Osteoporosis: Symptoms, What is it, and Treatment

In the early stages, patients usually have no discomfort or pain. Often they only find out about the disease when they suffer a fracture. ^[1]

Common manifestations include:

• Repeated fractures, which occur in situations that would not normally cause a fracture (a minor fall, picking up objects, or even just coughing), ^[2]
• back pain,
• deterioration of posture and visible reduction in body height. ^[3]

A medical examination is recommended if you experience pain or discomfort in areas typical of osteoporotic fractures (for example, the wrist). Back pain accompanied by noticeable changes in posture can also be a reason to see a doctor. Medical consultation for disease is appropriate for people who have been taking corticosteroids for a long time or if women have gone through premature menopause. ^[9],[10]

When examining it, the doctor is interested in the exact description of the problem, the general state of health and the medications taken.

The main examination method is densitometry – examination of bone density and mineral content in bone mass.

• It is a painless, uncomplicated procedure reminiscent of an X-ray.
• Depending on the result, the doctor will assess the risk of osteoporosis-related fractures and recommend appropriate treatment.
• Repeated densitometry helps to monitor the progress and success of therapy. ^[11]

The result of the densitometric examination is the so-called T-score. This is a comparison of the measured values with the tabulated values of bone density in young healthy subjects.

• Value -1 and higher: indicates normal bone condition
• Value -1.1 to -2.4: mild bone loss, osteopenia
• Value -2.5 and lower: the patient has osteoporosis ^[12]

• It is the most common cause of fractures in postmenopausal women and in elderly men. ^[13]
• Statistics show that one in two women and one in four men over the age of 50 will experience an osteoporotic fracture at some point in their lives. ^[14]
• It affects approximately 200 million people worldwide. ^[15]

Treatment is based on the results of densitometry and the T-score. Based on all the information, the doctor can estimate the risk of fractures in the next 10 years.

If the risk is low, treatment does not need to be based on taking medication. Patients focus more on eliminating risk factors, lifestyle modification and fall prevention.

If the patient’s condition requires treatment with drugs, bisphosphonates are mainly used (they prevent loss of bone density). It is among the prescription drugs for this condition.

Biological treatment helps against bone loss and reduces the risk of fractures.

Patients are concerned about whether treatment is free of side effects with both therapies. Bisphosphonates may cause nausea, abdominal pain, or headache.

• Hormone therapy (estrogen, which is started soon after menopause) helps keep bone mass in good condition. However, it can increase the risk of breast cancer and blood clots. ^[17]
• Taking parathyroid hormone, which stimulates mineralization of bone structures, can lead to improved bone density. ^[18]
• Drugs that promote the formation of new bone mass are usually taken for a maximum of two years.
• A new therapy involves a drug that contributes to bone formation. Patients receive injections at monthly intervals. ^[19]

The best medication is always recommended by the doctor individually for each patient.

A healthy, varied diet and sufficient vitamins play an important role in the prevention and treatment. It’s never too late to adjust your eating habits. Therefore, familiarize yourself with the basic rules of a proper diet.

Nutrition

1. Bones need calcium.
   Natural sources are dairy products, beans, kale or soy. Calcium can also be obtained from dietary supplements.How much calcium a day?
   The recommended dose for women under 50 years of age is 1000 mg per day, over 50 years of age the dose is 1200 mg per day.
   Men up to 70 years of age should have a daily intake of 1000 mg of calcium, above 70 years of age the dose increases to 1200 mg.
   When taking calcium for a long time, be careful to balance magnesium intake 2:1 in favour of calcium.
2. Sufficient vitamin D is needed for proper calcium absorption.
   Suitable sources are oily fish, egg yolk or cod liver. However, natural sources are often not enough and vitamin D must be obtained from supplements. What is the recommended dose of vitamin D?
   The daily dose for people under the age of 70 is 600 IU (international unit), for older people 800 IU is recommended.
3. Potassium improves calcium metabolism
   Therefore, it should not be missing in the diet. Potassium is found in bananas, potatoes, plums and spinach.
4. Diet should, of course, contain all essential nutrients and especially sufficient protein. ^[21]
5. Excessive salting can lead to increased urinary calcium excretion.
   Therefore, follow the recommended maximum of 6 g of salt per day (approximately 1 teaspoon). ^[22]

Alcohol

Excessive alcohol consumption negatively affects bone density. Experts recommend drinking no more than 14 units of alcohol per week – one unit roughly translates to a small “shot” of hard liquor or one small beer. ^[23]

Coffee

Large amounts of caffeine can contribute to an imbalance in calcium management in the body. So remember to drink coffee and other caffeinated beverages in moderation. With regard to calcium, you can “improve” coffee with milk. ^[24]

There is a lot you can do for your bone health. The basis is a good, healthy diet and regular exercise. In the prevention is essential:

• sufficient intake of calcium and vitamin D,
• an active lifestyle without alcohol and cigarettes,
• regular check of bone density (densitometry).

Don’t forget practical tips to avoid falls and accidents. It pays to remove loose rugs and other objects from the floor and use sturdy grab bars in the bathroom. Make sure you have enough light in your home so you don’t trip over anything. ^[25]

Regular weight training exercises contribute to bone health and build strong muscles. Thanks to the muscles, the musculoskeletal system has sufficient support and can better cope with everyday activities and more demanding activities. Exercises that focus on flexibility and balance reduce the risk of falls and subsequent fractures. ^[26] A physiotherapist who has experience with disease can prepare a suitable training plan for you.

Note: Exercises – yoga improves balance and strength.

Studies show that patients have a poorer quality of life. Not only is the increased risk of fractures and the associated limitations to be blamed, but especially the osteoporotic fractures themselves and the subsequent disability that may result. ^[27]

Various patient associations and organisations can be used to help patients cope better with their illness and support their quality of life. They raise awareness, organise patient meetings or provide practical tips for living with disease. In the UK, people can contact the Royal Osteoporosis Society (https://theros.org.uk/). ^[28]

The topic of osteoporosis is addressed by many professional research institutes. In the spring of 2024, Japanese scientists published findings on a key protein that could prevent excessive bone loss. ^[29] However, research is also moving in an alternative direction – American experts have recently found that some substances in ginseng have the potential to work against osteoporosis. ^[30]