Perhimpunan Reumatologi Indonesia
Indonesian Rheumatology Association

Are Your Bones at Risk of Osteoporosis?

What is Osteoporosis?

Osteoporosis is a disease characterized by low bone mass and loss of bone tissue which can cause bones to become brittle and break easily. If you have osteoporosis, you have an increased risk of fractures.

Does Osteoporosis Only Affect the Elderly?

Osteoporosis is often considered a condition that is often encountered in older women. However, the breakdown from osteoporosis starts much earlier in life. Since peak bone density is reached around the age of 25, it is important to build strong bones at that age, so they will remain strong later in life. Adequate calcium intake and exercise are essential for building strong bones.

Why is Osteoporosis an Important Public Health Issue?

In the United States, more than 10 million people have osteoporosis and nearly 34 million people have low bone density. About 80% of them are women. One in two women and one in eight men who are over 50 years old are thought to have had a fracture due to osteoporosis in their lifetime. White and Asian racial groups are at greater risk. With increasing age, the number of osteoporosis sufferers with fractures will increase substantially. The pain, suffering and economic costs will be enormous.

What are the Symptoms of Osteoporosis?

Normal bones are composed of protein, collagen, and calcium, all of which give bone strength. Bone affected by osteoporosis can fracture (fracture) with a relatively minor injury that usually does not cause a bone to fracture.

The condition osteoporosis can present without symptoms for decades. Therefore, patients may only realize they have osteoporosis when they suffer a fracture. Symptoms depend on the location of the fracture.

Symptoms of Osteoporosis: Fracture of the Spine

Fractures of the spine (vertebrae) can cause pain that radiates from the back to the sides of the body. Over the years, repeated vertebral fractures can cause chronic back pain as well as decreased height or curved spine, giving a slouched appearance

Symptoms of Osteoporosis: Stress Fracture

A fracture that occurs during normal activity is called a minimal trauma fracture or a stress fracture. For example, some patients with osteoporosis may experience stress fractures while walking or crossing curbs.

Symptoms of Osteoporosis: Hip Fracture

Hip fractures usually result from falling. But with osteoporosis, hip fractures can occur as a result of trivial accidents. Hip fractures are also difficult to heal after surgery because of the poor quality of the bones.

What Are the Consequences of Osteoporosis?

Fractures due to osteoporosis cause severe pain, decreased quality of life, lost work days, and disability. Up to 30% of patients suffering from hip fracture will need long-term home care. About 20% of women with hip fractures will die in the following year as an indirect result of the fracture. In addition, once a person has had a fracture due to osteoporosis, he / she is at very high risk of suffering another fracture in the future (the next few years).

What Factors Determine Bone Strength?

Bone mass (bone density) is the amount of bone found in the bone structure. Generally, the higher the bone density, the stronger the bones. Bone density is strongly influenced by genetic factors and can be influenced by environmental factors and drugs. For example, men have a higher bone density than women. African Americans have a higher bone density than Caucasians or Asian Americans. Usually, bone density accumulates during childhood and peaks at about 25 years of age. The bone density will then be maintained for about 10 years. After age 35, both men and women will typically lose 0.3% -0.5% of their bone density per year as part of the aging process.

Menopause, Estrogen, and Osteoporosis

Estrogen is important in maintaining bone density in women. When estrogen levels drop after menopause, bone density decreases rapidly. During the first five to 10 years after menopause, women can lose up to 2% -4% of their bone density per year! This can result in a decrease of up to 25% -30% of their bone density during that time. The rapid reduction in bone density after menopause is a major cause of osteoporosis in women.

What Are the Risk Factors for Osteoporosis?

