Relatyv

Osteoporosis is diagnosed in over three million people every year and remains a major health concern for 54 million Americans. 

But despite how widespread this condition is, its “silent” nature makes it difficult to diagnose and treat. Indeed, besides living on a daily basis with osteoporosis pain, patients are often unable to self-diagnose the origin of their pain and typically get their self-diagnosis wrong.

In most cases, Osteoporosis pain typically presents as back pain, making it very difficult for a patient to know the cause. To make things worse, in addition to uncertain self-diagnoses, patients also must grapple with trusting their doctor’s diagnosis and their recommended treatments. 

Even for doctors, osteoporosis related pain can be a condition difficult to diagnose because of its several risk factors and symptoms. Having a thorough understanding of the causes and treatment options available for osteoporosis can help doctors ease the burden of this disease  – and support patients in their choice of therapy. 

In this guide, we’ll dive deep into the nature of osteoporosis and explore how neurofunctional pain management can provide a safe and natural alternative to traditional treatments.

Understanding The Damage Caused By Osteoporosis

The easiest way to understand the condition is to break down the parts of the word “osteoporosis”: osteo- meaning bone, and porosis- meaning filled with holes.

It might be hard to imagine a bone being filled with holes like a sponge because our bones appear smooth and relatively solid. However, the holes that riddle the bone are not on the surface but on the inside. 

Understandably, any structure would weaken if it were filled with holes. This is why many compare the condition of osteoporosis to termites and how they slowly weaken the wooden frame of a well-constructed house. 

Eventually, the termites wear the house down to the point where several other essential parts of a home are affected. Much like termites, osteoporosis is difficult to notice without proper and careful diagnosis.

Patients with osteoporosis, after knowing the structure of their bones and how it manifests underneath the surface of the bone, can begin to see why it is so difficult to diagnose osteoporosis related pain.

Why Osteoporosis And The Pain It Causes Are Hard To Diagnose

Today, the rates of untreated or undiagnosed osteoporosis cases are as high as ever. In a 2020 study, over 22% of women with postmenopausal osteoporosis did not receive treatment for their condition. On the other hand, while osteoporosis accounts for over 2 million broken bones in the US, over 80% of patients with fractures are not tested or treated for osteoporosis. 

Fortunately, thanks to recent advances in medicine, doctors and patients can now access new, more accurate diagnostic tools. 

However, understanding the risk factors and symptoms of osteoporosis should remain a priority for healthcare providers. In turn, this can help patients obtain a reliable diagnosis before they begin to suffer from fractures and pain. 

Here is an overview of the medical research available today on osteoporosis and osteoporosis pain. 

Low Screening Rates For Osteoporosis

According to a 2022 study, only around 20% of female participants were screened for osteoporosis within 2 years before a bone fracture, and only 20% of those screened received accurate treatment for their condition. 

Additionally, despite official recommendations by the U.S. Preventive Services Task Force, screening rates of osteoporosis remains low among eligible patients. These same patients are even less likely to be screened for low bone mineral density and increased risk of fracture closer to the time of fracture. Among women aged 65 to 79 (high-risk group), screening rates in primary care were as low as 12.8% in 2020.

The Use of Imaging Tools For Osteoporosis Screening

There are common risk factors that make osteoporosis much easier to identify.

In a 2018 study evaluating the prominence of osteoporosis and its developing diagnostic methods, Dr. Palak Choksi and his associates with the University of Michigan found that “[t]wo million osteoporosis fractures occur in the U.S. each year costing approximately $19 billion. 

Despite the medical and economic costs of fragility fractures, osteoporosis screening is often overlooked and viewed as a low priority. Dual-energy X-ray absorptiometry (DXA) was introduced in the mid-1980s as a rapid and safe imaging modality to estimate bone mineral density (BMD) and predict skeletal fracture risk. 

Up until the widespread use of DXA, patients at high fracture risk were not easily identified and effective osteoporosis medications were limited. Today, not only are DXA scanners utilized in hospital radiology departments, but they are also found at many physician group outpatient clinical practices” (2018). 

