What is osteoporosis?
Osteoporosis is a metabolic bone disease that causes bones to become weak and brittle. It occurs when bone mass and density decrease, making bones more prone to fractures even with minor falls or injuries. This condition develops gradually, often without noticeable symptoms until a fracture happens.
Bone tissue constantly undergoes a cycle of breakdown and rebuilding. In osteoporosis, bone loss outpaces bone formation, leading to structural deterioration. Osteoporosis often affects the spine, hips, and wrists, making them more prone to fractures. Without a proper prevention strategy, this can lead to mobility issues and a reduced quality of life.
Common causes and risk factors
- Ageing: Bone density naturally decreases, making fractures more likely in older adults. This gradual loss weakens bones and affects overall mobility.
- Hormonal Changes: Postmenopausal women face a higher risk of osteoporosis due to reduced oestrogen levels, while lower testosterone in men can also contribute to bone loss.
- Genetics: A family history of osteoporosis increases the likelihood of developing the condition, especially if close relatives have experienced fractures.
- Dietary Factors: Insufficient calcium and vitamin D intake might weaken bone structure, leading to a faster decline in mineral density and an increased risk of fractures.
- Lifestyle Choices: Smoking, excessive alcohol consumption, and sedentary lifestyle can accelerate bone loss. Doing weight-bearing exercises can help maintain bone strength.
- Medical Conditions: Diseases like rheumatoid arthritis, chronic kidney disease, and hyperthyroidism disrupt bone metabolism and weaken bones.
- Medications: Long-term use of corticosteroids, epilepsy drugs, and certain cancer treatments can lead to bone thinning and higher fracture risk.
Signs and symptoms
Osteoporosis is often called a silent disease because it develops without noticeable symptoms until a fracture occurs. However, there are some signs that may indicate bone loss, such as:
- Loss of Height: A gradual reduction in height over time may result from vertebral fractures.
- Back Pain: Weak or fractured vertebrae can cause persistent back pain.
- Stooped Posture: Spinal compression fractures can lead to a hunched back or kyphosis.
- Fragility Fractures: Bones become so fragile that minor falls, bending, or coughing can cause fractures, particularly in the hip, spine, or wrist.
Other metabolic bone disorders you should know
While osteoporosis is the most common metabolic bone disorder, several other conditions also affect bone health. These disorders disrupt bone metabolism and might lead to structural weakness, fractures, and long-term complications. Understanding these conditions before they get worse can help in early detection and appropriate treatment.
Hyperparathyroidism
Primary hyperparathyroidism occurs when the parathyroid glands overproduce parathyroid hormone (PTH), raising calcium levels and increasing bone resorption. This weakens bones, making fractures and osteoporosis more likely. Common symptoms include bone pain, kidney stones, and fatigue. Without treatment, it can cause skeletal deformities and severe bone loss. Endocrinologists diagnose it through blood tests and imaging.
Osteomalacia
Osteomalacia, or adult rickets, results from prolonged vitamin D deficiency, leading to poor bone mineralisation. Bones become soft, weak, and prone to fractures. Symptoms include bone pain, muscle weakness, and difficulty walking. Unlike osteoporosis, osteomalacia affects bone quality rather than density. Treatment involves supplementation with vitamin D and calcium.
Renal Osteodystrophy
Renal osteodystrophy is a bone disorder caused by chronic kidney disease (CKD). It disrupts calcium and phosphate balance and leads to bone pain, deformities, and increased fracture risk. As kidney function worsens, bones become more brittle and prone to fractures. Severe cases can affect posture and mobility. Treatments for renal osteodystrophy include phosphate control, vitamin D supplements, and managing secondary hyperparathyroidism.
Hypocalcemia
Hypocalcemia is a condition characterised by low calcium levels in the blood. Causes may include vitamin D deficiency, parathyroid disorders, and chronic kidney disease (CKD). Symptoms range from muscle cramps to severe complications like seizures. Prolonged hypocalcemia weakens bones, making them porous and fracture-prone. Treatment involves calcium and vitamin D supplementation.
Other Disorders
Less common bone disorders like hypophosphatasia and fluorosis also affect bone health. Hypophosphatasia disrupts bone mineralisation, causing fragile bones and dental abnormalities. Fluorosis, from excessive fluoride intake, results in dense but structurally weak bones. Both conditions increase fracture risk and may lead to joint pain or stiffness. Consulting an endocrinologist is essential for proper diagnosis and management.
