The condition itself, or the fact that the fracture is a complication of a bigger medical condition, is quite often painful and usually traumatic. It frequently leads to hospitalization, ending in long-term care and disability. A hip fracture patient can be post-surgery and/or bedridden for a long period, and in some severe cases, adults are unable to live independently again and need someone to take care of them or to admit them to a nursing home. In most cases, the pain and disability caused by osteoporosis and fractures are major drivers of the economic cost. This condition and its outcomes can be depressing. But all of this can be avoided. Osteoporosis, the fractures, and various complications are largely preventable. Osteoporosis itself is treatable. But before it can be treated or prevented, it needs to be diagnosed.
In simpler terms, this problem weakens the bones of the patient and leads to an increased probability of fracture of affected bones. According to the latest studies, it is found that half of the female population will experience an osteoporosis-related fracture in their lifetime. With this simple explanation, one can understand why it is so important to avoid or prevent osteoporosis.
As an active part of the health blog series, we are here with a new post. This time we switch our gear from common male health problems to their female counterpart. Today, the post is aimed at diagnosing osteoporosis among females. So let us look at the medical condition. Osteoporosis is defined as a “skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture.”
What is low bone density?
Low bone density is a situation where the mineral density of the bones is a lot lower than ordinary, but no longer low enough to be labeled as osteoporosis. Bone density is a measure of how strong and healthful your bones are. If your bones have been less dense, or thinner, it could potentially make you extra liable to break a bone if you had a fall, raise the danger of a fracture in a moderate effect injury such as bumping into some objects, or lead to a deformity consisting of a stooped back. Regular bone is filled with tiny spaces. When bone density is decreased the spaces inside the bone become larger and the bone starts to weaken and is susceptible to breaking. Having low bone density is not painful itself, but it does increase the risk of breaking a bone. Low bone density can effect on any bone, however the most common place bones to fracture are the hip, spine and wrist. These fractures can be very debilitating and result in a loss of independence. An for person who had a hip fracture, the chance of them fracturing the other hip is increased.
Importance of addressing low bone density
What is the big deal about bones becoming thinner and thinner, or with lower density (osteoporosis)? The internal structure of a normal bone has a honeycomb-like appearance, but when the spaces in this “honeycomb” grow larger, the bone loses density or mass and the outer shell becomes thinner. Although it was once thought to be a disease of the elderly, it is becoming increasingly common among younger people. Low bone density is also a sure predictor of future fracture. The most common fractures in people with osteoporosis are of the hip, spine, and wrist. The last two are much less serious, but a broken hip is usually a life-changing or ending event. You might think “well, being young, a hip fracture so many years down the road isn’t likely to affect me, so no big deal.” But bone degeneration happens gradually, and it takes more than just a few years of good calcium intake to keep bones strong. In fact, bones reach their peak mass at around age 30, and after that, it’s all downhill. So if you don’t have the habit of maintaining a healthy lifestyle by age 30, you may be in trouble. Another thing to note is that fractures in the upper part of the thigh bone (the hip) require surgery at any age and total bed rest or limited movement for recovery. If you were thinking a hip fracture wouldn’t be so bad as long as you’re older and don’t need to walk much longer anyway, think again. This type of fracture inactivity often leads to blood clots in the leg veins, loss of muscle strength, and pneumonia, and in today’s world, a future surgery might be delayed due to the risk of infection from three-stage repeat surgeries.
Causes of Low Bone Density
There are many causes of low bone density. These may vary from person to person, the most common being a change in hormone levels, an inactive lifestyle with little exercise, and low body weight often related to a diet deficient in vital nutrients. The most influential factor in bone density is your sex and age. The process of bone density is at its peak at around 25-30 years of age. At which point, men and women start to lose bone mass. For women, the rate of loss is fastest in the few years after menopause then continues at a slower rate through the rest of their lives. This is due to the decrease in estrogen that occurs at menopause. For men, there is no specific period of hormone change, their bone density tends to gradually decline as their age increases. The chance of developing osteoporosis later in life can be minimized if a good peak bone mass is achieved before 30 years of age. If there is a high rate of bone mass at this point, then there is more to lose in old age before osteoporosis develops. This is the most influential way of preventing osteoporosis later in life. The next most influential factor is the prevention of excessive loss of bone mass in old age. This can be done in similar ways to those used in the prevention of heart disease and cancer. Hormone replacement therapy (HRT) has been used and may be effective, but there are many other associated risks and it is now generally not advised purely for the prevention of osteoporosis. The use of medication can be considered in severe cases of low bone density, but there are many side effects and risks involving long-term drug use. The best choice for preventing further bone loss in old age is calcium and vitamin D, a well-balanced nutritious diet, regular weight-bearing exercise, and a healthy lifestyle. These are the fundamental ways to maintain good bone density throughout life.