– female gender

– Caucasian or Asian race
– thin and small body shape
– family history (for example, having a mother with a hip fracture due to & nbsp; & nbsp; & nbsp; osteoporosis will increase the risk twofold affected by the same thing)
– personal history of fractures as an adult
– smoking
– Excessive alcohol consumption
– lack of exercise
– low calcium diet
– poor nutrition and health general & nbsp; bad
– poor absorption of nutrients
– low levels of estrogen
– chemotherapy
– loss of menstrual periods (amenorrhea)
– chronic inflammation
– immobility, such as after stroke or a condition that interferes with walking
– hyperthyroid (excessive thyroid hormone)
– hyperparathyroid (excessive hormone production causes too much calcium to be removed from the bones)
– vitamin D deficiency (vitamin D helps the body absorb calcium )
– certain drugs can cause osteoporosis, such as users long-term treatment of heparin (a blood thinner), the anti-seizure drug phenytoin (Dilantin) and phenobarbital, and long-term use of oral corticosteroids (such as prednisone)

How Is Osteoporosis Diagnosed?

Routine X-rays (X-rays) can show osteoporosis of the bones, which look thinner and lighter than normal bone. Unfortunately, by the time X-rays detect osteoporosis, at least 30% of the bone has been lost. Also, X-rays are not an accurate indicator of bone density. The appearance of bone on an X-ray is often influenced by variations in the degree of exposure to the X-ray film.

National Osteoporosis Foundation (NOF) , the American Medical Association (AMA) , and organizations Other medical doctors recommend & nbsp; dual energy X-ray absorptiometry scan (DEXA or DXA) to diagnose osteoporosis. This exam measures bone density in the hips and spine for five to 15 minutes, uses very little radiation (less than one-tenth to one hundredth of the amount used on standard X-rays), and is quite precise.

Who should be tested for bone density?

Guidelines issued by the National Osteoporosis Foundation state that there are several groups of people who should be considered for DXA:

– all menopausal women under the age of 65 who have risk factors for osteoporosis;
– all women aged 65 years or more;
– menopausal women with fractures, although this is not mandatory because therapy can be given immediately regardless of bone density;
– women with one of the medical conditions associated with osteoporosis, and
– women whose decision to use certain drugs may be helped by bone density testing

How to Measure Bone Density?

After completion of the DXA scan, the patient’s bone density was then compared with the peak mean bone density of young adults of the same sex and race. This score is called a “” T score, “” and bone density is expressed as a standard deviation (SD) below the peak bone mass of young adults.

– Osteoporosis is defined as a bone density T score of -2.5 SD or less.
– Osteopenia (between normal and osteoporosis) is defined as a bone density T score between -1 and -2.5 SD.

How to Treat and Prevent Osteoporosis?

The goal of osteoporosis treatment is to prevent fractures by stopping bone loss and increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially reduce the risk of future fractures, there is no therapy that can actually cure osteoporosis. In other words, it is difficult to rebuild bone that has been brittle by osteoporosis. Therefore, preventing osteoporosis is as important as treatment.

Here are some prevention and treatment options for osteoporosis:

Prevention and Treatment: Exercise

Exercise has various beneficial health effects. However, exercise does not bring about a substantial increase in bone density. The benefits of exercise for osteoporosis have mostly to do with a reduced risk of falls, possibly due to better balance and / or increased muscle strength. Research has not yet determined exactly which type or duration of exercise is best for osteoporosis. However, most doctors recommend exercises, such as daily walking.

It is very important to avoid exercises that can injure an already brittle bone. In patients over 40 years of age and those with heart disease, obesity, diabetes mellitus, and high blood pressure, exercise should be prescribed and monitored by their doctor. Strenuous exercise like running a marathon may not be healthy for the bones. Running marathons / strenuous training in young women which causes weight loss and loss of menstrual periods can actually lead to osteoporosis.

Prevention and Treatment: Quit Smoking and Reduce Alcohol

Smoking one pack of cigarettes per day throughout an adult’s life can cause a loss of 5% -10% of bone mass. Smoking reduces estrogen levels and can result in bone loss in women before menopause. Smoking can also lead to premature menopause.

Data on the effect of alcohol and caffeine consumption on osteoporosis are not as clear as those of exercise and smoking. In fact, research on alcohol and caffeine as risk factors for osteoporosis has shown mixed results and is controversial. Of course, this effect is not as strong as other factors. However, avoiding both is wise.

