What Does the Osteoporosis Clinic Aim to Achieve?

The Osteoporosis Clinic aims to: Diagnose osteoporosis (bone thinning) Identify the causes of osteoporosis Educate osteoporosis patients on rehabilitation principles they need (such as diet regulation, teaching exercises, fall prevention, and reducing risk factors) Manage the regular follow-up of patients Inform the public about principles for osteoporosis prevention Plan and monitor cause-specific treatments for osteoporosis Collect necessary documents and statistical information for publication

Working Procedure

• For patients visiting the outpatient clinic, necessary inquiries and examinations are conducted for osteoporosis. Risk factors are identified.
• BMD (Bone Mineral Density) testing is requested for all patients who have entered menopause or have any of the risk factors listed below.
• X-rays of the back and lumbar spine are requested to check for fractures.
• Routine blood and urine tests are conducted to identify secondary causes that may lead to osteoporosis.
• If necessary, bone formation and resorption markers, as well as advanced laboratory tests, are requested.
• The required tests mentioned above are repeated periodically as needed.

Osteoporosis Working Group

• Physical Medicine and Rehabilitation Specialist
• Endocrinology and Metabolic Diseases Specialist
• Geriatrics Specialist
• Nutrition and Diet Specialist
• Physiotherapist

What is Osteoporosis?

Osteoporosis is a systemic disease that weakens the entire skeletal system, occurring when the hardness of the bones in our body decreases and their quality deteriorates, making them more fragile and prone to fractures. Due to the increasing life expectancy and an aging population, osteoporosis has become one of the most common diseases today. Studies show that one in three women and one in five men over the age of 50 will experience a fracture at some point in their lives, and experts emphasize that prevention is the best treatment.

Symptoms, Diagnosis, and Treatment of Osteoporosis

The most significant symptom of osteoporosis is fractures. A common misconception about osteoporosis is that it causes pain; however, osteoporosis-related pain is quite rare unless a fracture occurs. Fractures in the spine can lead to a decrease in height, postural deformities, and kyphosis (hunching). As kyphosis develops, bones press on the abdominal and chest areas, negatively affecting organs in these regions and disturbing the patient's body image. This can lead to psychological issues, causing osteoporosis patients to withdraw from social life.

Why is Osteoporosis Important?

• It is considered the most common bone disease.
• With increased life expectancy, the aging of the global population has led to a significant rise in the incidence of osteoporosis and osteoporosis-related fractures.
• It has become a significant economic and social problem today.
• It is a preventable and treatable disease.
• In the U.S., about half of people with osteoporosis or low bone density are unaware of their condition.
• Osteoporosis causes 1.5 million fractures annually in the U.S., including 300,000 hip fractures, 700,000 spine fractures, 250,000 wrist fractures, and 300,000 other fractures.
• About 20% of people with hip fractures die within the first year, and more than 30% are left disabled.
• Lifetime mortality risk in postmenopausal women aged 50: Coronary heart disease 31%, hip fracture 2.8%, breast cancer 2.8%, and uterine cancer 0.7%.
• Worldwide hip fractures: 1.7 million in the 1990s, expected to reach 6.3 million by 2050.

Is Osteoporosis Only Seen in Women?

While osteoporosis is known to affect women predominantly, it is also a significant health issue for men. Aging is the most recognized risk factor for osteoporosis. Although advances in diagnosing and treating diseases in the current century have extended average life expectancy, osteoporosis ranks high on the health agenda, as its incidence increases with age. With the aging global population, there has been a significant rise in osteoporosis and related fractures. Today, death from hip fractures ranks third after deaths due to heart disease and cancer.

Should Men Be Screened for Osteoporosis?

Studies show that one in three women over 50 and one in five men over 50 will experience a fracture at some point in their lives, with experts stressing that "prevention" is the best treatment. Experts recommend that all women over 65 undergo osteoporosis screening, and it is generally advised to have bone density measurements between the ages of 45-50. In addition, postmenopausal women under 65 who have additional osteoporosis risk factors or have recently experienced a fracture should also be screened.

On the other hand, there is no official guidance on when men should undergo osteoporosis screening. However, some experts recommend routine osteoporosis screening for certain older men. According to a recent study published in the Journal of the American Medical Association, routine testing and treatment for osteoporosis are also necessary for specific elderly men. The study used a computer program to predict hip fracture risk in men over 65, the group at highest risk for osteoporosis. It calculated both direct and indirect medical costs associated with osteoporosis fractures, such as decreased productivity. The study concluded that routine bone mineral density testing should be conducted in men over 65 with early fractures and that routine testing is essential for men over 80, regardless of fracture history.