Aging and hormonal changes
There are two major types of bone tissue, cortical and trabecular. The growth of the latter prepares females for pregnancy and lactation. At the end of lactation, bone is replaced. In later life, for many women, inadequate dietary calcium intake and/or poor absorption of calcium lead to a further period of bone loss. Bone loss in women greatly accelerates at menopause and for a period of 5-10 years thereafter, is the same as that experienced during the 1st year postmenopausally. After this, the rate of bone loss returns to that expected before menopause. The postmenopausal acceleration in bone loss is due to estrogen deficiency. In men, there is no marked period of accelerated bone loss, but there is an overall gradual loss in later life. This occurs at a later age and at a slower rate than in women. During the ninth decade, there is a more rapid loss in both sexes. It is known that bone loss in late life is associated with calcium and/or vitamin D insufficiency and immobility. The gastrointestinal tract, kidneys, and skin are the sites for the formation of vitamin D. Senile atrophic changes to the skin and less time spent outdoors means that the elderly form less vitamin D. In addition, impairments of renal and gastrointestinal function, which are common in later life, reduce the formation and absorption of the active form of the vitamin and calcium. These elements are also essential for maintaining muscle function. Reduced muscle function increases the risk of falls, which contribute to the high incidence of fractures in old age.
Nutritional deficiencies
Low bone density can be attributed to a variety of nutritional deficiencies, often exacerbated by a sedentary lifestyle. These nutrients include calcium, vitamin D, potassium, and vitamin C. Low intake of calcium contributes to diminished bone mass and may be a significant determinant of osteoporosis, and is more prevalent in non-milk drinkers. Good food sources of calcium include dairy products such as milk, yogurt, and cheese, as well as leafy green vegetables, nuts, seeds, and legumes. Some food products are also fortified with calcium. According to a report from the Nurses’ Health Study, an ongoing study monitoring the health of 121,700 US female registered nurses, women who get most of their calcium from food sources have healthier bones than women taking calcium supplements. It was suggested that maintaining an overall healthy diet with natural sources is the most beneficial to bone health. This is contradictory to the popular belief that supplementation is the best way to prevent bone loss. This is not to say supplementation is not important. Women should try to get 1,000-1,500 mg of calcium daily from a combination of food and supplements, depending on their dietary calcium intake and bone health. Estrogen deficiency in post-menopausal women is a particularly significant cause of osteoporosis and is related to low calcium and vitamin D intakes, and an increased rate of calcium loss from the body. This hormonal change also decreases the rate of calcium absorption in the intestines. A high sodium intake and anorexia or bulimia can also lead to increased calcium excretion from the body.
Sedentary lifestyle
Sedentary lifestyle refers to a lifestyle with no or irregular physical activity. People who are sedentary have a higher risk of developing low bone density, since their bones are not receiving the mechanical stresses needed to stimulate bone cells to produce new bone, in other words, to make bone where bone is needed. This is a problem as the amount and strength of bone is directly related to the amount and intensity of the physical forces applied to the bone. Throughout our lives our bones are constantly changing with bits of old bone being taken away and replaced with new bone. During childhood there is more new bone being made than old bone being taken away, so the bones become larger, heavier, and denser. Peak bone mass occurs around the age of 30, at which point bones have reached their maximum strength and density. Failure to reach peak bone mass increases the risk of developing low bone mass or bone fragility. After peak bone mass, bone loss occurs with a much greater rate than the rate of bone gained during growth and adolescence. With this in mind it is important to make the most of the bone building years to decrease the risk of developing low bone density later in life.
