Osteoporosis

What is osteoporosis?

Osteoporosis is a disease that affects your bones. It means you have bones that are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These fractures can be disabling and may make it hard for you to live on your own.
See a picture of healthy bone versus bone weakened by osteoporosis.
Osteoporosis affects millions of older adults. It usually strikes after age 60. It’s most common in women, but men can get it too.

What causes osteoporosis?

Osteoporosis is
caused by a lack of bone strength or bone density. As you age, your bones get thinner naturally. But some things can make you more likely to have the severe bone thinning of osteoporosis. These things are called risk factors. Some risk factors you can change. Others you can't change.
Risk factors you can't change include:

• Your age. Your risk for osteoporosis goes up as you get older.
• Being a woman who has gone through menopause. After menopause, the body makes less estrogen. Estrogen protects the body from bone loss.
• Your family background. Osteoporosis tends to run in families.
• Having a slender body frame.
• Your race. People of European and Asian background are most likely to get osteoporosis. 

Risk factors you can change include:

• Smoking.
• Not getting enough weight-bearing exercise.
• Drinking too much alcohol.
• Not getting enough calcium and vitamin D in the things you eat or from supplements. 

What are the symptoms?

Osteoporosis can be very far along before you notice it. Sometimes the first sign is a broken bone in your hip, spine, or wrist after a bump or fall.
As the disease gets worse, you may have other signs, such as pain in your back. You might notice that you are not as tall as you used to be and that you have a curved backbone.

How is osteoporosis diagnosed? 

Your doctor will ask about your symptoms and do a physical exam. You may also have a test that measures your bone thickness (bone density test) and your risk for a fracture.If the test finds that your bone thickness is less than normal but is not osteoporosis, you may have osteopenia, a less severe type of bone thinning.It’s important to find and treat osteoporosis early to prevent bone fractures. The United States Preventive Services Task Force advises routine bone density testing for women age 65 and older. If you have a higher risk for fractures, it’s best to start getting the test at age 60.

How is it treated?

Treatment for osteoporosis includes medicine to reduce bone loss and to build bone thickness. Medicine can also give you relief from pain caused by fractures or other changes to your bones.
It’s important to take both calcium and vitamin D supplements along with any medicine you take for the disease. You need both of these supplements to build strong, healthy bones.
You can slow osteoporosis with new, healthy habits. If you smoke, quit. Get plenty of exercise. Walking, jogging, dancing, and lifting weights can make your bones stronger. Eat a healthy mix of foods that include calcium and vitamin D. Try dark green vegetables, yogurt, and milk (for calcium). Eat eggs, fatty fish, and fortified cereal (for vitamin D).
Making even small changes in how you eat and exercise, along with taking medicine, can help prevent a broken bone.
When you have osteoporosis, it’s important to protect yourself from falling. Reduce your risk of breaking a bone by making your home safer. Make sure there’s enough light in your home. Remove throw rugs and clutter that you may trip over. Put sturdy handrails on stairs. In women, more rapid bone loss 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 starts to develop gradually when 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 an effect on people until they are 60 or older.
Whether a person develops osteoporosis depends on the thickness of the bones (bone density) in early life, as well as health, diet, and physical activity later in life. Factors that increase the risk of osteoporosis in both men and women include:

• Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed with osteoporosis or has experienced broken bones from a minor injury, you are more likely to develop osteoporosis.
• Lifestyle factors. These include:
  • Smoking. People who smoke lose bone thickness faster than nonsmokers.
  • Alcohol use. Heavy alcohol use can decrease bone growth and increase the risk of falling. But moderate alcohol use (no more than 2 drinks a day for men and 1 drink a day for women) is linked to higher bone thickness. Most doctors recommend limiting, but not eliminating, alcohol use.
  • Getting little or no exercise. Weight-bearing exercises—such as walking, jogging, stair climbing, dancing, or lifting weights—keep bones strong and healthy by working the muscles and bones against gravity. Exercise may improve your balance and decrease your risk of falling.
  • Being small-framed or thin. Thin people and those with small frames are more likely to develop osteoporosis. But being overweight puts a woman at risk for other serious medical conditions, including type 2 diabetes, high blood pressure, and coronary artery disease (CAD).
  • A diet low in foods containing calcium and vitamin D.
  • Drinking cola soft drinks. Cola, but not other carbonated soft drinks, may be linked to low bone mineral density in women.
• Having certain medical conditions, such as hyperparathyroidism, hyperthyroidism, or rheumatoid arthritis, that put you at greater risk for osteoporosis.
• Taking certain medicines. Several medicines cause bone thinning, such as:
  • Corticosteroids, used to treat conditions such as asthma and chronic obstructive pulmonary disease (COPD). If used for a period of 6 months or longer, corticosteroids can lead to steroid-induced osteoporosis.
  • Medicines used to treat endometriosis.
  • Aromatase inhibitors, used to treat breast cancer.
  • Thyroid replacement medicine, if the dose is more than the body needs. This should be monitored by checking the level of thyroid-stimulating hormone (TSH) every year.
  • Depo-Provera, a birth control medicine given by injection. Longtime use may thin bones.
  • Antacids that contain aluminum, if they are overused. Aluminum-containing antacids remove calcium from your body.
  • Anticonvulsant medicines such as carbamazepine.
  • Hormone treatment for prostate cancer.
  • Medicines called SSRIs (selective serotonin reuptake inhibitors). SSRIs are used to treat many conditions, including depression, fibromyalgia, and premenstrual syndrome. Studies have found that daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Before you take an SSRI, talk to your doctor about this risk.
• Having certain surgeries, such as having your ovaries removed before menopause.

Other risk factors for osteoporosis may include:

• Being of European and Asian ancestry, the people most likely to have osteoporosis. People of African ancestry are least likely.
• Being inactive or bedridden for long periods of time.
• Dieting excessively or having an eating disorder, such as anorexia nervosa.
• Being a female athlete, if you have few or irregular menstrual cycles due to low body fat. 

Women who have completed menopause have the greatest risk of osteoporosis because their levels of the estrogen hormone drop. Estrogen protects women from bone loss. Likewise, women who no longer have menstrual periods—either because their ovaries are not working properly or because their ovaries have been surgically removed—also can have decreased estrogen levels.


Prevention

After the age of about 30, bone thinning is a natural process and cannot be stopped completely. Whether you develop osteoporosis depends not only on the thickness of your bones early in life but also on your health, diet, and physical activity later in life. The thicker your bones, the less likely the bones are to become thin enough to break. Young women in particular need to be aware of their risk for developing osteoporosis and take steps early to slow its progress and prevent complications. Plentiful physical activity during the preteen and teen years increases bone mass and greatly reduces the risk of osteoporosis in adulthood. If you eat a diet adequate in calcium and vitamin D and exercise regularly early in life and then continue with these healthy habits, you may be able to delay or avoid osteoporosis.

• Eat a nutritious diet that includes adequate amounts of calcium and vitamin D. Both are necessary for building healthy, strong bones. The recommended daily calcium intake for adults up to age 50 is 1,000 mg a day. Men and women age 50 and older need 1,200 mg of calcium each day. The recommended daily intake for vitamin D is 400 to 800 IU a day for adults up to age 50. If you are age 50 or older, the recommended amount is 800 to 1,000 IU of vitamin D a day. The best source of vitamin D is exposure to sunlight. Vitamin D is vital for calcium absorption in bones and to improve muscle strength. One study showed that vitamin D may reduce an older person's risk of falling by 22%.⁹
• Take supplements if you are not getting enough calcium and vitamin D in your diet. Most doctors suggest daily vitamin D supplements for children and teens, starting by age 2 months. Talk with your doctor about how much and what sources of vitamin D are right for you and your child.
• Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or weight lifting, keep bones healthy by working the muscles and bones against gravity.
• Don't drink more than 2 alcohol drinks a day if you are a man, or 1 alcohol drink a day if you are a woman. Drinking more than this puts you at higher risk for osteoporosis.
• Don't smoke. Smoking puts you at a higher risk for developing osteoporosis and increases the rate of bone thinning after it starts.

After osteoporosis develops, getting enough calcium and vitamin D, along with other healthy habits, can slow the process and reduce the chances of bones breaking. It's common for a person's diet to supply only half the calcium the bones need, so you probably need to take supplements. Your bones need vitamin D to absorb calcium. One study showed that vitamin D may reduce an older person's risk of falling by 22%.
Research studies do not agree about whether calcium plus vitamin D supplements can prevent fractures. Some studies show that calcium and vitamin D supplements reduce the risk of fracture. But other studies show little effect of supplements on fracture risk. The greatest benefit of supplements appears to be for people who have osteoporosis. Calcium and vitamin D supplements are recommended if you have been diagnosed with osteoporosis.