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Mrs. Eva Kassi, Endocrinologist, Professor of Endocrinology-Biochemistry at the Medical School of the Greek Academy of Sciences, talks to ygeiamou about the disease that eight out of ten patients neglect to treat, the causes and treatments
THE osteoporosis is a disease that leads to thinning and reduced bone strength. It is considered a “silent disease”, since it progresses progressively without symptoms, until a fracture is caused. According to statistics from the International Osteoporosis Organization (IOF) even after an osteoporotic fracture approx. 80% of patients they are not investigated for the cause of osteoporosis, nor are they treated for it.
Because it happens
It is known that during adult life, our bones are renewed. In fact, every 10 years or so we have a completely new skeleton, since the old bone is removed and completely replaced by new. However, as we age, less and less new bone is made, leading to a negative balance and thinner and more fragile bones that can fracture.
Who will show it?
Although osteoporosis is more common in women, it also occurs in men. Indeed 1/3 of hip fractures occur in men. The difference with women is that in men the process of bone loss progresses more slowly and considering that men start with more bone mass they show the same risk of fracture as women 10 years later.
Except age which we know is the most important risk factor in both sexes, menopause in women also increases the risk of osteoporosis. We know that the loss of estrogen after menopause leads to faster bone loss, especially in the first three years after menopause.
Genetic factors (heredity) they are important for the appearance of osteoporosis, affecting mainly the acquisition of peak bone density, i.e. the greatest bone mass we acquire during our young adulthood (18-28 years). Lack of physical exercise, smoking, overconsumption of alcohol and coffee, a diet poor in calcium and a lack of vitamin D, which ensures the absorption of calcium from our food, are risk factors for osteoporosis. Other diseases such as Diabetes Mellitus, hyperparathyroidism, hyperthyroidism, lack of sex hormones, autoimmune inflammatory diseases such as rheumatoid arthritis, diseases of the gastrointestinal system such as malabsorption syndromes, hematological diseases, diseases of the nervous system can cause osteoporosis. Finally, the use of various drugs, most often corticosteroids (cortisone), and some classes of antidepressants can increase the risk of osteoporosis and fracture.
The skeletal sites where osteoporotic fractures usually occur are the vertebrae, hip and wrist.
How is it diagnosed?
As mentioned it is a silent disease and in reality its diagnosis is made when a fracture occurs. However, bone mineral density measurement, which is a simple test, can diagnose osteoporosis early, before a fracture occurs. All people aged 65 and over, and in some cases younger people, are recommended to have a bone mineral density test. Those diagnosed with osteoporosis or osteopenia with a high risk of fracture should be treated promptly.
The socioeconomic implications of osteoporosis are enormous, as well as the burden on the health system and the family. According to recent epidemiological data, one in three women and one in five men over the age of 50 will suffer an osteoporotic fracture. About one in four people who suffer a hip fracture will die within the first year, and one in three will be completely dependent on care in the first year after the fracture. It is worth noting that for women over the age of 45, osteoporotic fractures are responsible for more hospital days than other diseases such as diabetes, myocardial infarction and breast cancer. In addition, there is also a significant mental burden, since isolation and the lack of social interaction due to the inability to perform physical activities, leads to depression and a poor quality of life.
How is it treated?
It should be emphasized that it is very important to prevent osteoporosis that starts already in childhood/adolescence when we are still “building” bones. Adequate intake of calcium and vitamin D through diet (either through supplementation) and physical activity are important throughout our lives. In addition, smoking, excessive consumption of alcohol and coffee should be avoided, and factors that cause an increased risk of falls should be corrected in the elderly. If osteoporosis is diagnosed, possible causes that cause it should be sought and corrected. In addition, there are currently available safe and effective anti-osteoporotic treatments with drugs that either stop the rate of bone loss (anti-catabolic) or stimulate the production of new bone (osteoanabolic).