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Center of Orthopaedic Surgery, Sports Medicine, and Rehabilitation

Osteoporosis

What is it? Osteoporosis is a disease where increased bone weakness increases the risk of a broken bone.

It is common? It is common, and it becomes more common with age. It is present in more than 30% of people over 60 years of age. It is more common in women.
In Greece, in 2000 there were around 500,000 women with osteoporosis, while worldwide there are over 350,000,000.

Is it a dangerous condition? It is. The risk of fracture in osteoporotic patients ranges between 17 and 40%. The mortality of these fractures exceeds 30%; that is 1 in 3 patients with a serious osteoporotic fracture will die in the first 3 months post-fracture.

Which is the aetiology? Estrogen deficiency in women following menopause causes rapid reduction in bone mineral density, leading to osteoporosis. Secondary osteoporosis is caused by other diseases or drugs and are mentioned later.

Who is in greater danger? Small body framed women, who are lean and/or light-colored are statistically in greater risk, although osteoporosis can affect almost anyone.

Which areas does it affect? The whole skeleton! In younger ages, the wrist, ankle and spine are more vulnerable, while the hips are more vulnerable in older ages.

What are the risk factors?

  • Heredity
  • Premature menopause
  • Age
  • Smoking
  • Caffeine
  • Alcohol
  • Low calcium intake
  • Eating meat
  • Lack of exercise
  • Meication like steroids, thyroxin, heparin etc
  • Medical conditions, such as rheumatoid arthritis, hyperthyroidism, renal failure etc
  • Which are the symptoms? Osteoporosis typically has no symptoms, and thus is called a “silent epidemic”. Pain presents when microfractures of the spine have occurred, and they lead to kyphosis of the spine and loss of height over time.

How is it diagnosed? Plain radiographs cannot diagnose osteoporosis. Diagnosis is made with bone mineral density measurement, most commonly performed with dual-energy X-ray absorptiometry (DEXA scan), together with blood exams.

How often should someone be scanned? In people without any predisposing risk factors the first scanning should be performed after menopause or after the first low-energy fracture. In people with predisposing risk factors it should be performed right away.

Is there any cure? Osteoporosis can be treated. The aim of treatment is to increase bone mass and strength, in order to prevent fractures from occurring. An osteoporotic fracture is a low-energy fracture caused by decreased bone hardiness. These fractures usually require surgical intervention, and are associated with a high mortality rate (exceeding 20% during the first-year post-injury for hips).

Medications used for osteoporosis treatment are:

  • Hormonal substitution with oestrogens and progesterone
  • Anti-osteoclast therapy, the most commonly used: SERMS, Calcitonin, Bisphosphonates, Denosumab
  • Bone producing drugs, which are mpre powerful, but have limited indications: Teriparatide, 1-84 Parathormone, Strontium ranelate
  • Calcium and Vitamin D

Exercise is of vital importance for maintaining and promoting bone density and muscle strength.
Nutrition should include adequate quantities of calcium and vitamin D (dairy products, fishes etc).
Prevention is equally important. Smoking should be quitted, alcohol consumption should be minimized, nutrition should be appropriate, exercises should be initiated, risk factors in the environment should be limited and frequent scanning should be performed under supervision from your doctor.

In TheMIS Orthopaedic Center we have great experience in treating metabolic disorders of the bone. A dedicated osteoporosis clinic is open every morning in the TheMIS center located in Kalamaria.