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Osteoporosis

Overview

Osteoporosis is a disease of the bones that is characterized by reduced bone mass and bone quality. In other words, osteoporosis is marked by weaker, or deteriorating, bones. Osteoporosis increases the risk of fractures, notably at the hip, spine, and wrist.

Osteoporosis is often associated with aging. Medical experts, however, increasingly believe that osteoporosis is not an unavoidable part of aging and that it is largely preventable. As well, people already affected by osteoporosis may be able to take steps to slow its progress and reduce risk of fractures.
Who is affected by osteoporosis?

Men and women can both develop osteoporosis, though it occurs more frequently in women. According to the National Institutes of Health, of the 44 million Americans affected by osteoporosis, 68 percent are women.

How does bone deteriorate?

Throughout an individual’s lifetime, bone undergoes a continuous process of removal of old bone (called resorption) and addition of new bone (called formation). This process makes bones larger, heavier, and denser. Peak bone mass is reached around age 30. After age 30, bone resorption begins to outpace bone formation—meaning bone is removed at higher rate than it is replaced.

Causes

Though osteoporosis tends to affect older individuals, it may be caused during childhood and adolescence—if bones don’t grow adequately early in life, optimal peak bone mass is never reached. Less than optimal bone mass increases risk for osteoporosis later in life.

Additional causes of osteoporosis include a higher than expected rate of bone resorption and a decreased rate of bone formation.

Hormonal changes later in life also contribute to bone loss. This is especially true for women, who experience a decrease in estrogen production when menopause occurs. Estrogen may be decreased by natural menopause, surgical removal of the ovaries, or chemotherapy and radiation treatments for cancer. Men also experience a decline in sex hormone (testosterone) levels that can contribute to bone loss, but the decline is not as pronounced as it is in women.

Osteoporosis can also be the result of diseases (such as kidney disease and Crohn’s disease), eating disorders (such as anorexia nervosa), and certain medications (including antiseizure medication and anti-inflammatory drugs prednisone and cortisone), alcoholism, and several other health conditions.

In addition to causes of osteoporosis, there are risk factors that increase and individual’s likelihood of developing the disease. Some of the risk factors cannot be changed; others can be changed to reduce risk.

Risk factors that cannot be changed:

  • Gender—Women are at greater risk than men.
  • Age—Risk increases with age, as bones become thinner and weaker.
  • Body size—People (women, in particular) with small, thin bones are at greater risk.
  • Ethnicity—White women and Asian women are at highest risk. Risk is lower but significant in African-American and Hispanic women.
  • Family history—A family history of fractures (specifically, in one’s parents) may increase risk.
Risk factors that can be changed with medical treatment and lifestyle measures

(Consult your doctor about approaches to treating these conditions.)

  • Sex hormones—Estrogen deficiency resulting from abnormal absence of menstrual periods and menopause (natural or due to surgical removal of ovaries or medical treatments) can contribute to osteoporosis in women; Low testosterone levels can increase a man’s risk.
  • Anorexia nervosa—This eating disorder (irrational fear of weight gain) increases risk.
  • Calcium and vitamin D intake—A diet low in these nutrients increases risk.
  • Medication use—Certain medications increase risk (anti-inflammatory drugs known as glucocorticoids and anticonvulsants, or antiseizure medications, for example).
  • Lifestyle—People with an inactive lifestyle or those on extended bed rest may have weaker bones.
  • Cigarette smoking—Smoking, which harms the heart and lungs, is also bad for bone health.
  • Alcohol intake—Excessive consumption of alcohol can increase bone loss and risk for fractures.

Symptoms

The first symptom of osteoporosis may be a fracture or collapsed vertebrae. Otherwise, the disease causes no symptoms and is therefore often called a “silent disease”. A collapsed vertebra causes severe back pain, loss of height, or spinal deformities such as stooped posture.

