Osteoporosis (OP) is a medical condition where the bones are getting weak and prone to fracture. Bone is a living tissue that is in a constant state of regeneration by a physiologic process known as bone remodeling. In bone remodeling, old bone is removed (bone resorption) and replaced it by new bone with better mechanical properties (bone formation).
Both processes are coupled until 40s where most people begin to slowly lose more bone than can be replaced. As a result, bones become thinner and weaker in structure. Osteoporosis will be a major health problem in developed countries due to inverted population pyramid.
Over age 50, one in two women and one in six men will suffer an osteoporosis-related fracture at some point in their lives. Characteristically, is a “silent” problem that does not produce pain and should be ruled out in the presence of some risk factors before it becomes worse. Some of the major risk factors include: older age, family history of OP-fracture, previous low-impact fracture, premature menopause, no pregnancies, small bone structure, cigarette smoking, alcohol abuse, certain medications (corticosteroids, hormone therapies…) or certain osteopenic diseases (rheumatoid arthritis, chronic renal impairment…).
It can be easily diagnosed by a quick and painless test that measures bone mineral density. The best current available test is called Dual energy X-ray absorptiometry. Once it has been diagnosed, an expertise should design a customized treatment plan based on three main therapeutic aspects: diet, physical activity and medication. Diet should guarantee enough calcium and vitamin D intake to achieve physiologic requirements.
The National Osteoporosis Foundation recommends 1,200 mg per day for women over age 50 (or men over age 70) and 800 IU of vitamin D. Most recommended physical activity to prevent OP is weight-bearing exercise, such as walking, running or even dancing. A dairy exercise of, at least, one hour walking or half an hour jogging should be enough.
An increasing number of medications are being developed to prevent OP-fractures. Most of them are focused in inhibiting bone resorption, thus, stopping bone getting weaker. These medications prevent new fractures although they do not produce great increases of bone mass. There is another therapeutical approach to imbalance bone remodeling in favor of a net gain of bone: to stimulate bone formation. Patients treated with bone forming agents should expect greater increases in bone mass than those treated with bone resorbing blockers. There are still few medications that can effectively do this but they represent one of the most promising advances in the management of osteoporosis.
Rheumatologists are experts in diagnosing and treating diseases of the joints, muscles and bones, thus, they are one of the best appropriate specialists to find the cause of osteoporosis, to weight the risk of fracture and to design a personalized treatment plan that effectively prevents the worse consequence of OP: bone fracture.