Osteoporosis

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Introduction

What is osteoporosis?

Osteoporosis is a disease in which bone density deteriorates and decreases over time, causing weak and brittle bones and increasing the risk of fracture. Wrist, spine and hip bones are most affected, although any bones are susceptible to the disease.

Osteoporosis is very common. In fact, it is the most widespread bone disease, especially among elderly men and women. In general, women are more likely than men to develop osteoporosis. About one out of five American women older than age 50 is affected by osteoporosis, according to the National Institutes of Health (Source: NIH). 

Your bones are made up primarily of calcium and protein. Bone is a living tissue that continuously sheds and reabsorbs old cells and grows new ones. Osteoporosis develops when new bone fails to form, or when excessive amounts of bone are reabsorbed by the body. Osteoporosis often occurs due to a reduction of the hormone estrogen in a woman’s body after menopause or a loss of testosterone in aging men, but it can also be caused by a number of other factors, such as taking certain medications.

In most cases, osteoporosis develops gradually over years, and a person with osteoporosis may not be aware that he or she has the disease until a fracture occurs. At this stage, the disease has already lead to serious thinning and weakening of the bones. There is no cure for osteoporosis, but treatments are available, and you can also make lifestyle changes that can slow or stop bone loss, and even prevent future fractures.

If you have risk factors for osteoporosis, such as family history or being postmenopausal, your health care provider may recommend that you get a bone density test. This test is a special type of X-ray that can help determine if you have osteoporosis, if you have a high risk of developing the disease, or if you are at risk for a bone fracture due to thinning and weakening of the bones.

There are generally no symptoms of osteoporosis until the disease has advanced to a serious stage and a fracture occurs. Seek regular medical care to most effectively diagnosis and treat osteoporosis in its earliest, most treatable stage and to reduce the risk of fractures and other complications.

Seek immediate medical care (call 911) if you, or someone you are with, have hip pain or are unable to walk normally after a fall or other injury. These may be symptoms of a hip fracture, which is a medical emergency and a common complication of osteoporosis.    

Symptoms

What are the symptoms of osteoporosis?

In general, there are no symptoms in the early stages because the disease usually develops so gradually. This is why osteoporosis is known as a silent disease. When symptoms do occur, they can vary depending on the individual, the severity, and other factors.

A common symptom of osteoporosis is a fracture of the spine, wrist or hip. Fractures generally signal that the disease is already in its advanced stages, in which severe bone thinning and damage have already occurred. In this late stage, the symptoms of osteoporosis can include:

  • Back pain, which can be severe, due to spinal bone fractures
  • Bone pain or tenderness
  • Fracture that occurs with little or no trauma
  • Loss of height
  • Neck pain, which can be severe, due to spinal bone fractures
  • Stooped posture (spine curvature, kyphosis)

Causes

What causes osteoporosis?

The most common cause of osteoporosis is the reduced production of certain hormones due to aging. Women of menopausal age (about 50 years and older) experience reduced estrogen production, while men 70 and older experience reduced testosterone production. Other causes of osteoporosis include:

  • Aging

  • Alcoholism

  • Certain antiseizure drugs

  • Chronic (long-term) conditions, such as rheumatoid arthritis (RA) and kidney disease

  • Corticosteroid medications daily for more than three months

  • Eating disorders

  • Heredity

  • Hyperparathyroidism, an excessive production of parathyroid hormone (PTH) that causes calcium to be pulled from bones, and then reabsorbed by the intestines and kidneys

  • Not consuming enough dietary calcium, vitamin D, and phosphate, which are essential for normal bone formation

  • Sedentary lifestyle and long periods of inactivity, such as complete bed rest

  • Smoking

What are the risk factors for osteoporosis?

A number of factors are thought to increase your chances of developing osteoporosis. However, not all people with risk factors will develop the disease. Common risk factors include those that cannot be managed or prevented and those that are treatable.

Risk factors that cannot be managed

Certain risk factors for osteoporosis cannot be controlled, treated or prevented including:

  • Age

  • Body size (thin, small, thin-boned women are at greater risk)

  • Ethnicity (Caucasian and Asian women have the highest risks; African-American and Hispanic women have lower but significant risks)

  • Family history (having parents with a history of fractures is associated with reduced bone mass and increased fracture risks)

  • Gender (women are much more likely than men to develop osteoporosis; menopause increases women’s loss of bone and bone tissue)

Risk factors that can be managed

Some risk factors for osteoporosis may be prevented or treated including:

  • Absence of menstrual periods (amenorrhea) in some cases

  • Alcohol consumption

  • Chronic liver disease

  • Cigarette smoking

  • Diets low in calcium, calcium deficiency, or not using calcium properly

  • Diets low in vitamin D or vitamin D deficiency

  • Eating disorders and low body weight, due to diet

  • Excessive cortisone or thyroid hormone production

  • Hormone treatments for breast and prostate cancer

  • Lack of physical activity or extended bed rest

  • Malabsorption syndromes

  • Medications (including steroids, thyroid hormone replacement, heparin, proton pump inhibitors for GERD)

Treatments

How is osteoporosis treated? 

