Osteoporosis. Symptoms, Causes, Laboratory Tests, Prevention, Treatment

Osteoporosis is a medical condition characterized by a decrease in bone density and strength, resulting in an increased risk of fractures. It is often referred to as a "silent disease" because it progresses slowly and is usually asymptomatic until a fracture occurs.

Causes of Osteoporosis

Osteoporosis can have various causes that contribute to the development of the condition. The primary factors involved are:

Age-related bone loss: As individuals age, there is a natural decline in bone mass and density. This occurs due to a gradual imbalance between bone formation and bone resorption. The rate of bone breakdown (resorption) exceeds the rate of bone formation, leading to a net loss of bone tissue. This age-related bone loss is more prominent in women after menopause when estrogen levels decline.

Hormonal changes: Hormones play a crucial role in maintaining bone health. Decreased levels of estrogen in women after menopause are a significant contributing factor to osteoporosis. Estrogen helps regulate bone metabolism, and its decline leads to increased bone resorption and decreased bone formation. Similarly, low testosterone levels in men can also contribute to bone loss.

Genetic factors: Genetic factors can influence an individual's susceptibility to osteoporosis. Family history plays a role in determining bone density and the risk of fractures. If a close family member, such as a parent or sibling, has osteoporosis or has experienced a fracture, the likelihood of developing the condition is increased.

Lifestyle factors: Certain lifestyle choices and habits can contribute to the development of osteoporosis. These include:

Lack of physical activity: Regular weight-bearing exercises, such as walking, running, and weightlifting, promote bone strength and density. Sedentary lifestyles can lead to weaker bones.
Poor nutrition: A diet lacking in calcium and vitamin D can negatively impact bone health. Calcium is essential for bone formation, and vitamin D helps with calcium absorption. Inadequate intake of these nutrients can increase the risk of osteoporosis.
Excessive alcohol consumption: Consuming alcohol excessively can interfere with bone remodeling and reduce bone density.
Smoking: Smoking has been linked to decreased bone mass and increased fracture risk. It can disrupt the balance between bone formation and resorption.

Medical conditions and medications: Several medical conditions and medications can contribute to osteoporosis. These include:

Hormonal disorders: Conditions such as hyperthyroidism, Cushing's syndrome, and diabetes can affect bone health.
Autoimmune disorders: Rheumatoid arthritis and systemic lupus erythematosus (SLE) can increase the risk of osteoporosis.
Gastrointestinal disorders: Conditions like celiac disease, inflammatory bowel disease (IBD), and gastric bypass surgery can impair nutrient absorption and affect bone health.
Medications: Long-term use of corticosteroids (glucocorticoids), such as prednisone, can lead to bone loss. Other medications, such as certain anticonvulsants, proton pump inhibitors (PPIs), and some cancer treatments, can also increase the risk of osteoporosis.

It's important to note that osteoporosis is often influenced by a combination of these factors. Understanding the underlying causes can help in developing appropriate prevention and treatment strategies for individuals at risk or diagnosed with osteoporosis.

Symptoms of Osteoporosis

Osteoporosis is often considered a "silent disease" because it typically doesn't cause noticeable symptoms until a fracture occurs. However, when symptoms do occur, they can vary depending on the location and severity of the fractures. Some common symptoms associated with osteoporosis are:

Fractures: Osteoporosis increases the risk of fractures, particularly in the spine, hips, and wrists. Fractures resulting from osteoporosis are often referred to as fragility fractures because they can occur with minimal trauma or even during routine activities. The most common types of fractures associated with osteoporosis include:

Spinal fractures: Also known as vertebral compression fractures, these can cause back pain, a loss of height, and a stooped or hunched posture (kyphosis). Spinal fractures may also lead to a decrease in mobility and affect the individual's overall quality of life.
Hip fractures: These fractures typically occur due to a fall, and they can cause severe pain, difficulty walking or standing, and a noticeable change in gait. Hip fractures often require surgery and have a significant impact on an individual's mobility and independence.
Wrist fractures: Fractures in the wrist can result from falls and may cause pain, swelling, and difficulty using the hand.

Back pain: Osteoporosis-related spinal fractures can cause persistent or recurrent back pain. The pain may range from mild to severe and can be worsened by movement, prolonged standing, or lifting heavy objects.

Loss of height: Osteoporosis can lead to a loss of height over time, especially when multiple vertebral fractures occur. This is due to the collapse of the vertebrae, resulting in a stooped posture and a noticeable reduction in overall height.

Changes in body shape: Severe osteoporosis can cause the spine to curve forward, resulting in a hunched or rounded upper back (dowager's hump) and a protruding abdomen.

Weak and brittle nails: Some individuals with osteoporosis may experience changes in their nails, such as increased brittleness and a higher susceptibility to breaking or splitting.

