Primary Osteoporosis

What is Osteoporosis?

Osteoporosis is a progressive metabolic bone disease characterized by low bone mass and deterioration of the microarchitecture of bone tissue. This leads to a reduction in the number of trabeculae, thinning and loss of connection of trabeculae, a decrease in cortical thickness, and an increase in porosity, which in turn results in increased bone fragility and susceptibility to fractures.

Osteoporosis is a disease that carries a risk of fractures. The most significant complication of the disease is bone fractures, which can lead to many secondary health problems and even be fatal. Osteoporosis is a “silent disease” that often progresses without symptoms until a fracture occurs. Fractures can result from minimal trauma or sometimes no trauma at all and are particularly common in older individuals. They impose a significant burden on individuals as well as social security systems in terms of treatment and care. Osteoporosis can be diagnosed before fractures occur, and the health problems caused by fractures can be prevented through appropriate precautions and treatments.

Classification of Osteoporosis

Osteoporosis is classified into primary osteoporosis and secondary osteoporosis, taking into account factors influencing bone metabolism.

Primary Osteoporosis is divided into two main categories:

Type I Osteoporosis: Refers to the loss of primarily trabecular bone tissue after menopause due to endogenous estrogen deficiency. It is also known as postmenopausal osteoporosis.
Type II Osteoporosis: Also referred to as age-related (senile) osteoporosis. It describes the age-related loss of cortical and trabecular bone tissue in both sexes.

Secondary osteoporosis is osteoporosis that occurs during various diseases or the use of medications. The prevalence of secondary osteoporosis is higher in men.

Osteoporosis types not included in this classification are juvenile osteoporosis, pregnancy osteoporosis, premenopausal osteoporosis, localized osteoporosis, and idiopathic osteoporosis.

Clinical Assessment:

Osteoporosis is a preventable and treatable “silent disease” that typically shows no warning signs until a fracture occurs. It’s crucial to take a thorough medical history and perform a physical examination on patients with known or suspected osteoporosis to identify risk factors that influence bone physiology and fragility.

What are the Risk Factors for Primary Osteoporosis?

While there isn’t a single cause for primary osteoporosis, several risk factors can increase the likelihood of its development:

Age: As we age, bone density naturally decreases, and bones become weaker. Therefore, age is one of the most significant risk factors for primary osteoporosis.
Gender: Women are more vulnerable to primary osteoporosis, especially after menopause, due to a decline in estrogen hormone levels.
Genetic Predisposition: Individuals with a family history of osteoporosis have a higher risk of developing primary osteoporosis. Genetic factors can influence bone density and structure. A history of fractures in parents is a significant risk factor.
Hormonal Factors: Hormones like estrogen and testosterone play a vital role in bone health. Declines in these hormones can lead to bone loss.
Lifestyle Factors (indirect effects): Insufficient calcium and vitamin D intake, a sedentary lifestyle, smoking, and excessive alcohol consumption can negatively impact bone health and increase the risk of primary osteoporosis. Although these factors play a more prominent role in secondary osteoporosis, they can also contribute to the development of primary osteoporosis.

What are the Symptoms of Primary Osteoporosis?

Primary osteoporosis typically progresses insidiously, and significant symptoms may not appear until bone density has decreased substantially. For this reason, it’s often called the “silent disease.” The first symptom is often a bone fracture. Common fracture sites associated with primary osteoporosis include:

Vertebral Fractures: Can occur as a result of minor strain or a fall. They may cause back pain, loss of height, and a hunched back (kyphosis).
Hip Fractures: These are serious fractures that can have severe consequences for older individuals. They frequently occur as a result of falls.
Wrist Fractures: Can occur when bracing oneself with the hand during a fall.

In advanced stages, postural changes like height loss and kyphosis can also occur due to vertebral fractures. However, these symptoms usually appear when the disease is already advanced.

How is Primary Osteoporosis Diagnosed?

The diagnosis of primary osteoporosis is made by measuring bone density using various methods and evaluating risk factors:

Bone Density Measurement (DXA – Dual-energy X-ray Absorptiometry): This test is the most common and reliable method used to measure bone mineral density. Measurements are typically taken from the hip and spine. The resulting T-score is used to determine an individual’s osteoporosis risk by comparing their bone density to that of young, healthy adults. The diagnosis of primary osteoporosis is usually made with a low T-score.
Physical Examination and Medical History: In diagnosing primary osteoporosis, Endocrinologist Uzm. Dr. Burcu Meryem Atak Sançmış thoroughly assesses the patient’s general health status, risk factors such as age and gender, family history, lifestyle, and past fractures. This holistic approach forms the foundation for an accurate diagnosis and an effective treatment process.
X-rays: Can be helpful in detecting bone fractures or spinal compression fractures. However, they do not show a decrease in bone density in early stages.
Blood and Urine Tests: These may be performed to rule out other medical conditions (e.g., hyperthyroidism, hyperparathyroidism, certain types of cancer) that could mimic primary osteoporosis or affect bone health. These tests are generally more important for investigating the causes of secondary osteoporosis.