Osteoporosis is not curable at this time, but it is treatable to minimize the amount of bone loss and reduce the risk of complications, such as fractures.

Treatment of osteoporosis is individualized to the severity of the disease, your age, sex, medical history, and other factors. Goals of osteoporosis treatment programs include slowing or stopping bone deterioration, controlling pain, and reducing the risk of fractures, falls, and other complications. Your physician or health care provider may recommend a plan that includes lifestyle changes, including changes in diet and physical activity, and possibly medications.

Dietary guidelines for osteoporosis and prevention of osteoporosis

Following a diet containing sufficient amounts of calcium and vitamin D, and taking supplements as recommended by your health care provider, promotes normal bone and bone tissue formation. Good sources of dietary calcium include low-fat milk and dairy products. Vitamin D is produced primarily by exposure to the sun but is also available in supplements and certain foods, such as salmon, tuna fish, eggs, fortified cereals, and fortified dairy products. Sufficient vitamin D helps your body absorb calcium. It is also important to consume adequate protein in your diet.

Medications for osteoporosis

Medications may be prescribed once osteoporosis is diagnosed. To diagnose osteoporosis, your health care provider will use a bone mineral density (BMD) study to measure the levels of calcium and other minerals in a section of bone.

A variety of medications are available to treat osteoporosis including:

  • Bisphosphonates, such as alendronate (Fosamax), and risedronate (Actonel), which can decrease bone loss and possibly increase bone density

  • Calcitonin, which can slow the rate of bone loss and help minimize pain

  • Hormone replacement therapy (estrogens) may be considered in some cases. Hormone replacement therapy is no longer considered as a first line of treatment due to serious risks, such as increased risk of blood clots, breast cancer, and uterine cancer.

  • Raloxifene (Evista), which is used to prevent and treat osteoporosis in postmenopausal women and which can make bones stronger and reduce the risk of fractures

  • Teriparatide (Forteo), which contains parathyroid hormone and encourages new bone tissue growth and reduces the risk of fractures

Exercises for osteoporosis

Regular physical activity is an important part of the prevention and treatment of osteoporosis. Regular exercise, at least three times a week, can reduce bone loss and the risk of falls and bone fractures in both men and women.

If you have osteoporosis, you should avoid contact sports or exercises that pose risks for falling, such as mountain biking, or high-impact exercises that may cause fractures. Low-impact weight-bearing exercises, such as walking, riding a stationary bike, and treadmill exercises are generally recommended. Resistance exercises using light weights and weight machines or swimming also help to maintain bone mass. Activities such as tai chi and yoga, which emphasize balance, flexibility and strength, are also generally a good choice to include in a complete exercise program. However, you should consult with your physician or health care provider before beginning an exercise program.

Unhealthy habits to stop

Quitting smoking and reducing alcohol intake or not drinking alcohol at all can reduce the risk of osteoporosis.

Guidelines for preventing falls

You can reduce your risk of falls and fractures by:

  • Avoiding sedating medications

  • Having your vision checked regularly and wearing glasses or contacts as recommended

  • Installing and using grab bars in the bathroom and other areas where extra support is needed to avoid falling

  • Removing or repairing household hazards that can cause tripping, such as throw rugs or concrete steps that have cracked or shifted  

  • Wearing boots or shoes with good traction and avoiding walking on snowy or icy surfaces without assistance

  • Wearing well-fitting shoes and avoiding high heels, shoes with little support, and open flip-flop shoe styles

What are the potential complications of osteoporosis?

Complications of osteoporosis can be serious. You can treat osteoporosis and minimize the risk of complications by following the treatment plan that you and your health care professional design specifically for you. Potential complications of osteoporosis include:

  • Adverse effects of osteoporosis treatment

  • Chronic pain, such as in the spine

  • Disability

  • Fractures in the hip, spine, wrist or other bones

  • Loss of ability to walk due to hip fractures

  • Loss of height

  • Neurologic deficits following vertebral fracture

  • Poor mobility

  • Weakness

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Oct 31
    1. Osteoporosis. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm
    2. Learn About Osteoporosis > Bone Health Basics.  National Osteoporosis Foundation. http://nof.org/learn/basics
    3. Osteoporosis Prevention. American Academy of Orthopaedic Surgeons (AAOS).  http://orthoinfo.aaos.org/topic.cfm?topic=A00315
    4. Screening for Osteoporosis to Prevent Fractures: Recommendation Statement. U.S. Preventive Services Task Force. American Family Physician. https://www.aafp.org/afp/2018/1115/od1.html

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