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Definition: what is osteoporosis?
L’osteoporosis is a bone diseasecharacterized by a decrease in the quantity and quality of bone tissue withmodification of its micro-architecture, exposing it more easily to the risk of fractures. This pathology, the frequency of which increases with age, is asymptomatic before the occurrence of one or more fractures which occur in the absence of a major traumatic context. It relates to two to three times more often women than menmainly after the menopause. It is thus nearly 39% of women who are concerned from the age of 65, and 70% over the age of 80.
“Bone is a living tissue, and its cells are constantly renewing themselves, notably under the influence of estrogen, which maintains this bone turnover”, describes Dr. Pizzuti. Menopause resulting in a drop in estrogen production, which therefore accelerates the process of loss of bone densitye.
Symptoms: what are the signs of osteoporosis, and can it cause pain?
The problem with osteoporosis, which makes it a serious disease when it could be mild with early treatment, is precisely that initially it does not cause no symptoms. The bone loss is painlessexcept of course in the event of a fracture, in which case the pain will be linked to the fracture resulting from osteoporosis.
Osteoporosis threshold: when can we speak of severe osteoporosis?
There are two ways to assess the severity of osteoporosis: the T-score determined by the densitometric criteria, and the fracture history.
The T-score
The diagnostic test for osteoporosis is bone densitometry, which measures bone mineral density, ie the amount of calcium found in the bones. The results of this examination are called T score and are given in comparison with the bone density of a reference population made up of young adults.
Professor Cortet, rheumatologist: “We speak of severe osteoporosis when the T score is below -3, ie about 30% below the average for 20-year-old women.”
Osteoporotic fractures: fracture history
The broken bones related to the loss of bone density make all the seriousness of the osteoporotic disease. They are therefore the ones who ultimately sign the diagnosis of severe osteoporosis when they concern the most frequently affected sites (hip, shoulder, vertebrae, etc.). When an osteoporotic fracture is discovered, bone densitometry is this time prescribed – and reimbursed – to the patient. This is also called severe osteoporosis. when the patient has at least one fracture and a T-score of less than -2.5.
The risks of severe osteoporosis: is it serious?
Osteoporosis should be taken seriously because its complications can be serious and decrease life expectancy. “Osteoporosis is a disease whose frequency and severity are underestimated, because it evolves silently: unless a fracture occurs, it can therefore evolve and reach a significant stage of severity without us Whence theimportance of prevention“, underlines the specialist.
Femoral neck fracture and musculoskeletal disorders
The main risk of osteoporosis is osteoporotic fracture, linked to the weakening of the skeletal structure and following a minor trauma. The fractures most often encountered are those of the hip (neck of femur), the proximal humerus (shoulder), bowlof the vertebrae and multiple ribs. It has thus been demonstrated that these fractures in the elderly increased the risk of death by 20% to 30% in the year following this event.
In addition, they are almost always the cause of musculoskeletal disorders. “25 to 50% of older people who have a hip fracture keep a significant disability and will have to be institutionalized” insists Professor Cortet, who underlines the public health issue of the early diagnosis of osteoporosis.
Dr Pizzuti also laments thelack of screening in France today, as well as the systematic non-reimbursement beyond the age of 60 of bone densitometry by the Health Insurance, which is however the only examination allowing early diagnosis of osteoporosis. The examination is in fact only reimbursed in certain situations and paradoxically it is prescribed less and less, probably because of its complex conditions of coverage by the Health Insurance.
In video: Why does osteoporosis promote fractures?
“We have been witnessing for ten years an increasingly deficient management of osteoporosis”, regrets Professor Cortet.
The occurrence of a severe osteoporotic fracture requires an anti-osteoporotic treatment. In reality: it is only done in 12% of cases!
It exists several treatments osteoporosis whose mechanisms of action and methods of administration differ. “The treatments can be taken by the stuffy or be administered by injectable route, either in the form of an infusion once a year, or a subcutaneous injection every 6 months”, explains Professor Cortet.
A particular injectable treatment must be mentioned, theteriparatide. It is a bone anabolic agentwhich thus makes it possible to “rebuild bone”. However, it is reserved for people suffering fromsevere osteoporosis having already caused at least 2 vertebral fractures.
The two most commonly used injectable treatments are:
- zoledronic acid : it belongs to the class of bisphosphonates, the drugs most frequently prescribed during osteoporosis
- denosumab(marketed under the name Prolia): it is a second-line treatment in relay of bisphosphonates.
Can we recover bone density?
The aim of anti-osteoporotic treatments is to reduce the occurrence of a fragility fracture as much as possible. “Overall, the majority of treatments only slightly improve bone mineral density after 2 to 3 years, whereas reduce the risk of fracture by 50 to 70% vertebral in particular, and the risk of hip fracture by about 50% compared to a placebo”, indicates Professor Cortet. The interest of a densitometric control after 2 to 3 years is therefore in the first place to ensure that there was no accelerated bone loss.
“On the other hand, for an anabolic bone treatment such as teriparatide, we can expect a bone gain of around 10% after 18 months of treatmentcorresponding to a reduction compared to a placebo of approximately 65% in the risk of occurrence of a vertebra fracture” adds the specialist, specifying that it is the only treatment which increases bone mineral density as much.
Although osteoporosis is a pathology whose frequency increases with age, it is not a fatality. It is possible to avoid its occurrence by taking a number of preventive measures:
- A feed balanced, both rich in calciumvitamin D – which allows the good fixing of calcium on the bone – but also in proteinsis essential to limit the bone demineralization. “Older people are very often deficient in protein, which is an essential nutrient for bone quality,” recalls Professor Cortet. If vitamin D and calcium needs cannot be covered by dietary intake, vitamin-calcium supplementation can be proposed.
- the hormone treatment for menopause (TSH or THM); Indeed, since bone turnover occurs mainly through estrogen, the onset of menopause is a risk factor for bone demineralization. Taking a TSH at menopause may be advisable, since it restores estrogen stock of the organism. “You must first of course assess the risk-benefit balance, and check that there are no contraindications: history of breast cancer or proven cardiovascular risks”, explains the rheumatologist, who specifies however that if he There is indeed a discreet increase in the risk of breast cancer under hormonal treatment, these are also less serious because they are generally quickly diagnosed. Indeed, women on THMs benefit from increased monitoring. Ultimately, this treatment is only possible in recently postmenopausal women.
- Physical activity : Maintaining physical activity is essential for maintain bone capital. Sport makes it possible to maintain and even strengthen bone density, but also to improve balance and posture. In this context, it is “load” activities that must be favored (running, Nordic walking, tennis, etc.).
- Limit your alcohol consumption : Excess alcohol tends to decrease bone mineral density and increase the risk of fracture.
- the tobacco is also an aggravating factor, the withdrawal smoking is therefore highly recommended.
- Maintain weight within health standards : Too low weight, just like too much weight, are risk factors for fracture. Abody mass index (BMI) less than 19is thus associated with a greater risk of osteoporosis, linked to a lack of muscle tissue. Conversely, people with obesity(BMI greater than 30) also have an increased risk of developing certain fractures (ankle, leg, humerus, etc.), due in particular to an excess of fat cells lodged in the bones.
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