When Does Bone Loss Start in Osteoporosis?

Bones are actually living tissues that are constantly renewed through processes of formation and resorption. This balance between building and breaking down of bone continues harmoniously in women until around age 30, after which resorption gradually outweighs formation. Starting from the peak bone mass achieved around age 30, women begin to experience an irreversible bone loss of approximately 0.5% annually. This loss accelerates significantly after menopause, and the amount of bone tissue lost is one of the most critical factors determining whether a woman will suffer from fractures in the future

Which Organs Are Affected by Osteoporosis?

Osteoporosis primarily affects the vertebrae, which bear the body's weight. Around 47% of osteoporosis cases are observed in the spine, 20% in the hip, 13% in the wrists, and 20% in other bones. Compression fractures in the vertebrae can lead to height reduction, especially in older age. Fractures that can be fatal may occur in the hip and other bones even from minor falls or sometimes spontaneously.

What Are the Consequences of Osteoporosis?

The most significant consequence of osteoporosis is fractures and the resulting disabilities. Among individuals over age 50, the risk of fractures—particularly in the hip, spine, and wrist—is estimated to be 40% in women and 13% in men. These statistics show that four out of ten people over age 50 are at risk of fractures in these areas. The financial and social impact of fractures is substantial, with approximately 1.5 million fractures occurring annually in the United States alone. Among these, 300,000 are hip fractures, 700,000 are spine fractures, 250,000 are wrist fractures, and 300,000 are other types of fractures. Around 20% of hip fracture patients do not survive the first year after the fracture, and over 30% are left permanently disabled. The number of hip fractures, estimated to be 1.7 million in the early 1990s, is expected to reach 6.5 million by 2050.

What Are the Risk Factors for Osteoporosis?

Risk factors for osteoporosis are categorized as major and minor. The most prominent major risk factor is low bone density. Therefore, it is recommended that women between the ages of 45 and 50, typically the onset of menopause, undergo a bone density test at least once. After assessing risk factors, the frequency of these tests should be determined by a physician.

Another risk factor is age. For two patients with the same bone density, one aged 50 and the other 80, the risk of fractures differs greatly, as bone quality declines with age. Regardless of density, a decrease in quality increases fracture risk. Unlike previous understanding, assessing fracture risk now includes examining the bone’s microarchitecture and quality, not just its density.

Previous fractures also increase the risk of new fractures. If a patient has had a vertebral fracture, the risk of another vertebral fracture within one year is five times higher, and the risk of a hip fracture within three years doubles. If a mother, sister, or aunt has a history of fractures, the risk of a new fracture within one year increases by 1.5 to 2 times.

Minor Risk Factors in Osteoporosis

The primary minor risk factor for osteoporosis is gender. Four out of every five fractures occur in women. White women also have a much higher risk of fractures compared to African women. Genetic factors are believed to impact bone structure by 70-80%. High caffeine intake, prolonged use of corticosteroids and medications used in thyroid treatment also contribute to osteoporosis risk. Estrogen deficiency is another factor that triggers osteoporosis.

Early menopause, whether due to natural causes or surgical intervention, disrupts the balance in bone formation in favor of resorption. Therefore, women who enter menopause for any reason at age 38 or earlier should be closely monitored for osteoporosis. Additionally, thyroid issues, severe liver and kidney diseases, and certain rheumatic diseases are also considered minor risk factors.

How Is Osteoporosis Diagnosed?

The gold standard for diagnosing osteoporosis and monitoring treatment is measuring bone mineral density (BMD). Additionally, patients are routinely asked to have spinal X-rays to check for fractures. Blood and urine tests are also important to investigate other diseases that might contribute to osteoporosis.

How Is Osteoporosis Treated?

In the past, hormone therapy was the primary treatment for osteoporosis. However, this approach is not widely recommended anymore. Hormone therapy should only be used during periods of intense menopausal symptoms, such as sweating, hot flashes, insomnia, and irritability. Otherwise, hormones do not play a role in osteoporosis treatment. The goals of osteoporosis treatment are to prevent fractures, maintain or increase bone mineral density, alleviate symptoms related to fractures and posture problems, and improve quality of life by maximizing daily activities. Instead of hormones, other options are preferred, including bisphosphonates, elements like strontium, selective estrogen receptor modulators (SERMs), calcitonin, parathyroid hormone, and plant-based estrogen supplements. Treatment should also include calcium, the main component of bone, along with vitamin D to enhance calcium absorption.

Preventing Osteoporosis

• Preventing falls
• Maintaining a balanced diet
• Promoting physical activity and exercise
• Avoiding risk factors
• Ensuring adequate calcium intake
• Ensuring adequate vitamin D intake