How is Osteoporosis Treated?

The treatment of primary osteoporosis aims to reduce the risk of bone fractures and either increase bone density or slow down bone loss. Uzm. Dr. Burcu Meryem Atak Sançmış typically combines lifestyle changes and medication therapy to help achieve faster results.

Lifestyle Changes:
- Nutrition: Adequate intake of calcium (1000-1200 mg daily) and vitamin D (800-1200 IU daily) is vital for bone health. Calcium sources include dairy products, green leafy vegetables, and some fortified foods. Daily requirements should primarily be met through diet. For adults, the average dietary calcium intake is around 700-800 mg. If sufficient calcium intake cannot be achieved through diet, supplemental calcium should be given. Vitamin D can be obtained through sunlight, fatty fish, and vitamin D supplements. Serum 25(OH)D levels should ideally be above 20 ng/ml.
- Exercise: Regular weight-bearing exercises (such as walking, dancing, weightlifting, tennis, running, climbing stairs) and muscle-strengthening exercises can help maintain and increase bone density. Exercises performed against gravity are defined as weight-bearing exercises. If there are no contraindications to exercise, it is recommended to walk for at least 30 minutes three times a week and, if possible, do a few minutes of back and posture exercises daily. Muscle-strengthening exercises include balance, resistance, and posture exercises like yoga and Pilates. Since swimming is not performed against gravity, it does not have a positive effect on bones.
- Smoking, Alcohol, and Coffee: Smoking and excessive alcohol consumption negatively affect bone health. Therefore, it’s important to avoid these habits. Limit coffee consumption to no more than 3 cups per day.
- Fall Prevention: Measures such as fixing slippery floors at home, ensuring good lighting, and wearing appropriate footwear can reduce the risk of falls and thus prevent fractures.
Medication Therapy: Various medications are available that slow bone loss or promote bone formation. Your doctor will prescribe the most suitable medication or combination of medications based on your bone density, fracture risk, and overall health status. Commonly used drug groups include:
- Bisphosphonates: Slow down bone breakdown, increase bone density, and reduce fracture risk. Oral or injectable treatment options are preferred based on the patient (e.g., alendronate, risedronate, ibandronate, zoledronic acid).
- Denosumab: Is another medication that inhibits bone breakdown and is administered by injection every 6 months to suitable patients.
- Selective Estrogen Receptor Modulators (SERMs): Their effect on non-vertebral fractures has not been demonstrated. They can be an option for treating osteoporosis in postmenopausal women who have no fractures, cannot tolerate bisphosphonates, or are not suitable for bisphosphonates, and have a high risk of invasive breast cancer.
- Teriparatide: Is a medication that stimulates bone formation and is generally used in patients with a high fracture risk.
- Romosozumab: Is a newer medication that both increases bone formation and reduces bone breakdown, used in postmenopausal women with a high fracture risk.
Follow-up and Monitoring: Regular bone density measurements (DXA) and doctor check-ups are important to evaluate the effectiveness of the treatment and adjust the treatment plan if necessary. For patients undergoing treatment, bone mineral density should be measured once a year, and for patients receiving teriparatide treatment, every 6 months.

Frequently Asked Questions

Why do women experience bone loss after menopause?

With menopause, estrogen hormone levels decline, which accelerates bone loss.

What foods should one eat to prevent bone loss (osteoporosis)?

Consume foods rich in calcium and vitamin D (dairy products, green leafy vegetables, fatty fish).

How do I know if I have bone loss (osteoporosis)?

There are usually no obvious symptoms. Diagnosis is made through bone density measurement (DXA). Fractures can be the first sign.

Are there supplements for bone loss (osteoporosis)?

Calcium, magnesium, vitamin K, and vitamin D supplements can be used under your doctor’s recommendation.

Can deteriorated bones regenerate?

Bone loss can be slowed, and bone density can be increased to some extent with medication therapy and lifestyle changes, but complete restoration may not be possible.

At what age does bone loss begin?

Although bone loss starts with age, osteoporosis usually becomes clinically evident in older age (65 years and above). However, it can also appear at an earlier age depending on risk factors.

Who is typically affected by bone loss (osteoporosis)?

It’s more common in older adults, postmenopausal women, individuals with low body weight, those on long-term corticosteroids, people with a family history of osteoporosis, individuals with insufficient calcium and vitamin D intake, smokers, and those who consume excessive alcohol.

Can osteoporosis be prevented?

The risk of osteoporosis can be reduced through a healthy diet, regular exercise, adequate vitamin D intake, and avoiding risk factors.

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