End-Stage Osteoporosis: Causes, Symptoms, Diagnosis, and Treatment

1. Introduction

   Explanation of What Osteoporosis is and its Prevalence

   Osteoporosis is a medical condition that occurs when the body loses bone density and gets fragile and prone to fracture. Mostly it is a silent disease and does not show up any symptoms until a fracture occurs.

   Bone is a tissue that is constantly broken down and replaced by new bone tissue. In osteoporosis, bone loss outpaces new bone growth and causes a decrease in bone mass and density over a period of time.

   Osteoporosis is most commonly diagnosed in elderly people and in females after menopause. Other factors increasing the risk of developing osteoporosis include: 

   • Family history of the disease
   • Deficiency of vitamin D and calcium
   • Smoking
   • Consuming alcohol in excess and having a sedentary lifestyle

   Definition of End-Stage Osteoporosis

   End-stage osteoporosis is not a medical term, it is stage 4 or severe osteoporosis associated with significant pain, impaired mobility, and stooped posture. A person with stage 4 osteoporosis has a bone mineral density score of more than 2.5 deviation below the healthy average for young adults. There is a higher risk of falls and experiencing fractures. The stages of osteoporosis are decided on the bone density numbers to assess how severe the condition is. The staging of Osteoporosis is as follows ⁽¹⁾:

   • Stage 1: In stage 1 the bone mineral density numbers are similar to those of a young person.
   • Stage 2: The person with stage 2 osteoporosis has a bone mineral density 1-2.5 deviation below the healthy average for a young adult.
   • Stage 3: In this stage, the person is known to suffer from osteoporosis and bone mineral density that has more than 2.5 deviation below the adult average.
   • Stage 4: It is a severe osteoporosis stage in which the person has had a fracture and the bone mineral density has a deviation of more than 2.5 below the adult average.

2. Causes of End-Stage Osteoporosis

   There are several causes that may contribute to increasing the risk of severe bone loss and fractures. These factors include:

   • Age-Related Bone Loss: As a person gets older, bone density decreases naturally making them more susceptible to osteoporosis and fractures.
   • Hormonal Changes: There are certain medical conditions that affect the hormone levels of a person and contribute to osteoporosis. One such condition is hypothyroidism. Also, in females after menopause there is a decrease in estrogen levels, contributing to osteoporosis ⁽²⁾.
   • Medical Conditions Affecting Bone Health: Certain medical conditions that affect hormone levels and calcium metabolism contribute to the development of osteoporosis. These include hyperparathyroidism, hyperthyroidism, Cushing syndrome, multiple myeloma, rheumatoid arthritis, and anorexia nervosa ^{(3, 4, 5)}.
   • Lifestyle Factors: Lifestyle factors such as diet, physical activity, habits including smoking and alcohol consumption, and other unhealthy behaviors can increase the risk of osteoporosis and bone loss ⁽⁶⁾.

   The above factors may increase the chances of suffering from bone loss or severe osteoporosis. Still, there are treatments that can help reduce the risk.

3. Symptoms of End-Stage Osteoporosis

   Most people with osteoporosis may not show any symptoms unless their bones get very weak ⁽⁷⁾.

   Some of the common symptoms of end-stage osteoporosis include:

   • The bones in end-stage osteoporosis get very brittle and break easily. Even minor falls or accidents lead to fractures.
   • The weakened bones may cause chronic pain mostly in the back, hip, and other weight-bearing joints.
   • Compression of the spine can lead to height loss.
   • There may be spinal deformity or hunched back also known as kyphosis in some people.
   • The hunched posture may compress the digestive system and lead to digestive problems such as bloating and constipation.
   • The person may have limited mobility making it difficult to perform daily activities.
   • Some may also suffer from dental problems including tooth loss and gum disease. Some may even face difficulty in getting dental procedures including those involving bone.

   Not everyone with osteoporosis experiences the same symptoms. The symptom of end-stage osteoporosis may vary from person to person.

4. Diagnosis and Treatment of End-Stage Osteoporosis

   Diagnostic Tests

   There are several diagnostic tests that can be helpful in diagnosing end-stage osteoporosis. These tests help in assessing bone density and bone strength and the risk of fracture.

   • X-rays: These help in detecting any fracture or structural changes in the bone.
   • Dual-Energy X-Ray Absorptiometry (DXA) scan: This test is most commonly used to check bone density. In it, a low dose of an X-ray is used to measure the amount of bone mineral in the hip, spine, and other areas.
   • CT scan: This imaging test can help detect fractures and other structural changes in the bone. It can also assess the health of soft tissues.
   • Bone Biopsy: It involves removing a small sample of the bone tissue and assessing it for bone quality.

