Osteoporosis

Introduction

A fall or even minor pressures like coughing or bending over might result in a fracture because osteoporosis makes bones weak and fragile. The hip, wrist, or spine are where osteoporosis-related fractures most frequently occur.

Live tissue, such as bone, is continually being broken down and replaced. When the production of new bone isn’t keeping up with the loss of existing bone, osteoporosis develops.

All races of men and women are affected by osteoporosis. However, Asian and Caucasian women are more at risk, particularly older women who have passed menopause. Weight-bearing activity, a nutritious diet, and medications can help strengthen weak bones or stop bone loss.

The weakening and porosity of osteoporotic bone increases the risk of fractures, particularly in the hip, spinal vertebrae, and certain peripheral joints like the wrists.

Over 44 million Americans are thought to have osteoporosis at this time, according to the International Osteoporosis Foundation (IOF).

Defination

A bone disorder called osteoporosis develops when the body either produces too little bone or loses too much bone. Because of this, bones weaken and can break from a fall or, in more severe situations, from small bumps or sneezing. The term “porous bone” refers to osteoporosis.

Signs and Symptoms

In the early phases of bone loss, there are usually no symptoms. However, after osteoporosis weakens your bones, you may experience the following symptoms.

• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that fractures significantly more often than anticipated
• receding gums
• weakened grip strength
• weak and brittle nail

Because osteoporosis progresses slowly, a person may not be aware that they have it until they break or fracture after a simple event, such a fall. Osteoporotic bones can break even when you cough or sneeze.

For those with osteoporosis, fractures frequently happen in the hip, wrists, or spinal vertebrae.

Changes in posture, a stoop, and the curvature of the spine can result from a break in the spinal vertebrae.

Additionally, people may realize that they are shorter than they used to be or that their clothing no longer fits them as well.

Growing elderly people has been associated to a higher risk of falls.

Risk factors

Age:

Age is the primary risk factor for osteoporosis. Your body develops new bone and breaks down old bone during the course of your lifetime.

However, your body begins to break down bone more quickly than it can replace it as you reach your 30s. As a result, bone becomes less dense and more brittle, making it more likely to break.

Menopause:

Another major risk factor is menopause, which affects women between the ages of 45 and 55. Menopause can accelerate the loss of bone in a woman’s body because of the hormonal changes that follow it.

At this age, men still lose bone, although more slowly than women. However, men and women often lose bone at the same rate by the time they are 65 to 70 years old.

Other osteoporosis risk factors include:

• being female
• being Caucasian or Asian
• having a family history of osteoporosis
• Poor nutrition
• physical inactivity
• smoking
• low body weight
• small-boned frame

Some of these osteoporosis risk factors, like inactivity and poor diet, are under your control. For example, you can start an exercise regimen and make dietary changes to improve the health of your bones. Other risk variables, including your age or gender, are beyond your control.

Other risk factors include cigarette smoking, eating disorders like bulimia or anorexia nervosa, poor calcium intake, excessive alcohol usage, sedentary lifestyles, and the use of certain drugs including corticosteroids and anticonvulsants.

Thyroid problems:

Bone loss can result from an excess of thyroid hormone. This can happen when you use too much thyroid hormone therapy to treat an underactive thyroid or when your thyroid is overactive.
Osteoporosis risk is increased by rheumatoid arthritis itself.

Causes

An imbalance between the production of new bone and the resorption of existing bone leads to osteoporosis. Too much old bone may be reabsorbed, the body may not produce enough new bone, or both may occur.

Bone development and bone tissue may deteriorate if the body does not absorb enough calcium from the food or if calcium intake is inadequate. As a result, the bones could deteriorate, becoming brittle and easily broken.

Lack of several hormones, especially androgen in men and estrogen in women, is the main cause of osteoporosis.

Women are diagnosed with the disease more often than males, particularly those over 60. Menopause raises a woman’s risk of osteoporosis and is associated with decreased estrogen levels.

Overuse of corticosteroids (Cushing syndrome), thyroid issues, inactivity, bone cancer, certain genetic abnormalities, the use of specific drugs, and issues like inadequate calcium in the diet are additional circumstances that can cause osteoporosis.

Diagnosis

A system that measures the amount of minerals in your bones using modest doses of X-rays can calculate your bone density. You lie on a cushioned table as a scanner moves over your body during this painless test. Only a few bones are typically examined, usually those in the hip and spine.

Bone mineral density (BMD) measurements and standard radiography can be used to diagnose osteoporosis. The dual-energy X-ray absorptiometry is the most widely used technique for determining BMD.

Conventional radiography is helpful for both the differential diagnosis of osteopenia and the detection of its consequences, such as fractures, from osteopenia (low bone mass; pre-osteoporosis), both alone and in combination with CT or MRI. Radiography requires a significant amount of bone loss (about 30%) to be visible on X-ray pictures, and it is not very sensitive to early disease identification.

