Osteoporosis

Overview

• In general, Osteoporosis is the most common bone disease and affects millions of people worldwide.
• Fractures related to osteoporosis are estimate to affect around 30% of women also 12% of men in developed countries, and are a major public health problem.
• Specifically, In the UK alone, fractures are sustain by over 250000 individuals annually, with treatment costs of about £1.75 billion.
• Osteoporotic fractures can affect any bone, but the most common sites are the forearm (Colles fracture), spine (vertebral fracture) and hip.
• Of these, hip fractures are the most serious.
• Their immediate mortality is about 12% and there is a continue increase in mortality of about 20% when compared with age­ matched controls.
• All in all, the defining feature of osteoporosis is reduce bone density, which causes a micro­architectural deterioration of bone tissue and leads to an increased risk of fracture.

Prevalence

• The prevalence of osteoporosis increases with age, reflecting the fact that bone density declines with age, especially in women. [1]
• Osteoporosis causes bones to become weak and brittle. So brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture.
• Bone is living tissue that is constantly being break down also replace.
• Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.
• Especially older women who are past menopause are at highest risk.
• Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones. [2]

Indian epidemiology then other

Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption.

The body may fail to form enough new bone, or too much old bone may be reabsorbed, or both.

Two essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones.

Calcium:

• It is essential for proper functioning of the heart, brain, and other organs.
• To keep those critical organs functioning, the body reabsorbs calcium that is store in the bones to maintain blood calcium levels.
• If calcium intake is not sufficient or if the body does not absorb enough calcium from the diet, bone production and bone tissue may suffer.
• Thus, the bones may become weaker, resulting in fragile and brittle bones that can break easily.
• Usually, the loss of bone occurs over an extended period of years.

Hormones:

• The leading cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men.
• Women, especially those older than 60 years of age, are frequently diagnosed with the disease.
• Menopause is accompany by lower estrogen levels and increases a woman’s risk for osteoporosis.

Other factors:

• They may contribute to bone loss in this age group include;
• Inadequate intake of calcium & vitamin D
• Lack of weight-bearing exercise
• Other age-related changes in endocrine functions (in addition to lack of estrogen)
• Overuse of corticosteroids (e.g. Cushing syndrome)
• Thyroid problems
• Lack of muscle use
• Bone cancer
• Certain genetic disorders
• Use of certain medications
• Problems such as low calcium in the diet

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Risk factors for osteoporosis:

• Women are at a greater risk than men, especially women who are thin or have a small frame, as are those of advanced age.
• Women who are white or Asian, especially those with a family member with osteoporosis, have a greater risk of developing osteoporosis than other women.
• Woman who are postmenopausal, including those who have had early or surgically induced menopause, or abnormal or absence of menstrual periods, are at greater risk.
• Cigarette smoking, eating disorders such as anorexia nervosa or bulimia, low amounts of calcium in the diet, heavy alcohol consumption, inactive lifestyle, also use of certain medications, such as corticosteroids and anticonvulsants, are also risk factors.
• Rheumatoid arthritis itself is a risk factor for osteoporosis.
• Having a parent who has/had osteoporosis is a risk factor for the offspring. [3]

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology

• Osteoporosis occurs because of a defect in attaining peak bone mass and/or because of accelerated bone loss.
• In normal individuals, bone mass increases during skeletal growth to reach a peak between the ages of 20 and 40 years but falls thereafter.
• In women there is an accelerated phase of bone loss after the menopause due to oestrogen deficiency, which causes uncoupling of bone resorption and bone formation, such that the amount of bone removed by osteoclasts exceeds the rate of new bone formation by osteoblasts.
• Age­ related bone loss is a distinct process that accounts for the gradual bone loss that occurs with advancing age in all genders.
• Bone resorption is not particularly increased but bone formation is reduced and fails to keep pace with bone resorption.