While patients might take comfort in knowing there is a technology (like the DXA scanner that measures bone density) for osteoporosis, they might also consider that they might not be identified before a DXA screening. In this case, most patients will either find out about their osteoporosis through general pain or a fracture.

Dr. Choski and his associates continue and attest to the impressive structure of the human bone by explaining that “[t]he determinants of bone strength are complex but can be divided into four basic components: size, shape, architecture and composition. Bone has a unique ability to coordinately adjust these traits. 

This results in a structure that is sufficiently stiff to resist habitual loads but minimizes mass, keeping the overall energy of movement to a minimum. The overall strength of a bone depends on the proportion of cortical and trabecular tissues, their morphologies and their material properties, and the interactions among these traits. 

An individual’s unique genetic program also contributes to bone strength; it is estimated that up to 70% of ultimate bone strength and structure is genetically determined”.

The “Silent Disease”: Why Are Osteoporosis Symptoms Hard to Diagnose

One of the factors that make osteoporosis so hard to diagnose is that patients are unable to notice its symptoms before they experience a bone fracture, which commonly takes place in the wrist, hip, or spine. 

Additionally, osteoporosis tends to be painless until a bone is broken. Once a fracture happens, the disease makes it harder to heal, which can lead to long-term pain. Beyond simple pain and discomfort, osteoporosis can also lead to a loss of height and a stooped or hunched posture, which is known as kyphosis (“dowager’s hump”).

The fact that symptoms tend to only appear after a broken bone, coupled with the low screening rates for bone density, causes patients to only receive an accurate diagnosis for their pain after a fracture.

Known Risk Factors For Osteoporosis

Having a clear understanding of which lifestyle and genetic factors lead to a heightened risk of osteoporosis is critical to choose an adequate disease management program. 

In particular, for patients who are at greater risk of declining bone density (such as women over 50) learning the root causes of this condition can prevent recurring fractures and their complications.

Today, the body of research agrees that the human bone will retain its strength based on a number of factors categorized by both risk and treatment. 

In addition to the contributors to bone strength mentioned by Dr. Choski, there are unfortunately several risk factors associated with osteoporosis. 

Some of these risk factors associated with bone density and strength may be mitigated by a change in lifestyle while others are immutable. 

For example, women over 50 are four times more likely than men of a similar age to develop osteoporosis Additionally, being older, having a small body frame, and holding a family history of low bone density can increase the risk of bone loss and fractures.

Nonetheless, there are many risk factors that can be changed and reduce the likelihood of diagnosis include diet, exercise, and sometimes a change in medications that might worsen the condition.

Let’s look at these factors in more detail below.

Common Risk Factors For Osteoporosis

It is common that patients who have a slight or small frame, are postmenopausal, and are over the age of sixty have a greater risk of being diagnosed with osteoporosis. It must be understood that patients who would otherwise seem healthy cannot change the immutable risk factors of age, frame, or sex. 

In a 2018 article summarizing the risk factors associated with osteoporosis, Dr. Farkhondeh Pouresmaeili determined that “[t]he genetics of osteoporosis represents one of the greatest challenges and the most active area of research in bone biology. It is well established that the variation in BMD is determined by our genes. 

Several candidate gene polymorphisms in relation to osteoporosis have been implicated as determinants of BMD . . . Osteoporosis is a challenging human disease. In spite of using various therapeutic approaches for the prevention or treatment of osteoporosis, their side effects are undeniable. 

Increasing our knowledge about the signaling pathways involved in bone remodeling will help us to design new therapeutic options for osteoporosis” (2018). Either way, as fixed risk factors such as age increase, the likelihood of diagnosis with osteoporosis increases.

Dietary Risk Factors

Since our bones are made up of porous tissues of calcium, the introduction of calcium vitamin D and magnesium to a patient’s diet early on is likely to decrease the risk of being diagnosed with osteoporosis. In the same way, making a change to a more active lifestyle will increase bone strength and density, also decreasing the likelihood of osteoporosis.