Prevention strategies
Maintaining strong bones requires a holistic approach to balanced diet, exercise, and lifestyle choices. A diet rich in calcium and vitamin D is essential for bone health. Dairy products, leafy greens, and fortified foods provide calcium, while sunlight exposure and supplementation help maintain adequate vitamin D levels.
Regular weight-bearing exercises like walking, jogging, and strength training stimulate bone formation and prevent bone loss. Avoiding smoking and excessive alcohol consumption is also crucial, as these habits weaken bones and increase fracture risk.
Additionally, managing underlying medical conditions like thyroid disorders and kidney disease can help protect bone health. Routine screenings, especially for high-risk individuals, allow for early detection and timely intervention to prevent severe complications.
When to see a specialist
Consulting an endocrinologist is crucial when experiencing persistent bone pain, unexplained fractures, or signs of osteoporosis such as height loss and a stooped posture. Individuals with risk factors like family history, hormonal disorders, or CKD should also seek evaluation from an endocrinologist.
Frequent fractures, muscle weakness, and symptoms of calcium imbalances like muscle cramps or numbness could indicate the need for medical attention. Early diagnosis and treatment by an endocrinologist can help prevent further bone deterioration and improve long-term outcomes.
Diagnosing osteoporosis and bone disorders
Early detection of osteoporosis and other metabolic bone disorders is key to preventing fractures and complications. The most common diagnostic tool is the Dual-Energy X-ray Absorptiometry (DEXA) scan, which measures bone mineral density and helps assess fracture risk.
Blood tests can help endocrinologists identify underlying causes, such as calcium, phosphate, vitamin D deficiencies, or abnormal parathyroid hormone levels. Additional imaging tests, like X-rays and CT scans, may be used to detect fractures or bone deformities.
Endocrinologists may conduct specialised hormone tests and kidney function assessments for metabolic bone disorders like hyperparathyroidism and renal osteodystrophy. Routine screening for high-risk individuals enables early intervention, helping to slow bone loss and maintain skeletal health.
Treatment options for osteoporosis and bone disorders
An Endocrinologist can prescribe medications to treat osteoporosis by reducing bone resorption, promoting osteoblastic or bone formation activities, etc.
Another treatment option to consider is hormone therapy, which replaces hormones such as oestrogen that decline during menopause and can help postmenopausal women maintain stronger bones and help prevent fractures.
Get osteoporosis and bone disorder treatment in Singapore
Patients can seek osteoporosis treatment at hospitals, specialist clinics, and healthcare centres. Early intervention is key to preventing complications and maintaining bone health.
Consulting with an endocrinologist ensures personalised care and effective treatment. If you or your loved ones are concerned about osteoporosis or other bone disorders, book a consultation with Dr Vikram Sonawane, Medical Director at Harmony Thyroid Endocrinology and Diabetes Centre.
Frequently asked questions
What are the early signs of osteoporosis?
Early osteoporosis often has no symptoms, but some warning signs include back pain, gradual height loss, and a stooped posture. Frequent fractures from minor falls may also indicate weakened bones.
How do endocrinologists diagnose osteoporosis?
Endocrinologists diagnose osteoporosis using bone mineral density (BMD) tests, such as a dual-energy X-ray absorptiometry (DEXA) scan. Blood tests may also be conducted to assess calcium, vitamin D, and hormone levels.
Can osteoporosis be reversed?
While osteoporosis cannot be fully reversed, treatment can significantly slow bone loss and improve bone strength. Medications, lifestyle changes, and proper nutrition can help manage the condition effectively.
Who is at the highest risk of developing metabolic bone disorders?
Postmenopausal women, older adults, individuals with a family history of osteoporosis, and those with chronic conditions like kidney disease or hormonal imbalances are at higher risk. Lifestyle factors such as poor diet, smoking, and physical inactivity also contribute.
Why are postmenopausal women at higher risk for osteoporosis?
After menopause, estrogen levels drop significantly, leading to increased bone resorption and decreased bone formation. This accelerates bone loss and raises the risk of fractures.
What are the best ways for postmenopausal women to prevent osteoporosis?
Maintaining a diet rich in calcium and vitamin D, engaging in weight-bearing exercises, and avoiding smoking and excessive alcohol can help preserve bone strength. In some cases, doctors may recommend medications to slow bone loss.
How do endocrinologists treat osteoporosis postmenopause?
Treatment includes calcium and vitamin D supplementation, weight-bearing exercises, and medications such as bisphosphonates or selective estrogen receptor modulators (SERMs). In some cases, hormone therapy may be considered to slow bone loss and reduce fracture risk.