Accumulation of fat

• Accumulation of fat in the bone marrow space also occurs because of an age­ related decline in the ability of bone marrow stem cells to differentiate into osteoblasts and an increase in their ability to differentiate into adipocytes.
• Peak bone mass and bone loss are regulated by both genetic and environmental factors.
• Genetic factors account for up to 80% of the population variance in peak bone mass and other determinants of fracture risk, such as bone turnover and bone size.
• Environmental factors, such as exercise and calcium intake during growth and adolescence, are important in maximising peak bone mass and in regulating rates of post­menopausal bone loss.
• Smoking has a detrimental effect on bone mineral density (BMD) and is associate with an increased fracture risk, partly because female smokers have an earlier menopause than non­smokers.
• Heavy alcohol intake is a recognise cause of osteoporosis and fractures, but moderate intake does not substantially alter risk. [1]

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Patients with osteoporosis are asymptomatic until a fracture occurs.

Osteoporotic spinal fracture may present with;

• Acute back pain
• Gradual onset of height loss
• Sloping shoulders
• Kyphosis with chronic pain.

Acute vertebral fracture:

• It can occasionally radiate to the anterior chest or abdominal wall and mistake for a myocardial infarction or intra abdominal pathology, but worsening of pain by movement and local tenderness both suggest vertebral fracture.

Peripheral osteoporotic fractures:

• It present with local pain, tenderness and deformity, often after an episode of minimal trauma.

Hip fracture:

• The affected leg is shorten and externally rotate. [1]

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A doctor will consider the patient’s family history and their risk factors.

Often blood tests are use to measure i.e.;

• Calcium,
• Phosphorus,
• Vitamin D,
• Testosterone,
• Thyroid also  kidney function. [4]

Levels of sex hormones and gonadotrophins should measure in men with osteoporosis and women under the age of 50.

If they suspect osteoporosis, they will request a scan, to measure bone mineral density (BMD).

Bone density scanning uses a type of x-ray technology known as dual-energy X-ray absorptiometry (in other words, DEXA) and bone densitometry.

Combined with the patient’s risk factors, DEXA can indicate the likelihood of fractures occurring due to osteoporosis.

It can also help monitor response to treatment.

Two types of device can carry out a DEXA scan:

• A central device: A hospital-based scan measures hip and spine bone mineral density while the patient lies on a table.
• A peripheral device: A mobile machine that tests bone in the wrist, heel, or finger.

DEXA test results:

The results of the test are give as a DEXA either T-score or a Z-score.

The T-score compares the patient’s bone mass with peak bone mass of a younger person.

• -1.0 or above is normal
• from -1.0 to -2.5 suggests mild bone loss
• -2.5 or below indicates osteoporosis

The Z-score compares the patient’s bone mass with that of other people with similar build and age.

The test is normally repeated every 2 years, as this allows for comparison between results.

Other tests:

• A lateral vertebral assessment (LVA) may recommend for an older patient who is more than one inch shorter than they use to, or who has back pain that is not relate to another condition.
• An ultrasound scan of the heel bone is another way to assess for osteoporosis.

It is less common than DEXA, and the measurements cannot compare against DEXA T-scores. [3]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment recommendations are often base on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test.

If your risk isn’t high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.

Biophosphonates:

For people of all genders at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates.

Examples include:

• Alendronate (Binosto, Fosamax)
• Risedronate (Actonel, Atelvia)
• Ibandronate (Boniva)
• Zoledronic acid (Reclast, Zometa)

Side effects include nausea, abdominal pain and heartburn-like symptoms.

These are less likely to occur if the medicine is taken properly.

Intravenous forms of bisphosphonates don’t cause stomach upset but can cause fever, headache and muscle aches for up to three days. It might be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so.

Monoclonal antibody medications:

• Compared with bisphosphonates, denosumab (Prolia, Xgeva) produces similar or better bone density results and reduces the chance of all types of fractures.
• Furthermore, Denosumab is delivered via a shot under the skin every six months.
• Recent research indicates there could be a high risk of spinal column fractures after stopping the drug.
• A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thigh bone.
• Besides this, A second rare complication is delayed healing of the jawbone (osteonecrosis of the jaw).
• Lastly, this can occur after an invasive dental procedure such as removing a tooth.

