone resorption, preventing further loss of orthopedic mass and anabolic , which increase the production of molecules needed for bone regeneration.
Nutritional correction
Nutritional correction alters the patient’s diet in order to correct any existing nutrient deficiency. In the case of osteoporosis, calcium is usually what is lacking in the body.
Osteoporosis medications
Drug treatment is often necessary to prevent the patient’s bones from deteriorating further. The main drugs used are:
- Teriparatide ( Forteo );
- Calcitonin ( Miacalcic );
- Zoledronic acid ( Aclasta );
- Sodium alendronate ;
- Risedronate sodium ( Actonel );
- Estradiol – Hormone replacement ( Climene );
- Colecalciferol – Vitamin D ( Depura );
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Living together
Living with osteoporosis requires care. The great danger involves fractures, which become easier as the bone loses mass. Bone regeneration can also be more complicated in people with osteoporosis, especially at older ages.
Reduce the risk of falls
Taking care of falls is especially important. In advanced cases, weak impacts can be dangerous, but even in situations of moderate osteoporosis it is possible that a simple fall, or from a low height, results in a fracture.
Be sure to watch out for slippery floors or obstacles, and use non-slip rugs in bathrooms and kitchens.
Eat well
Food is very important to keep the body healthy and to slow down the deterioration process caused by osteoporosis. Calcium foods, such as milk, are essential.
Do not drink
In addition to alcohol being bad for the bones, drunkenness can facilitate a fall, which can result in a fracture. Avoiding drinking, especially in large quantities, is important to prevent complications from osteoporosis.
Do not smoke
Smoking affects the health of the entire body, including bones. Avoid tobacco so that your bones do not lose more mass.
Soak up the sun
Sunlight is essential for the production of vitamin D in the human body. In turn, it is necessary for the proper absorption of calcium, which is essential for bones. Expose yourself to at least 10 minutes of sunlight a day.
What is the best exercise for those who have osteoporosis?
The best exercises for those who have osteoporosis are those with low impact, such as walking and dancing, for example. They have little chance of fractures while still stimulating the growth of bone mass.
Do not forget to seek the help of a physical educator, as he can indicate other exercises with the potential to safely improve your condition.
What to eat to improve osteoporosis?
It is possible to reduce the pace and risks of osteoporosis, allowing bones to stay strong for longer. One of the means for this is to adopt, since childhood, a balanced and diversified diet. Nutrients help to keep the body strengthened as a whole, and some in particular help to protect bone health.
Calcium foods are the main method for bone stabilization. You can eat:
- Milk and dairy products;
- Soy;
- White bean;
- Salmon;
- Linseed;
- Chestnuts;
- Sesame;
- Corn;
- Broccoli;
- Chia;
- Quinoa.
A little of each of these foods can give you the indicated amounts of calcium, which are around 1200mg of calcium per day.
Prognosis
Patients diagnosed with osteoporosis have a high risk of fractures. Especially at older ages, they can be dangerous.
The greatest risk is when hip fractures occur, since when it happens in this bone, it causes difficulty in movement and takes time to regenerate.
Approximately 20% of hip fractures lead to death due to complications. This number is high, especially since most patients are elderly.
Vertebrae are also at risk of fractures, sometimes spontaneous and, in rare cases, they can be dangerous to internal organs due to pressure.
Osteoporosis itself does not cause death, but some of its complications can lead to death. The treatment considerably reduces the risk of fractures.
Complications
There are some possible complications related to osteoporosis. In some cases, they can be very dangerous, especially since most patients are elderly.
Among them are:
Fractures
Fractures are the main consequence of osteoporosis and the more severe the condition, the more common the fractures become.
The bones that are most often affected are those of the wrists, followed by the vertebrae, femur and the hip bones. The last two are very dangerous due to the difficulty of recovery.
Deep vein thrombosis
When bones that compromise the patient’s mobility break, there is a risk of developing deep vein thrombosis (DVT), which is the formation of a clot in the veins.