Natural Treatment Options
The protocol for increasing the osteoblastic activity and reducing the osteoclastic activity varies depending on the severity and cause of the low bone density. Osteoblasts are cells that construct new bone and osteoclasts are cells that dissolve bone. In the case of menopausal women with decreased bone density due to lower estrogen levels, the goal is to increase the osteoblastic activity to a level that is achievable with hormone replacement therapy, but without hormone therapy. This is because hormone replacement therapy can have many side effects, including an increased risk of certain cancers. Estrogen is a very powerful stimulator of osteoblastic activity and its metabolites have been shown to increase bone formation as well. In order to do this, certain estrogen metabolites can be given to the patient, but it must be ensured that the liver detoxifies them into a specific type of estrogen and not into a toxic catechol estrogen that can damage DNA and potentially inhibit bone formation. An increase in general hormone activity and an improvement in hormone receptor binding can be achieved through diet and certain supplements, i.e. vitamin E and proper essential fatty acids. High fiber diets that include 25-30 grams per day are effective at reducing excessive levels of certain hormones.
Instead, the practitioner employing methods outlined in the book will seek to modify the biochemistry of the bone bilayer, the part of the bone that is very metabolically reactive and has been shown to be imbalanced in those with osteoporosis. An improper ratio of bone resorption to formation will lead to less structural integrity and an increase in the risk of fracture.
Low bone density natural treatment and remedies is highly informative, laying out the therapy options within integrative medicine framework. This book explains that the natural medicine approach to prevention and treatment of osteoporosis takes into account the underlying disturbances in the patient’s physiology and anatomy before rushing into the use of prescription medication, which can have much risk and little benefit in those with osteopenia or mildly decreased bone density.
Diet and nutrition for strong bones
Some foods can have a negative impact on calcium balance within the body. For example, caffeine has been shown to cause increased urinary excretion of calcium. Therefore, it is best to limit caffeinated beverages in order to prevent calcium loss. Foods that are high in sodium can also cause increased calcium excretion through the urine. Reducing sodium intake is preferable – UK health guidelines advise consuming no more than 2.4g of sodium per day. Alcohol consumption adversely affects bone health. High intakes of alcohol are generally associated with an increased risk of fractures, but this could be due to an increased risk of falling, rather than an effect on bone density. Current evidence suggests that moderate alcohol consumption is not harmful to bone health, provided that an adequate intake of calcium is consumed. High levels of vitamin A can also be detrimental to bone health, but this is not a concern if vitamin A is consumed through carotenes, which are found in fruit and vegetables. It is excessive retinol intake (the preformed animal-derived version of vitamin A) that has been associated with increased fracture risk. Therefore, limited intake of liver and liver products is recommended.
To begin with, consuming a diet that is rich in vitamins and minerals is important for bone health. A study published in the “Journal of Bone and Mineral Research” in 2007 concluded that vitamin C, vitamin K, potassium, and magnesium are vital for the production and maintenance of optimal bone mass. Therefore, an increased intake of foods rich in these nutrients may help to prevent bone density loss. Increasing dietary intake of calcium and vitamin D, from food and/or dietary supplements, is also vital in optimizing bone health. Sources of calcium include dairy products, cereals, almonds, canned fish with the bones, and green leafy vegetables. Increasing your intake of fruits and vegetables will also be beneficial, as these foods have been linked to higher bone mineral density.
Exercise and physical activity
Bone is dynamic tissue, responding to the stresses put on it. Weight-bearing and resistance exercises are the best for promoting healthy bones. Weight-bearing exercises are activities one does on your feet that work your bones and muscles against gravity. Examples of weight-bearing exercises are walking, hiking, jogging, climbing stairs, dancing, low impact aerobics, elliptical training machines, and gardening. Although they aren’t weight-bearing, activities like swimming and bicycling also are excellent exercises. Studies have shown that swimming and cycling improve bone mineral density in a manner similar to weight-bearing exercise. The reasons for this are not clear, but it can be concluded that these activities are also effective for preventing osteoporosis. Resistance exercises include free weights, weight machines, and elastic bands for strength training. These exercises are also referred to as strength training or muscle-strengthening activities. Individuals should do resistance exercise at least 2-3 days a week. Exercise intensity, generally described as how much weight or force is used, depends on your fitness level. High intensity exercises improve bone health more than low intensity exercises. Given the great adaptability of bone in response to physical activity, it is usually easy to find an appropriate mix of weight-bearing and resistance exercises to match one’s age, fitness level, and other health conditions. Exercise can also help to prevent bone loss and fractures in people with osteoporosis, but those who have already suffered fractures need to protect themselves from further injury. It is important for individuals with osteoporosis/fractures to check with their doctors to ensure that they can safely do these exercises and modify exercises that put them at higher risk of injury. Weight-bearing, resistance, and flexibility exercises can all be utilized to improve bone health in individuals with osteoporosis, but safety concerns for fractures will generally exclude high impact weight-bearing activities and certain resistance exercises. Specific exercises for posture may be recommended to people with osteoporosis who have lost height or developed excessively rounded or hunched posture. Tai Chi has also been highly recommended as a gentle exercise to improve balance, prevent falls, and improve overall health in individuals with osteoporosis.