Hormone-related therapy:

• Estrogen, especially when started soon after menopause, can help maintain bone density.
• However, estrogen therapy can increase the risk of blood clots, endometrial cancer, breast cancer also possibly heart disease.
• Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment.
• Raloxifene (Evista) mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen.
• Taking this drug can reduce the risk of some types of breast cancer.
• Hot flashes are a common side effect.
• Raloxifene also may increase your risk of blood clots.
• In men, osteoporosis might be linked with a gradual age-related decline in testosterone levels.
• Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.

Bone-building medications:

If you can’t tolerate the more common treatments for osteoporosis or if they don’t work well enough your doctor might suggest trying:

Teriparatide (Forteo):

• This powerful drug is similar to parathyroid hormone and stimulates new bone growth.
• It’s given by daily injection under the skin.
• After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth.

Abaloparatide (Tymlos) is another drug similar to parathyroid hormone:

•  You can take it for only two years, which will be followed by another osteoporosis medication.

Romosozumab (Evenity):

• Basically, this is the newest bone-building medication to treat osteoporosis.
• It is given as an injection every month at your doctor’s office.
• It is limited to one year of treatment, followed by other osteoporosis medications. [2]

Diet:

• Young adults should be encouraged to achieve normal peak bone mass by getting enough calcium (1,000 mg daily) in their diet (drinking milk or calcium-fortified orange juice and eating foods high in calcium such as salmon), performing weight-bearing exercise such as walking or aerobics (swimming is aerobic but not weight-bearing), and maintaining normal body weight.

Exercise:

• Lifestyle modification should also be incorporated into your treatment.
• Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis.
• Studies show that exercises requiring muscle to pull on bones causes the bones to retain, and perhaps even gain, density.
• Researchers found that women who walk a mile a day have four to seven more years of bone in reserve than women who don’t.
• Some of the recommended exercises include weight-bearing exercise, riding stationary bicycles, using rowing machines, walking, and jogging.
• Before beginning any exercise program, make sure to review your plan with your doctor. [4]

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Calcarea Phosphorica:

• Excellent remedy in homeopathic treatment especially for Osteoporosis where there is excess curvature of spine.
• Patient has weakness also brittleness of bones and is unable to appropriately support the body leading to bending of bones.

Calcarea Fluorica:

• Of use in homeopathic treatment for Osteoporosis by promoting calcium absorption in the body.
• Cracking specifically in the joints.
• Easy dislocations of joints.
• Enlargements of bone either with or without caries, particularly of traumatic origin.
• Has got action on long bones.

Silicea:

• Especially suited in homeopathic treatment for Osteoporosis to people who have a fragile appearance and weak spine.
• Injuries and fractures take a long time to heal.

Symphytum:

• Of great use in the healing process when fractures occur.
• It strengthens the bones and takes care of the pain in old fractures that have healed. [5]

Ruta Graveolens:

• It is yet another very effective homeopathic cure used for the treatment of fractures in osteoporosis.
• Whenever a bone gets broken, the ligaments and tendons of bones that surround it additionally get harmed.
• This regular solution helps in mending torn ligaments and tendons.

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1. Davidson’s Principles and Practice of Medicine (22nd edition)
2. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968
3. https://www.medicalnewstoday.com/articles/155646.php
4. https://www.emedicinehealth.com/osteoporosis/article_em.htm#are_there_home_remedies_for_osteoporosis
5. https://www.womenshealth.gov/a-z-topics/osteoporosis

Frequently Asked Questions

What is Osteoporosis?

Osteoporosis is a disease characterized by low bone mass and loss of bone tissue that may lead to weak and fragile bones.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Osteoporosis?

• Calcarea Phosphorica
• Calcarea Fluorica
• Silicea
• Symphytum
• Ruta Graveolens

What causes Osteoporosis?

• Calcium intake is not sufficient
• Body does not absorb enough calcium from the diet
• Lack of certain hormones (estrogen)
• They may contribute to bone loss
• Inadequate intake of calcium & vitamin D
• Lack of weight-bearing exercise
• Overuse of corticosteroids
• Thyroid problems
• Lack of muscle use
• Bone cancer

What are the symptoms of Osteoporosis?

• Acute back pain
• Gradual onset of height loss
• Sloping shoulders
• Kyphosis with chronic pain
• Local pain, tenderness and deformity