More specifically, our diet has a profound impact on the overall wellness and strength of the bones. Here are three of the main factors that can lead to osteoporosis among other complications:

• Low Calcium Intake – Calcium is the principal component of the human body, and has the role of maintaining the bones strong, giving them shape, and managing a reservoir of minerals necessary for other body functions. Healthy calcium levels also support the contraction and expansion of blood vessels, thus influencing blood flow and muscle health. A significant calcium deficiency for long periods of time can reduce bone density and slow down the bone’s regeneration process, thus leading to an increased risk of fractures and osteoporosis. 
• Eating Disorders – Patients with unaddressed eating disorders might be more prone to developing osteoporosis. This is because restricting calorie intake for long periods of time and being underweight can lead to severe nutritional deficiencies (i.e.: calcium and vitamin D), thus affecting bone strength. A 2019 study shows that 20-30% of patients with anorexia nervosa also had low bone density. 
• Gastrointestinal Surgery – Although gastrointestinal surgery does not directly cause nutritional deficiencies, it can interfere with how the body absorbs and metabolizes nutrients. This happens because some gastrointestinal surgical procedures involve the removal of a part of the stomach, which reduces the size of the intestinal surface in charge of absorbing nutrients.

Hormone-Related Risk Factors

Hormones and hormonal changes can have a significant impact on bone density and bone health. Because of this, low bone density and osteoporosis are more likely in people that have too much or too little of one or more hormones. 

• Sex Hormones – Changes in the levels of sex hormones, such as estrogen and testosterone, can impact bone density. In women, menopause represents the major risk factor for developing osteoporosis. This is because estrogen plays a role in slowing down the natural breakdown of the bone to release minerals (bone resorption). When estrogen levels drop in menopause, bones begin to break down much faster than they regenerate. Similarly, testosterone deficiency in men (which might be caused by certain medications for prostate cancer) can decrease bone mineral density.
• Thyroid Disorders – The thyroid covers an important role in all metabolic processes in the human body, including setting the rate at which the old bone tissue is replaced by a new one. In the case of an overactive thyroid, too much thyroxine (the thyroid hormone) is produced. In turn, thyroxine speeds up the rate of bone loss. This can also happen in people taking medications to manage an underactive thyroid. 
• Gland Overactivity – Dysfunction of other hormone-producing glands or problems affecting the endocrine system can also lead to faster bone loss. In particular, overactive pituitary, parathyroid, and adrenal glands  – which produce hormones in charge of regulating growth and metabolism  – can lead to low bone density. 

Medication Use

Some medications and pharmaceutical therapies can have an adverse effect on bone density and speed up the rate at which bones break down, especially in older age. In particular, patients should be aware of the impact of the following treatments on their musculoskeletal system:

• Long-Term Steroid Use – High doses of steroids (such as taking prednisone at doses of 7.5 mg per day or more) over a long period of time can have a negative effect on bone health. These medications alter how the body absorbs calcium and vitamin D, as well as how fast these nutrients are used. In turn, this can cause bones to break down more rapidly. Cortisone-induced osteoporosis occurs in 30-50% of patients taking glucocorticoid (a type of steroid hormone). 
• Seizure Medication – High doses of anti-epileptic drugs can increase the body’s production of certain enzymes, which speed up the rate at which the body uses and destroys Vitamin D. In turn, Vitamin D deficiencies interfere with how calcium is absorbed, thus leading to bone loss. 
• Gastric Reflux Medication – Medicines used to ease gastroesophageal reflux disease (which are called proton pump inhibitors) may cause a decline in bone density. This is because these medications reduce the amount of stomach acid produced by glands in the stomach lining, which has been seen to facilitate calcium absorption. 
• Cancer Drugs – Chemotherapy and exposure to radiation can have multiple effects on bone health. In women, chemotherapy can drop estrogen levels, which can lead to early menopause and increase the risk of osteoporosis. Additionally, cancer treatments might trigger a process known as cellular senescence (permanent cell growth arrest) which might impact bone density. Lastly, drugs such as doxorubicin and cisplatin can reduce calcium levels in the body. 
• Anti-Transplant Rejection Medication – These medications are administered to prevent a patient’s body from rejecting an implanted organ, and they act as immunosuppressants. Although not all anti-transplant rejection medications cause bone weakness, some (such as prednisone and tacrolimus) can increase the rate at which bone tissue is lost.. 

