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, affecting more than 10 million Americans. 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 1 out of 5 American women older than age 50 is affected by osteoporosis.
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 led to serious thinning and weakening of the bones. There is no cure for osteoporosis, but treatments are available. 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 healthcare provider may recommend 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 diagnose 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.
What are the different types of osteoporosis?
Doctors classify osteoporosis into primary osteoporosis, meaning the condition develops on its own, and second osteoporosis, in which bone loss results from a separate cause, such as certain diseases or medications that reduce bone strength.
Within primary osteoporosis, there are three types:
- Juvenile osteoporosis, which occurs in children and young adults, typically between the ages of 8 and 14
- Type 1 primary osteoporosis, also called postmenopausual osteoporosis, which results from estrogen deficiency
- Type 2 primary osteoporosis, also known as age-associated or senile osteoporosis, marked by a loss of bone density in women and men as they get older
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.
Common symptoms of osteoporosis
A common sign 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)
Serious symptoms that might indicate a life-threatening condition
Osteoporosis itself is not a life-threatening condition, but the weakness it causes can lead to dangerous falls or bone fractures that could result in a disability or an increased risk of death following the injury.
Within the spine, loss of bone density can lead to compression fractures, breakdowns of the vertebrae that can lead to a loss of height, a hunched posture, or back pain.
Seek prompt treatment if you develop chronic back or neck pain or notice a change in your posture.
Seek immediate treatment (call 911) if you, or someone you are with, experiences a fall that results in severe hip pain or the inability to walk. This could indicate a hip fracture, which is a medical emergency.
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:
- Certain antiseizure drugs
- Corticosteroid medications taken daily for more than three months
- Eating disorders
- 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
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 for osteoporosis include those you cannot prevent or manage and those you can treat.
Risk factors that cannot be managed
Certain risk factors for osteoporosis cannot be controlled, treated or prevented including:
- Age. Women age 50 and older and men age 70 and older have increased risk of osteoporosis.
- Body size. Thin, small, thin-boned women are at greater risk.
- Ethnicity. White and Asian women have the highest risks; Black 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.
- Sex. 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, and proton pump inhibitors for GERD)
Approximately 34 million people in the United States have low bone mass, or osteopenia, and therefore have an increased risk of osteoporosis.
How do you prevent osteoporosis?
While you cannot definitively prevent osteoporosis, there are steps you can take to reduce your likelihood of developing the condition or to delay the onset and progression of osteoporosis symptoms.
Osteoporosis prevention centers on building good bone health as early in your life as possible:
- Consider a vitamin D supplement. Many women don’t get enough vitamin D naturally through diet or sunlight, making them more vulnerable to osteoporosis after menopause.
- Do resistance or weight-bearing exercises, ideally 3 to 4 times a week. In addition to building bone, these types of exercises strengthen muscles and improve balance, reducing your risk of a dangerous fall.
- Eat a well-balanced diet that includes nutrient-rich, bone-building foods, including dairy products; fatty fish; dark, leafy greens; and fresh fruits and vegetables.
- Get the right amount of calcium. Talk with your doctor about your current diet to identify natural sources of calcium you currently consume and discuss whether you may need a calcium supplement.
- Include protein in your diet. It’s not just your muscles—bones need protein, too. Talk to your doctor about the right amount of protein for you (too much protein can result in calcium loss) and find healthy sources, such as lean poultry, fish, and plant-based proteins like tofu.
- Quit smoking. Tobacco use has been shown to decrease bone density, and smokers often have other lifestyle habits, such as heavy drinking, sedentary routine, and poor diet, that contribute to osteoporosis risk.
What are the diet and nutrition tips for osteoporosis?
Eating a healthy diet rich in the nutrients that promote bone health can help prevent the development of osteoporosis or, for those who have it, help slow the progression of symptoms.
Talk to your doctor about your current diet and whether you are receiving the recommended daily amount of bone-building vitamins and minerals like calcium, vitamin D, and magnesium. Along with dietary adjustments, you may need to take one or more supplements to reach the proper intake of these nutrients.
Foods to eat with osteoporosis
Any recommended foods should be eaten in moderation as part of a nutritionally-balanced diet. Foods that are good for your bones and help prevent or slow osteoporosis symptoms include:
- Dairy products, such as cheese, yogurt, and low-fat or non-fat milk
- Fatty fish, including fresh mackerel, salmon and tuna, as well as canned sardines and salmon (with bones)
- Foods fortified with vitamin D, including certain packaged breakfast foods and non-dairy milks
- Fruits high in vitamin C, such as oranges, grapefruits, strawberries, pineapples, papaya, and red and green peppers
- Fresh vegetables, including leafy greens (spinach, kale, collard greens, Brussels sprouts), broccoli, okra, potatoes, sweet potatoes, and Chinese cabbage
- Protein, such as lean poultry, fish and plant-based protein like tofu. Keep protein in moderate amounts, as too much protein can result in calcium loss.
Foods to avoid with osteoporosis
Certain foods can affect your body’s absorption of calcium, which can lead to loss of bone density. Keep these foods to a minimum when working to build bone health:
- Alcohol, which should be limited to, on average, 2 drinks or less per day for males and 1 drink or less per day for females
- Caffeine, found in coffee, tea, soda, and chocolate
- Salty foods, such as canned vegetables, processed meats, and packaged snacks
- Wheat bran, particularly products that are 100% wheat bran, such as certain cereals. Wheat bran contains high amounts of phytates, which interfere with the body’s ability to absorb calcium. This includes calcium in foods eaten at the same time as 100% wheat bran, such as the milk in your cereal.
How do doctors diagnose osteoporosis?
Diagnostic procedures for osteoporosis may include a complete medical history, physical exam, skeletal X-rays, blood tests to measure serum calcium and potassium levels, and a bone density test (also called bone densitometry), which measures the mass of bone in relation to its volume.
Bone densitometry testing is primarily performed to identify osteoporosis and osteopenia so that your healthcare provider can implement the right treatment. Early treatment helps to prevent future bone fractures. Doctors sometimes recommend early treatment for people who have already fractured a bone and are considered at risk for developing osteoporosis. The bone densitometry test determines your bone mineral density (BMD). Your BMD is compared to two norms: healthy young adults (your T-score) and age-matched (your Z-score).
What are the treatments for osteoporosis?
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 healthcare 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 healthcare 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
Healthcare providers typically prescribe medicine for an osteoporosis diagnosis. To diagnose osteoporosis, your healthcare 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), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast), which can decrease bone loss and possibly increase bone density
- Calcitonin, which can slow the rate of bone loss and help minimize pain
- Denosumab (Prolia), which works to increase bone mass in people at high risk for fracture from osteoporosis
- Hormone replacement therapy (estrogens) may be considered in some cases. Hormone replacement therapy is no longer considered as a first line of treatment of osteoporosis 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 healthcare 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
- Installing adequate lighting in and outside your residence, including nightlights and stair lights
- 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 healthcare professional design specifically for you. Potential complications of osteoporosis include:
- Adverse effects of osteoporosis treatment
- Chronic pain, such as in the spine
- 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