DVT is very dangerous because the clot can prevent the passage of blood, causing necrosis which, in turn, can lead to amputations. The clot can also be carried through the bloodstream to other regions of the body, which can cause pulmonary embolism .
Deformation
Consecutive fractures can cause deformations, in addition to microfractures, which can happen in the spine, have the potential to cause the formation of a hump. It is important that there is treatment for osteoporosis to avoid these complications.
Pains
Fractures hurt. In addition, when they regenerate poorly, or if they affect the spine, they can cause chronic pain.
How to prevent osteoporosis?
Although osteoporosis will eventually affect the vast majority of people, it is possible to delay the disease and prevent it for as long as possible. The prevention of osteoporosis occurs throughout life.
Soak up the sun
Taking at least 10 to 15 minutes of sun a day, without sunscreen, guarantees an adequate production of vitamin D, which is essential to prevent osteoporosis.
Few foods contain vitamin D, so sun exposure is the most efficient way to produce the substance.
Give preference to sun exposures before 9 am and after 3 pm, as during these times the sun can be too strong and cause other problems.
Eat calcium
Calcium is essential for bone health. Calcium foods include cheese, milk and dairy products, chia seed, sesame, soy, broccoli, corn, among others. Make sure that some of them are in your diet so that calcium intake is adequate.
It is recommended between 800mg and 1500mg of calcium per day, varying according to the person’s stage of life.
In childhood, 800mg per day is recommended while in adulthood, 1000mg daily is recommended.
The phases of life that most need the nutrient are adolescence, 1300mg, and from 50 years old, between 1200mg and 1500mg.
A glass of yogurt contains approximately 300mg of calcium, as well as a slice of cheese. A glass of milk contains 250mg of the mineral.
Practice exercises
Physical exercise is important as it can help your body balance bone replacement. Look for a physical educator, as he is the professional who can indicate which exercises are suitable for you.
It also causes an increase in bone mass, especially during the growth stages, but also in adulthood.
The force exerted by the muscles on the bones in carrying out the exercises causes microfractures , which are small cracks in the bones. They stimulate bone regeneration, which causes a slight increase in bone.
Over time, this increase serves to strengthen the structure and delay possible osteoporosis in the future.
Reduce alcohol
Alcohol can have negative effects on bone mass. Drink in moderation or avoid alcohol as a whole so your bones are healthy.
Give up smoking
Tobacco is bad for the whole body and bones are no exception. Avoid smoking to have a healthier life and avoid osteoporosis.
Hormone replacement
Where necessary, hormone replacement can delay osteoporosis. Talk to your doctor, especially if you are close to menopause, to make sure your hormone levels are correct.
Common questions
What is the difference between osteoporosis and osteopenia?
The osteopenia is reduced bone mass, not necessarily at the level of osteoporosis. Osteoporosis, on the other hand, is a disease characterized by a high reduction in bone mass, resulting in bone weakness and a high risk of fractures.
Osteopenia may be an indication that osteoporosis is on the way. It can take years to happen, but if left untreated, the condition can turn into osteoporosis.
Only women have osteoporosis?
No . The chances of women developing the disease are greater, but men can also have it. 1 in 3 women develops the disease after the age of 50, while 1 in 5 men acquire it.
Only elderly people have osteoporosis?
No . The disease is more common in the elderly, but other conditions can cause bone porosity in younger people.
Osteoporosis causes pain?
Symptoms of osteoporosis, in some cases, include pain in the bones. However, this is an unusual symptom. The first sign given by the disease is usually a fracture. The fractures, in turn, cause severe pain and must be treated in a hospital.
Is there a home remedy for osteoporosis?
No. In addition to the actions that can be taken to prevent osteoporosis – ingesting calcium, sunbathing, avoiding drinking and smoking – there is nothing that can be done at home to treat the disease.
Osteoporosis is a disease that can bring dangerous complications, especially for the elderly, who are the most affected by it.
