Bone diseases, like osteoporosis and osteomalacia are coming into the light with the rise in the geriatric population, and associated with complications like fractures, reduced activities of daily living. Also, there are some in the pharmaceutical industry catering to the geriatric population, and without specific knowledge on their conditions/ailments, patients are sometimes duped by unscrupulous individuals. So here, we will try to see what exactly are these two conditions, how they occur and how they present, what we can do to prevent it and treat it, and finally what are the complications expected out of these conditions.
Osteoporosis, the most common type of bone disease, is caused by the thinning of bones and loss of bone density over a time. Osteoporosis occurs when the body fails to form enough new bones or when too many old bones are reabsorbed by the body, or it may be due to both. Two essential minerals for the formation of bones are calcium and phosphate. During youth, our bodies produce bones. If we do not get enough of calcium, or if our bodies do not absorb enough calcium from our diet, the bone production and bone tissues get affected. Menopauses, being bed bound, chronic kidney disease, rheumatoid arthritis, long term steroids, etc. are some of the causes which promote osteoporosis. This is relatively symptomless in early stage, and in late stages, they present with bone pain, loss of height, non traumatic fractures, neck pain and kyphosis. The management principles are based on analgesia for bone pain, slow down or stop bone loss, prevent bone fractures and treat concurrent condition, which may lead into falls. Taking dietary supplementation of vitamin D and calcium from an early age and refraining from long term use of corticosteroids will prevent future osteoporosis. Drugs like bisphosphonates, calcitonin, and hormone replacement therapy are some of the treatment options. Prevention of further osteoporotic fractures is the main aim, and this can be complicated with bone fractures of vertebrae, wrist and hip, leading to neurological problems and difficulty in walking.
Osteomalacia occurs due to lack of vitamin D in the body or inability to absorb it, leading to impaired mineralization of the bones. This may be due to inadequate vitamin D in the diet, inadequate exposure to the sun, or inability to absorb from intestines. It may also occur in liver disease, kidney disease, neoplasms, and due to medications. They will present with bone pain, muscle weakness, fracture, abnormal heart rhythms, spasms of the limbs, etc. Treatment may involve vitamin D, calcium, and phosphorus supplements, taken by mouth. If the body cannot properly absorb nutrients into the intestines, then a larger doses of vitamin D and calcium may be recommended. Improvement can be seen in 2 weeks time, and complete healing may take 6 – 8 months. Recurrence of the disease is a possible complication.
What is the difference between Osteoporosis and Osteomalacia?
Both diseases involve the bone structure and weakness of it due to different mechanisms, associated with systemic illness like liver and kidney disease, and anticonvulsant drugs. Bone pain and fractures are common to both. Osteoporosis is due to reduced bone density and osteomalacia by impaired mineralization. Osteomalacia has neuromuscular manifestations, as well. OP is preventable early on, and once acquired only preventions of complications and further deterioration can be done. OM can be managed with supplementation of the deficient component, to have a full recovery.