The word "osteoporosis" comes from the Greek language. Ostéon means bone, and póros means hole. In osteoporosis, the bone becomes porous, thin and brittle. The bones of a healthy person are very mechanically strong and break only under the influence of high forces. The bones of a patient with osteoporosis are so weakened that they break with a banal fall at home, and even without injury, during a normal walk. Osteoporosis is what we call the "silent thief" - the exposed person does not know that this disease is "stealing" them of minerals. He finds out about the losses too late, when the bone loss is already very large. Unfortunately, quite often the first sign of the disease is a fracture, which is an inherent feature of osteoporosis.
Cross-section of the vertebral bodies: on the left a normal vertebra, on the right a vertebra with osteoporosis.
The vertebra is thinned and has a reduced height
(Images: Ciba-Geigy Ltd Medical Atlas, Basel, Switzerland 1992)
How does osteoporosis develop?
After reaching the peak mass at about 30 years of age, our bones stabilize. The processes of bone formation and destruction are in balance. After the age of 40, bone formation declines and destruction begins to predominate. We begin to inevitably lose bone mass. This is a normal aging process, just like getting wrinkles on your face or losing your hair. We lose about 0,5 - 1,0% of minerals annually in this way. On the other hand, in osteoporosis bone loss is much greater, reaching 2-5% per year and more.
Decreasing the mineral content in the bones does not cause any problems. Pain occurs only as a result of deformation or fracture of the spine. Often the first symptom of osteoporosis is a fracture. A small loss of bone mass may still be safe, but exceeding a certain level leads to a fracture. So why, while we all lose minerals, do some break? Exceeding the threshold depends primarily on the initial state - what kind of bones we had before the disease. If they were thick, healthy bones, i.e. we had a high peak mass, then we have a large reserve of bone mass and even its significant loss will not lead to a fracture. In contrast, in people with low bone mass, the margin of safety is very small. Even with a small defect, a fracture can occur. Osteoporosis usually lasts many years before it leads to a fracture.
Who is at risk of osteoporosis?
Why do some people get osteoporosis and others don't? How do I know if I am vulnerable or safe? It is decided by the so-called risk factors. These are circumstances resulting from hereditary characteristics and the physiology of our body, i.e. internal factors and external factors, such as nutrition or lifestyle. Many years of research have shown that the most important of them are:
- maternal osteoporosis
- slender body structure
- menopause in women
- advanced age
- calcium deficiency in the diet
- no exercise
- smoking and alcoholism
- diseases and drugs that cause osteoporosis
It has been shown beyond doubt that the tendency to osteoporosis is inherited from the mother. If our mother or grandmother had osteoporosis, we are also exposed to it and more than others. This does not mean that the matter is settled, because the inheritance of traits is extremely diverse, and never unambiguous. Genetic features determine mainly what peak bone mass we will achieve, whether we will have a thin or massive physique. So the important question is: did my mother or grandmother have osteoporosis? Recall whether she has had any fractures, such as: the radius (a fracture in the "wrist"), the femoral neck (a fracture in the "hip"). If the mother had a fracture of the femoral neck, unfortunately, her daughter has twice the risk of fracture. Maybe she "shrunk" and slouched significantly in old age?
Slender body structure
The more massive the physique, the lower the risk of osteoporosis. People with "small bones" are therefore more at risk than "fluffy" women. Low body weight is considered to be below 57.8 kg. Bone loss affects everyone, but the same 5% loss of bone mass will have different effects in a small-boned person compared to a massive-boned person. With a low bone mass of 5%, the loss may mean exceeding the so-called fracture threshold, while in a person with massive bones we have a significant margin of safety (see pages 10-11: chapter - How Osteoporosis Develops; peak mass).
Cessation of menstruation (menopause) in women
Both the first and the last menstruation are harbingers of a new period in the life of every woman. With the last menstrual period, the period of menopause begins, i.e. without menstruation. This usually occurs around the age of 49. The sooner this period occurs, the greater the side effects can be. The ovaries stop producing the female hormone - estrogen, which leads to dysfunction of many organs: the circulatory system, reproductive tract and bones.
