Osteoporosis

Overview

What is osteoporosis?

Osteoporosis (say: "ost-tee-oh-pore-oh-siss") is a disease of the bones. It happens when you lose too much bone, when your body doesn’t make enough bone, or both. This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break.

Once total bone mass has peaked — usually in your mid 20s — all adults start to lose it. However, women are more likely to develop osteoporosis than men. This is due to several factors. Women have less bone mass than men, tend to live longer and take in less calcium. In women, the rate of bone loss speeds up after menopause, when estrogen levels fall. Since the ovaries make estrogen, faster bone loss may also occur if both ovaries are removed by surgery.

If men live long enough, they are also at risk of getting osteoporosis later in life.

Symptoms

What are the signs of osteoporosis?

You may not know you have osteoporosis until you have serious signs. Signs include frequent broken bones or fractures, low back pain or a hunched back. You may also get shorter over time because osteoporosis can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.

Causes & Risk Factors

What causes osteoporosis?

Your bones are made up of living, growing tissues that change as you age. When you’re a child, adolescent, and young adult, your bones actually become denser (thicker and stronger). Eventually, sometime around your mid 20s, you reach your peak bone mass — this is when your bone mass is at its highest level. After bone mass peaks, all adults start to lose some bone mass.

Osteoporosis occurs if you lose too much bone or don’t make enough bone to begin with.

What are the risk factors for osteoporosis?

The following things put you at an increased risk for osteoporosis. Some of these risk factors are beyond your control. For other risk factors, you can take steps to reduce your risk. Talk to your family doctor about your risk factors.

Uncontrollable Risk Factors:

Controllable Risk Factors:

  • Being female: Women are more likely to have osteoporosis than men.

  • Age: The older you get, the more likely you are to develop osteoporosis.

  • Race: Caucasians and Asians are more likely to develop osteoporosis.

  • Genetics: You are more likely to develop osteoporosis if you have a family history of it.

  • Menopause: The hormone changes caused by menopause may increase the risk of osteoporosis. This is especially true for women who have early menopause (before age 45).

  • Body frame: People who have small, thin bone frames are more likely to develop osteoporosis.

  • Not getting enough calcium and/or vitamin D

  • Sedentary lifestyle (not getting enough exercise)

  • Smoking or tobacco use

  • Alcohol abuse

  • Eating disorders such as anorexia nervosa

  • Hormone imbalances, such as low estrogen or testosterone, or too much thyroid hormone

  • Use of certain medicines, such as the long-term use of corticosteroids, which are medicines prescribed to treat inflammation, pain and chronic conditions such as asthma and rheumatoid arthritis. Long-term use of medicines to reduce stomach acid for acid reflux or other conditions can cause reduced calcium absorption and osteoporosis.

Diagnosis & Tests

How is osteoporosis diagnosed?

If your doctor suspects osteoporosis or you are a woman aged 65 or older, he or she may suggest you have a bone density scan. A common test that measures bone density is called a dual energy X-ray absorptiometry (DEXA). This test measures the density of the bones in your hips, spine and wrist, which are all places likely to be affected by osteoporosis.

Treatment

How is osteoporosis treated?

Treatment for osteoporosis starts with changes to your diet and lifestyle. You want to take in more calcium. Your doctor will suggest ways to get more calcium through food, drink and possibly a calcium supplement. He or she will also suggest you take a vitamin D supplement, which helps your body process calcium.

Your doctor will want you to increase your physical activity, especially weight-bearing exercise. This helps increase bone density. Examples of weight-bearing exercise include walking, jogging and climbing steps.

Your doctor will also want you to stop smoking and avoid drinking too much alcohol. If you’re at risk for falls, reduce the likelihood of falls in your home by getting rid of tripping hazards (such as electrical cords and rugs) or slippery surfaces. You can also install grab bars in your shower or anywhere else in your home that you might need them.

How much calcium do I need?

Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,000 mg of calcium per day if you’re taking estrogen and 1,500 mg of calcium per day if you’re not taking estrogen. You should also aim for 800 international units (IU) of vitamin D each day to help your body absorb the calcium.

It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, pink salmon, spinach and broccoli.

If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium supplement. Take it at meal time or with a sip of milk.

What medicines are available to treat osteoporosis?

Some medicines used to treat osteoporosis include the following:

Biophosphonates. These medicines help reduce the risk of breaks and fractures, as well as increase bone density in the hips and spine. They can be taken orally (in pill form) or intravenously (with an injection). Side effects include nausea, abdominal pain and irritation of the esophagus (the tube that connects the mouth to the stomach). People who cannot take biophosphonates include people who have kidney disease, low levels of calcium in their blood and women who are pregnant or nursing. Types of biophosphonates include:

Calcitonin. This is a hormone that helps slow the breakdown of bone. It is available as an injection or nasal spray. Side effects include irritation of the lining of the nose and headache (with use of the nasal spray) and diarrhea, abdominal pain, nausea and vomiting (with use of the injection).

Raloxifene. This medicine is used to prevent and treat osteoporosis in women by increasing bone density. It is not a hormone, but it mimics some of the effects of estrogen. Side effects may include hot flashes and a risk of blood clots.

Teriparatide. This medicine is a synthetic form of parathyroid hormone and helps new bone to grow. It comes in an injectable form, and is injected once a day in the thigh or abdomen. It can be used in both women and men for the treatment of osteoporosis. Common side effects may include nausea, abdominal pain, headache, muscle weakness, fatigue and loss of appetite.

  • Alendronate and risedronate. These medicines are used to help prevent and treat osteoporosis. They help reduce the risk of fractures by decreasing the rate of bone loss. They are taken orally in pill form. Their most common side effect is an upset stomach.

  • Ibandronate. This medicine helps to slow bone loss and increases bone density. It is available both as a pill or as an injection. If you take the pill, you have 2 options: a daily pill or a monthly pill (the pill you take each month has a greater dose of ibandronate than the pill you take daily). If you take the injection, your doctor or nurse will give you a shot every 3 months. Some of the possible side effects include lower back or side pain, shortness of breath, tightness in the chest, and bloody or cloudy urine.

  • Zoledronic acid. A bisphosphonate medication that is given intravenously every 12 months.

Prevention

How do I prevent osteoporosis?

To help keep your bones healthy as you age, you need to get enough calcium and vitamin D, and exercise regularly.

Calcium To help prevent osteoporosis, women 50 years of age and younger and men 70 years of age and younger should get 1,000 mg of calcium per day. Women older than 50 years of age and men older than 70 years of age should get 1,200 mg of calcium per day.

It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, pink salmon, spinach and broccoli.

If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium supplement. Take it with meals or with a sip of milk.

Vitamin D You can get vitamin D from sunlight, food, or supplements. Your skin makes vitamin D when it’s exposed to sunlight. However, many people don’t get enough vitamin D due to geographic location, sunscreen use, or fears of skin cancer from sun exposure. Your doctor can test your blood to measure your vitamin D level. If your vitamin D level is low, your doctor may recommend that you take a vitamin D supplement.

ExerciseExercise helps you build strong bones. To help prevent osteoporosis, start exercising when you’re young and to continue exercising throughout your life. Even if you’re older, it’s never too late to start exercising. Ask your doctor for tips on how to start exercising safely.

The best exercise to help prevent osteoporosis is a combination of strength training and weight-bearing exercise. Examples of weight-bearing exercise include walking, jogging and climbing steps.

Questions to Ask Your Doctor

  • Do I need a bone density test? How often should I get one?

  • I’m peri- or post-menopausal. Am I at risk for osteoporosis?

  • How can I be sure that I’m getting enough calcium?

  • Is it safe for me to exercise? What kind of exercise should I do?

  • Are there other lifestyle changes I can make at home to decrease my risk of osteoporosis?

  • Will I need to take medicine to prevent bone loss?

  • Will these medicines interact with any of the other medicines I take?