Osteoporosis is a common bone disorder where the bones become weak and fragile due to a loss of bone mass. Bones are dynamic tissues that constantly undergo “bone remodelling,” where old bone is broken down to release calcium and other minerals. In contrast, new bone is formed to replace it. When this balance is disrupted, more bone is lost than is formed, leading to decreased bone density. The internal structure of the bone, which normally looks like a sponge, becomes more porous with larger holes, making the bones brittle and more prone to fractures.
Managing osteoporosis involves preventing fractures, strengthening weakened bones, and addressing the consequences of the condition. Your physician will work with you to create a personalized treatment plan that meets your specific needs. Treatment options may include lifestyle changes, medication, hormonal therapy, and biological treatments.
Types of Osteoporosis
There are two main types of osteoporosis
Primary Osteoporosis
This type commonly occurs as part of the natural ageing process, especially in women after menopause. Estrogen, a hormone that plays a key role in maintaining bone density, decreases significantly after menopause, leading to an increase in bone resorption (breakdown). This makes women four times more likely to develop osteoporosis compared to men. Other risk factors include having a small body frame or a family history of osteoporosis.
Secondary Osteoporosis
This form results from other medical conditions, nutritional deficiencies, or certain medications. Contributing factors include:
Vitamin D or calcium deficiency, is often caused by diseases like kidney disorders or gastrointestinal conditions that impair nutrient absorption.
Poor diet, including low fruit and vegetable intake, and excessive consumption of caffeine or alcohol.
Medical conditions such as bone marrow disorders, joint diseases, and hormonal imbalances (e.g., overactive thyroid).
Medications, particularly long-term use of steroids.
Eating disorders like anorexia, which lowers sex hormone levels, weakening bones.
Physical inactivity or prolonged periods of immobility, which reduce bone strength.
Cancer treatments, can also negatively affect bone density.
Your doctor may recommend the following lifestyle modifications to manage osteoporosis
Dietary Adjustments: Incorporate foods rich in calcium and vitamin D to support bone health.
Exercise: Engage in regular weight-bearing exercises, such as walking or strength training, to improve bone density and muscle strength.
Smoking and Alcohol: Quit smoking and reduce caffeine and alcohol intake, both of which can contribute to bone loss.
Medication Review: Discontinue or adjust any medications that may induce or worsen osteoporosis, under your doctor’s supervision.
Fall Prevention: Reduce the risk of falls by wearing appropriate footwear and ensuring your home is free of obstacles that could lead to tripping or falling.
Medicinal Therapy: Comprehensive Osteoporosis Management Plan
Your physician may prescribe medications to slow bone loss, manage pain, or supplement essential nutrients. These treatments may include:
Bisphosphonates and Calcitonin: Medications that help prevent bone breakdown and maintain bone mass.
Pain Relievers: To alleviate discomfort caused by fractures or bone weakness.
Calcium and Vitamin D Supplements: To ensure you are meeting your daily nutritional needs for bone health.
Hormonal Therapy: Comprehensive Osteoporosis Management Plan
Hormonal treatments can be beneficial, particularly in cases where hormonal imbalance is contributing to bone loss:
Parathyroid Hormone: Prescribed for a few months, especially if you have experienced a fracture, to stimulate bone formation.
Selective Estrogen Receptor Modulators (SERMs): These medications help prevent fractures, improve blood lipid profiles, and reduce the risk of breast cancer in women.
Hormone Replacement Therapy (HRT): A combination of estrogen and other hormones used in women to stop bone loss and reduce the risk of fractures.
Testosterone Replacement Therapy (for men): May help improve bone density in men with low testosterone levels.
Biologic Therapy: Comprehensive Osteoporosis Management Plan
Biologic agents, often administered through injections, are available to slow bone loss and reduce the risk of fractures.
Diagnostic Tools
To diagnose osteoporosis and monitor its progression, your doctor may perform several tests:
Bone Mineral Density (BMD) Test: A DEXA scan (Dual-Energy X-ray Absorptiometry) may be used to measure bone density in commonly affected areas such as the hip, spine, or wrist. This test is often recommended for women over 65 and men over 70.
X-rays: These may be used to assess the mineral content of your bones.
Blood and Urine Tests: These tests can help detect underlying conditions that may be contributing to osteoporosis or bone loss.
Managing osteoporosis effectively requires a combination of lifestyle adjustments, appropriate medical treatment, and regular monitoring to prevent fractures and maintain bone health.
Osteoporosis’s undertreatment in Pakistan
Osteoporosis weakens bones over time, making people more prone to low-impact fractures. In Pakistan, an estimated 9.9 million people have osteoporosis, with 7.2 million being females, and these numbers are expected to rise to 12.01 million by 2050. Due to a limited health budget, there is a shortage of DEXA machines, and clinicians often rely on heel ultrasound scanning for diagnosis.
The prevalence of osteoporosis in Pakistan is increasing due to factors such as multi-parity, extended life post menopause, low calcium and vitamin D intake, and a sedentary lifestyle. There are also limited guidelines and patient compliance regarding this issue. The Asia-Pacific Consortium on Osteoporosis aims to reduce osteoporosis prevalence in the region, but there are currently no local guidelines for osteoporosis treatment. Primary health centres are essential for detecting osteoporosis, but studies show that primary health care physicians find it challenging to use screening tests for the condition due to a lack of formal training.
The health ministry must take this issue seriously and establish a national-level committee comprising various specialities to develop local guidelines for treating osteoporosis. Promoting bisphosphonates for diagnosed patients and organizing seminars on World Osteoporosis Day can help raise awareness and encourage early intervention. Additionally, setting up hotlines for patients diagnosed with osteoporosis at the national level can aid in addressing poor compliance issues.
