What is Osteoporosis?
Osteoporosis is a silent disease this means it doesn't produce any symptoms. Is characterised by a decrease in bone tissue that weakens bones and increases the chance of suffering fractures. It tends to manifest as fractures caused by brittle bones, i.e., fractures that result when individuals simply fall over.
What is bone remodelling?
Most frequently fractured bones
The most frequently fractured bones are the hip, wrist and vertebra (backbone). Fractures can sometimes occur “spontaneously” upon straining or coughing.
Hip fracture. Is often the first indication of osteoporosis. They are associated with age and tend to occur in the elderly. It is a severe fracture for which it is difficult to provide a functional and vital prognosis as this depends on the patient's overall condition, the fracture type and the duration of immobilisation.This kind of fracture usually require surgery. Patients require constant care during recovery, particularly in the case of hip fractures, and therefore if you live alone it is safer to recover in a health centre. After recovering from the fracture you may experience chronic pain and difficulty performing daily activities.
Vertebral fracture. Vertebral fractures are the most frequently observed complication of osteoporosis. They are almost always spontaneous fractures and tend to occur during certain everyday movements, such as bending over, turning around, turning over in bed or during a coughing fit. The acute, intense back pain produced by the fracture tends to disappear, although it may persist in some patients. Height loss due to vertebral compression and progressive deformities, such as thoracic kyphosis or increased muscle contracture, both produce chronic back pain. This problem must be treated by a multidisciplinary team and patients provided with the knowledge and skills required to retrain their posture and manage their symptoms.
Wrist fracture. Fractures of the distal radius (Colles’ fractures) tend to occur in women aged 45–65 years. They are caused by falling forward and landing on your hands. Some patients present prolonged discomfort with a certain degree of incapacity. They can also result in deformities in the case of poor bone healing.
Atypical femoral fracture
These are extremely rare, but when they occur they are known as atypical femoral fractures. There are between 5 and 100 cases/year in a group of 100,000 patients.
This type of fracture can occur spontaneously or after minimal trauma. The fracture may be bilateral and occurs in the femoral diaphysis (approximately halfway along the femur) or beneath the trochanter (each of the protrusions at the upper end of the femur and other long bones). Sometimes it is a linear fracture in the femur’s cortical tissue, while in other instances it progresses to a complete fracture. The incidence decreases once the osteoporosis medicine is withdrawn.
Atypical femoral fractures have some specific clinical and radiological characteristics and have been described in patients receiving antiresorptive treatment with bisphosphonates and denosumab, although they have also been observed in individuals who were not receiving any osteoporosis treatment or other bone diseases.
The risk of suffering an atypical fracture increases as the duration of treatment with bisphosphonates increases, and also when they are used in combination with glucocorticoids.
It is important to emphasise that the drug therapy for osteoporosis significantly reduces the incidence of fragility fractures of the femur (by up to 55%), while the possibility of an atypical femoral fracture is exceptionally rare (0.0005% of patients).
The table below summarises the main characteristics of an atypical femoral fracture.
|Key points about atypical femoral fractures|
Is it very common?
These proportions increase in both sexes when considering the records for osteoporosis-related fractures. As such it is estimated that 2 out of every 5 women (40%) and 1 in every 5 men (22%) aged over 50 will suffer a fracture as a consequence of osteoporosis during their lifetimes.
What does bone quality mean?
Osteoporosis is evidenced by a change in the quantity and quality of bone tissue. Bone quality is closely related to a bone’s fracture resistance. The notion of bone quality takes into consideration the bone’s structural characteristics, the degree of mineralisation or calcification, collagen alterations and even includes the repair and accumulation of previous microfractures.
An individual’s skeletal development and maximum acquisition of bone, called the peak bone mass, primarily occurs while the body is growing and up to the age of 25–30 years. The peak bone mass acquired is determined by various factors; the main influences are genetics and environmental conditions, while physical exercise also seems to play an important part.
Humans then undergo a progressive loss of bone mass throughout their lifetimes; this is more notable in women aged 45–50 years and upwards, i.e., during the menopause due to decreased oestrogen levels. From this point on and throughout the rest of our lifetimes we experience a total loss of around 20–30% of bone mass.
Osteopenia is a slight decrease in bone density (to a level that is below average) and can represent a precursor for osteoporosis. With the exception of a few specific situations, such as patients being treated with glucocorticoids, osteopenia does not normally require medical treatment.
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