Osteoporosis: Symptoms, Causes and Treatment

At a Glance

• Osteoporosis is a condition caused by the bones losing minerals faster than the body can replace them
• Due to mineral loss, the bones become less dense and as a result become brittle and more prone to fractures
• Anyone may develop osteoporosis but women are far more likely to develop the condition than men
• Other risk factors that may contribute to the development of osteoporosis include age, a family history of osteoporosis, inflammatory diseases, endocrine diseases, tobacco smoking, alcohol abuse and eating disorders
• Osteoporosis is incurable but through various treatments and lifestyle changes bone loss may be slowed and new bone tissue may be grown
• It is estimated that around 1.2 million people in Australia are living with osteoporosis and a further 6.3 million people show signs of osteopenia - bone density lower than normal but not low enough to be considered osteoporosis

Breaking a bone is never fun. Depending on the bone broken, the pain may be excruciating, recovery may take months and during that recovery time you may have your mobility or ability to perform day to day tasks severely impaired. For a person living with osteoporosis, both the risk of and damage from fracture may be much greater than that of the general public.

Osteoporosis literally means “porous bones”, and is a condition that leads to fragile, thin and porous bones. Most bones are not solid structures but rather a honeycomb like core surrounded by a strong, solid outer layer. Osteoporosis causes both the spaces in this honeycomb core to become larger, lowering the density of the bone, as well as causing the outer layer to thin and become brittle.

The decrease in bone density seen in osteoporosis is caused by the bones losing calcium and other minerals faster than the body can replace them. The bones in a person living with osteoporosis are much more prone to fracture than those of a healthy person. Events that may be uncomfortable or minimally damaging to a person with healthy bone density, such as falling out of bed, tripping or walking into an object, can easily lead to one or more fractures. 

In cases of severe osteoporosis, sneezing or coughing may lead to fractured ribs, and the simple weight of the body may lead to what are referred to as “compression fractures”. These fractures, most commonly found in the spine, are caused when vertebrae become so brittle that they break under the normal pressure in the spine.

It is estimated that around 1.2 million Australians are living with osteoporosis, and a further 6.3 million are living with osteopenia, a condition typified by bone density lower than normal but not low enough to be classified as osteoporosis. 

Both men and women, especially over the age of 50, may develop osteoporosis, but women are more likely to develop the condition due the rapid loss of oestrogen during menopause. Men also experience a loss of testosterone as they age but that decrease in testosterone production is typically gradual making it a lesser risk factor for osteoporosis.   

Symptoms of Osteoporosis

There are typically few or no symptoms in the early stages of bone density loss, as the condition progresses gradually over time. Many people don’t realise they have brittle bones until their first fracture.

In some cases, the first signs of osteoporosis may include:

• Brittle or weak nails on the fingers and toes
• Receding gums due to tooth loss or gum disease
• Loss of grip strength

Once the condition has progressed, in addition to the increased risk of fractures, a person living with osteoporosis may display a number of physical symptoms such as:

• A loss of height due to collapsed or fractured vertebrae
• A pronounced stoop or hunched posture
• Back pain due to fractures
• Sloping shoulders

Increased risk of fracture is the most serious symptom of osteoporosis. While all bones are affected by a loss of density, fractures most commonly occur in the following.

• Wrists
• Hips
• Vertebrae

Although the outward signs of osteoporosis may be difficult to detect until the disease has progressed to a state that the bones have become brittle, testing for osteoporosis is an easy and painless process. Bone mineral density (BMD) can be assessed through dual energy X-ray absorptiometry (DXA or DEXA scan).

Dual energy X-ray absorptiometry is similar to an X-ray albeit using much less radiation. Bone mineral density readings are taken, typically from the spine and the femoral neck (the part of the hip closest to the femur), and those readings are compared to those taken from young, healthy people with peak bone mass to give a final score. 

This number, referred to as a T-score, shows the relative level of bone density.

• No less than -1.0 = Normal bone density
• Between -1.0 and -2.5 = Osteopenia
• Greater than -2.5 = Osteoporosis  

What Causes Osteoporosis?

While there is no single identifiable cause for bone density loss, there are a number of risk factors that may lead to osteoporosis. Some of these risk factors are unfortunately unavoidable while others may be mitigated through medication, lifestyle changes, physical exercise and diet.