Prevention and Treatment: Calcium Supplements

Building strong and healthy bones requires adequate calcium intake. Importantly, once osteoporosis is present, a diet high in calcium or calcium supplements alone is not sufficient in treating osteoporosis and should not be viewed as an alternative or substituted for osteoporosis prescription medications. In the first few years after menopause, rapid bone loss can occur even when calcium supplements are being taken.

Unfortunately, surveys show that the average woman in the United States consumes less than 500 milligrams of calcium per day in her diet, less than the recommended amount. Additional calcium can be obtained by drinking more milk and eating more yogurt or cheese or by taking calcium supplement tablets and calcium fortified foods, such as calcium-fortified orange juice.

Prevention and Treatment: Vitamin D

Adequate calcium intake and adequate body vitamin D are essential foundations for maintaining bone density and strength. Unfortunately, vitamin D deficiency is very common in the United States. Vitamin D is important in several ways:

– vitamin D helps absorption of calcium from the intestines;
– vitamin D deficiency causes osteomalacia , which further weakens the bones and increases the risk of fractures, and
– vitamin D, along with adequate calcium (1,200 mg elemental calcium), it has been shown in several studies to increase bone density and decrease the incidence of fractures in post-menopausal women but not in pre- or peri-menopausal women.

The Food and Nutrition Council of the Institute of Medicine has recommended the following for adequate vitamin D intake:

– 200 IU per day for men and women 19 to 50 years;
– 400 IU per day for men and women 51 to 70 years, and
– 800 IU per day for men and women 71 years and older.

Good sources of vitamin D are natural sunlight, fortified milk, cheese, butter / margarine, cereals, and fish.

Prevention and Treatment: Menopausal Hormone Therapy

Menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) has been shown to prevent bone loss, increase bone density, and prevent fractures. Estrogen is available orally (Premarin, Estrace, Estratest, and others) or as a skin patch (Estraderm, Vivelle, and others). Estrogens are also available in combination with progesterone as pills and patches. Progesterone is routinely given together with estrogen to prevent uterine cancer that may arise from taking estrogen alone.

Women who have had a hysterectomy (surgical removal of the uterus) can take estrogen alone. Due to the side effects of menopausal hormone therapy, such as an increased risk of heart attack, stroke, blood clots in blood vessels, and breast cancer, menopausal hormone therapy is no longer recommended for long-term use, but short-term use to relieve menopausal hot flashes < / em>. Every woman should discuss estrogen replacement therapy with her doctor in advance.

Prevention and Treatment: Treatment

Currently, the most effective drugs for osteoporosis that are approved by the FDA are anti-resorptive agents, which prevent bone breakdown. Antiresorptive drugs inhibit bone absorption (resorption), improve balance in rebuilding bone and increase bone density. Menopausal estrogen hormone therapy is one example of an antiresorptive agent. Others include alendronate, risedronate, raloxifene, & nbsp; ibandronate, and zoledronate.

Selective estrogen receptor modulator (SERM) is a class of drugs that act like estrogen in some tissues. SERMs were developed to take advantage of estrogen and avoid the potential side effects of estrogen. Examples include tamoxifen and Raloxifene.

Prevention of Hip Fractures

The FDA has approved hip protective clothing to prevent hip fractures in the elderly with osteoporosis. This can be of benefit to certain patients who are in a nursing home setting, although so far the protection against hip fractures obtained with the use of a hip protector is controversial.

Osteoporosis at a Glance

– Osteoporosis is a condition of increased susceptibility to fractures due to brittle bones.
– Osteoporosis weakens bones and increases the risk of fractures.
– Bone mass (bone density) decreases after 35 years of age and decreases faster in women after menopause.
– the main risk factors for osteoporosis include genetic factors, lack of exercise, calcium and vitamin D deficiency, history of fractures in adulthood, suffering from rheumatoid arthritis, smoking, excessive alcohol consumption, low body weight , and families with osteoporosis.
– & nbsp; Patients with osteoporosis have no symptoms until a fracture occurs.
– Diagnosis can be made by X-ray and confirmed using a bone density test (DXA / DEXA).
– Treatment for osteoporosis, in addition to osteoporosis medications , is enough exercise, stopping the use of alcohol and cigarettes, as well as adequate exercise, calcium and vitamin D.