Perhimpunan Reumatologi Indonesia
Indonesian Rheumatology Association
Broken Bone or Osteoporosis

Broken Bone or Osteoporosis

Osteoporosis is a disease characterized by reduced bone mass and bone microarchitecture damage that causes bones to become brittle and increases the risk of fractures. The latest definition of osteoporosis is a bone disorder characterized by reduced bone strength which increases the risk of fracture.

Figure 6. Normal and porous bones

Osteoporosis is divided into primary and secondary

Primary osteoporosis consists of type 1, namely postmenopausal osteoporosis, which occurs in women after stopping menstruation. Meanwhile, type 2 is senile osteoporosis, occurs in older people over the age of 75 years.

Secondary osteoporosis is bone loss that occurs due to other diseases or drugs, such as those who take corticosteroid drugs, & nbsp; anti-seizure, or antacids that are used long-term or those with rheumatoid arthritis or other autoimmune diseases, thyroid disorders, or in patients who lie down for a long time, for example those who have had a stroke.

Risk factors

Risk factors for osteoporosis can be divided into modifiable and non-modifiable risk factors.

What cannot be modified is : old age, female gender, family history of osteoporosis.

What can be modified : excessive alcohol consumption, smoking, vitamin D deficiency, calcium deficiency, low body weight, and excessive consumption of soft drinks, or consumption of certain drugs (occasional these drugs cannot be stopped because they are needed for other diseases).


Osteoporosis does not have any symptoms, because it is often dubbed a “stealth thief”, until one day the sufferer suddenly suffered a fracture. The fracture that occurs here should not occur in a normal bone state, for example a fracture in the pelvis due to slipping in a standing position. The most common locations for fractures are the spine and forearm, in addition to the pelvis.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; As a result of compression fractures in the spine (the spine becomes flattened), pain in the spine can occur with pain radiating to the lower limbs. The patient appears hunched over, the height is reduced and sometimes also experiences abdominal pain due to pressure on the abdomen

Figure 7. Fractures of the spine due to osteoporosis

A fracture in the pelvis makes it difficult for the patient to move his leg, often the patient can only lie down because of pain. Further complications will arise due to lying down constantly, airway disorders and various other complications which in turn can be fatal to death.


The diagnosis of osteoporosis is done by examining the density of the bone mass using a device called central densitometry (BMD). This tool measures bone mass density in the spine, pelvis and forearms. The results are read as recommended by WHO or the world health agency.

The tool used to measure bone density via ultrasound of the heel area is less accurate, therefore this tool is used only for screening, then a definite diagnosis is made by BMD.

Another test is through bone markers in the blood. This examination is not performed for diagnosis but is more necessary to monitor the success of therapy.

Prevention of osteoporosis

Osteoporosis without symptoms, therefore prevention is the most important thing to avoid fractures as a result of osteoporosis.

Early prevention is sufficient calcium and vitamin D for bone formation from an early age, even from infancy.

Osteoporosis Therapy

The main therapy is a change in lifestyle in the form of:

Calcium: The recommended calcium intake is 1200 mg / day in adults over 50 years Women need a calcium supplement 500-700 mg / day
Vitamin D:Rekomendasi asupan vitamin D adalah 400-800 IU per hariKebutuhan vitamin D lebih tinggi pada mereka di atas usia 70 tahun
Exercise: Exercise using weights (including your own body weight) otherwise known as weight-bearing exercise. If possible: walk for 40 minutes / times and do 4 times a week. Strengthen the muscles. Including the spine muscles, thigh muscles and calves, so they are not easy to fall.
Avoid: cigarettes, excessive alcohol and fizzy drinks. Possible factors for falling: lack of light, slippery floors etc.

Medicines for osteoporosis:

There are several drugs that are used to reduce the acceleration of bone loss and reduce osteoporosis. These drugs include: bisphosphonates, strontium ranelate, recombinant parathyroid hormone, and selective estrogen receptor modulators, as well as the biological drug denosumab. The use of estrogen hormone replacement therapy is controversial because of the cancer risk it causes.

If there has been a fracture due to osteoporosis, surgery is required to repair the bone.

By: dr. Laniyati Hamijoyo SpPD-KR, MKes

Division of Rheumatology Department e men Internal Medicine

Faculty of Medicine, University of Padjadjaran / Hasan Sadikin Hospital

Bandung / West Java