Osteoporosis

As the name suggests, osteoporosis means that the inside of the bone has developed many tiny holes, or pores. The interior of a bone normally consists of a honeycomb-like network. As this structure thins and breaks down, the bone becomes less able to withstand force, even if its overall size stays the same.

Despite appearances, bone is living tissue with constant metabolic activity. Cells that break down old bone and cells that build new bone are always at work, sustaining bone remodeling. From adolescence through around the 20s, bone formation outpaces breakdown, making bones stronger. After that, the balance gradually shifts toward breakdown with age. In women, hormonal changes around menopause bring a period when these changes accelerate.

Diagnosis usually involves a test that measures bone mineral density. For adults, a T-score of -2.5 or lower, compared with the young adult average, is a widely used criterion for classifying osteoporosis.

There are usually few symptoms in the early stages. The first sign may be a broken wrist after a minor fall, or a vertebra collapsing under compression during a sneeze or while lifting something—a vertebral compression fracture. The hip, spine, and wrist are common fracture sites. Osteoporosis may also lead to a loss of height or a forward-curving back. These fragility fractures are fractures that occur from everyday impacts because the bones have become weak.

Bone weakening often occurs alongside changes in muscles and balance. This is because muscle loss and poorer balance make falls more likely, and weak bones are more likely to fracture in a fall. That is why the importance of assessing bones, muscles, and balance together in older age is emphasized. You can read more about muscle-related changes in Sarcopenia and Osteosarcopenia.

Diagnosis and treatment are the responsibility of healthcare professionals. Alongside that care, it helps to understand how everyday habits can support your bones.

• Weight-bearing activities: Bone is a tissue that responds to mechanical stimulation. Activities in which your body bears its weight against gravity, such as walking and climbing stairs, are a foundation.
• Strength exercises: Resistance training increases the stimulation that muscles provide as they pull on bones. Try starting with light weights.
• Balance practice: Fall prevention exercises are often used to reduce falls. Removing raised thresholds at home and addressing slippery floors or dark stairways are also important preventive measures.
• Nutrition and lifestyle: Get calcium and vitamin D consistently, and consume enough protein. Smoking and excessive drinking are known to place a burden on bones.

If you have broken a bone after a minor fall, suddenly developed severe pain in your upper or lower back, or noticeably lost height, tell your healthcare professional during your visit. Also mention any family history of osteoporosis or hip fractures.

Osteoporosis in adolescents (pediatric osteoporosis) refers to bones becoming weak enough to fracture easily in growing children and adolescents. The same criteria used for adults cannot be applied directly. This is because bone size, shape, and mineral content continue to change during growth and puberty.

For this reason, assessment during growth does not rely on a single bone mineral density value alone. Literature associated with the international society for pediatric bone densitometry presents definitions that also consider the circumstances of fractures, such as vertebral fractures occurring with little or no trauma, or a significant fracture history together with low bone mass. Rather than using a T-score that compares bone mineral density with the young adult average, as in adults, a Z-score is used to compare it with the distribution among children of the same age and sex. Another consideration is that, while bones are still small during growth, bone mineral density calculated by area may not directly reflect actual bone strength.

Bone weakening in children can occur with genetic disorders, or alongside other health conditions such as chronic inflammatory diseases, neurological or muscle diseases, or the use of certain medications. Another difference from adults is that growing bones have greater potential to recover and remodel on their own. Reading about the growth plate can help explain how children grow.