The Skeleton in the Cupboard: osteoporosis and other bone diseases

One rarely comes home after a busy day and says: ‘Gee, my bones were working well today.’ No, we don’t. We worry about things we can see – like a mountainous pimple just before an important date, or an expanding waistline, or a broken nail, or a bloodshot eye. But we rarely think about our bones, moving us through life with the smooth articulation of a myriad of joints working in perfect unison.

We don’t give them a thought. Until something goes wrong and we are suddenly made aware of this internal and delicate network that gives us such superb structure and mechanical mobility in every movement of our day. But being aware of our bones, and giving them the right care from as early as possible, could prevent a variety of discomforting and disabling diseases or provide early recognition of a problem.

Bone diseases

Osteoporosis: Probably the chief culprit in bone disease, osteoporosis is a deteriorating bone disease that occurs when the body loses too much bone or makes too little bone, or both. It is often a disease of old age but can present in anyone at any age, depending on circumstances. Genetics, diet, lifestyle, lack of exercise, smoking, certain medications… are all contributory factors which can compromise both healthy and aging bones. As a result, bones become weak and may break from a fall or even under minor stress such as turning over in bed or even sneezing. Osteoporosis is often called a silent disease because one can’t feel bones weakening, there is rarely pain involved, and breaking a bone is often the first sign that you may have osteoporosis.

Paget’s Disease: Paget’s disease is a disorder of cells called osteoblasts and osteoclasts. These are the cells responsible for breaking down, rebuilding and remolding bone tissue. This process is at work all our lives, more busily when we are young, but gradually declining the rebuilding as our skeleton ages. This is a normal process. However, due to abnormal structural development, Paget’s disease can cause bones to become thickened and enlarged but also brittle.

Osteogenesis Imperfecta: A genetic disorder characterised by brittle bones that break or fracture easily. It is caused by a gene defect in the production of collagen, a protein that is needed to make bones strong. Osteogenesis Imperfecta can even affect bones in the inner ear and can cause hearing loss, as well as weak teeth and a curved spine.

Bone Cancers: Bone cancer may be due to a primary cancer that begins in the bone or spreads to the bone as secondary cancer from another part of the body such as cancer in the lungs, breast or prostate. There are several types of primary bone cancers such as leukemia, osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma and chondrosarcoma.

Rickets: This affects young children and is caused by a deficiency of Vitamin D. Rickets causes weak, brittle bones that fracture easily, along with muscle pain. It is entirely preventable and the keys are plenty of play in fresh air under sunshine whenever possible. In adults a prolonged vitamin D deficiency causes osteomalacia.

Perthes’ Disease: A disease affecting the hip joints in children. The femoral head, the joint area on the long bone in the upper leg, deteriorates due to a lack of blood supply. It is a condition both painful and crippling.

Important differences between osteoporosis and other bone diseases

Osteoporosis and Arthritis

Osteoporosis refers to loss of bone tissue that leaves bones less dense and more likely to fracture. It can progress undetected for many years without symptoms until a fracture occurs. However, over time, the disease can cause loss of height, resulting in back pain and change in one’s posture. Arthritis on the other hand, affects specifically the joints and surrounding tissues, such as the knees, wrists, fingers, toes, and hips. Two common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is a painful, degenerative joint disease that often involves the hips, knees, neck, lower back, or small joints of the hands. It is usually the result of repeated use of a joint through a repetitive task such as typing or playing sport such as tennis. Eventually this repeated impact causes the cartilage of the joint to thin and wear away, leaving bones to rub together. Joint flexibility is reduced, bony spurs develop, and the joint swells. And there is considerable pain arising from this condition.

Rheumatoid arthritis is an autoimmune inflammatory disease that usually involves various joints in the fingers, thumbs, wrists, elbows, shoulders, knees, feet, and ankles. An autoimmune disease means that the body releases enzymes that attack its own healthy tissues. When one develops rheumatoid arthritis, these enzymes destroy the linings of joints, causing pain, swelling, stiffness, malformation, and reduced movement and function.

Osteoporosis and osteopenia

Osteopenia is a less drastic form of osteoporosis. The difference between osteopenia and osteoporosis is basically the measurement of the degree of decreased bone density. There is less decreased bone density than if diagnosed with osteoporosis. Osteopenia can lead to osteoporosis, but it may remain a milder condition and therefore not require aggressive treatment. Osteoporosis is more serious because of the danger of bone fractures. All people begin to lose bone mass after the age of 30, when peak bone mass is reached. However, some people who have osteopenia may not have bone loss – they just may naturally have a lower bone density.

Osteoporosis and Paget’s disease

Paget’s disease is a chronic, painful disorder that can result in enlarged and misshapen bones. The excessive breakdown and formation of bone tissue causes affected bone to weaken, resulting in misshapen bones, fractures, and other bone and joint problems. Typically, it affects just one or a few bones, as opposed to osteoporosis which affects all the bones in the body. There is a similarity to osteoarthritis but they are distinctly different disorders. However, Paget’s disease can cause osteoarthritis. Some reading may help in understanding the differences:

Distinguishing Between Paget’s Disease and Osteoarthritis

So, keep an eye on your bones. Well… as best you can. After all you’ve got to live with them all your life. Love your bones, because wherever you go and whatever you do, they’ve got your back.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only nonprofit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za