Bone is a highly metabolic organ with constant bone formation and bone resorption. Various factors including PTH, Vit D, Calcium, Phosphorous, FGF23 are involved.
Rickets (in children) and Osteomalacia (in adults) are due to poor mineralization of bone. Osteoporosis, which indicates low bone mineral density, is due to an imbalance between bone formation and resorption.
Our body has a mechanism of regenerating itself; different structures of the body regenerate at a different pace. Bone cells regenerate almost immediately, but for a complete bone to regenerate, it takes nearly 10 years. The bones undergo a continuous process of regeneration (replacing old bone with new bone) throughout life
The rate of formation of new bone is faster than removal of old bone. This continues till the bone mass and bone strength reaches its maximum. However, after the age of 30, the rate of formation of new bone becomes slower than the removal of old bone. As a result, bones become weak or porous and can easily break or fracture from a fall or minor bumps.
In the early stages of bone loss, one may have no indications of this condition. However, once the bones get weakened by osteoporosis, the following signs and symptoms may occur:
There are various factors which may increase your risk of developing osteoporosis, including:
Osteoporosis can be treated by taking supplements or taking a balanced diet consisting of minerals like calcium or phosphorous and vitamin D, exercise, hormonal replacement therapy and preventing falls that may result in fractures. The risk of falls can be reduced by taking care while going downstairs and sitting or rising from a chair or ground. Care should also be taken while walking on uneven surface or slippery surfaces like in washrooms.
Medications can also be prescribed to prevent further bone loss and to increase bone strength. These medications may include bisphosphonates (used for post-menopausal women at high risk of fracture), raloxifene, romosozumab and denosumab.
Osteoporosis can be prevented by taking certain measures such as the following:
Hormones like estrogenand progesterone protect bones by helping bone cells to form a new bone. However, during menopause, the estrogen levels decrease sharply, and the new bone formation is reduced. This increases the risk of osteoporosis.
Menopausal hormone therapy is also known as post-menopausal hormone therapy or hormone replacement therapy. It is usually given as a treatment to relieve symptoms of menopause and to address long term consequence like osteoporosis. The hormones used in this therapy are synthetic hormones (estrogen and progestin) which are similar to natural estrogen and progesterone but not identical.
Synthetic estrogen alone can increase risk of endometrial cancer in early menopause women. However, a combination of estrogen and progestin eliminates this risk and the therapy can be used safely in these women. Menopausal hormone therapy may cause breast cancer or stroke, but these risks are rare and are outweighed by the benefits of this therapy. Nevertheless, it is essential to talk your doctor and check whether you are a good candidate for this therapy.
A bone density test is recommended to measure the bone mass; it helps to know your bone health. The most widely used BMD test is dual energy x-ray absorptiometry or DXA test to confirm osteoporosis, detect risk of fracture, or to check the progress of the treatment given to the women with osteoporosis.
The scan is safer than normal X-ray test and doesn’t expose an individual to higher levels of radiation. It is performed in the commonly affected areas like your wrist, spine and hip.
FRAX refers to fracture risk assessment tool. This tool is designed to assess the risk of fractures in patients with osteoporosis. It is developed by considering the individual patient risk factors.
