What is osteoporosis?
Osteoporosis is a disease of the bones. It causes you to lose bone mass. Osteoporosis occurs most often in older adults. Women are more likely to have it than men. This is due to several factors. Women have less bone mass than men to begin with. Women also tend to live longer and absorb less calcium. In women, the rate of bone loss speeds up after menopause, when estrogen levels decrease. Since the ovaries make estrogen, faster bone loss may occur if both ovaries are removed by surgery.
Symptoms of osteoporosis
You may not know you have osteoporosis until your symptoms are severe. Signs include frequent broken bones or fractures, low back pain, or a hunched back. You may get shorter over time due to osteoporosis. The condition 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.
What causes osteoporosis?
There are two ways osteoporosis can occur. You can lose too much bone, or your body cannot produce enough bone. Some people have both issues. When you’re young, your bones are dense and strong. Osteoporosis makes your bones brittle and breakable.
It is natural to lose some bone mass as you age. For most adults, this begins in their mid 20s. Other factors can increase your risk of osteoporosis. Some of these risk factors are out of your control. For others, you can take steps to reduce your risk. Talk to your family doctor about your risk factors.
Uncontrollable risk factors:
- Sex: Osteoporosis is more common in women than men.
- Age: The older you are, the greater your chance of having osteoporosis.
- Race: Caucasians and Asians are more likely to have osteoporosis.
- Genetics: Your risk of osteoporosis is higher if it runs in your family.
- Menopause: This period in a woman’s life causes physical and hormonal effects. For example, it lowers your estrogen. These changes can increase your risk of osteoporosis. Your risk is even higher if you have early menopause (before age 45).
- Body frame: People who have small, thin frames are more likely to develop osteoporosis.
- Health: Certain conditions, such as cancer or stroke, can lead to osteoporosis.
Controllable risk factors:
- Lack of calcium and/or vitamins.
- Inactive lifestyle or lack of exercise.
- Smoking or tobacco use.
- Alcohol abuse.
- Eating disorders, such as anorexia nervosa.
- Hormonal imbalances. Examples include low estrogen or testosterone and high thyroid levels.
- Long-term use of certain medicines. Examples include corticosteroids and proton pump inhibitors (PPIs). Corticosteroids treat inflammation, pain, and chronic conditions, such as asthma and rheumatoid arthritis. PPIs help reduce stomach acid. These medicines can make it hard for your body to absorb calcium and cause osteoporosis.
How is osteoporosis diagnosed?
Contact your doctor if you have signs of osteoporosis or if it runs in your family. The American Academy of Family Physicians (AAFP) recommends that certain women be screened for osteoporosis. This includes women who are 65 years and older or have an equal or greater fracture risk. Your doctor can help you assess your fracture risk. Currently, the AAFP does not recommend that men be screened for osteoporosis.
To diagnose the condition, your doctor will do a bone density scan. This is a common test that measures your bone density. It is called a dual energy X-ray absorptiometry (DEXA). The scan often checks your hips, spine, and wrist. These are the most common places to have osteoporosis.
The AAFP does not recommend that doctors use DEXA scans for women younger than 65 or men younger than 70 unless there are risk factors.
Can osteoporosis be prevented or avoided?
You cannot always avoid osteoporosis. However, there are some changes you can make to prevent or reduce your risk. These include regular exercise and getting enough calcium and vitamin D. They help keep your bones healthy as you age.
Calcium. 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. Women who are post-menopausal may need 1,500 mg of calcium per day. It is best to get your calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other options include dried beans, salmon, spinach, and broccoli. If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium supplement.
Vitamin D. Most people need about 800 International Units (IU) of vitamin D each day. It helps your body absorb calcium. You can get vitamin D from sunlight, food, and supplements. Your skin makes vitamin D when it is exposed to sunlight. However, you should be careful of sun exposure. Too much can cause skin cancer. Your doctor can test your blood to measure your vitamin D level. If your vitamin D level is low, your doctor may suggest taking a supplement.
Exercise. Regular exercise helps you build and keep strong bones. This is why it’s important to begin an active lifestyle at a young age. However, it’s never too late to start exercising. Ask your doctor for tips on how to exercise safely. Try to do a mix of strength training and weight-bearing exercises.
Treatment for osteoporosis starts with changes to your diet and lifestyle. You need to get enough calcium and vitamin D. Your doctor will want you to increase your physical activity. This helps to strengthen your bones and increase your bone mass. Examples of weight-bearing exercises include walking, jogging, and climbing steps. You also should stop smoking and limit alcohol.
If you’re at risk for falls, reduce your risk by getting rid of tripping hazards in your home. For example, remove rugs, avoid slick surfaces, and move electrical cords. You can install grab bars in certain places, such as your bathroom and shower. The bars can help you move around more easily and safely.
Your doctor may prescribe medicine(s) to help treat osteoporosis. There are several types and forms.
- Biophosphonates. This type helps reduce your risk of breaks and fractures. It also increases bone density. It comes in oral (pill) form or intravenous (IV or injection) form. Side effects can include nausea or stomach pain. You may have irritation of the esophagus (the tube that connects your mouth and stomach). Some people cannot take biophosphonates. This includes people who have kidney disease or low levels of calcium in their blood, and women who are pregnant or nursing. Examples of biophosphonates include:
- Alendronate and risedronate. These medicines are used to help prevent and treat osteoporosis. They help reduce your risk of fractures by decreasing the rate of bone loss. They are available in pill form. Their most common side effect is an upset stomach.
- Ibandronate. This medicine helps to slow bone loss and increase bone density. It is available as a pill or injection. You have 2 options for the pill. You can take it daily or monthly. For the injection, your doctor or nurse will give you a shot every 3 months. Side effects may include lower back or side pain, shortness of breath, tightness in your chest, and bloody or cloudy urine.
- Zoledronic acid. This medicine is given through IV once a year.
- Calcitonin. This is a hormone that helps slow down bone loss. It is available as an injection or nasal spray. Side effects of the injection include diarrhea, stomach pain, nausea, and vomiting. Side effects of the nose spray include headache and irritation of your nose lining.
- Raloxifene. This medicine helps prevent and treat osteoporosis in women. It increases your 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 helps to grow new bones. It is a synthetic form of parathyroid hormone. Both women and men can use it. It is available as an injection. You inject it in your thigh or stomach once a day. Common side effects are nausea, stomach pain, headache, muscle weakness, fatigue, and loss of appetite.
- Denosumab. This drug is used when other drugs don’t work or if you can’t tolerate other treatment options. Denosumab increases your bone density. It can be used by both women and men. It is given as an injection by your doctor. Side effects can include lower calcium levels, skin rash, or pain in the arms and legs.
If your doctor prescribes medicine to treat osteoporosis, it is important that you take it. When your doctor prescribes a medicine, be sure to discuss:
- Side effects.
- Any fears you have about taking medicines (especially if this may cause you to stop).
- The higher likelihood of fractures if you stop taking your medicine.
- How you will let your doctor know if you fall.
- When your next follow-up visit will be. (Schedule this for 3-6 months after your appointment.)
Living with osteoporosis
There is no complete cure for osteoporosis. You should work with your doctor to treat the condition. You also can make diet and lifestyle changes to reduce the effects and prevent falls.
Questions to ask your doctor
- Do I need a bone density test? When and how often should I get one?
- How do I know if I’m at risk for osteoporosis?
- How much calcium and vitamin D do I need?
- What changes can I make to prevent or manage osteoporosis?
- If I have osteoporosis, is it safe for me to exercise? What kind of exercise should I do?
- Will I need to take medicines to prevent bone loss? Will these medicines interact with other medicines I take?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.