Cortical thinning and enhanced radiolucency are the primary radiographic characteristics of widespread osteoporosis. Vertebral fractures are common osteoporosis consequences, and spine radiography can greatly aid in both diagnosis and follow-up. Several techniques, such as height loss combined with area reduction—especially when examining vertical deformity in T4-L4—or the calculation of a spinal fracture index that accounts for the number of involved vertebrae can be used to objectively measure vertebral height using plain-film X-rays. The dowager’s hump is caused by kyphosis of the thoracic spine, which is caused by involvement of many vertebral bodies.

Dual-energy X-ray:

The gold standard for diagnosing osteoporosis is dual-energy X-ray absorptiometry, or DEXA scan. When the bone mineral density is 2.5 standard deviations or less than that of a young person (30–40 years old), osteoporosis is diagnosed. As people age, more of them develop osteoporotic conditions because bone density declines with age.

Biomarkers:

One helpful technique for identifying bone deterioration is the use of chemical biomarkers.

Other measuring tools:

Additional measuring instruments: When evaluating osteoporosis, quantitative ultrasonography offers numerous benefits.

Differential Diagnosis

• Osteomalacia/ Rickets
• Bone Infection
• Pediatric osteogenesis imperfecta

• Cancer: Although osteoporosis is frequently the source of fractures with little to no force, bone cancer or metastatic disease can also be the reason.

• Multiple Myeloma
• Renal osteodystrophy
• Scurvy: Vitamin C deficiency

Treatment of Osteoporosis

Lifestyle:
Osteoporosis patients’ bone strength is increased via weight-bearing endurance workouts and/or muscle-strengthening activities. Resistance, weight-bearing, and aerobic workouts all help postmenopausal women maintain or improve their BMD. Preventing falls can help avoid consequences from osteoporosis. Evidence supports the use of hip guards, particularly for residents of assisted living facilities.

Staying away from smoking, which can lower estrogen levels and inhibit the formation of new bone in women

Reducing alcohol consumption to promote strong bones and avoid falls

Engaging in regular weight-bearing activities, like walking, helps to maintain healthy bones and improves the muscles that support them.

Yoga and other exercises that increase balance and flexibility can lower the incidence of fractures and falls.

Medication: 

For those who have already experienced a fracture as a result of osteoporosis, bisphosphonates can help lower their risk of fractures in the future.

Bisphosphonates are the most commonly recommended osteoporosis drugs for both men and women who are at higher risk of fracture.

Examples include:

• Alendronate (Binosto, Fosamax)
• Risedronate (Actonel, Atelvia)
• Ibandronate (Boniva)
• Zoledronic acid (Reclast, Zometa)

Abdominal pain, heartburn-like symptoms, and nausea are among the side effects. If the medication is taken correctly, these are less likely to happen.

Prevention

The risk of osteoporosis can be decreased by making specific lifestyle changes.

Intake of calcium and vitamin D:

Bones require calcium. It is important for people to make sure they get enough calcium each day.

Adults who are 19 years of age or older should take 1,000 mg of calcium daily. All people 71 years of age and older, as well as women over 51, should consume 1,200 mg each day.

Dietary sources consist of:

• dairy products, including cheese, yogurt, and milk
• Green leafy vegetables like broccoli and kale; 
• soft-boned fish like canned salmon and tuna;
• breakfast cereals with added nutrients

Physiotherapy Treatment

The risk of osteoporosis can be decreased by making specific lifestyle changes. Intake of calcium and vitamin D: Bones require calcium. It is important for people to make sure they get enough calcium each day. Adults who are 19 years of age or older should take 1,000 mg of calcium daily. All people 71 years of age and older, as well as women over 51, should consume 1,200 mg each day. Dietary sources consist of: dairy products, including cheese, yogurt, and milk Green leafy vegetables like broccoli and kale; 

soft-boned fish like canned salmon and tuna;

breakfast cereals with added nutrients You can strengthen your muscles and bones with physiotherapy exercises. It can help you control any pain, lessen falls, and stop bone loss. Since bone is a living tissue, certain forms of exercise can help it. You can work with a physiotherapist to identify bone-strengthening activities that meet your needs. Pain can occasionally result from a compression fracture, which occurs when the bones in the spine collapse. This pain can be managed with the aid of physiotherapy. Older adults are more likely to have osteoporosis, which frequently causes falls. People 65 and older frequently experience falls. A physiotherapist can help you strengthen your balance if you are at danger of falling.

You can strengthen your bones by engaging in weight-bearing activities like dancing or walking. Any workout that requires you to support your own body weight with your feet and legs (or arms and hands) is considered weight-bearing.

Weight-bearing exercises, such as walking, can help to strengthen bones strengthening exercises, using weights or resistance bands, have also been shown to maintain or improve bone density at the location of the targeted muscle attachments. Maintaining bone health in this population is extremely important, especially in the elderly as there is typically a decline in bone mass with age.