It's important to note that these symptoms are not specific to osteoporosis alone and can be caused by other conditions as well.

Laboratory Tests for Osteoporosis

While there are no specific laboratory tests that can diagnose osteoporosis on their own, certain tests can help assess bone health and aid in the diagnosis and management of the condition. Some commonly used lab tests for osteoporosis are:

Dual-energy X-ray absorptiometry (DXA): DXA is a non-invasive imaging test that measures bone mineral density (BMD). It is the gold standard for diagnosing osteoporosis and assessing fracture risk. DXA scans are typically performed on the hip and spine, and the results are reported as T-scores and Z-scores. The T-score compares an individual's BMD to that of a young, healthy adult of the same sex, while the Z-score compares it to an age-matched population.

Biochemical markers of bone turnover: These blood and urine tests provide information about the rate of bone turnover, which is the balance between bone formation and resorption. Examples of biochemical markers include:

Serum calcium and phosphate levels: Abnormal levels can indicate bone mineralization problems.
Serum alkaline phosphatase (ALP): Elevated levels of ALP can suggest increased bone turnover.
Serum C-terminal telopeptide (CTX) and serum N-terminal propeptide of type I collagen (P1NP): These markers reflect bone resorption and formation, respectively, and can help monitor response to treatment.

Vitamin D levels: Vitamin D plays a crucial role in calcium absorption and bone health. Low levels of vitamin D can contribute to osteoporosis. The 25-hydroxyvitamin D test (25(OH)D) is commonly used to measure vitamin D levels in the blood.

Parathyroid hormone (PTH) levels: PTH regulates calcium and phosphate metabolism in the body. Elevated PTH levels may indicate secondary causes of osteoporosis, such as vitamin D deficiency or primary hyperparathyroidism.

These tests are usually used in combination with a thorough medical history, physical examination, and assessment of fracture risk factors. The diagnosis of osteoporosis is typically based on the combination of clinical evaluation, BMD measurements, and the presence of fragility fractures.

Functional Medicine Laboratory Tests for Osteoporosis

Functional medicine approaches aim to identify underlying imbalances and dysfunctions that contribute to health conditions like osteoporosis. While functional medicine lab tests can vary depending on the individual and the practitioner's approach, some examples of functional medicine lab tests that may be utilized in assessing osteoporosis are:

Menopause Comprehensive Profile (MenoScan®): This panel includes tests for hormones such as estrogen, progesterone, testosterone, DHEA, and cortisol. Hormonal imbalances, particularly in postmenopausal women, can contribute to bone loss and osteoporosis.
Vitamin D Testing: Inadequate vitamin D levels can impair calcium absorption and bone health. Testing for 25-hydroxyvitamin D (25(OH)D) levels can help identify deficiencies.
Vitamin Comprehensive Profile: This panel evaluates all vitamin levels, including vitamin K, which is essential for bone health.
Comprehensive Stool Analysis (EnteroScan®): This test assesses digestive function, gut microbiome diversity, and the presence of gut dysbiosis or imbalances. It can identify factors that may impair nutrient absorption and contribute to osteoporosis.
Food Intolerance Testing (TrophoScan®): Food sensitivities or intolerances could affect nutrient absorption and contribute to inflammation, which can impact bone health.
Genetic Testing (OsteoGenomiX®): Certain genetic variations can affect bone metabolism and increase the risk of osteoporosis. Genetic testing can identify these variations and provide insights into personalized treatment strategies.

These functional medicine tests can provide additional information about an individual's health status and potential underlying factors contributing to osteoporosis and they are typically used in conjunction with conventional diagnostic methods like DXA scans and clinical evaluation. Functional medicine approaches focus on personalized and comprehensive care, aiming to address underlying imbalances and promote overall health and well-being.

Osteoporosis Conventional Therapies

Conventional therapies for osteoporosis aim to slow down bone loss, maintain or improve bone density, and reduce the risk of fractures. These therapies typically include lifestyle modifications, nutritional interventions, and medications. Some commonly used conventional therapies for osteoporosis are:

Calcium and Vitamin D supplementation: Adequate calcium and vitamin D intake are essential for maintaining bone health. Calcium helps build and strengthen bones, while vitamin D enhances calcium absorption. Supplements may be recommended if dietary intake is insufficient.
Lifestyle modifications:
- Weight-bearing exercises: Regular weight-bearing exercises, such as walking, dancing, or weightlifting, help strengthen bones and improve bone density.
- Fall prevention: Taking steps to prevent falls, such as improving home safety, using assistive devices, and practicing balance exercises, can reduce the risk of fractures.
- Smoking cessation: Quitting smoking is beneficial for bone health as smoking can contribute to bone loss.
Bisphosphonates: Bisphosphonates are the most prescribed medications for osteoporosis. They work by slowing down bone breakdown and reducing the risk of fractures. Examples of bisphosphonates include alendronate, risedronate, and ibandronate.
Selective Estrogen Receptor Modulators (SERMs): SERMs, such as raloxifene, mimic the effects of estrogen on bone tissue. They help maintain bone density and reduce the risk of fractures in postmenopausal women. SERMs can also have beneficial effects on other tissues, such as reducing the risk of breast cancer.
Teriparatide: Teriparatide is a synthetic form of parathyroid hormone (PTH) that stimulates bone formation. It is prescribed for severe osteoporosis or in cases where other treatments have not been effective.
Denosumab: Denosumab is an injectable medication that inhibits bone breakdown by targeting a protein called RANK ligand (RANKL). It is used when other treatments have failed or in specific clinical situations.
Hormone Replacement Therapy (HRT): Estrogen therapy, often combined with progesterone, can be considered in postmenopausal women to help maintain bone density. However, the decision to use HRT involves careful consideration of the risks and benefits and should be individualized based on factors like age, menopausal symptoms, and overall health.

The choice of therapy depends on various factors, such as the severity of osteoporosis, individual risk factors, and patient preferences.

Osteoporosis Natural Therapies

Natural therapies for osteoporosis can complement conventional treatments and help support overall bone health. Natural therapies should be used in conjunction with conventional therapies. Some natural approaches that may be considered are:

Nutritional interventions

Adequate calcium intake: Consuming calcium-rich foods, such as dairy products, leafy green vegetables, and fortified foods, can help support bone health. It is generally recommended to obtain calcium from food sources rather than relying solely on supplements.
Vitamin D supplementation: Ensuring adequate vitamin D levels is important for calcium absorption and bone health. Sun exposure, fortified foods, and vitamin D supplements can help maintain optimal levels.
Magnesium and vitamin K: These nutrients play a role in bone health. Magnesium-rich foods include nuts, seeds, legumes, and whole grains. Leafy green vegetables and fermented foods are good sources of vitamin K.
Omega-3 fatty acids: Consuming omega-3 fatty acids from sources like fatty fish, flaxseeds, and walnuts may have anti-inflammatory effects that support bone health.

Regular exercise

Weight-bearing exercises: Engaging in weight-bearing exercises, such as walking, jogging, dancing, or weightlifting, can help strengthen bones and improve bone density.
Resistance training: Incorporating resistance exercises, such as lifting weights or using resistance bands, can help build muscle strength and support bone health.
Balance and posture exercises: Practicing balance exercises and maintaining good posture can reduce the risk of falls and fractures.

Herbal and dietary supplements

Herbal remedies: Certain herbs, such as horsetail, red clover, and black cohosh, have been traditionally used for bone health. However, their effectiveness and safety need further scientific investigation.
- Black Cohosh (Actaea racemosa): Black cohosh is a plant native to North America and has been traditionally used to treat menopausal symptoms. Some studies suggest that black cohosh may have estrogen-like effects and could potentially help with bone health. However, more research is needed to establish its efficacy and safety specifically for osteoporosis.
- Chinese Skullcap (Scutellaria baicalensis): Chinese skullcap is an herb used in Traditional Chinese Medicine. It contains compounds with potential anti-inflammatory and antioxidant properties and some preliminary studies suggest it may have a positive effect on bone health.
- Dong Quai (Angelica sinensis): Dong quai is another herb used in TCM and is often promoted for women's health concerns, including menopause symptoms and bone health. However, there is limited scientific evidence to support its effectiveness specifically for osteoporosis.
- Horsetail (Equisetum arvense): Horsetail is a plant that contains high levels of silica, which is believed to be beneficial for bone health. However, evidence supporting its use in osteoporosis is limited, and there are concerns about potential side effects and interactions with medications.
Bone-supportive supplements: Some supplements, including strontium, boron, and silica, have been studied for their potential benefits in bone health.

Lifestyle modifications

Smoking cessation: Quitting smoking can help reduce bone loss and improve overall health.
Limiting alcohol intake: Excessive alcohol consumption can negatively affect bone health. Moderation is key, with recommended limits varying by country and gender.

Stress reduction techniques

Chronic stress can contribute to bone loss. Engaging in stress reduction practices, such as meditation, yoga, deep breathing exercises, or seeking support from a therapist, can help promote overall well-being.

Acupuncture

This traditional Chinese medicine practice involves inserting thin needles into specific points on the body. Some studies suggest that acupuncture may help reduce pain and improve the quality of life in individuals with osteoporosis, but more research is needed to establish its efficacy for bone health.

It's important to emphasize that natural therapies for osteoporosis should be approached with caution and under the guidance of a healthcare professional. They should not replace conventional treatments but can be used as adjunctive strategies to support bone health and overall well-being.

Vasilis J. Sideris
Biologist
Medical Doctor, Biopathologist (Microbiologist)
Certified Functional Medicine Practitioner, CFMP®