Osteoporosis Bone Loss progresses stealthily without any symptoms

OSTEOPOROSIS

The word osteoporosis originates from the Greek words osteon/bone and poros/small hole, and it quite accurately describes the changes that occur in bone tissue in this disease. Normal bone also contains pores in its structure, but in osteoporosis, these pores widen, causing the bone to become spongy and reducing its strength. The decrease in bone mass increases the risk of fractures.

IT PROGRESSES SILENTLY WITHOUT ANY SYMPTOMS

Since osteoporosis is a silent and progressive disease, it may not cause any symptoms until the first osteoporotic fracture occurs. Fractures in the spine can lead to severe back pain, hunchback, and loss of height. Hip fractures, which negatively affect quality of life due to their functional impact, generally require surgical intervention. Osteoporosis is a disease that can be largely treated through early diagnosis. Lifestyle changes and appropriate medication can slow bone loss and prevent many fractures.

Diagnosis of Osteoporosis

Today, osteoporosis is defined as a systemic disease characterized by low bone density, deterioration in bone structure, and an increased propensity for bone fractures. The diagnosis is made through quantitative measurement of bone mineral density. This technique, called bone densitometry, is extremely easy, economical, and hassle-free for the patient. It provides accurate and precise results regarding bone mass. The World Health Organization (WHO) has established criteria for the diagnosis of osteoporosis and the determination of fracture risk. These criteria are based on comparing the values obtained from individuals whose bone mineral density has been measured with the measurements of a young woman aged 25.

Bone Density Measurement

Bone is primarily composed of minerals such as calcium and phosphorus. Decreased mineral content in the bone leads to bone loss, also known as osteoporosis..

What is Bone Density Measurement?

Bone is primarily composed of minerals such as calcium and phosphorus. Decreased mineral content in bone leads to bone loss, or osteoporosis. The purpose of the procedure is to measure the amount of mineral loss in the bone.

Why is Bone Density Measurement Performed?

Bone density measurement tests are performed to assess mineral loss in bone caused by various factors. This loss is higher in women compared to men because women have less bone mass in their bodies than men. The bone remodeling process continues until the age of 30, which is the period when the structure is at its strongest. Around the age of 40, bone mass begins to decrease, and this process is accelerated further by the reduction in estrogen, the female hormone, especially in women after menopause. Because unlike structuring, melting occurs more rapidly. This condition visually also makes itself shorter in height, rounded appearance on the shoulders, etc. as it turns out, the risk of fractures increases. With the measurement, both the risk of osteoporosis and fractures can be calculated and follow-up can be performed after treatment.

What Should Be Considered Before a Bone Density Measurement?

Whether the person is hungry or full does not matter; however, it is necessary to avoid calcium-rich foods for the 24 hours leading up to the test. Individuals who have undergone a different procedure involving the use of contrast material within the last week should inform their doctor. In this case, the procedure may be postponed for 10–15 days.

How often should bone density measurement be performed?

In high-risk patients during menopause, it should be done annually; in low-risk patients, it should be done every 2 years. The specialist doctor in the field can also determine the frequency of procedures based on the course of the disease and the treatment being administered.

KTo Whom Is Bone Density Measurement Recommended?

Women who have entered menopause through surgical intervention (ovary removal), Women at risk of osteoporosis in the premenopausal period, Women in the postmenopausal period not using hormones. For women over the age of 65, In cases where adults frequently experience bone fractures due to minor accidents, In bone loss occurring during the course of a different disease, For those with a family history of hip or spinal fractures, When medications that cause bone loss are used,  In individuals with signs of osteoporosis or vertebral fractures,  In those with a diet low in calcium. Recommended for individuals with excessive alcohol, coffee, or cigarette consumption, and for men with low testosterone levels.

To Whom Is Bone Density Measurement Not Recommended?

• Those with advanced spinal disorders, Pregnant women or those at risk of pregnancy, Those unable to lie still during the procedure due to lack of mobility. Various procedures are not recommended for patients who have used contrast agents in the last week.

How is Bone Density Measurement Performed?

The patient is asked to lie still on the table. No medication is administered intravenously, and the procedure is painless. The procedure typically takes no more than 20 minutes, depending on the case. The bone densitometry instrument sends a very low dose of X-ray (X-ray), it sends it in two separate energy packets. One package is mainly absorbed by the soft tissues, and the other package is absorbed by the bones.

When the amount in soft tissue is subtracted from the total amount, what remains is the patient's bone mineral density. The amount of radiation used is about one-tenth that of a chest X-ray, which is a very small amount.

CALCIUM AND VITAMIN D INTAKE IS VERY IMPORTANT IN OSTEOPOROSIS TREATMENT

The most important method in the treatment of osteoporosis is making dietary and lifestyle changes.800-1200 mg of calcium should be taken daily, and adequate vitamin D intake through sunlight and diet should be ensured. Regular physical activity should be performed for at least 30 minutes each day. Smoking and excessive alcohol consumption should be avoided. Along with these precautions, continuing the medication treatment prescribed by the doctor will slow down bone loss. In addition, certain measures should be taken to prevent falls, which is one of the most important factors triggering bone loss. To reduce falls, balance, muscle strengthening, and posture exercises should be performed regularly. In advanced ages, assistive devices such as canes or walkers should be used. In homes and workplaces, cords and cables that could trip over should be removed, and the floor should be covered with a non-slip material. Handrails should be installed on the sides of stairs, showers, bathtubs, and toilet bowls.

KNOW THE RISK FACTORS!

The first step in combating osteoporosis is knowing the risk factors. If individuals are aware that they are at risk, it may be possible to slow down and prevent osteoporosis. The most important risk factors that trigger bone resorption; advanced age, gender (more common in women), family history, previous fractures, long-term cortisone use, rheumatoid arthritis, alcohol, smoking, low body mass index and bone mineral density, insufficient physical activity, low calcium intake and vitamin D deficiency can be listed as.

You can make an appointment at our "Physical Therapy and Rehabilitation" center for bone density measurement and new, up-to-date treatments.

References:

• National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture (CG146). London.

• Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019.

• Turkish Osteoporosis Association. Osteoporosis Diagnosis and Treatment Guide. Ankara.

• Turkish Endocrinology and Metabolism Association. Osteoporosis and Metabolic Bone Diseases Diagnosis and Treatment Guide.