• Malabsorption: This can be due to problems, as in Coeliac disease (an autoimmune disease in which the immune system attacks your tissues when you eat gluten) and Crohn’s disease (an inflammatory bowel disease that causes swelling of your digestive tract).

• Chronic kidney disease: Studies suggest that chronic kidney disease (CKD) is associated with the development of osteoporosis and fragility fractures.

• Blood disorders: Studies show that hematological diseases like thalassemia (when the body doesn’t make enough of a protein called hemoglobin) and pernicious anemia (a decreased production of red blood cells due to lack of vitamin B12) represent a frequent cause of secondary osteoporosis.

• Rheumatoid arthritis (RA): It is an inflammatory disease associated with osteoporosis due to active inflammation and glucocorticoids.

• Dementia: It is a group of symptoms affecting memory, thinking, and social abilities. Dementia can lead the patients to have decreased activity levels and lower sunlight exposure, predisposing them to osteoporosis.

• Depression: Research shows that depression is a risk factor for low bone mineral density (BMD) and fractures. This has been shown in middle-aged women and elderly subjects of both genders.

• Cancer: Bone metastases (spread of cancer) are a common consequence of cancer, leading to decreased bone density and pathologic fractures.

• Long-term bed rest: Studies have concluded that bone loss is more evident in elderly patients advised with prolonged bed rest.

• Spaceflight: Astronauts who travel in outer space tend to lose bone mass density due to microgravity, which can lead to osteoporosis.

Modifiable risk factors

• Smoking: Studies have shown a direct relationship between tobacco use and decreased bone density and hence, as a risk factor for osteoporosis and bone fracture.

• Low BMI: Body mass index (BMI) estimates body fat based on height and weight. A low BMI is an important and modifiable risk factor for osteoporosis and osteoporotic fracture development.

• Inadequate physical activity: This is because a sedentary lifestyle encourages the loss of bone mass, leading to osteoporosis.

• Low dietary calcium intake: Osteoporosis is more likely to occur in people with low calcium intake, and a lifelong lack of calcium plays a role in the development of osteoporosis.

• Vitamin D deficiency: Vitamin D plays a crucial role in the absorption of calcium and phosphorus from the food you eat, and a lack can lead to osteoporosis.

  • Alcoholism: Alcohol consumption compromises bone health and increases the risk of osteoporosis as excessive alcohol interferes with calcium balance in the body.

Specialists To Visit

Doctors that can help detect and treat osteoporosis include:

• Rheumatologist

• Endocrinologist

• Orthopedic surgeon

A rheumatologist is a specialist who treats patients with age-related bone diseases. An endocrinologist sees patients with hormone-related issues, and an orthopedic surgeon fixes fractures.

Prevention Of Osteoporosis

Your genes may affect your height, weight, and bone density, but a healthy lifestyle can protect your bones. Here are a few tips to prevent osteoporosis:

Early screening is vital

Early screening can identify the risk factors for osteoporosis, which can help you make the right lifestyle changes to prevent it.

Bask in the sunlight

Insufficient exposure to sunlight may be associated with many disorders, and getting sufficient and healthy sunlight helps strengthen teeth and bones, which in turn helps in preventing osteoporosis.

Optimize calcium and Vitamin D intake

Calcium is essential for maintaining bone health. Vitamin D is vital for healthy bones and teeth as it aids in the absorption of calcium in the body. However, it can be hard to get enough from food alone. So, consider taking vitamin D and calcium supplements.

Stop smoking and drink alcohol in moderation

Smoking and alcohol are associated with an increased risk of osteoporosis. So quitting smoking and limiting your alcohol intake can help prevent osteoporosis.

No excuses for not exercising

Exercises like walking, dancing, low-impact aerobics, elliptical training machines, and stair climbing work directly on the bones in your legs, hips, and lower spine and can slow mineral loss.

Treatment Of Osteoporosis

Treatment recommendations are often based on the risk of breaking a bone and slowing down the bone loss process. It consists of the following:

Non- pharmacological management

This includes making specific lifestyle changes like increasing calcium and vitamin D intake, weight-bearing exercise, smoking cessation, limiting alcohol/caffeine consumption, and preventing falls.

Pharmacological management

The goal of pharmacological therapy is to reduce the risk of fractures. It includes medications like:

1. Antiresorptive agents: These drugs slow down the resorption of the bone. They include:

• Bisphosphonate: These decrease bone resorption by limiting the activity of bone destruction cells.

Note: Oral bisphosphonates should be administered with a full glass of water in the morning on an empty stomach 30 minutes before a meal or other medications.

• Denosumab: This drug is used as first-line therapy for patients at high risk of fracture and for patients who are not able to use oral therapy as denosumab is available as an injectable formulation

2. Hormonal therapies: These use synthetic hormones to manage osteoporosis. They include:

• Estrogen agonists/antagonists: This class of drugs is also known as selective estrogen receptor modulators (SERMs). It includes:

  • Raloxifene

  • Conjugated estrogens/bazedoxifene

• Estrogen-progestin therapy: In osteoporotic management, estrogen therapy is FDA-approved only for the prevention of osteoporosis in high-risk postmenopausal women.

• Testosterone therapy: This therapy is recommended for those for whom antiosteoporotic treatment is contraindicated, whose testosterone levels are less than 200 mg/dL, or those at borderline high risk for fracture.

• Calcitonin: It is a synthetic polypeptide hormone with properties similar to natural calcitonin. It is FDA approved treatment for osteoporosis in women who have been postmenopausal for more than five years when alternative therapies are not feasible.

• Parathyroid hormone analogues: These are synthetic forms of parathyroid hormones used to treat osteoporosis. Drugs include;

  • Teriparatide 

  • Abaloparatide

3. Newer drugs: These include:

• Romosozumab

• Odanacatib

• Lasofoxifene

Home-care For Osteoporosis

The best home remedies to reduce the risk of osteoporosis and to strengthen the bones is to eat foods rich in calcium and Vitamin D. These include:

1. Milk: It is a rich source of calcium and vitamin D, the two essential nutrients for bone growth and development.

2. Apple cider vinegar: It is abundant in nutrients like calcium, potassium, and magnesium, which can help enhance your bone health.

3. Cheese: Studies suggest that cheese, especially Parmesan is an excellent food for bone health and osteoporosis prevention.

4. Eggs: Research demonstrated that whole eggs could prevent osteoporosis and reduce the risk of fractures in the elderly.

5. Fish: Fatty varieties such as salmon, mackerel, tuna, and sardines are rich in Vitamin D and can help individuals with osteoporosis.

6. Citrus fruits: Fruits rich in Vitamin C, like oranges, can help your body produce what it needs for strong bones.

7. Green leafy vegetables: Dark leafy greens like Chinese cabbage, kale, and turnip greens are rich sources of calcium.

8. Sesame (Til): It contains copper, calcium, manganese, magnesium, and selenium and is ideal for people with calcium deficiencies.