Osteoporosis is characterized by loss of bone strength, which predisposes to fracture. In most cases, bones weaken due to lack of calcium, phosphorus and other minerals. Osteoporosis causes bones to be more porous and more prone to fracture during a common fall that, in normal times, would have been inconsequential.
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Keep in mind that this is not a disease, but a natural process more often related to aging.
Who is affected?
Most of the time, osteoporosis occurs in people 65 and older, but it can happen sooner.
It is estimated that in some countries, 1 in 4 women and 1 in 8 men will be affected in their lives. From the age of 50 until the end of life, 4 out of 10 women will suffer a fracture due to osteoporosis.
The bones of the hip, wrists and spine are the most common bone fractures due to osteoporosis.
Prevent Fractures
Physicians should primarily aim to prevent fractures instead of treating osteoporosis at any price. This new orientation is based on the most recent scientific data. In fact, it turns out that osteoporosis is just one of the many risk factors for fracture. This means that it is possible to have osteoporosis, but a low risk of fracture. On the contrary, it is possible to have a high risk of fracture without osteoporosis.
The doctor must make a general assessment of the patient's health status, the medications he or she consumes, his family history, his lifestyle, etc. Only if deemed necessary, will you propose a bone densitometry test, which measures bone mineral density. Previously, the decision to deal or not was based mainly on the results of this test.
All the data collected is used to establish the probability of a fracture occurring within the next 10 years. Several questionnaires have been developed to allow the physician to evaluate this risk. These vary slightly from one country to another and have been tested in large population samples.
It should be noted that the diagnosis of osteoporosis can be made following one of the following two situations:
- A radiological examination or osteodensitometry test reveals osteoporosis, a fracture occurred due to bone fragility.
When osteoporosis is diagnosed and treated, it is possible to stabilize or improve the condition of the bones to the point of reducing the risk of fracture by 50%.
The bone densitometry test
The osteodensitometry test allows to know the bone mineral density (BMD), that is the content of various minerals (calcium, phosphorus, etc.) in the bones.
There are several techniques to measure bone mineral density. The most commonly used is two-photon X-ray absorptiometry. This painless test exposes very little radiation. The result of this test (the T score) is compared to the average bone mineral density of young adults.
Keep in mind, however, that this test does not allow knowing the quality of the bone structure. The strength of the bone depends not only on its density, but also on the quality of its structure.
Evolution of bone mass with age
Not all people have the same bone "capital". 3/4 of it is determined by inheritance. Good lifestyle habits (exercise, calcium consumption, etc.) help to preserve this capital and make it grow.
The maximum peak of bone mass is reached around the age of 35 (see diagram below). It is usually maintained until age 40. Subsequently, the bone mass tends to decrease from 1 to 2% per year.
In the 10 years after the start of menopause, bone loss accelerates between 2% and 3% per year, due to the decrease in estrogen production. The loss then stabilizes at approximately 1% per year.
In the case of men, the loss is more gradual. At age 65, however, their risk of osteoporosis increases and they are more likely to have fractures.
The following graph gives an idea of the evolution of bone mass with age. This is an average curve. Therefore, the curve for a particular individual may be different because it depends on their inheritance and lifestyle.
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Possible complications
When trying to limit or prevent bone fractures, we want to avoid mainly the consequences: pain, loss of autonomy, reduced quality of life (especially for hip fracture), etc. Between 20 and 25% of people who have a hip fracture will die next year.
The consequences are often more serious for the man who, at the same age, is generally in a worse state of health than the woman.