Osteoporosis, characterized by reduced bone density and increased fragility, presents various adverse effects affecting bone and overall health.

Introduction

Osteoporosis, a condition characterized by decreased bone density and increased bone fragility, exposes individuals to a range of significant adverse effects. Navigating the bone challenges brought on by osteoporosis requires a thorough understanding of the physical impacts and tailored management strategies to minimize the complications associated with this debilitating bone disease.

One of the major side effects of osteoporosis is an increased risk of fractures, particularly in the hips, spine and wrists. These fractures can lead to loss of mobility, severe pain, and even serious medical complications. Decreased bone density makes bones more vulnerable to daily stresses, and fractures can occur even with minor trauma.

Besides fractures, osteoporosis can also cause a decrease in height due to compression of the vertebrae. Vertebral fractures, often asymptomatic at first, can gradually cause curvature of the spine, loss of height and altered posture. These physical changes impact quality of life and can contribute to mobility and self-esteem issues.

Managing the adverse effects of osteoporosis involves a holistic approach. Interventions often include fracture prevention strategies, such as eating a diet rich in calcium and vitamin D, doing regular muscle-strengthening exercises, and making lifestyle changes to reduce the risk of falls. . Additionally, healthcare professionals may recommend specific pharmacological treatments to strengthen bone density.

Psychosocial management of the adverse effects of osteoporosis is also essential. Patients can benefit from the support of a multidisciplinary medical team, including osteopaths, physiotherapists and mental health counselors, to deal with the physical and emotional challenges associated with the disease.

In conclusion, navigating the bone challenges of osteoporosis requires a comprehensive approach to minimize adverse effects. Early management, combined with lifestyle interventions and regular monitoring by healthcare professionals, can help improve the quality of life of those affected by this degenerative bone condition.

This review explores the impacts of osteoporosis, going beyond bone fragility, examining possible complications, functional limitations, and approaches to minimize associated risks.

Frequent Fractures

The most common fractures in people with osteoporosis usually occur in the wrists, spine, and femoral neck.

  1. Cuffs:
    • Wrist fractures are common in people with osteoporosis, often caused by a fall on the hand.
  2. Spine:
    • Vertebral fractures, also called spinal compressions, are common. They can occur without significant trauma, but rather following low energy, such as a simple fall.
  3. Femoral neck :
    • Fractures of the neck of the femur are particularly serious and can lead to a significant loss of autonomy. These fractures often occur following a fall.

