Symptoms of Osteoporosis
One insidious thing about osteoporosis is that it is a "silent" disease – there are no noticeable symptoms in most people with the disease, especially in the first years. There is no pain, no swelling, no change in how the patient looks or feels. The first visible symptom might be a bone fracture or a visible loss in height, by which time the osteoporosis is well along. That’s one reason older people should have periodic bone density tests.
In the advanced stages, symptoms can include pain and literal disfigurement. It is not an easy pain to treat. Don’t think aspirin or ibuprofen can affect this type of pain. The disfigurement can mean the person’s body looks different. Kyphosis, aka dowager’s hump, is when the osteoporosis patient’s spine curves and compresses so much there is a loss in height. It is not always painful (sometimes not painful at all), but it tells observers the person has osteoporosis.
Minor fractures might not be painful either, and the sufferer might not know a fracture has occurred without an x-ray. The minor fractures add up after a while and may cause pain, and can also increase the risk of major fractures. Stress fractures in osteoporosis patients are often caused by what might seem like trivial sources of stress. Walking or stepping down one step can trigger a stress fracture in someone with weak bones.
When fractures occur in the spine, the pain is often severe and feels to the patient like radiating pain from the middle of the body to the sides. Loose teeth can be a sign of osteoporosis, too.
You hear a lot about older people having broken hips. Often it isn’t
the hip per se that breaks but the femur high up near the hip. Most
people who break hips have weakened bones. Sometimes they get a
broken hip as a result of a fall; other times the bone breaks because
of some very trivial stress (stepping off a step) and the resulting
break causes the person to fall down.
Living Tissue
Our bones are constantly remodeled throughout life. The hard mineral matter is broken down by cells called osteoclasts and then built back up by other cells called osteoblasts. This remodeling process is important for healing microscopic fractures that occur during daily activities. Unfortunately the activity of osteoblasts slows down as we age while osteoclasts keep eating away at bone at a fairly steady rate. Over time, this results in low bone density. Also, bone density loss increases when circulating female hormones decrease after menopause. More on the pathogenesis of osteoporosis.
As bone loss increases with age, the steady process of remodeling, or bone
turnover removes bone more than it replaces it. It involves two distinct
stages: (1) bone resorption or bone formation, and (2) bone formation. Since
calcium is stored in the bones, cells known as osteoclasts surface and attach
to the bone surface when there is a need for calcium. Osteoblasts, bone-forming
cells, then break the bone down and leave tiny cavities and infiltrate them
w
ith
collagen and other proteins to stimulate bone mineralization. After osteoblasts
merge with calcium and other proteins and minerals, a new matrix of bone
material replaces what was lost, making them osteocytes.
According to Harvard Women's Health Watch, resorption at a particular bone site takes approximately two weeks, whereas formation could take 3 months or more. If the remodeling process is out of balance, bone turnover can result in major bone loss, so in this way bone turnover is congruent to fracture risk.
As men and women approach age 35, bone breakdown supersedes bone build up and advances low bone density to an almost default position for many nearing middle-aged adults. For several years, women lose bone two to four times faster than they did before menopause, according to FDA Consumer Magazine. "Bone remodeling" according to the Cleveland Clinic, is the process of rebuilding the body's bone or calcium supply slows down and inevitably takes more of a toll, depending on the state of one's overall health.
Doctors might suspect when a patient has disorders or treatments known to cause osteoporosis such as hypogonadism, hyperparathyroidism, hypercalciuria, and glucocorticoid therapy.
A widespread procedure used for diagnosing osteoporosis is the dual-energy x-ray absorptiometry (DEXA) test. Researchers are at work trying to figure out simple ways to examine the microarchitecture of the bone as a way to diagnose osteoporosis.
Hip Fractures
A study of trends found that hip fractures among Americans increase from the mid-80s to the mid-90s and then declined to the mid 2000s. The mortality rate from hip fractures also decreased during the same period.
On-Line Diagnosis Aids
The British company ClinRisk publishes a website that estimates the risk of fracture due to osteoporosis. Their proprietary copyrighted algorithm – which is not explained on their site – uses patient information about age, medicine and alcohol usage, BMI, and more. It reports an estimate of a bone fracture in the next 10 years.
This may be useful and interesting for some people, but it should not substitute for a visit to the doctor’s office.
Osteopenia
The often under-recognized condition of osteopenia can be a precursor to the development of osteoporosis. High-risk individuals and their doctors should keep their eyes out for osteopenia and make an informed decision as to the need to take medication alongside exercise therapy, dietary and lifestyle modifications. More on osteopenia.
Other bone diseases that can be confused with osteoporosis include osteomalacia (rickets) and osteonecrosis.
Sources for Material on this Page: Womenshealth.gov, Washington University
Last updated: Oct 1, 2011