Other Medical Conditions

Some medical conditions can affect the rate at which bone tissue is replaced, speed up bone loss, and impact how the body absorbs calcium. In particular, you might be at greater risk of developing osteoporosis if you have one of the following medical conditions: 

• Celiac Disease – In people with celiac disease, the body responds to food containing gluten by attacking the small intestine’s lining. In turn, a damaged stomach lining can negatively impact how the body absorbs calcium and Vitamin B among other nutrients. This can lead to nutritional deficiencies as well as osteoporosis. A 2016 study showed that nearly 30% of people with celiac disease had osteoporosis, and an additional 56% had osteopenia (low bone density). 
• Inflammatory Bowel Disease – Patients with inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis have a higher risk of osteoporosis. This is because these diseases damage the lining of the intestine and prevent the body from absorbing nutrients that are essential for bone health, such as calcium and Vitamin D.  
• Kidney/Liver Disease – The kidney and liver play a significant role in several metabolic processes, including how nutrients like calcium are absorbed and how toxins are processed. Kidney or liver disease also impacts the rate at which bones are formed and boosts the levels of phosphorus in the body, which are associated with lower levels of calcium. Around 30% of people with chronic liver disease also have osteoporosis. 
• Cancer – Besides the detrimental effect of chemotherapy on the musculoskeletal system, cancer cells alone can weaken the bone and make patients more prone to fractures. This is especially true in the case of types of cancer that are likely to spread to bone structures, such as breast and prostate cancer. 
• Multiple myeloma – Multiple Myeloma refers to a type of cancer that affects the plasma cells in the bone marrow. Myeloma speeds up the rate at which bones break down, while also reducing the speed at which the body can regenerate lost tissue. This can lead to thinning of the bones and lytic lesions (holes in the bone structure), which can make fractures far more likely. 
• Rheumatoid Arthritis – Directly, arthritis can lead to loss of bone tissue in the area surrounding the affected joint. Indirectly, this disease can cause osteoporosis because of the therapies recommended to ease pain (usually steroids) and due to the fact that it encourages a more sedentary lifestyle. 

Lifestyle Choices

Although some factors leading to osteoporosis are out of control for patients (i.e., genetics), some lifestyle factors can be managed to reduce the risk of losing bone mass density. Here is what patients should be aware of:

• Sedentary Lifestyle – Regular exercise and weight-bearing are essential for bones to remain healthy. Physical activity stimulates bone regeneration and slows down the bone’s aging process. In turn, leading a sedentary lifestyle can speed up bone loss and increase the risk of fractures. 
• Excessive Alcohol Consumption – Consuming alcohol excessively can impact how the intestine absorbs calcium, and negatively influence how the pancreas and the liver metabolize vitamin D. Combined, these effects reduce bone density and increase the risk of osteoporosis. 
• Smoking And Tobacco Use – Nicotine has a cascade of negative effects on bone health. Firstly, smoking tobacco can reduce the supply of blood – and, in turn, of nutrients and oxygen – to bones. Additionally, nicotine inhibits the production of bone-regenerating cells and impacts how calcium is absorbed. Over long periods of time, this can lead to osteoporosis and reduced bone density.

Is Osteoporosis Treatable?

Osteoporosis is considered to be the least resolvable condition and is widely known to be incurable. However, there are many treatments and actions that can be taken to mitigate the onset and progression of osteoporosis so patients living with the condition every day and in fear of damaging their fragile bones have at least a few options available.

Regardless of the risk factors associated with osteoporosis, diagnosis is often tricky and commonly missed before bone fractures occur. Patients who do not wish to wait for a fracture to learn of their diagnosis and treatment options may find value in learning and recognizing signs of osteoporosis. 