Consequences of fractures linked to osteoporosis

List of consequences
  1. Pain and Immobility: Osteoporotic fractures, often occurring at the wrist, hip or vertebrae, cause significant pain. Pain can limit mobility and affect the ability to carry out daily activities.
  2. Loss of Independence: Hip fractures, in particular, can lead to a significant loss of independence. People with osteoporosis, especially older adults, may have difficulty fully recovering after a fracture, which can lead to increased dependence on others for daily care.
  3. Medical Complications: Spinal fractures can cause medical complications, including respiratory and digestive problems. These fractures can also cause a decrease in height and deformity of the spine.
  4. Reduced Quality of Life: The physical and psychological consequences of osteoporosis-related fractures can lead to a significant reduction in quality of life. Persistent pain, limitation of activities, and changes in physical appearance can contribute to a decrease in overall well-being.
  5. Health Care Costs: Osteoporotic fractures often require intensive medical care, including hospitalizations, surgeries and rehabilitation treatments. This can result in significant costs for health systems and individuals.
  6. Fear of Falls: After a fracture linked to osteoporosis, the fear of falling can set in. This fear can lead to a decrease in physical activity, which, in turn, can worsen bone fragility.
  7. Cycle of Recurrent Fractures: People who have previously suffered an osteoporosis-related fracture are more likely to experience recurrent fractures. This can create a cycle of worsening bone health.
  8. Depression and Anxiety: Living with a fracture and the resulting physical limitations can contribute to the development of depression and anxiety. Constant pain, lifestyle changes and loss of independence can have a significant impact on mental health.
  9. Social Impact: Osteoporotic fractures can lead to reduced social participation. Individuals may avoid social activities due to pain, fear of falls, or embarrassment related to physical changes such as altered posture.
  10. Alterations in Posture and Balance: Vertebral fractures can lead to altered posture and balance, which increases the risk of falls and subsequent fractures.
  11. Need for Mobility Aids: After a fracture, some people may need mobility aids such as crutches, walkers, or wheelchairs to aid mobility and prevent further injury.
  12. Family Impact: Osteoporotic fractures can impact family members who may become caregivers, which can lead to emotional and logistical challenges.
  13. Career Interruption: For people of working age, an osteoporotic fracture can result in career interruption due to the need to take extended time off for recovery and rehabilitation.
  14. Nutritional Problems: Decreased physical activity due to a fracture can lead to nutritional problems, as the individual may have difficulty maintaining a balanced diet.
  15. Deterioration of Bone Quality: Osteoporotic fractures can accelerate the deterioration of bone quality, contributing to an increased risk of new fractures.
  16. Secondary Medical Complications: Osteoporosis-related fractures, particularly those involving the spine, can lead to secondary medical complications such as lung infections. People may be more vulnerable to infections due to impaired lung function from spinal deformity.
  17. Digestive Problems: Vertebral fractures can also lead to digestive problems, as compression of the internal organs due to spinal deformity can affect the normal functioning of the digestive system.
  18. Changes in Family Dynamics: Osteoporotic fractures can lead to significant changes in family dynamics, particularly if an elderly person is affected. Family members may need to adapt their lifestyle to provide additional support.
  19. Inability to Perform Daily Activities: Fractures can lead to an inability to perform daily activities independently, such as bathing, dressing, and even cooking. This may require constant assistance.
  20. Sexual Consequences: Vertebral fractures can influence sexual relations due to pain and change in posture. This can have implications for intimate life and the quality of relationships.
  21. Effect on Surrounding Bone Mineral Density: Fractures can impact the bone mineral density of surrounding areas, creating an increased risk of further fractures in those areas.
  22. Impact on Cardiovascular Health: Prolonged periods of immobility after a fracture can impact cardiovascular health, increasing the risk of developing problems such as blood clots.
  23. Economic Harm: Osteoporotic fractures can cause significant economic harm, with costs associated with medical care, housing modifications, and loss of income due to inability to work.
  24. Deterioration of Surrounding Bone Quality: Fractures can contribute to the progressive degradation of surrounding bone quality, creating a vicious cycle of increased bone fragility.
  25. Impact on Sleep Quality: Pain associated with osteoporosis-related fractures can disrupt sleep, leading to insomnia problems and a reduction in the quality of rest.
  26. Increased Risk of Future Falls: People who have previously suffered an osteoporotic fracture are more likely to experience future falls, which can worsen existing problems and lead to new fractures.
  27. Communication Challenges: Physical changes resulting from fractures, such as spinal deformity, can present non-verbal communication challenges, affecting the way individuals interact with their social environment.
  28. Stigma and Social Isolation: Osteoporotic fractures can cause social stigma, particularly if they cause changes in posture or physical appearance. This can lead to social isolation and decreased social participation.
  29. Impact on Self-Confidence: The physical consequences of fractures, as well as the limitations resulting from pain, can influence self-confidence. Individuals may feel less confident in their physical and social abilities.
  30. Need for Long-Term Care: Some osteoporotic fractures may require long-term care, creating ongoing challenges for individuals and their families in terms of management and coordination of care.
  31. Nutritional Challenges: People with fractures may face nutritional challenges due to the need to maintain a healthy diet to promote healing and bone health.
  32. Respiratory Problems: Spinal fractures can compress the lungs, causing breathing problems that can impact lung health.
  33. Impacts on Social Life: Physical limitations and mobility challenges related to fractures can have significant impacts on social life, including participating in social events and engaging in social activities.
  34. Emotional Cost to Family: Managing the consequences of osteoporotic fractures can also impose a significant emotional cost on the family, particularly caregivers who provide daily support.

Prevention and management

Prevention

  1. Adequate Nutritional Intake: Ensure adequate intake of calcium and vitamin D, essential for bone health. Foods rich in these nutrients and, if necessary, dietary supplements may be recommended.
  2. Regular Exercise: Encourage regular physical activity, especially weight-bearing exercises, such as walking, dancing, and weight training, to strengthen bones and improve balance.
  3. Risk Factor Assessment: Identify and assess individual risk factors such as age, sex, family history, menopause, and medications that could contribute to bone fragility.
  4. Avoidance of Modifiable Risk Factors: Encourage smoking cessation and moderation of alcohol consumption, as these factors can contribute to bone fragility.
  5. Education and Awareness: Provide information on osteoporosis, fracture risks and preventative measures to increase awareness and engagement in self-care.
  6. Home Safety Measures: Implement home safety measures, such as removing obstacles, improving lighting, and installing mobility aids to reduce the risk of falls .

