Osteoporosis

Cause

Osteoporosis is caused by a lack of bone strength or bone density.

As a natural part of aging, bone tissue breaks down. It is absorbed faster than new bone is made, and bones become thinner. You are more likely to have osteoporosis if you didn't reach your ideal bone density during your childhood and teen years.

Osteoporosis is much more common in women than in men. In women, bone loss increases around menopause. That's when ovaries decrease production of estrogen, a hormone that protects against bone loss. So the older a woman gets, the more likely she is to have osteoporosis.

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What Increases Your Risk

Several things put you at risk for osteoporosis.

Some factors include:

• Your age. Your risk goes up as you get older.
• Being a person who has gone through menopause. After menopause, the body makes less estrogen. This hormone protects the body from bone loss.
• Men with low testosterone.
• Your family background. Osteoporosis tends to run in families.
• Taking corticosteroids or certain other medicines.
• Drinking too much alcohol.
• Smoking.
• Not getting enough calcium and vitamin D.
• Being inactive due to being in a bed, wheelchair, or other type of chair for long periods of time.

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Prevention

To help prevent osteoporosis:

• Make sure that your diet is rich in calcium and vitamin D.
• Do weight-bearing exercise. This will help you build strong bones.
• Don't smoke, and limit how much alcohol you drink.

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Symptoms

In the early stages of osteoporosis, you probably won't have symptoms. As the disease progresses, you may have symptoms related to weakened bones, such as:

• Broken bones (fractures) that might occur with a minor injury, especially in the hip, spine, and wrist.
• Back pain.
• Loss of height and stooped posture.
• A curved upper back (dowager's hump). You might notice that you aren't as tall as you used to be.
• Compression fractures in the spine that may cause severe back pain. But sometimes these fractures cause only minor symptoms or no symptoms at all.

What Happens

In a normal, healthy adult, bone is constantly absorbed into the body and then rebuilt. During childhood and the teen years, new bone tissue is added faster than existing bone is absorbed. As a result, your bones become larger and heavier until about age 30 when you reach peak bone mass (density). After age 30, the rate at which your bone tissue dissolves and is absorbed by the body slowly increases, while the rate of bone building decreases. So overall you lose a small amount of bone each year after age 30.

In women, bone loss is more rapid and usually begins after monthly menstrual periods stop, when a woman's production of the hormone estrogen slows down (usually between the ages of 45 and 55). A man's bone thinning typically starts to develop gradually when his production of the hormone testosterone slows down, at about 45 to 50 years of age. Women typically have smaller and lighter bones than men. As a result, women develop osteoporosis far more often than men. Osteoporosis usually does not have a noticeable effect on people until they are 60 or older. The more bone mass you developed early in life, the less likely you are to get osteoporosis.

A person with thinning bones may be diagnosed with low bone density (sometimes called osteopenia). Low bone density sometimes progresses to osteoporosis.

When bones thin, they lose strength and break more easily. The bones that break most often due to osteoporosis are:

The spine.

Vertebrae that are weak because of osteoporosis may break and collapse on top of each other. (This is called a compression fracture.) These fractures of the spine can cause back pain, stooped posture, loss of height, and a curved upper back (dowager's hump).

The hip.

Hip fractures are often caused by a fall. They can make it very hard for you to move around. And they usually require major surgery. After a hip fracture, you may have medical complications such as blood clots, pressure injuries, or pneumonia.

The wrist and forearm.

Wrist fractures can make you less active and independent.

In women, bone loss increases when the ovaries reduce production of estrogen, a hormone that protects against bone loss.

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When to Call a Doctor

Call your doctor now if you:

• Think you have a broken bone or notice a deformity after a fall.
• Have sudden, severe pain when bearing weight.

Call your doctor for an appointment if you:

• Want to discuss your risk for osteoporosis.
• Have symptoms of menopause or have completed menopause and want to discuss whether you should take medicine to prevent osteoporosis.
• Have been treated for a fracture caused by a minor injury, such as a simple fall, and want to discuss your risk of osteoporosis.