These early signs might be better recognized by examining family history with osteoporosis, acknowledging prescribed medications that might contribute to loss of bone density, and testing balance or noticing loss of posture. 

In the meantime, while pain from osteoporosis can be a persistent problem, there are safe and effective options that can treat this pain.

The Healthcare Costs Of Treating Osteoporosis

Because of the consequences of osteoporosis, it is difficult to quantify the impact that this condition has on the healthcare system on a national and global scale. 

However, fractures due to weak bones cost the US healthcare system $10 to $17 billion each year. When taking into account the cumulative burden of osteoporosis in the US, Canada, and Europe, this figure can reach a whopping $5000 to $6500 billion. For patients, the impact of a fracture on their annual medical cost is as high as $8,600. 

To have a better picture of the impact of bone conditions nationally and worldwide, it is also important to consider that those patients with osteoporosis who did not experience a fracture still incurred medical costs as high as $500 per person. This translates into a cost of over $2 billion nationwide. 

But not the full impact of osteoporosis is quantifiable. Indeed, fractures and pain can lead to a significant loss of productivity, higher rates of disability, lost wages, and significant mental health implications.

At a glance, these figures show that efforts to strengthen bones have multiple benefits. Strengthening bones and preventing osteoporosis reduces the fear of fracture for patients, allowing patients to be more comfortable being active. 

It improves quality of life by reducing pain associated with osteoporosis by not having to endure hospital visits, and it reduces overall healthcare costs.

A Better Treatment Alternative For Pain From Osteoporosis

Relatyv has pioneered the field of Neurofunctional Pain Management which offers a safe and effective way to reduce pain.

Why We Use The Neurofunctional Approach For Osteoporosis

Pain is a nervous system condition, with pain neurons referring pain to the brain and the brain interpreting that pain and creating inflammation responses. It’s a feedback loop that is supposed to be a healing mechanism for short term injuries but is destructive with long-term chronic problems. 

If there is no healing occurring then it simply becomes a negative feedback loop with the pain neurons and the brain reacting to that pain and triggering inflammation which causes more pain, and the cycle continues. 

Neurofunctional Pain Management is an effort to relieve pain while also restoring health so that the conditions causing chronic pain can be resolved as much as possible in the effort to relieve overall pain from osteoporosis.

How Neurofunctional Pain Management Works

Neurofunctional Pain Management is the next generation in pain management with an emphasis on safe and effective pain treatments that are supported by health restoration. 

Neurofunctional Pain Management uses a combination of high-pulse electric stimulation that works to depolarize pain neurons associated with reporting pain, a process called sustained depolarization. This method of pain relief is effective when performed on a regular basis over a period of time. 

We combine this treatment with specialized nutritional hydration therapy which can help to restore health in general. Any degree of health restoration will help maintain the pain relief effect. 

In addition to pain neuron depolarization, high pulse electrical stimulation stimulated smooth muscle vascular tissue, effectively stimulating repair and regeneration of vascular tissues like blood vessels and capillaries in the bones themselves. 

This stimulation does not directly treat or cure the condition of osteoporosis, but it does assist with stimulation of vascular blood flow in those areas which helps everything in the process. 

Neurofunctional Pain Management treatments typically last for one hour twice a week to create the ongoing pain relief effect required for long-term pain relief. Patients who stick with their treatment plan may be able to experience long-term pain relief and a degree of health restoration that can help the pain relief effect last longer.

Get The Right Treatment For Your Pain

For many, a bone fracture or a diagnosis of osteoporosis equals a life tied to pain-killing medications, steroids, and hormone treatments. However, these are no longer the only options available to restore your bone health, prevent complications, boost your overall quality of life, and live a life free of medications and pain.

And, our mission at Relatyv is to make these alternatives available to each and every patient. Thanks to our proprietary Neurofunctional Pain Management approach, we strive to relieve pain, restore health, and magnify the quality of life without drugs, surgery, or invasive procedures. After a patient has experienced pain relief and their health has improved, their outlook on life is often better and brighter. Magnifying quality of life is the pinnacle of our efforts.