Herbal remedies and supplements
Herbal remedies, also known as botanical medicine, are another non-invasive treatment option for low bone density. Herbs have been used throughout history dating back to the beginning of the world. Herbs have been recorded in the first recorded texts of the Chinese, predating even the earliest records. In the West, folklore medicine and traditional medicine systems such as Ayurveda also have a rich history of herbal use. Herbal remedies are a much disputed form of treatment. The reason for this is the variability of their effectiveness and safety. The results with herbal remedies can be much more indirect and take longer than their pharmaceutical counterparts. Nevertheless, the use of plants as medicine is an integral part of being human and the search for health. Modern herbal medicine has the advantage of using the scientific method to identify the constituents and actions of medicinal plants. This makes for a safer and more reliable form of herbal medicine. There are a number of herbs which have been used as a traditional treatment for low bone density. Although there has been much less research on their effects versus the pharmaceutical drugs, many people have reported an improvement in bone density while using these herbs. Herbal medicine takes a more holistic approach and as a result, many of the herbs for osteoporosis will also be beneficial for general health. This can be an advantage or a disadvantage depending on the person. Herbs are typically given in the form of a tea, tincture or tablet. They are best used under the guidance of a qualified herbal practitioner. Always ensure that the herbs that you are taking are safe and compatible with any drugs that you may be taking.
Lifestyle modifications for bone health
This refers to changes in an individual’s activity or inactivity at home or safely in the community. Immobility is one of the major causes of bone loss and fractures. Exercises that particularly improve balance and coordination are good to maintain activity and to avoid fall-related fractures. These include t’ai chi and yoga. Avoiding smoking and excessive intake of alcohol are also very important for maintaining healthy bones. Excessive alcohol can lead to poor bone health and increase the risk of falling. Smoking can affect the body’s ability to absorb calcium and can cause early menopause in women. This, in turn, leads to an increased risk of fracture. Postmenopausal women who drink more than one alcoholic beverage per day have a higher rate of fractures than those who drink less. Those who smoke have less body weight and have menopause at an earlier age. They also are found to have lower heel bone density measurements and sustain more osteoporotic fractures. All of these conditions can be changed, thus reducing the level of risk.
Medical Treatments for Poor Bone Density
There are other drugs that can be used if bisphosphonates are unsuitable or intolerable. For postmenopausal women with osteoporosis, hormone replacement therapy (HRT) was once the treatment of choice. It was believed to increase bone density and reduce fracture risk. However, HRT has been associated with significant health risks including breast cancer and heart disease. Many women are no longer advised to take HRT for prevention of osteoporosis. Other medications include parathyroid hormone, and a drug called raloxifene. The former has been shown to reduce the risk of fractures, the latter maintains bone density and reduces breast cancer risk. Calcitonin is sometimes used to treat pain associated with vertebral fractures. It is a hormone which helps to regulate calcium levels in the body. It has been shown to relieve pain in some patients, and has a weak effect in increasing bone density.
Medical intervention is usually considered when natural treatment for poor bone density does not prove successful, or if a patient has multiple fractures. There are many medications to treat osteoporosis, and these are changing and being improved all the time. Bisphosphonates are one of the most commonly used drugs, and are often first line treatment. They work by inhibiting bone breakdown, maintaining, or slightly increasing bone density. They have been shown to reduce the risk of hip, spine, and wrist fractures by approximately 50%.
