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Osteoporosis is a loss of the mineral content of the bone, not to be confused with osteoarthritis, which is a degenerative, inflammatory disease of the joints that are found in between bones. This loss of mineral content results in a weakening of the structure of the bone, increasing the risks of fracture, or a break in the bone, especially with a certain degree of trauma e.g. after a fall.
Osteopenia is a condition in which there is some degree of bone loss but has not yet reached the severity of osteoporosis. The greater the degree of bone loss, the greater the degree of trauma, the greater the likelihood of fractures.
Accumulation of bone mineral is greatest during the teenage and young adult years. The peak bone mineral mass is achieved around the age of 30 to 35 years. The greater the bone mineral mass achieved, the lower the likelihood of developing osteoporosis in later age. The bones whilst seemingly solid and undergoing a minimal change from day to day is actually very metabolic active. The bones serve as a reservoir for minerals in the body, especially that of calcium.
Calcium is an important mineral that allows cells to communicate with each other and controls important cell function such as cell death. The blood and tissue concentrations of calcium are very tightly regulated. If dietary calcium is insufficient, then mineral is released from the bone to make up for the deficiency, or calcium absorption capabilities of the intestines are increased. Vitamin D sufficiency is important for increasing calcium absorption. Other minerals such as magnesium, as well as vitamins such as vitamin A and vitamin K, are important for proper mineralisation of the bones.
Hormones such as oestrogen, testosterone and growth hormone are important for proper mineralisation of the bone. As these hormones are reduced with ageing, and especially reduction of oestrogen in the menopause increases the risk of bone loss and osteoporosis. Weight-bearing exercise such as running, or skipping, exerts compression forces on the bone. The pull of muscles which are attached to bones also increases stimulating forces on the bone. These forces are important to provide stimulating signals to the bone, to tell the bones to keep the mineral on the bones.
Bone mineral density can be assessed in a few ways. The most commonly used test is probably that of the dual energy X-ray absorptiometry (DEXA) scan, which is a test utilising a very low dose of radiation. This usually looks at the bone mineral density in the hip and the lumbar spine.
Low bone mineral density is best managed by increasing exercise, especially weight-bearing exercise.
A good diet is also important to ensure adequate dietary calcium. Plant sources of calcium are particularly important, especially green leafy vegetables (with the exception of spinach as the calcium is poorly absorbed due to high oxalate content), nuts and seeds, and tofu. Reducing the intake of excessive meats, sweets, refined carbohydrates and salt is also important for bone health as these dietary choices increase the excretion of calcium.
Patients who have had a history of chronic disease, use of medications such as anti-acid pills, steroids and anti-depressants are also at increased risk of bone loss and should consider having a DEXA scan. Menopause is also a risk factor for bone loss and if there are other risk factors, a DEXA scan should be considered.
Besides exercise and dietary optimisation, other considerations for optimal health include supplementation, hormone replacement therapy (especially if there are other indications for hormone replacement) and other medications specific to improving bone mineral density such as bisphosphonates, strontium and selective-oestrogen receptor modulators.