pathoscribe

Written by Simran Ahluwalia | Art by Simran Ahluwalia

As we age, our bodies undergo numerous changes, and one of the most insidious yet often overlooked conditions is osteoporosis. Often referred to as a “silent disease,” osteoporosis occurs when bone mineral density and bone mass decrease, or when the structure and strength of bone change. This can lead to a decrease in bone strength, increasing the risk of fractures. It is a progressive disease that weakens bones and makes affected individuals more susceptible to fractures and breaks. In the United States alone, an estimated 10 million people over the age of 50 have been diagnosed with osteoporosis. Given the prevalence of this disease, we must work towards educating not only ourselves but other people about it to mitigate the impacts of Osteoporosis.

Unlike many other diseases, osteoporosis usually does not cause any symptoms; it is only discovered through the breaking of a bone, which is why medical professionals call it a “silent disease.” Patients will not notice any signs indicating they are undergoing this bone loss. There are certain warning signs that patients should be aware of when trying to determine if they have osteoporosis. These signs include losing an inch or more of height, changes in natural posture (stooping or bending down more), shortness of breath (caused by reduced lung capacity due to the compression of spinal disks), and lower back pain. The most important sign to look out for is when one breaks a bone after minor incidents like small falls, which would usually not cause a bone to break. 

There are certain risk factors and causes that can make patients more susceptible to developing osteoporosis. Anyone over the age of 50, assigned female and birth (especially those in postmenopause), known to have a family history of the disease, who is naturally thinner or has a small frame (less bone mass), and those who smoke are more susceptible to osteoporosis. White and Asian women over the age of fifty are at greater risk, as are men with lower testosterone levels. Certain health conditions can also lead to osteoporosis. These include endocrine disorders (i.g thyroid disease), gastrointestinal diseases (i.g celiac disease), autoimmune disorders (i.g rheumatoid arthritis), and blood disorders. Certain medications and procedures can increase the risk of osteoporosis like diuretics (used to lower blood pressure), corticosteroids (used to treat inflammation), seizure medication, weight loss surgery, hormone therapy for cancer, anticoagulants, and lastly proton pump inhibitors (used to treat acid reflux).

While osteoporosis does not display conspicuous symptoms, medical professionals have ways of diagnosing the disease. Bone density tests can be used to observe bone strength through imaging and X-rays measuring how much calcium and other minerals are in one’s bones. They are usually referred to as DEXA or DXA tests. DXA tests are dual-energy x-ray absorptiometry tests. They use a low level of X-rays to measure the BMD (bone mineral density) of the skeleton at various sites prone to fracture, like the hip and spine. This is the most reliable way to diagnose osteoporosis and predict future risks. As osteoporosis is a disease that causes a loss in bone density, looking out for changes in bone density is the best way to catch osteoporosis before it causes broken or fractured bones. Doctors may also check for loss in height or weight, changes in posture, balance, and gait, or changes in muscle strength when determining if a patient has osteoporosis.

There is no cure-all for osteoporosis; treatment focuses on slowing and preventing bone loss and fractures. Medical professionals often advise proper nutrition, lifestyle changes (i.g quitting smoking), regular exercise, fall prevention to prevent fractures, and medications. Nutrition is paramount for calcium and vitamin D intake, crucial minerals for bone strength and reaching peak bone mass. Without enough of those minerals in one’s diet, the body takes them from their bones, causing them to become weak and thin. Good sources of calcium include low-fat dairy products, dark leafy greens, broccoli, sardines, and salmon, and calcium-fortified foods (e.g. tofu, orange juice, and bread). Exercise is equally important to strengthen the bones. Exercises that help one’s body work against gravity like yoga, pilates, and tai chi can strengthen bones without putting too much stress on the body. Health providers may also prescribe certain medications to help maintain osteoporosis. Common medications include hormone therapies or replacements like estrogen, testosterone, and bisphosphonates. Patients with severe osteoporosis and are at an extremely high risk for fractures often need other medications like parathyroid hormone (PTH) analogs, denosumab, and romosozumab, which are usually given as injections.

In conclusion, osteoporosis is a significant challenge to the health of many and requires proactive measures and a collective commitment to bone health. While aging is a primary risk factor for this condition, it is important to recognize that osteoporosis is not an inevitable consequence of growing older. There are many sources of risk for this condition which we must be aware of to prevent osteoporosis. By adopting a holistic approach to bone health throughout our lives through practicing good nutrition and habits, regular exercise, and more, we can significantly reduce the risk of developing osteoporosis and the symptoms that come with it.

Works Cited:

Cleveland Clinic medical. “What Are Osteoporosis Warning Signs?” Cleveland Clinic, my.clevelandclinic.org/health/diseases/4443-osteoporosis. Accessed 13 Apr. 2024.

“Osteoporosis Risk Factors.” UC San Diego Health, health.ucsd.edu/care/endocrinology-diabetes/osteoporosis/risk-factors/. Accessed 13 Apr. 2024.

“Osteoporosis Workgroup.” Osteoporosis Workgroup – Healthy People 2030, health.gov/healthypeople/about/workgroups/osteoporosis-workgroup#:~:text=In%20the%20United%20States%2C%20an,at%20increased%20risk%20for%20osteoporosis. Accessed 13 Apr. 2024.

“Osteoporosis.” National Institute of Arthritis and Musculoskeletal and Skin Diseases, U.S. Department of Health and Human Services, 25 Sept. 2023, http://www.niams.nih.gov/health-topics/osteoporosis.