Management

  1. Drug Treatment: Consider drug treatments, such as bisphosphonates, selective estrogen receptor modulators (SERMs), and anabolic agents, to strengthen bone density.
  2. Regular Medical Assessment: Conduct regular medical assessments to monitor bone mineral density, evaluate the effectiveness of treatments, and adjust management plans as needed.
  3. Physical Rehabilitation: Providing physical rehabilitation programs to help individuals recover after a fracture, with a focus on restoring mobility, strength and balance.
  4. Pain Management: Manage pain associated with fractures with medicinal and non-pharmacological approaches, such as physiotherapy and stress management techniques.
  5. Psychological Support: Provide psychological support to help individuals cope with the emotional consequences of fractures, including depression, anxiety, and changes in quality of life.
  6. Fall Prevention Training: Provide fall prevention training, including specific exercises, to reduce the risk of falls and further fractures.
  7. Care Coordination: Ensure effective coordination of care among healthcare professionals, including physicians, physiotherapists, and social workers, for a comprehensive approach to management.
  8. Continuing Education: Provide continuing education on the management of osteoporosis and related fractures for patients and healthcare professionals to promote active management.

Chronic Pain

Vertebral fractures related to osteoporosis can lead to chronic back pain. This pain often persists over time, affecting mobility, quality of life and the ability to carry out daily activities. Here are some additional facts regarding chronic pain related to vertebral fractures in the context of osteoporosis:

Characteristics of chronic pain related to vertebral fractures

  1. Location: Pain is often localized in the back region, generally in the spine.
  2. Nature of pain: Pain can vary, from dull, persistent aches to more acute episodes, particularly during movements or changes in position.
  3. Impact on mobility: People with osteoporosis-related vertebral fractures may experience limited mobility due to pain, which can lead to difficulty with daily activities.
  4. Reduction in physical activity: Due to persistent pain, individuals tend to reduce their level of physical activity, which can contribute to loss of muscle strength and general deterioration in physical fitness.

Chronic pain management

  1. Medications: Certain painkillers and anti-inflammatories may be prescribed to relieve pain.
  2. Physical therapy: Osteopathy can play a vital role in pain management by strengthening muscles, improving posture and providing pain management techniques.
  3. Adapted exercises: An adapted exercise program, focused on strengthening muscles, flexibility and improving balance, can help reduce pain and improve mobility.
  4. Supportive Devices: Using support devices, such as corsets or belts, can help relieve pressure on the spine.
  5. Education: Education about pain management, correct posture, and strategies to avoid activities that could make pain worse is often beneficial.

Height Loss and Spine Curvature

When left untreated, these fractures can lead to several complications, including:

  1. Loss of height: Untreated vertebral fractures can cause progressive collapse of the affected vertebrae. This can lead to a decrease in the overall height of the spine and, consequently, a loss of height in the affected person.
  2. Curvature of the spine (dorsal kyphosis): An untreated spinal fracture can also lead to abnormal curvature of the spine, especially in the dorsal region. Dorsal kyphosis can affect posture and create a forward curvature, giving a hunched appearance.
  3. Respiratory complications: Dorsal kyphosis can influence the position of the ribs and diaphragm, which can compromise the space available for the lungs. This can lead to respiratory complications, including reduced lung capacity, difficulty breathing, and other breathing problems.
  4. Impaired lung function: Altered position of the vertebrae can also affect normal respiratory mechanics, leading to impaired lung function. This can affect the ability of the lungs to expand and contract properly, which can have implications for breathing and oxygen saturation.

It is important to note that these complications can vary in severity depending on the location and severity of the fracture, as well as other individual factors. Early treatment of vertebral fractures is crucial to prevent or alleviate these complications. If you suspect you have a vertebral fracture or are experiencing symptoms, it is essential to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan.

Functional Limitations

Fear of fractures can lead to a reduction in physical activity, contributing to loss of muscle strength and decreased balance 4 . These functional limitations increase the risk of falls, creating a vicious cycle of potential complications.

  1. Reduction in physical activity: Fear of spinal fractures can lead to a reduction in physical activity. People can avoid activities that involve sudden movements, heavy loads, or activities with a high risk of falls. This decrease in physical activity can lead to loss of muscle strength, decreased flexibility and impaired balance.
  2. Loss of muscle strength: When physical activity decreases, muscles can atrophy due to lack of stimulation. Loss of muscle strength, particularly around the spine and lower extremities, can increase the risk of falls.
  3. Decreased balance: Reduced physical activity and loss of muscle strength can contribute to decreased balance. Good balance is essential to preventing falls, especially in older people. Balance disorders may also be exacerbated by dorsal kyphosis and other postural changes associated with vertebral fractures.
  4. Increased risk of falls: Functional limitations resulting from fear of fractures, combined with loss of muscle strength and decreased balance, increase the risk of falls. Falls can be particularly dangerous for people with brittle bones, as they can lead to new fractures or worsen existing ones.
  5. Vicious cycle: Fear of fractures can create a vicious cycle where reduced physical activity leads to functional limitations, which in turn increases the risk of falls. Falls can then reinforce the fear of fractures, leading to an even greater reduction in physical activity.

