Osteoporosis is a bone disease in which the bone is more fragile and less resistant. The risk of fracture is high. In France, around the age of 65, it is estimated that 39% of women suffer from osteoporosis. Symptoms, causes, diagnosis, drugs: the essentials to know.
Osteoporosis is bone disease which is characterized by the reduction of the density of the bone and the modifications of its micro-architecture. In other words, the bone is more fragile and the risk of fracture (vertebral, wrist, femoral neck, etc.) increases. What are the symptoms ? What causes osteoporosis? Is that bad ? What consequences? Can we cure it? Die of it?
Definition: what is osteoporosis?
Osteoporosis is a disease that affects the bones. This diffuse disease of the skeleton is characterized by a decrease in bone density and alterations in the micro-architecture of the bones, can we read on the website of the Health Insurance. This disease exposes a higher risk of fracture. There is generally bone loss accompanied by fragility, most often caused by an imbalance between bone formation and bone resorption. This loss of bone density is accompanied by a change in the overall bone architecture.
What are the figures for osteoporosis in France?
It affects nearly 40% of women and 8% of men. A third of the women concerned risk being the victim of a fracture secondary to osteoporosis, and this from the age of 50.
What causes osteoporosis?
Not all women have osteoporosis.
Osteoporosis is most often caused by hormonal changes of the menopause and of theandropause in man. The drop in estrogen and testosterone leads to an increase in the rate of bone remodeling, which causes bone loss leading to this fragility. However, not all women have osteoporosis. The risk of seeing this pathology occur depends on many predispositions. Up to about 45 years old, the activities of resorption and formation balance each other and allow the renewal of the bone structure. With aging, both in women and in men, there is a “natural” decrease in bone mass. In some people, this loss of bone mass is without serious consequences. In others, abnormal acceleration of bone resorption not compensated by sufficient bone formation leads to excessive loss of bone mass and strength. Osteoporosis appears.
What are the risk factors for osteoporosis?
THE background osteoporosis in the family, especially in the mother, or slimming are risk factors for osteoporosis, as well as late pubertya early menopause or surgical, low physical activity and one low calcium intake And in vitamin D. Heavy consumption of alcohol and coffee increases the risk of osteoporosis, as does taking certain medications (corticosteroids, thyroid hormones, heparin), and certain endocrine diseases, such ashyperthyroidismwhen their treatment is late.
What are the symptoms of osteoporosis?
Osteoporosis is a disease that passes often unnoticed because it sometimes does not cause any manifestation or any pain and it is discovered only on the occasion of a fracture.
Signs of osteoporosis include:
- Height loss of a few centimeters
- Fracture outside of a violent shock from the fifties
- Scoliosis or kyphosis
- Violent spinal pain, difficulty performing certain actions of daily living.
What are the consequences of osteoporosis?
The major risk of osteoporosis is the increased risk of osteoporotic fractures (fragility fractures) which is all the greater the older the person. The fractures observed during osteoporosis are generally 3 types :
- wrist fractures,
- femoral neck fractures,
- fractures of the spine (vertebrae).
Fractures can cause pains as well as’a loss of autonomy particularly disabling in everyday life but also a loss of self-confidence.
The appearance of these manifestations requires talking to your doctor who will consider carrying out a bone densitometry to assess the amount of demineralized bone. This examination allows an early diagnosis of osteoporosis, in order to quickly implement treatment and preventive measures. It also helps to monitor the progression of osteoporosis. Before starting treatment for osteoporosis, the Bone Mineral Density (BMD) should be measured by bone densitometry which quantifies bone loss by T-score. The more it decreases, between -1 and -4, the more the invoice risk increases.
What treatment to treat osteoporosis?
Hygiene rules can reduce the risk of seeing osteoporosis occur or reduce its manifestations. Physical activity helps preserve bone capital, regardless of age, by increasing calcium fixation and thus avoiding bone demineralization. In some cases, a treatment can be proposed to limit the risk of fracture. According to the recommendations of the High Authority of Health in January 2023:
► Drugs used in 1time intention are bisphosphonates, raloxifene, romosozumab and teriparatide. The bisphosphonates differ from each other in particular by their tolerance, their rhythm and their route of administration.
► Denosumab is a treatment of 2e intention as a relay for bisphosphonates in postmenopausal patients at high risk of fracture.
► Raloxifene is reserved for subjects at low risk of peripheral fracture.
► Romosozumab is for use only in postmenopausal patients aged < 75 years patients with severe osteoporosis, with a history of severe fracture and in the absence of a history of coronary artery disease (including revascularisations and hospitalizations for unstable angina).
► Teriparatide is used only in patients with at least 2 vertebral fractures.
Before initiating treatment, you should:
- to correct any calcium and/or vitamin D deficiency;
- to recall the importance of smoking cessation;
- to recall the importance of physical exercise and the prevention of falls.
What diet to prevent osteoporosis?
The prevention of osteoporosis goes through once you reach adulthood:
- a diet slightly salty,
- a good supply of vitamin D (fatty fish, liver)
- limitation of animal protein intake.
- regular consumption of milk, cheese, yogurt or cottage cheese.
- regular consumption of plants, also a source of polyphenols, whose effects on the bone structure are increasingly recognized.
When to supplement with calcium and vitamin D?
A sufficient intake of calcium and vitamin D must be ensured, in particular in young subjects, in the midst of building up bone mass. Calcium and/or vitamin D supplementation is sometimes necessary in the event of proven calcium and/or vitamin D deficiency.
Calcium contributes to the construction and maintenance of bone mass. Dairy products naturally provide calcium. The recommendations are currently 2 dairy products per day, which corresponds for example to a natural yogurt and a piece of cheese or grated cheese on pasta, gratins and quiches… For children, adolescents and the elderly, it is 3 or 4 dairy products that are recommended to consume. A glass of milk is equivalent to 20 grams of cheese or 1 yoghurt of 125 grams. Calcium supplementation is necessary in case of deficiency, but it is useless in non-deficient subjects. Most often, in the general population, there is no deficiency of calcium intake, but a deficiency of vitamin D. When calcium deficiency is present and at the origin of a loss of bone mass, Calcium intake alone is not enough, it is also necessary to provide vitamin D.
There vitamin D promotes the assimilation and fixation of calcium on the bone. It increases the body’s ability to absorb calcium from food. It is mainly synthesized by the body thanks to the action of the sun on the skin. Pregnant women often lack vitamin D, especially at the end of pregnancy and in winter. Vitamin D is naturally present in fatty fish, eggs, liver and dairy products. Elderly subjects, many of whom only benefit from low sun exposure, often lack vitamin D. Vitamin D supplementation is therefore often useful in this area, particularly in subjects living in institutions.
Can you die from osteoporosis?
Osteoporosis is not a fatal disease but she greatly reduces life expectancy due, in particular, to the consequences of fractures which can alter the quality of life. “Rather than waiting for the consequences of osteoporosis, it is better to prevent it very early on by strengthening your bones through regular physical activity and a balanced diet rich in calcium and vitamin D.“advises Dr. Claire Lewandowski, a doctor specializing in general medicine.
Source: Osteoporosis drugs, HAS, updated January 24, 2023