What is it?

Osteoporosis (osteo ‘Bone’, poros ‘pore’) is a skeletal disease causing weak and brittle bones. It makes the bone fragile that even slight movement can cause a fracture. 

Bone is a dynamic tissue that undergoes a constant remodeling process. Osteoporosis ensues when bone-forming tissues (osteoblasts) cannot keep pace with the bone resorption process. This results in increased bone fragility and fracture incidents that occur most commonly on the hip, spine, or wrist.

In the Philippines, based on the 2003 National Nutrition Health Survey, the overall prevalence of osteoporosis in adult Filipinos 60 to 69 years of age was 0.8%, while those beyond 70 years old were 2.5%. Although osteoporosis can affect both sexes, there was a higher prevalence of fractures in women (11.3%) than in men (9.0%).

What are the different types of osteoporosis?

Osteoporosis can be a primary or secondary disorder. Primary osteoporosis includes post-menopausal osteoporosis and late-onset hypogonadism in older men while secondary osteoporosis occurs if a definable cause has been identified. These include, but are not limited to, endocrine disorders ( i.e. diabetes mellitus, hyperparathyroidism, hypothyroidism, hypogonadism, premature menopause), autoimmune disorders (rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis), hematologic disorders (multiple myeloma), oncologic causes (breast cancer, prostate cancer, metastatic lesions) and drug-induced disorders (glucocorticoids, methotrexate, anti-convulsants).

What are the risk factors ?

Several clinical risk factors were identified to increase the likelihood of developing osteoporosis.

  • Non-modifiable risk factors:
    1. Sex – Women are more affected than men.
    2. Age – The older you get, the higher is the likelihood of the disease.
    3. Ethnicity – Caucasians and Asians are more likely to develop osteoporosis amongst others.
    4. Peak Bone Mass – Low peak bone mass is a causative factor in osteoporosis in later life.
    5. Family History – a history of fracture by your parents increases your risk as well.
  • Modifiable risk factors:
    1. Smoking
    2. Excessive alcohol consumption
    3. Medication use
    4. Dietary factors (low calcium intake)
    5. Physical activity (sedentary lifestyle)

What are the symptoms?

There are generally no symptoms during the early stages of bone loss. However, once the bone has severely weakened and resulted in a fracture, the following symptoms may appear: 

  • Back pain – due to collapsed vertebral bodies
  • Loss of height
  • Change in posture
  • Bones that easily fracture

How is it diagnosed?

Diagnosing osteoporosis is based on a special radiologic imaging technique called Bone Mineral Densitometry. Also called Dual Energy Xray Absorptiometry (DEXA), it measures bone loss. It determines whether you have osteopenia ( mild bone loss) or osteoporosis. This simple and non-invasive procedure also helps in estimating the risks of developing osteoporotic fractures in the future and monitoring treatment.

How is it treated?

Our goal is in treating the disease is to prevent fractures from occurring. This preventive approach starts with a healthy diet with good sources of calcium and adequate amounts of Vitamin D. This is coupled with a regular exercise program to help strengthen the bones and the muscles and improve balance to prevent falls.

Once diagnosed, your endocrinologist may start agents that may augment bone formation (teriparatide, estrogen, SERMS) and attenuate bone loss (bisphosphonates like alendronate and ibandronate, and denosumab). Supplements like calcium (RDA – 1000 mg to 1200 mg) and Vitamin D (~ 600 IU/day) are also recommended. 

Why is there a need to treat osteoporosis? 

There is a need to treat osteoporosis because compromised bone quality increases the risk for breaks and fractures.  

Fractures of the spine, hip, and wrist are the most common fractures associated with osteoporosis. Hip fracture is a major cause of morbidity and occurs more frequently among the older age group. It is a source of disability, leading to loss of independence, and a major economic burden. A collaboration study of OSPFI and the Philippine Health Insurance Corp (PhilHealth), which analyzed data from 2007–2012, found that a hip fracture approximately costs 2,200 US dollars (94,611 PH pesos). 

Besides fracture, which is the most serious complication of osteoporosis, it can also limit your mobility and cause instability during daily activities. It prevents you from being physically active and may even lead to weight gain and increase your risk for lifestyle diseases such as diabetes and cardiovascular problems. Loss of mobility results in loss of independence and leads to a feeling of isolation and depression. Pain caused by fractures may be so severe that they become debilitating and decrease their quality of life.

When do you need to visit your Endocrinologist?

It is beneficial to see an  endocrinologist regarding osteoporosis if you are older than 70 years for males or older than 65 years for females. Screening for men 50 to 69 years and women 50 to 65 years are recommended if they have significant risk factors as stated above.