Osteoporosis - Symptoms and Treatment

Osteoporosis is a disease that leads to bone loss and weakening of bone, increasing the risk of fractures.

Our bones are not all massive as their appearance suggests, and our skeleton is not only a support structure, but rather a living organ with many functions in the body.



On the outside (cortical) a bone is compact and has a solid look. However, therein it is a trabecular bone, with the appearance of a sponge. These spaces and blood vessels are located in the red marrow.

Bone is composed of an organic and a mineral substance composed mainly of calcium phosphate (phosphorus + calcium).

Osteoporosis is a reduction of the mineral mass in both trabecular and cortical bone, causing a large reduction in bone density, making it more brittle and less resistant to mechanical trauma in day to day activities. The word osteoporosis means cancellous bone.

As have been already mentioned, the bone structure is not a thing with the only function to give mechanical support to the body. Bones are in constant renewal, a process necessary for the correction of micro trauma injuries of the common daily mechanical stress. The body is constantly destroying and building new bones.

To stay strong and healthy a bone requires constant supply of minerals like calcium and phosphorus, which is regulated by the parathyroid glands. The parathyroid glands are glands at the base of the neck over the thyroid, which are responsible for controlling levels of calcium and phosphorus in bones, kidneys and the concentration of vitamin D in blood.

Even at 30 years the body can maintain bone mass and structure. After 30, the process of bone resorption begins to be greater than that of the production of new bones, which over several years leads to the development of osteoporosis.

The osteoporosis and reduction of bone mineral density also causes disturbances in their natural architecture, further contributing to its fragility.

• Old female = 70% of cases of osteoporosis occur in females.
• Consumption of alcoholic beverages
• Short stature and low weight
• Low intake of calcium and vitamin D
• Physical inactivity
• Caucasian (white) and Asian race
• Never being pregnant
• Positive family history
• Menopause
• Low sun exposure = the risk factor common to living in the northern hemisphere
• Smoking
• High consumption of soft drinks = There is evidence but still it cannot be asserted with 100% certainty

• Hyperthyroidism
• Cushing's syndrome
• Multiple Myeloma
• Anorexia nervosa
• Depression
• Pernicious anemia (B12 deficiency)
• Crohn's disease

• Methotrexate
• Carbamazepine
• L-thyroxine (thyroid hormone)
• Warfarin
• Antidepressants
• Corticosteroids (cortisone)
• Phenytoin
• Heparin
• Furosemide

Osteoporosis is a silent disease and usually only causes symptoms in advanced stages. The main ones are bone pain, especially back pain, fractures and reduced height for collapse of the vertebrae of the spine.

The fracture of the femoral neck is very common in the elderly. In the U.S. alone, 250,000 new cases occur each year, usually associated with falls. The older the patient and the more severe osteoporosis is, the greater is the risk. Besides the fracture of the femoral neck and vertebrae, fractures of the wrist and ribs are also common.


The best test for the diagnosis of osteoporosis is bone densitometry. The results are provided by comparing the bone density of young people (T-score or standard deviation).

The criteria for osteoporosis according to World Health Organisation (WHO) are:
1. Normal bone density = T-score between 0 and -1
2. Osteopenia = T-score between -1 and -2.5
3. Osteoporosis = T-scores less than -2.5

The lower the T-score is, the greater is the severity of osteoporosis and increased risk of fractures.

Osteopenia is a reduction in bone density, but is still not considered osteoporosis. We can say that is a pre-osteoporosis.

Bone densitometry should be performed in all women over 65 or those in post-menopausal women who have risk factors for osteoporosis. There is no indication to perform it in men unless there are significant risk factors.


In osteoporosis the saying "prevention is better than cure" is especially true since, when the lesions in bone architecture caused by osteoporosis are present, they are irreversible.

The drugs do not reverse osteoporosis, and hence the treatment is intended to prevent disease progression. Treatment is indicated in all criteria of osteopenia or osteoporosis on bone densitometry.

The drugs most commonly used are:

• Replacement of calcium and Vitamin D
• Bisphosphonates (alendronate, risedronate, zoledronic acid). It should be taken on an empty stomach with at least one full glass of water and you should not lie down for at least one hour due to the risk of severe reflux and esophagitis
• Raloxifene. It is a selective modulator of estrogen receptor. It is a drug that acts like estrogen, but is not. It performs its benefits without the side effects

Prevention of osteoporosis
• Estrogens and hormone replacement. They are widely used to treat osteoporosis until recently; hormone replacement therapy despite having excellent results brings with it an increased risk of cardiovascular disease, stroke and breast cancer. So it is no longer indicated as first-line treatment for osteoporosis and should be used only in selected cases
• Teriparatide is an analog of PTH, produced by parathyroid hormone and responsible for the control of calcium and phosphorus in bones. One of the most promising drugs in the treatment of osteoporosis, the only disadvantage so far is that the part appears to reverse existing lesions. There are still no comprehensive studies on the safety profile of its long-term taking and its use is still limited to a maximum of two years

In addition to treatment with drugs, it is important to implement changes in lifestyle. You should quit smoking and avoid excess alcohol. Patients should exercise more, including weight training, and give preference to foods such as dairy products, green vegetables, cereals, nuts and fish.

Also important thing is sun exposure, 20 to 30 minutes of sunlight per day, between 6am and 10am is indicated. Only 25% of the body must be exposed.