Psychological Impacts

Living with osteoporosis can have psychological repercussions, leading to anxiety, depression and impaired psychosocial quality of life 5 . Mental health management therefore becomes essential in the context of this condition.

This condition, characterized by increased bone fragility, can impact mental health, influencing various aspects of daily life. Here’s how osteoporosis can affect you psychologically:

  1. Anxiety: Fear of fractures and complications related to osteoporosis can generate anxiety in affected individuals. The constant thought of fracture risk can lead to increased apprehension in daily activities and in making mobility-related decisions.
  2. Depression: Constant worry about bone health, altered posture, and possible functional limitations can contribute to the development of depression. Physical changes associated with osteoporosis, such as loss of height and dorsal kyphosis, may also have implications for self-esteem and emotional well-being.
  3. Impairment of psychosocial quality of life: Osteoporosis can influence daily, social and professional life. Activity restrictions, possible pain and physical changes can affect social relationships, participation in social activities and general well-being.
  4. Stress: Living with a chronic medical condition like osteoporosis can cause high levels of stress. Constant disease management, necessary treatments, frequent medical visits and health-related concerns can contribute to psychological stress.
  5. Social isolation: Functional limitations and health concerns can lead to social withdrawal. People with osteoporosis may sometimes avoid social activities for fear of falls or physical discomfort, which can lead to social isolation.

Medical Complications

It is correct to say that hip fractures, especially in people with osteoporosis, can be associated with serious complications. Osteoporosis is a disease characterized by a decrease in bone density, making bones weaker and more likely to fracture. Hip fractures are often considered one of the most serious complications of osteoporosis.

Indeed, older people, particularly postmenopausal women, are more prone to osteoporosis, which increases the risk of fractures, particularly at the hip. These fractures can cause prolonged immobility, which can lead to several complications, including lung infections and pressure sores.

Prolonged immobility can cause respiratory problems such as chest infections, as lack of physical activity can cause secretions to build up in the lungs. Additionally, the risk of pressure sores, which are skin sores caused by prolonged pressure on a specific area of ​​the body, is also increased due to immobility. Pressure sores can lead to infections and additional complications.

It is important to take preventative measures to minimize the risk of hip fractures in people with osteoporosis, such as diets rich in calcium and vitamin D, appropriate exercises and drug treatments. Additionally, prompt intervention and appropriate rehabilitation after a hip fracture are essential to reduce potential complications related to immobility.

Approaches to Minimizing Risks

  • Drug Treatment: Bisphosphonates, such as alendronate, are commonly prescribed to strengthen bones and reduce the risk of fractures 7 .
  • Nutritional Supplements: Calcium and vitamin D supplements are often recommended to maintain bone health 8 .
  • Adapted Exercises: Muscle strengthening and balance exercises, under the supervision of health professionals, can help prevent falls 9 .
  • Education and Prevention: Education on preventive measures, home safety and posture management can play a crucial role 10 .

Conclusion: Living Positively with Osteoporosis

Although osteoporosis presents challenges, a proactive approach focused on prevention, pain management, and promotion of bone health can enable individuals to live positively despite this condition. Collaboration with healthcare professionals, including rheumatologists and physiotherapists, is essential for effective overall management of osteoporosis.

References

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  2. Siris ES, Chen YT, Abbott TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Archives of Internal Medicine. 2004;164(10):1108-1112. 
  3. Kopperdahl DL, Aspelund T, Hoffmann PF, Sigurdsson S, Siggeirsdottir K, Harris TB, et al. Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans. Journal of Bone and Mineral Research. 2014;29(3):570-580. 
  4. Papaioannou A, Kennedy CC, Ioannidis G, Sawka A, Hopman WM, Pickard L, et al. The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporosis International. 2009;20(5):703-714. 
  5. Silverman SL, Calderon AD. The utility and limitations of FRAX: a US perspective. Current Osteoporosis Reports. 2010;8(4):192-197. 
  6. Bouxsein ML, Szulc P, Munoz F, Thrall E, Sornay-Rendu E, Delmas PD. Contribution of trochanteric soft tissues to fall force estimates, the factor of risk, and prediction of hip fracture risk. Journal of Bone and Mineral Research. 2007;22(6):825-831. 
  7. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. The Lancet. 1996;348(9041):1535-1541. 
  8. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. The New England Journal of Medicine. 1997;337(10):670-676. 
  9. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. Journal of the American Geriatrics Society. 2008;56(12):2234-2243. 
  10. Hekmatpou D, Shamsi M, Zamanzadeh V, Hakim A, Aligholipour R, Ramzi H. The effect of educational program on knowledge, attitude, and performance of nursing students towards prevention of osteoporosis. Journal of Family Medicine and Primary Care. 2019;8(9):2856-2862. 

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