Unavoidable risk factors include: 

1. Age - after the age of 55 the risk increases steadily over time
2. Sex - women are far more likely to develop osteoporosis than men
3. Menopause - the rapid loss of oestrogen may lead to bone mineral loss
4. Ethnic background - indigenous Australian males are almost twice as likely to develop osteoporosis than other men
5. Bone structure - people with a naturally small bone structure are more likely to suffer osteoporosis due to any bone mineral loss
6. Prior fractures - a fracture caused by trauma not osteoporosis, especially after the age of 50 increases the risk of bone mineral loss 
7. Genetic predisposition - people with a family history of osteoporosis have a higher risk than average of developing the disease

Risk factors that may be mitigated include:

1. Eating disorders - such as anorexia nervosa and bulimia
2. Tobacco smoking
3. Alcohol abuse -  or excess alcohol consumption (binge drinking)
4. Calcium and Vitamin D deficiencies - may be due to low intake through diet or through inadequate absorption through the gut. If the poor dietary intake started in a person’s teens or early 20s the risk may be greater
5. Inactive lifestyle - a lack of physical exercise, either through immobility or inactivity may lead to bone mineral loss
6. Endocrine (hormone) conditions - diseases affecting the endocrine system are the most frequent cause of secondary osteoporosis (osteoporosis caused by another disease or medication) in both men and women. Common endocrine diseases include diabetes mellitus, hyperthyroidism, hyperparathyroidism and Cushing’s syndrome 
7. Inflammatory diseases - including rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis 
8. Other diseases - a number of different diseases may increase the risk of developing osteoporosis, including celiac disease, inflammatory bowel disease (IBD), kidney or liver disease, cancer, lupus and multiple myeloma

Some medications used to treat other conditions may also increase the risk of a person developing osteoporosis. These medications include:

1. Corticosteroids - glucocorticoid medications (typically known as corticosteroids) used in the treatment of inflammatory diseases, such as rheumatoid arthritis may weaken the bones. This condition is known as glucocorticoid-induced osteoporosis.
2. Blood thinners - the commonly prescribed blood thinner heparin may lead to bone mineral loss
3. Thyroid hormone replacement - medications used in the treatment of hypothyroidism may increase the risk of developing osteoporosis 
4. Breast and prostate cancer treatments - some treatments that deplete sex hormones, such as anastrozole and letrozole used in the treatment of breast cancer or leuprorelin, used in the treatment of prostate cancer may lead to bone mineral loss. Although these drugs are most frequently used as cancer treatments, drugs that deplete sex hormones may be used to treat non-cancer related conditions as well

Treatment for Osteoporosis

Osteoporosis is incurable, but through different therapies bone density loss may be slowed and new bone mass grown. 

Treatment for osteoporosis is typically based on the theorised risk a patient has of fracturing a bone in the next 10 years based on information taken from a DEXA test and any contributing lifestyle or health factors that may contribute to the risk. Depending on how high the risk is perceived to be, treatment may vary from lifestyle change, supplements and exercise through to medication, or a mixture of treatments.

Vitamins and minerals

For both the prevention of osteoporosis and treatment of the condition a doctor may recommend an increased intake of calcium and vitamin D. These nutrients may come from diet, or from supplements. Although vitamin and mineral intake are more effective in preventing osteoporosis, they may also help in building bone density in people who have already developed the disease.

Weight bearing exercise

Effective in both the prevention and treatment of osteoporosis, weight bearing exercise is one of the primary ways to strengthen bones. Walking is important, but resistance and weight bearing exercises are vital for the strengthening of bones. These exercises cause the muscles to push and pull the bones, prompting them to form new tissue, which leads to the bones becoming stronger.

Exercise may include weight training, squats, pushups, stair climbing and the like, but before embarking on any exercise program, especially if you have a greater risk of fracturing a bone, you should consult with a physiotherapist or exercise physiologist to have a safe and effective exercise routine created. 

In addition to helping strengthen bones, regular exercise may also reduce the risk of developing secondary conditions related to inactivity due to osteoporosis, such as type 2 diabetes or heart disease.

Medications

A number of different medications may be used in the treatment of osteoporosis. These include:

• Bisphosphonates - these commonly prescribed drugs help retard bone loss and may in some cases aid in the formation of new bone tissue
• Denosumab - this drug appears to deliver similar or superior results to bisphosphonates in regards to bone mineral loss and tissue regeneration. It is typically delivered by injection on a biannual basis
• Hormone therapies - in women osteoporosis may be treated with oestrogen supplements or a drug called raloxifene that mimics oestrogen’s beneficial effects on bone density. In men, testosterone replacement therapy may slow bone mineral loss and promote bone growth
• Bone-building medications - drugs such as teriparatide, abaloparatide and romosozumab may be prescribed to promote bone-building, especially if other treatments have proven ineffective. Due to the nature of these drugs, they must be administered by a doctor and can only be used for a limited time

There have been some claims that natural remedies such as red clover, soy, K-2 and black cohosh may be beneficial in the treatment of osteoporosis, however, there are few in any scientific studies that show any efficacy. Before using any supplement or remedy, you should also consult a doctor to see if the supplement may interfere with medications or have potentially detrimental side effects.

If you have a family history of osteoporosis or have a number of risk factors that may increase your chance of developing the disease, don’t wait until you break a bone to take action.

Schedule an appointment with your GP to have your bone density tested. 

Exercise is an incredibly important factor in both the prevention and treatment of osteoporosis, so book a consultation with a physiotherapist for a safe and effective bone building exercise plan. The fastest and easiest way to search for and book healthcare appointments online is through MyHealth1st.