If you are nearing age 65, have low bone density, or think that you are at high risk for osteoporosis, talk with your doctor about your concerns.

Watchful waiting

If you don't have any risk factors for osteoporosis and you are already taking preventive measures, such as taking adequate calcium and vitamin D, you may only need routine screening.

Exams and Tests

To diagnose osteoporosis, your doctor will ask about your symptoms and do a physical exam. You may also have a test that measures your bone strength (bone density test) and your risk for a broken bone.

During the physical exam, the doctor will:

• Measure your height and compare the results with past measurements.
• Examine your body for signs of previous broken bones, such as changes in the shape of your long bones and spine.

The bone density test helps your doctor estimate the strength of your bones. If the test finds that your bone thickness is less than normal but isn't osteoporosis, you may have low bone density (sometimes called osteopenia). It's a less severe type of bone thinning.

Routine urine and blood tests can rule out other medical conditions. These include hyperthyroidism and Cushing's syndrome. These conditions can cause bone loss.

DXA test to screen for osteoporosis

A dual-energy X-ray absorptiometry (DXA) test is a type of bone density test. It checks for osteoporosis. The test measures bone thickness. It is used to see if your bones are getting thin and brittle, which means they could break more easily.

Testing at least two different bones each time is the most reliable and accurate way of measuring bone density.

In most cases, a bone density scan is done in a radiology department or clinic by a technologist. The DXA scan, which scans the hip and lower spine, takes about 20 minutes.

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Treatment Overview

Treatment for osteoporosis focuses on reducing bone loss, building bone strength, and preventing broken bones. Treatment may include:

• Taking medicines that slow the rate of bone thinning and help build bone density.
• Getting enough calcium and vitamin D to build strong, healthy bones.
• Having healthy habits, such as getting plenty of weight-bearing exercise, eating healthy foods, and not smoking. This can help slow osteoporosis.

Making even small changes in how you eat and exercise, along with taking medicine, can help prevent a broken bone.

It's also important to protect yourself from falling. For example, you can reduce your risk of breaking a bone by making your home safer.

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Self-Care

You can do a lot to slow bone loss and prevent broken bones.

• Get enough calcium and vitamin D. Vitamin D helps your body absorb calcium. Calcium is found in many foods, including dairy products like milk and yogurt. Ask your doctor if you need to take a supplement that contains calcium plus vitamin D.
• Get regular bone-building exercise. This includes:
  • Weight-bearing exercises like walking, jogging, stair climbing, and dancing.
  • Resistance exercises with weights or elastic bands.
• Don't smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines.
• Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
• Prevent falls.
  • Use a cane or walker, if you need it.
  • Install handrails on stairways, around your shower or tub area, and near the toilet.
  • Remove throw rugs and other objects that are in the way.

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Medicines

Medicines are used to both prevent and treat osteoporosis. Some medicines slow the rate of bone loss or make bones thicker. Medicines are also used for pain from broken bones caused by osteoporosis.

Medicine for treatment and prevention

Medicines that help treat and prevent bone loss include:

• Bisphosphonates. Examples are alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast).
• Denosumab (Prolia). It's used to treat people who are at high risk for bone fractures related to decreased bone density.
• Raloxifene (Evista). This medicine is a selective estrogen receptor modulator (SERM).
• Teriparatide (Forteo). It's used for the treatment of men and postmenopausal women who have severe osteoporosis and who are at high risk for bone fracture.

Medicine for pain from fractures

Compression fractures and other broken bones caused by osteoporosis can cause a lot of pain that lasts for several weeks. Medicines to relieve this pain include:

• Acetaminophen, such as Tylenol. You can buy this without a prescription.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. You need a prescription for some NSAIDs, and you can buy some without a prescription. But they are not safe for everyone. Talk to your doctor about whether NSAIDs are right for you.
• An opioid pain reliever. These include codeine or morphine.
• Calcitonin, such as Miacalcin.

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