Osteoporosis and related disorders of bone, muscle and joint health are devastating conditions that can lead to chronic pain, severe disability, dramatic deterioration in quality of life and premature death. Globally, 1 in 3 women and 1 in 5 men over the age of 50 will experience an osteoporotic fracture. According to figures from the World Health Organization (WHO), 1,600,000 hip fractures per year count towards the global osteoporotic disease burden, a figure that is expected to increase by 200% by the year 2050.
Osteoporotic fractures usually occur in the spine, wrist or hip, but they can also affect other parts of the human skeleton. While fractures of the extremities, such as the wrist and hip, are easy to detect, vertebral fractures are usually masked by other, more common causes of back pain.
Which "indirect" signs indicate the presence of a vertebral fracture?
- Height loss (>4 cm in 1 year)
- Appearance of "hump"
- Sudden pain in a part of the spine with local tenderness
Many people don't even know they have osteoporosis until they experience a fracture, and as the loss of bone mass is gradual and painless, there are usually no warning symptoms. This is why osteoporosis is often referred to as a 'silent disease'.
What are the high-risk groups for osteoporosis?
There are several categories of risk factors for the development of osteoporosis:
Fixed risk factors that are not amenable to intervention or modification, but must be taken into account so that the patient, with appropriate medical advice and monitoring, can modify his or her lifestyle to prevent further bone loss:
- Female sex
- Age
- Family history of known osteoporosis or low-force fracture in first-degree relatives
- Previous low-force fracture
- Nationality
- (Early) menopause/hysterectomy
- Long-term treatment with corticosteroids
- Various comorbidities (rheumatoid arthritis, type 1 diabetes mellitus, hyperthyroidism, etc.)
- Hypogonadism
Modifiable factors:
- Regular alcohol consumption (40% increased catastrophic risk)
- Smoking
- Poor nutrition
- Vitamin D deficiency
- Insufficient physical exercise
- Frequent falls
How can I find out if I belong to one of the "high risk" groups?
You can take the IOF One Minute Osteoporosis Awareness Test (IOF One Minute Osteoporosis Awareness Test):
https://riskcheck.osteoporosis.foundation/el
Discuss the results with your doctor, who will guide you appropriately to identify and eliminate modifiable risk factors and minimise the influence of fixed risk factors to ensure you maintain bone health and avoid fractures and their dramatic consequences.
Can I prevent or delay the onset of osteoporosis?
You can prevent the onset of osteoporosis by taking early steps to maintain a healthy lifestyle.
Active prevention of osteoporosis starts already in childhood, during which adequate calcium intake and physical exercise ensure the maximum possible peak bone mass, which is usually achieved shortly before the age of 30.
Bones are a living organism, subject to the degeneration-apoptosis-regeneration processes of the human body and respond to the needs and demands of our daily life. An increase in bone strength and strength requirements, for example during physical exercise, leads to a shift in the balance of bone degradation-reconstruction towards regeneration, thus enhancing bone tissue production and strengthening bone strength.
What is the basic treatment of osteoporosis?
The good news is that osteoporosis, like many musculoskeletal disorders, can be effectively treated, drastically reducing the risk of fractures.
- Ensure a balanced diet rich in calcium and protein, fundamental nutrients for bone health
- Ensure adequate sun exposure (15 minutes of daily exposure), taking the necessary safety measures to increase endogenous vitamin D production and/or increase the consumption of vitamin D-rich foods (eggs, mushrooms, salmon, etc.)
- Emphasize regular physical exercise, incorporating muscle strengthening and weight-bearing exercises into your daily routine
- Stop habits that are detrimental to bone health, such as tobacco and alcohol consumption
Which medicine is right for me?
In our therapeutic quiver there is a wide variety of drugs that have been evaluated and proven safe and effective in the treatment of osteoporosis.
The drugs used to treat osteoporosis act either by reducing the rate of bone resorption and, by extension, the rate of bone loss, or by increasing bone formation (recombinant parathyroid hormone).
The dominant representative of the first category is bisphosphonates, anti-absorptive agents, which reduce the incidence of vertebral and cortical fractures by at least 50%. These drugs are available in many forms (solutions for intravenous infusion, tablets or capsules) and are administered at varying intervals (daily, weekly, monthly, quarterly, semi-annually, annually). Bisphosphonates taken orally should be taken only with water, after an overnight fast and at least 30 minutes before ingestion of other food, liquids or medicines, and the patient should remain in motion for 1-2 hours after swallowing the tablet. The duration of treatment is determined by the severity of osteoporosis and is usually 3-5 years.
A dental assessment in case of known tooth or jaw disease before starting treatment is advisable. Bisphosphonate treatment is generally a long-lasting treatment and any dental interventions that take place during this period should be carried out with caution and after appropriate consultation with the treating dentist, in order to eliminate any aggravating factors for the development of osteonecrosis of the mandible (1/100 000 cases of bisphosphonate treatment).
Daily, parenteral administration of the recombinant form of parathyroid hormone (Teriparatide), a hormone that together with vitamin D plays a predominant role in bone remodelling and function, has been shown to significantly increase spinal bone density, reducing the incidence of both vertebral and non-vertebral fractures in patients with osteoporosis. Teriparatide treatment is limited to 24 months and must necessarily be followed by an anti-osteoclastic treatment (e.g. bisphosphonates) to avoid loss of the therapeutic effect of anabolic intervention.
In April 2019, Romosozumab monoclonal antibody received approval from the Food and Drug Administration (FDA) for the treatment of postmenopausal patients with osteoporosis and high fracture risk. This antibody, which is administered parenterally on a monthly basis for a period of 12 months, acts by binding to and inhibiting the activity of the protein Sclerostin, promoting the formation of bone mass while inhibiting bone resorption. With this dual action on bone metabolism, treatment with this new antibody brings about increases in bone mass of the cancellous and cortical bone and improvements in bone structure and strength. The efficacy and safety of Romosozumab were evaluated in two pivotal studies, an alendronate-controlled study (ARCH) and a placebo-controlled study (FRAME). After 12 months of treatment, a 73% reduction in vertebral fractures was observed, as well as a 27% increase in bone mass in the lumbar spine.
It is clear that the introduction of new therapeutic formulations has enabled the design of tailored medicine approaches, providing significant improvement in bone health and quality of life, particularly in patients at high risk of fracture. The cornerstone of treatment with the ultimate goal of reducing fracture risk is proper information, timely and accurate diagnosis, qualified medical advice on alternative therapeutic approaches and finding the golden mean to jointly initiate treatment, respecting the patient's wishes and needs for optimal therapeutic outcome.
The era of the "silent" disease is gone. Osteoporosis is a disease of our everyday life, with the significant advantage - compared to other diseases with such a wide population incidence - that it is to a considerable extent predictable with the necessary information and vigilance, perfectly controllable with appropriate medical advice and monitoring, and with excellent progression in the right therapeutic context.
Osteoporosis affects us all
.svg)
.svg)
.svg)
.png)
