Osteoporosis

Osteoporosis is a systemic disease characterized by decreased bone mineral density and deterioration of bone architecture, resulting in increased fragility and susceptibility to fractures. This bone damage occurs due to an imbalance between resorption and osteogenesis, leading to impaired bone formation. Osteoporosis is often asymptomatic and its diseases are aggravated by minor injuries or falls. It is important to diagnose and treat this disease promptly to prevent serious consequences, such as hip or spinal fractures.

History of the disease and interesting historical facts

There are indications of osteoporosis, dating back to ancient civilizations, where osteoporosis or "gross loss of bone mass" was mentioned as a cause of many fractures in the elderly. In ancient Egypt, archaeological finds indicate the remains of people with noticeable pathologies characteristic of osteoporosis. Over time, with the development of medicine and research into bone structure, the attention of health authorities began to be drawn to the study and prevention of osteoporosis. In the 20th century, work began to study the molecules that affect bone metabolism, which became the basis for effective treatment of this disease.

Epidemiology

Osteoporosis is a global public health problem. According to the World Health Organization, in 2020, there were more than 200 million people diagnosed with osteoporosis worldwide. The disease primarily affects women over 50, but also affects older men. Research shows that one in three women and one in five men over 50 will experience an osteoporosis-related fracture during their lifetime. In regions with low levels of physical activity and high alcohol and tobacco consumption, the incidence of osteoporosis is significantly higher.

Genetic predisposition to this disease

Genetic predisposition plays an important role in the development of osteoporosis. Various studies have identified genes involved, such as the LRP5 gene, which is responsible for signaling that regulates osteogenesis. Mutations in this gene can lead to impaired bone mineral density and an increased risk of osteoporosis. Other important genetic factors include genes related to vitamin D metabolism, thyroid hormones, and adrenal hormones (including the CYP2R1 and VDR genes). Thus, hereditary disorders can determine an individual’s predisposition to osteoporosis.

Risk factors for the development of this disease

There are several risk factors that contribute to the development of osteoporosis:

• Genetic predisposition: A family history of osteoporosis or fractures indicates a high risk.
• Age: As you age, the rate of bone resorption exceeds the rate of bone repair.
• Gender: Women, especially during menopause, experience a significant drop in estrogen levels, which increases the risk
• Poor nutrition: a lack of calcium and vitamin D in the diet slows down the process of osteomalacia.
• Physical activity: Low levels of physical activity increase the risk of bone loss.
• Alcohol and tobacco: Abuse of these substances has been linked to an increased risk of osteoporosis.

Diagnosis of this disease

The main symptoms of osteoporosis often do not appear until a fracture occurs. Clinical manifestations may include:

• Back pain, especially in the lumbar region.
• Decreased growth.
• Kyphosis or "cat's back".
• Constant fatigue.

The following methods are used to diagnose osteoporosis:

• Laboratory tests: calcium and vitamin D levels, as well as blood chemistry to assess levels of bone resorption markers.
• Radiological examinations: X-ray, densitometry (DXA), which allows measuring bone mineral density.
• Other types of diagnostics: ultrasound densitometry.
• Differential diagnosis: osteomalacia, osteopenia and other diseases affecting bone metabolism.

Treatment

Treatment of osteoporosis includes several aspects:

• General treatment: Lifestyle changes, including increased physical activity and dietary adjustments.
• Pharmacological treatment: administration of drugs to increase bone mineral density, such as bisphosphonates, renolaclate, and hormonal therapy in women.
• Surgical treatment: In case of fractures, surgery may be required to restore the deformities.
• Other types of treatment include physical therapy, strengthening of the muscle corset, massage and physiotherapy.

List of medications used to treat this disease

Given the pathophysiology of osteoporosis, the following drugs are recommended:

• Bisphosphonates: alendronate, risedronate, ibandronate.
• Selective estrogen receptor modulators: raloxifene.
• Preparations containing hormones: teriparatide.
• Vitamin D and calcium: preparations containing cholecalciferol and calcium.
• Denosumab: A drug that reduces the risk of fractures in patients with osteoporosis.

Disease monitoring

Osteoporosis monitoring includes:

• Checkpoints: Regular bone mineral density checks every 1-2 years.
• Prognosis: With adequate treatment, it is possible to maintain bone health and reduce the risk of fractures.
• Complications: Untreated osteoporosis can lead to serious fractures requiring surgery.

Age-related features of the disease

The course of osteoporosis varies considerably depending on age group. In young people, osteoporosis may develop as a result of genetic predisposition or as a consequence of lack of physical activity and poor nutrition. In older people, bone loss is more often due to hormonal changes, decreased physical activity and concomitant diseases.

Questions and Answers

• What is osteoporosis? Osteoporosis is a disease associated with loss of bone mineral density and increased bone fragility.
• What are the main risk factors for osteoporosis? The main risk factors include genetic predisposition, age, gender, poor nutrition, insufficient physical activity and bad habits.
• How is osteoporosis diagnosed? Osteoporosis is diagnosed using X-rays, densitometry and laboratory tests.
• How is osteoporosis treated? Treatment includes lifestyle changes, drug therapy, and in some cases surgery.
• How to control osteoporosis? Osteoporosis is controlled through regular check-ups, monitoring of bone mineral density, and following your doctor's recommendations.