Tuesday 16 March 2010, 09:01

Osteoporosis risk management

How to control risk factors associated with osteoporosis

Osteoporosis risk management

Osteoporosis is a metabolic bone disorder characterized by a reduction in bone mass and by the alteration of bone microarchitecture, resulting in reduced bone strength and increased susceptibility to bone fractures.


Osteoporosis is often called a “silent disease”, because it usually progresses asymptomatically, until a fracture occurs or one or more vertebrae collapse.


The incidence of osteoporosis significantly increases with age. The primary age-related change in bone mass results from an imbalance between bone formation (osteoblastic activity) and bone reabsorption (osteoclastic activity). This imbalance in bone remodeling process usually starts after 30 years of age and progressively increases with aging. Although affecting both sexes, the osteoporotic process is particularly prominent in postmenopausal women, due to the effect of estrogen loss.


Many people think that osteoporosis is a natural and physiological process associated with aging. But this age-related bone loss is actually affected by a number of both intrinsic and extrinsic factors and is largely preventable.


Apart from risk factors that cannot be changed and controlled (such as advanced age, female gender, white and Asian races, family history of osteoporosis), there are a variety of risk factors that can be managed or minimized, thereby reducing the likelihood of developing the disease. These factors include: estrogen deficiency, inadequate calcium or vitamin D intake, long-term use of glucocorticoids and some anticonvulsants, smoking and excessive use of alcohol.


The most common manifestation of estrogen deficiency is amenorrhea, that can be either physiological (before puberty, during pregnancy, while breastfeeding and after menopause) or pathological. There are many factors that can lead to pathological amenorrhea, such as hormonal disorders, extreme levels of physical activity and anorexia. In the last cases, the correction of the underlying conditions can re-establish normal estrogen levels and minimize the risk of developing osteoporosis.


Adequate calcium and vitamin D intake, as well as treatment of vitamin D deficiency, are key factors in managing and preventing osteoporosis. Both calcium and vitamin D play a critical role in bone formation and remodeling and are essential for maintaining bone health. Calcium and vitamin D requirements change during lifetime. Therefore diet (with or without supplements) should be adjusted to meet these varying age-related requirements.


Long-term use of certain medications, such as glucocorticoids and some anticonvulsants, and excessive use of aluminium-containing antacids and thyroid hormone can lead to bone mass loss and bone fractures. The reduction of dosage or withdrawal of these drugs should be always performed in consultation with a doctor.

As regards the other manageable risk factors (smoking and excessive use of alcohol), their management is rather simple: quitting smoking and avoiding excessive alcohol.


By Chiara De Carli

Category: Medical

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