Talking to Your Doctor

To help your doctor make an accurate diagnosis of osteoporosis and develop the most appropriate treatment plan, be prepared to discuss the following:

  • Any fractures you have had
  • Your risk factors (See a list of risk factors under “Causes”.)
  • Your family medical history, including osteoporosis
  • History of medications you have used
  • How much you exercise and the type of activities
  • For women, your menstrual history

Diagnosis and Testing

The process of diagnosing osteoporosis will begin with a physical exam. X-rays may also be taken to detect skeletal problems such as fractures.

A bone mineral density (BMD) test, which measures bone mass, is used to diagnose osteoporosis. As well, a BMD test can be used to assess your risk for fractures, determine your rate of bone loss, and measure your response to treatment for osteoporosis. The BMD test produces a measurement called a T-score, which compares your bone density to optimal bone density. A negative score indicates low bone mass.

In addition, there are laboratory tests (using blood or urine samples) that assess the process of bone breakdown and formation as well as identify conditions that may contribute to bone loss. Testing may include: blood calcium and vitamin D levels, thyroid function, measurement of estrogen levels in women and testosterone levels in men, and measurement of follicle stimulating hormone in women to establish menopausal status.

In order to diagnose osteoporosis, your doctor may also ask you certain questions. See “Talking with Your Doctor” above for more information about this important conversation.

Treatments and Medication

The first step in treating osteoporosis is to prevent it by taking measures to avoid bone loss and maintain strong bones. The following measures may contribute to long-term bone health:

  • Calcium—Dietary calcium may help combat low bone mass and reduce the risk of osteoporosis. Recommended food sources of calcium include low-fat dairy products (such as milk, cheese, and yogurt); dark, leafy green vegetables (such as broccoli and spinach); sardines and salmon with the bone; foods fortified with calcium (such as orange juice and cereals). Calcium needs change throughout life, with a greater demand occurring during childhood and adolescence, during pregnancy and breastfeeding, and in postmenopausal women and older men. For example, 1,300 mg/day of calcium is recommended for children and adolescents age 9 to 18 years, and 1,200 mg/day is recommended for adults age 51 and older.
  • Vitamin D—Vitamin D contributes to calcium absorption as well as bone health. The body makes vitamin D through exposure to sunlight (15 minutes per day is recommended), and it can also be found in food sources including egg yolks, saltwater fish, and liver.  Vitamin D supplements may be suggested for people who cannot get adequate sun exposure.
  • Exercise—Exercise, especially weight-bearing activities like walking, climbing stairs, and weight lifting, makes bones stronger.

As well, avoid smoking and excessive alcohol use, as these behaviors are associated with weaker bones and increased risk for fracture.

Living with Osteoporosis

In addition to nutrition and exercise to prevent and manage osteoporosis, you can reduce your risk of fractures. Preventing falls is especially important among people with osteoporosis. Falls may be caused by environmental factors (obstacles and slippery surfaces, for example), impaired vision or balance, chronic diseases that affect mental and physical functioning, and certain medications such as sedatives or antidepressants. Tips for managing environmental factors are listed below. If you are affected by any of the health conditions listed above, consult your doctor about ways to manage these conditions.

Managing Indoor and Outdoor Risks for Falls
  • Use a cane or walker.
  • Wear rubber-soled shoes for traction. Avoid walking in socks, stockings, or slippers. Instead, wear supportive, low-heeled shoes even indoors.
  • Avoid slippery surfaces whenever possible (slippery surfaces include wet or icy sidewalks and highly polished floors).
  • Use carpet runners.
  • Keeps rooms and floors free of clutter.
  • Keep stairwells and hallways well lit.
  • Install grab bars in the bathroom near the shower, tub, and toilet.
  • Use a rubber mat in the shower or tub.
  • Keep a flashlight with fresh batteries near your bed.

Resources

The National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse National Institutes of Health

National Osteoporosis Foundation

SOURCE

Osteoporosis. The National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center Web site. Available at: http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/default.asp.

Accessed August 2010.