Osteoporosis Causes

Dr.Kiran Adam.

Osteoporosis(OPS): Is a condition of fragile bone with an increased susceptibility to fracture.

• OPS Weakens bone and increases risk of bones breaking.
• Bone mass (bone density) decreases after 35 years of age, and bone loss occurs more rapidly in women after menopause.

What Is Osteoporosis(OPS)?

• OPS is a condition characterised by a decrease in the density of bone, decreasing its strength and resulting in fragile bones.
• OPS literally lead abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones.
• Osteopenia by definition is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis.

Normal bone is composed of protein, collagen and calcium, all of which give bone its strength. Bones that are affected by OPS can break (fracture) with relatively minor injury that normally would not cause   a bone to fracture. The fracture can be either in the form of crackling (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, ribs and wrist are common areas of bone fracture form, OPS although Osteoporosis related fracture can occur in almost any skeletal bone.

What Causes Osteoporosis?

Age-The older you get, the more likely you are to develop osteoporosis. This is simply due to the longevity of life paired with how long the degradation of bone in the body outpaces the formation of bone. Around 30, bone stops being produced at a higher rate than it is being resorbed, so the longer you live, the less bone you are likely to have. One study found that 70 percent of fractures are sustained by seniors, those 65 and above.

But this doesn’t mean that all older people will develop osteoporosis some are far more likely than others due to characteristics like race, gender, ethnicity, and family history. Some factors that play into the likelihood of developing osteoporosis include

Gender: Women are far more likely to develop osteoporosis than men, primarily because men develop more bone over their lives, thus they have more bone to lose. Women especially shorter and smaller women have less bone to lose, so bone density levels typically drop below normal more quickly than men. Women also have other medical conditions, like menopause and certain cancers that contribute to the development of osteoporosis.

Menopause

One demographic most at risk for developing osteoporosis is postmenopausal women. During the menopause process, women experience a dramatic decrease in hormones being produced by their bodies, and this can result in bone loss. While researchers aren’t completely sure why menopause is directly related lower bone density, the connection is there, especially in the first couple of years following the ceasing of periods. Some women lose nearly half their bone density in the decade following menopause. Treatment for bone loss needs to be taken seriously and efficiently during the menopausal process, because women already have smaller bones.

Amenorrhea Loss of the menstrual period in young women is associated with low estrogen and osteoporosis:

Amenorrhea can occur in women who undergo extremely vigorous exercise training and in women with very low body fat (for example, women with anorexia nervosa)

Steroids: Known in the medical world as glucocorticoids, these are used to treat conditions like lupus, allergies, rashes, autoimmune diseases, and plenty more. steroids can cause a range of bone density-decreasing habits like accelerating bone resorption and supporting fractures before bone density levels have even decreased to osteoporosis levels. Medication that helps prevent osteoporosis works well to combat osteoporosis-via-steroids.

The Following are factors that will increase the risk of developing OPS.

• Female Gender.
• Thin and small body frame.
• Family History of osteoporosis (for example, having mother with an osteoporotic hip fracture doubles your risk of hip fracture). 
• Personal history of fractures as an adult (45-50 years).
• Cigarette Smoking, Tobacco (Smokers suffer from lower bone density and a higher risk of fracture than non-smoker. direct toxic effects of nicotine on bone cells to blocking the body’s ability to use estrogen, calcium ,and vitamin D). 
• Excessive Alcohol consumption (alcohol can arrest bone remodelling and increase your calcium loss. Being tipsy increases the risk of falling, and with OPS you are risking a fracture ). 
• Lack of exercise.
• Diet low in calcium.
• Poor nutrition and poor general health especially associated with chronic inflammation.   
• Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from bowel disease. 
• Low oestrogen levels in women (which may occur in menopause or with early surgical removal of ovaries).
• Amenorrhea (loss of the menstrual period) in young women.
• Untreated hypogonadism in men and women, Low testosterone levels in men (hypogonadism), anorexia nervosa, chemotherapy for breast cancer.
• Chronic inflammation due to chronic inflammatory arthritis (will see in detail on this topic).
• Prolong Immobility, such as after a stroke or from any condition that interferes with walking (eg. due to spinal cord injury), Parkinson’s disease, muscular dystrophy, organ transplantation.
• Thyroid disorders (eg. Untreated Hyperthyrodism, hyperparathyroidism, over-treated hypothyroidism).
• Vitamin D lacking in the body cannot absorb adequate amount of calcium from diet to prevent osteoporosis.
• Certain medications can lead to bone loss and an increase in bone fracture. These medicines include long term use of heparin (a blood thinner), anticonvulsants medicine such as phenytoin (dilantin) and phenobarbital, psychotropics, polymedication.
• Inherited disorders.

Osteoporosis and Rheumatic Disease:

• Osteoporosis in rheumatic diseases-there is an increased risk of OPS in patients with Rheumatoid Arthritis(RA) as well as  other Rheumatic conditions such as ankylosing spondylitis(AS) and Systemic lupus erythematous(SLE).
• Disease Activity ,immobility and treatment factors that increases the risk of osteoporosis and fracture.
• RA-Generalised OPS is likely known extra articular complications  in uncontrolled ,longstanding RA.
• SLE-The risk of osteoporotic fracture is increased in some SLE patients, since several factors may accumulate in these individual, the use of glucocorticoids, Female gender, vitamin D deficiency, Renal factors, Inflammatory process and immobility, obvious use of glucocorticoid is one of the most important causes of osteoporosis in SLE.
• AS-The risk of vertebral fractures seen to be evaluated in patients with AS, Probably as a result of bone loss and /or increased rigidity of the spine.