Medications for osteoporosis
Bisphosphonates work by inhibiting bone resorption and by keeping the bone that the body has already built. Although they have been effective for many, there have been concerns over long-term uses of bisphosphonates in recent years due to the possibility of developing osteonecrosis of the jaw (ONJ) or atypical femur fractures. These are very small risks and do not outweigh the benefits for the majority of people taking bisphosphonates. The risk is even smaller for those who are at low risk of fracture. The medication can be ceased at the recommendation of the GP if a patient at higher risk of fracture suffers a fracture whilst on bisphosphonates. An annual break of 2 years may be considered for those with a low risk of fracture. Atypical femur fractures are very rare and ONJ is usually associated with cancer treatment. In both cases, patients will have usually taken a higher dose of bisphosphonates.
Bisphosphonates are the most widely prescribed medication for osteoporosis. They have been tested more than any other medication and have proven to reduce hip, spine, and non-vertebral fractures. They have also been shown to increase bone mineral density at the hip and spine. Bisphosphonates are taken orally or intravenously. The duration of the prescription can vary with the most popular form, alendronate, being prescribed for 3-5 years. Ibandronate is the intravenous form which is administered every three months and has been proven to reduce the risk of fracture. Risedronate and zoledronate are also prescribed for osteoporosis.
There are a number of different medications available for the treatment of postmenopausal osteoporosis. These include: bisphosphonates, hormone therapy, selective estrogen receptor modulators (SERMs), calcitonin, teriparatide, and denosumab. A lot of the research on these drugs includes testing their effectiveness on preventing fractures. It is important to remember that some of these medications may come with risks as well as benefits. It is recommended to ask your physician for information on effectiveness, possible side effects, and alternative medications. Your decision will also depend on the severity of your osteoporosis and your individual needs. Always consult with your GP if you are considering starting a medication.
Hormone replacement therapy
Hormone replacement therapy using estrogen and progesterone continues to be prescribed to relieve menopausal symptoms and it is effective in preventing bone loss during the period of treatment. So in women who have gone into early menopause as a result of having ovaries removed or the woman who is naturally menopausal and not at risk to the contraindications of hormone replacement therapy, this may be a suitable short term method to prevent rapid bone loss. The hopes for the future of HRT in prevention of osteoporosis may come from newer treatments including the tissue selective estrogen complex and selective estrogen-receptor modulators (SERMS). These treatments aim to maintain the positive effects of estrogen on bone with fewer adverse effects. At this stage these treatments are still being researched and are not specifically indicated for prevention of osteoporosis.
Hormone replacement therapy (HRT) is another option available to women at the time of menopause to prevent bone loss and osteoporosis. Estrogen therapy was the first form of treatment to be widely accepted for prevention of osteoporosis. It is now no longer recommended as first line therapy for long term prevention of osteoporosis due to a number of health risks and side effects. Studies showed estrogen to be effective in inhibiting bone resorption and maintaining bone mass in the spine and femoral neck. The largest and most effective study being the Women’s Health Initiative (WHI) which found that the risk of hip, vertebral, and overall fractures were decreased by postmenopausal women assigned to estrogen therapy. However, due to some of the adverse effects of estrogen treatment (such as increased risk of breast cancer, stroke, pulmonary embolism, endometrial cancer) and the lack of clear indication for women solely seeking to prevent osteoporosis, estrogen treatment is usually not recommended.
Surgical interventions
No discussion on interventions is complete without an analysis of the potential for prevention. The most effective prevention of osteoporosis is achievement and maintenance of a peak bone mass in young adulthood by the optimization of nutrition and physical activity along with the avoidance of negative lifestyle factors. This will be removed when emerging technologies improve rates of muscle and bone wasting, but many of the disease states that lead to secondary osteoporosis may still be treated surgically if this is a legal and ethical matter.
Decisions about using these procedures should be based on a discussion of the potential benefits and risks. Although the procedures have been shown to decrease the number of spine fractures in patients with osteoporosis and that these fractures have significant morbidity and mortality, the procedures have not demonstrated a favorable risk to benefit ratio given the costs involved. This is likely to change as the costs of performing these procedures continues to be evaluated, and if there is a more efficient way of identifying patients at high risk for future spine fractures, particularly those with low bone density.