Osteoporosis that occurs as a result of decreased estrogen levels is called postmenopausal osteoporosis. Estrogens directly affect bone cells and their absence causes bone loss. During menopause, a woman can lose up to 4-7% of her bone mass per year. Women who stop menstruating early, i.e. under the age of 50, are particularly at risk. Bone loss may be particularly rapid after surgical menopause in women who have undergone gynecological procedures during which the ovaries had to be removed.
The aging process affects the entire body. Our cells and organs age; our bones age. They are losing more and more minerals. Mineral depletion occurs in both men and women, but the process is faster in women. Women's bones lose 45-50% of their bone mass over the course of their lives, while men's bones lose about 30%. Women's situation is further aggravated by the fact that their maximum peak bone mass is 10-20% lower than men. Thus, even the same amount of bone loss per year will cause a woman to weaken the bone structure sooner than a man, leading to bone fracture.
Progressive deterioration of the ability to absorb calcium additionally negatively affects the processes of bone renewal. Both the production of vitamin D3 by the skin and its processing in the kidneys and liver are becoming weaker. The deterioration of overall fitness results in less and less exposure to the sun and less physical activity. Therefore, in the elderly, it is necessary to introduce osteoporosis prevention.
Calcium deficiency in the diet
Calcium is the basic component of bones. There are 1000-1500g of calcium in the body. Virtually all calcium, as much as 99%, is deposited in the bones. However, the remaining one percent (1%) is extremely important for the body, because the excitability of cells depends on it, e.g. heart muscle. Too high or too low serum calcium levels can even be fatal. Our body is perfectly protected against this and any changes in the level of calcium are immediately regulated. If the level of calcium in the blood rises too much, the bone cells quickly "wall" it in the bones. However, if the level is too low, calcium is released from the bones into the blood. It also plays an important role in these changes vitamin D and sex hormones estrogens.
We consume calcium with food, mainly with milk. The daily requirement for calcium in a menopausal woman is about 1500mg, which corresponds to about 1 liter of milk. Adequate calcium intake is important for children to help them build a strong skeleton and achieve a high peak bone mass. A diet devoid of calcium leads to a decrease in its level in the blood serum, which in turn forces the body to release calcium from the bones and reduce their mass. The persistence of this process for several years is one of the causes of osteoporosis.
No physical effort
The strongest regulator of the work of bone cells is physical, direct loading of the skeleton. Bone cells are “sensitive” to mechanical loads and, under the influence of stress, they build bone to cope with them. On the other hand, the lack of loads, little movement, such as long-term bed rest, causes bone destruction. The bone is adapted to withstand mechanical loads. The more you exercise, the stronger your bones. Lack of movement irrevocably causes their disappearance. Movement cannot be replaced by any drugs, but movement can replace many of them. It is necessary to take a daily walk of at least half an hour or a quarter of an hour of intense physical exercise.
Smoking and alcoholism
Both smoking and drinking alcohol are toxic to the bone-forming cells. Thus, even in a healthy but smoking person, the risk of osteoporosis is higher; as well as alcohol abusers. Unfortunately, too many women in Poland smoke cigarettes, and alcohol consumption is among the highest in the world.
Diseases and drugs that cause osteoporosis
Osteoporosis can occur in the course of other diseases or be a side effect of medications. First of all, it will appear in diseases of the glands that secrete hormones that regulate the calcium balance of the body, i.e.: parathyroid and thyroid glands. Various mechanisms cause osteoporosis in patients with: renal failure, liver diseases, gastrointestinal disorders, diabetes and rheumatoid arthritis. Long-term administration of steroid drugs (Encorton, Prednisolone), as in the treatment of asthma, or antiepileptic drugs may cause osteoporosis.
Osteoporosis does not hurt. For years, we lose minerals, and we don't know anything about it, nothing hurts. Unfortunately, often the first symptom of osteoporosis is a fracture. The most common cause of bone pain in the elderly are degenerative changes in the spine or joints.
Fractures in osteoporosis
Fractures are an inherent and certain feature of osteoporosis. The most common fractures are: spine, radius, humerus, ribs, ankles, pelvis.