Osteoporosis : Diagnosis and Management

Osteoporosis : Diagnosis and Management

Osteoporosis is a disease that makes bones weak and more likely to break. People with osteoporosis most often break bones in the hip, spine, and wrist. Osteoporosis is called the “silent disease” because bone is lost with no symptoms. You may not know you have osteoporosis until a strain, bump, or fall causes a bone to break.

Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry. The term “established osteoporosis” includes the presence of a fragility fracture. It is a medical condition that affects the bones, causing them to become weak and fragile and more likely to break (fracture).


There typically are no symptoms in the early stages of bone loss. Osteoporosis develops slowly over several years. Sometime a minor fall or sudden impact can cause a bone to fracture. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.

Symptoms include:

Back pain, caused by a fractured or collapsed vertebra
Loss of height over time
A stooped posture
A bone fracture that occurs much more easily than expected


Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you’re young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Most people reach their peak bone mass by their early 20s. As people age, bone mass is lost faster than it’s created.

How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.

Risk Factors:

Women are at greater risk of developing osteoporosis than men. This is because changes in hormone levels can affect bone density. Female hormone estrogen is essential for healthy bones. After the menopause, the level of estrogen in the body falls, and this can lead to a rapid decrease in bone density.

In most of the men who develop osteoporosis, the cause is unknown. However, there is a link to the male hormone testosterone, which helps to keep the bones healthy. Men continue to produce this hormone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone.

Other things thought to increase the risk of osteoporosis and broken bones include:

-Family history of osteoporosis
-A low body mass index (BMI) of 19 or less
-Long-term use of high-dose corticosteroid treatment (widely used for conditions such as arthritis and asthma), which can affect bone strength
-Heavy drinking and smoking
-Rheumatoid arthritis


Conventional radiography
Conventional radiography is used either alone or in conjunction with CT or MRI, for detecting complications of osteopenia (reduced bone mass preosteoporosis). However, radiography is relatively insensitive to detection of early disease and requires a substantial amount of bone loss (about 30%) to be apparent on X-ray images. The main radiographic features of generalized osteoporosis are cortical thinning and increased radiolucency. Involvement of multiple vertebral bodies leads to kyphosis of the thoracic spine, leading to what is known as dowager’s hump.

Dual-energy X-ray
Dual-energy X-ray absorptiometry (DXA) is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old) healthy adult women reference population. This is translated as a T-score.

Chemical biomarkers are a useful tool in detecting bone degradation. The enzyme cathepsin K breaks down type-I collagen protein, an important constituent in bones. Antibodies recognizes the resulting fragment, called a neoepitope, as a way to diagnose osteoporosis. Increased urinary excretion of C-telopeptides, a type-I collagen breakdown product, also serves as a biomarkers for osteoporosis.


Tobacco smoking and high alcohol intake have been linked with osteoporosis. Cessation of smoking and moderation of alcohol intake are commonly recommended.

Vitamin D and calcium supplements together can result in preventing fractures. However, there is an increased risk of myocardial infarctions and kidney stones with excess of these supplements.

Bisphosphonates are useful in decreasing the risk of future fractures. Teriparatide (a recombinant parathyroid hormone) has been shown to be effective in treatment of women with postmenopausal osteoporosis.


Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.
Protein is one of the building blocks of bone. And while most people get plenty of protein in their diets, some do not. Vegetarians and vegans can get enough protein in the diet if they intentionally seek suitable sources, such as soy, nuts, legumes, and dairy and eggs if allowed. Older adults may also eat less protein for various reasons. Protein supplementation is an option.
Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70. Good sources of calcium include
Low-fat dairy products
Dark green leafy vegetables
Canned salmon or sardines with bones
Soy products, such as tofu
Calcium-fortified cereals and orange juice

Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you’ll gain the most benefits if you start exercising regularly when you’re young and continue to exercise throughout your life.

Combine strength training exercises with weight-bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — affect mainly the bones in your legs, hips and lower spine. Balance exercises such as tai chi can reduce your risk of falling especially as you get older.