   Medications Used to Treat Osteoporosis

   There are several medications used in the treatment of osteoporosis, which include bisphosphonates, calcitonin, sclerostin inhibitors, various hormone therapies, and rank ligand inhibitors ⁽⁷⁾. Hormone therapies such as estrogen therapy can be used to prevent and treat osteoporosis in postmenopausal women. It works by reducing bone loss and increasing bone density.

   Non-Drug Therapies

   • Physical therapy: It involves an exercise program that can be safe and effective for individuals with severe osteoporosis. The exercises target improving strength and flexibility.
   • Nutrition Counseling: Adequate nutrition is important for end-stage osteoporosis as it can get exacerbated with malnutrition. A dietician can help develop a balanced diet including plenty of calcium and vitamin D and other nutrients essential for bone health.
   • Assistive devices: These include walkers, orthotics, and canes that can help an individual to walk.

   Surgery in Severe Cases

   Surgery in cases that are difficult to manage with medication and non-drug therapy include:

   • Joint replacement surgery including hip and knee replacement surgery.
   • Corrective surgery to improve function and quality of life.
   • Spinal fusion stabilizes the spine and reduces the risk of fractures.
   • Vertebroplasty or kyphoplasty involves the application of a special type of cement to the vertebra to stabilize and strengthen it.

5. Prevention of End Stage Osteoporosis

   Preventing osteoporosis involves maintaining bone health throughout life. This may involve:

   • Increasing intake of calcium and vitamin D that is age-appropriate.
   • Exercising regularly can be helpful in improving bone density
   • Quitting smoking as it also contributes to bone loss and increases the risk of fracture.
   • Limiting alcohol intake to control the risk of bone loss and risk of fracture.
   • Preventing falls by making changes in the home environment and installing handrails.

   Prevention is key, but for those diagnosed with osteoporosis need to take steps to manage the condition and reduce the risk of complications. A healthcare provider can develop a personalized plan based on individual needs.

6. Living with End-Stage Osteoporosis

   Coping with Chronic Pain and Mobility Changes

   The person can work with the healthcare provider and develop a pain management plan which may include using anti-inflammatory drugs, opioids, and other pain medications. Exercise and physical therapy can be helpful in dealing with mobility changes ⁽⁸⁾.

   Assistive devices can be used to move around. Also, certain modifications can be made at home to prevent falls and make movement easier.

   Psychological Impact of End-Stage Osteoporosis

   End-stage osteoporosis can have a psychological impact on individuals. It may lead to frustration, helplessness, and depression. As it limits one’s ability to participate in activities, it may cause social isolation and feeling of loneliness.

   Chronic pain may also lead to anxiety, fear, and anticipation, which may negatively affect mental health.

   Because of all this, it is important for people with end-stage osteoporosis to seek emotional support from healthcare providers and family members.

   Participation in support groups can also provide a sense of community and connection.

   A positive outlook and finding joy in activities can help in alleviating the psychological impact of any health condition.

7. Conclusion

   End-stage osteoporosis is not a medical condition and neither is it a serious condition. It can impact a person physically, emotionally, and socially.

   The condition can lead to mobility changes that can also bring frustration, depression, and helplessness. Treatment involves a multidisciplinary approach to treatment.

   Pain management, exercise, and physical therapy can help alleviate chronic pain and improve mobility. Assistive devices and home medications make it easier and safe to move around in the house.

   It is important for people with end-stage osteoporosis to focus on what they can do and find joy in it. Practicing mindfulness techniques such as meditation and deep breathing can help in managing stress and anxiety.

   People with osteoporosis should work with a healthcare professional to go ahead with the right course of treatment and reduce the risk of complications.

Also Read:

• Corticosteroid Induced Osteoporosis: Causes, Symptoms, Tests, Treatment- HRT, Tamoxifen
• Hormonal Causes of Osteoporosis and Its Treatment
• Osteoporosis Diet: Good and Bad Foods for Osteoporosis
• How Does Yoga Help with Osteoporosis?
• What is Senile Osteoporosis: Types, Causes, Symptoms, Treatment, Complications, Prevention
• Effects of Osteoporosis & Can it be Reversed?
• 10 Natural Ways to Reverse Osteoporosis
• Best Medications for Osteoporosis