By Mr. Gatos Georgios, Orthopaedic Surgeon, Scientific Partner of ANASSA Clinic
What is Osteoporosis
Osteoporosis is defined by the International Osteoporosis Organisation as a bone disease that occurs when our body loses too much bone, produces too little bone, or both. The World Health Organization defines osteoporosis as when bone mineral density (BMD) measured by the “dual energy photon beam” (DXA) method is 2.5 standard deviations or more from the bone mineral density of a healthy young woman (T score < -2.5 SD). As bone becomes less dense, the risk of fracture increases. In both women and men, bone density increases until about the age of 30 and then gradually begins to decrease. The decrease in bone density increases in women after menopause, due to a decrease in oestrogen, at a rate of about 2% each year. According to the World Osteoporosis Organisation, one in three women and one in five men over the age of 50 will suffer an osteoporotic fracture. The pathogenesis of the disease is due to a reduction in the rate of bone remodelling, which is influenced by many factors such as calcium, vitamin D, parathyroid hormone, calcitonin, thyroid hormones, oestrogen, testosterone. An estimated 9 million osteoporotic fractures occur each year, with those of the hip, forearm and vertebral bodies being the most common. It is estimated that by 2050 osteoporotic hip fractures will increase by 240% in women and 310% in men.
Risk factors
The risk factors of osteoporosis and therefore osteoporotic
fracture are:
- the female gender
- the white race
- the increased age
- genetic / family factors
- smoking
- the low weight
- limited exercise
- dietary factors such as low calcium intake
- late menstruation and early menopause
- hypogonadism in men
Secondary osteoporosis can be the result of endocrine disorders such as hyperparathyroidism, hyperthyroidism or diabetes mellitus, diseases such as multiple myeloma, inflammatory bowel diseases, rheumatoid arthritis, taking medication such as glucocorticoids (cortisone), anticonvulsants, aromatase inhibitors (for breast cancer and gynecomastia), proton pump inhibitors (stomach ulcer drugs). Because osteoporosis is unlikely to be symptomatic before the first fracture, it is necessary to diagnose it early and assess the possibility of a fracture in the future.
The role of Prevention
Of great importance is the taking of a detailed medical and family history, detailed clinical examination with measurement of body mass index, spinal tap for kyphosis, neurological assessment for balance and mobility, sarcopenia. Laboratory tests such as blood calcium, vitamin D, thyroid and parathyroid hormones, urea, creatinine, blood count, blood count, electrophoresis of albumin, etc. are considered necessary for diagnosis. The main imaging method for measuring bone density is that of “dual energy photon beam” (DXA) which is performed on the hip and spine. This is a method that makes use of low-energy X-rays. In essence, it measures and compares bone density with that of healthy adults. The World Health Organization defines osteoporosis as when the T score is less than -2.5 in postmenopausal women and men over 50 , osteopenia when it is between -1.5 and -2.5 and normal density is greater than -1.5 .
It is necessary to check osteoporosis with the DXA method in:
- Women aged 65 and over
- Women under 65 years of age with increased risk factors for fracture occurrence
- Postmenopausal women who have risk factors for fracture, such as thin build, history
previous fracture Men aged 70 years and over - Men under 70 years of age but with increased risk factors for fracture occurrence
- Adults of both sexes with conditions associated with low bone mass or associated with bone loss
- Adults of both sexes taking medications that can reduce bone mass, such as cortisone
- Patients already taking medication for reduced bone mass, to assess the effect of the treatment they are receiving
Bone Density Measurement
The bone density test is painless, bloodless and safe. During the test, the examinee lies down under a special scanner without having to take off his or her clothes. The scanner is moved across the patient to image the area of interest. The whole procedure takes no more than 15 minutes. The DXA method relies on the use of X-rays. However, the dose used is extremely low. For example, it is less than 1/10 of the dose received from a chest X-ray and is even less than the daily dose of radiation that each person receives unintentionally from the environment.
Treatment
Treatment of osteoporosis includes both pharmaceutical agents and lifestyle recommendations such as physical exercise, getting enough calcium in the diet, stopping smoking and reducing alcohol. There is a plethora of pharmaceuticals such as those related to calcium absorption, those that stimulate bone mass formation and those that do both. They should always be combined with calcium and vitamin D intake.