• Brisk walking
• Climbing stairs
• Dancing
• Hiking
• Jogging
• Jumping rope
• Step aerobics
• Tennis or other racquet sports
• Yard work, like pushing a lawnmower or heavy gardening

Exercises that increase your strength and balance can assist you avoid falls; balancing exercises are also crucial to include to further lower your chance of falling.

Postural exercises

These are essential for preventing thoracic kyphosis and other structural abnormalities that frequently come with osteoporosis. Extension exercises should be a part of any osteoporosis regimen.

• Chin tucks
• Retractions of the scapula
• Extensions of the thorax
• Extensions of the hips

Better posture and balance will result from strengthening the extensor muscles.
Exercises involving flexion are NOT RECOMMENDED. Compression fractures may result from anterior compressive pressures acting on the vertebra.

• Maintain a nutritious diet which includes adequate amounts of calcium and vitamin D.
• Make sure you are receiving enough calcium by using our simple calcium calculator.
• Put on appropriate, properly fitting footwear to prevent falls.
• Stay away of rugs and sloppy footwear as they can both lead to trips.
• Your staircases should be well-lit.
• Regularly get your eyesight checked (it’s free for those over 60).
• Avoid heavy lifting as much as possible by ordering groceries to be delivered to your house.

Many of the people we spoke with who had spinal fractures received hydrotherapy, which is mild movement in warm water, to help relax their muscles.

Is it possible to avoid osteoporosis?

Eating a nutritious diet high in calcium and vitamin D along with regular exercises and active life-style is the greatest way to maintain strong bones and help avoid osteoporosis. Reducing alcohol intake, quitting smoking, and engaging in regular physical activity can also be beneficial.

What is the prevalence of osteoporosis?

In the United States, around 50 million (5 crores) people suffer from osteoporosis.

People over 50 are prone to osteoporosis. According to experts, one in four men over 50 and half of all women suffer from osteoporosis.

According to studies, one in three persons over 50 who do not have osteoporosis also have osteopenia, or a reduced bone density. Early indicators of osteoporosis are seen in people with osteopenia. If osteoporosis is left untreated, it can develop into osteopenia.

Complications

Fractures happen more often when bones weaken and take longer to heal as people age.

As the spine’s bones start to give way, this may result in chronic pain and a decline in height. After suffering a broken hip, some people may not be able to live freely for a long time.

Anyone worried about osteoporosis risk might discuss screening with their physician.

Prognosis

Osteoporosis is something you will likely have to manage for the rest of your life. Bone density examinations and routine checkups with a physician are required. Your doctor will keep an eye on any changes in your bone density and modify your treatment plan as necessary.

How should osteoporosis be managed?

Maintaining your bone (and general) health can be achieved by sticking to a good diet and exercise regimen. See a doctor for routine examinations. Additionally, they will assist in quickly recognizing any problems or symptoms that may impact your bones.

If you have a family history of osteoporosis or are over 65, discuss a bone density test with your healthcare provider.

When should You visit the physician?

If you observe any changes in your body that could be warning symptoms of osteoporosis, see a doctor. Share any other symptoms you’re having with your healthcare professional, particularly if you have bone discomfort or difficulty moving.

When should You visit the emergency room?

If you believe you may have a broken bone or if you face any of the following symptoms, you should visit the emergency department:

• worsening pain.
• One part of your body is immobile.
• A body portion looks notably different or is not where it should be.
• Bone is visible through your skin.
• swelling.
• Fresh bruises that show up simultaneously with any of these other symptoms.

How long can a person with osteoporosis expect to live?

In and of itself, osteoporosis is not deadly and has no effect on life expectancy. However, it may raise your risk of a bone fracture (and, consequently, of more serious breaks or fracture-related problems). According to certain research, hip fractures in persons over 65 cause less mobility and an early mortality.

If you’re concerned about your risk of bone fractures or falls, speak with your healthcare physician. They will keep you healthy and protected.

Conclusion

When you have osteoporosis, your bones become weaker and thinner than they should be. It increases your risk of suffering a bone fracture, which can be dangerous. Before osteoporosis results in a broken bone, many people are unaware that they have the condition.

Early detection of osteoporosis is the strongest defense against bone fractures. See a physician for routine examinations. Ask them how frequently you should have follow-up tests to check the health of your bones and when you will need bone density examinations.

FAQs

References:

• Osteoporosis. (2025, April 25). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4443-osteoporosis
• Osteoporosis – Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968
• MacGill, M. (2023, November 14). What to know about osteoporosis. https://www.medicalnewstoday.com/articles/155646

Author: Nitesh Patel - Physiotherapist

Physiotherapist in Samarpan Physiotherapy Clinic Ahmedabad Bapunagar Amaraiwadi Vastral Mobile Physiotherapy Clinic Dr. Nitesh Patel ( Physiotherapist ) : Mo No : 09898607803