Osteoporosis

Osteoporosis is the thinning of bone tissue and loss of bone density over time, and is the most common type of bone disease. Researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine).

Osteoporosis occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both. Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

As you age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury. Usually, the loss occurs gradually over years. Many times, a person will have a fracture before becoming aware that the disease is present. By the time a fracture occurs, the disease is in its advanced stages and damage is severe.

The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women over age 50 and men over age 70 have a higher risk for osteoporosis.

Other causes include:

  • Being confined to a bed
  • Chronic rheumatoid arthritis, chronic kidney disease, eating disorders
  • Taking corticosteroid medications (prednisone, methylprednisolone) every day for more than three months, or taking some anti-seizure drugs
  • Hyperparathyroidism

Caucasian women, especially those with a family history of osteoporosis, have a greater than average risk of developing osteoporosis.

Other risk factors include:

  • Absence of menstrual periods (amenorrhea) for long periods of time
  • Drinking a large amount of alcohol
  • Family history of osteoporosis
  • History of hormone treatment for prostate cancer or breast cancer
  • Low body weight
  • Smoking
  • Too little calcium in the diet.

Symptoms

There are no symptoms in the early stages of the disease.

Symptoms occurring late in the disease include:

  • Bone pain or tenderness
  • Fractures with little or no trauma
  • Loss of height (as much as six inches) over time
  • Low back pain due to fractures of the spinal bones
  • Neck pain due to fractures of the spinal bones
  • Stooped posture or kyphosis, also called a "dowager's hump"

Exams and tests

Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. Your health care provider uses this test to predict your risk for bone fractures in the future. For information about when testing should be done, see bone density test.

A special type of spine CT that can show loss of bone mineral density, quantitative computed tomography (QCT), may be used in rare cases.

In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis.

You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age. 

Treatment

The goals of osteoporosis treatment are to:

  • Control pain from the disease
  • Slow down or stop bone loss
  • Prevent bone fractures with medicines that strengthen bone
  • Minimize the risk of falls that might cause fractures


There are several different treatments for osteoporosis, including lifestyle changes and a variety of medications.

Medications are used to strengthen bones when:

  • Osteoporosis has been diagnosed by a bone density study
  • Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred
Bisphosphonates
Bisphosphonates are the primary drugs used to both prevent and treat osteoporosis in postmenopausal women.Bisphosphonates taken by mouth include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). Most are taken by mouth, usually once a week or once a month.

Bisphosphonates given through a vein (intravenously) are taken less often.

Calcitonin
Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection. The main side effects are nasal irritation from the spray form and nausea from the injectable form.

Calcitonin appears to be less effective than bisphosphonates.

Hormone replacement therapy
Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis and are not approved to treat a woman who has already been diagnosed with the condition.

Sometimes, if estrogen has helped a woman, and she cannot take other options for preventing or treating osteoporosis, the doctor may recommend that she continue using hormone therapy. If you are considering taking hormone therapy to prevent osteoporosis, discuss the risks with your doctor.

Parathyroid hormone
Teriparatide (Forteo) is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. You can give yourself the shots at home.

Raloxifene
Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50 percent. However, it does not appear to prevent other fractures, including those in the hip. It may have protective effects against heart disease and breast cancer, though more studies are needed.

The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

Exercise
Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis.

Some of the recommended exercises include:

  • Weight-bearing exercises - walking, jogging, playing tennis, dancing
  • Resistance exercises - free weights, weight machines, stretch bands
  • Balance exercises - tai chi, yoga
  • Riding a stationary bicycle
  • Using rowing machines

Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures.

Diet
Get at least 1,200 milligrams per day of calcium and 800 to 1,000 international units of vitamin D3. Vitamin D helps your body absorb calcium. Your doctor may recommend a supplement to give you the calcium and vitamin D you need.

Follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include:

  • Cheese
  • Ice cream
  • Leafy green vegetables, such as spinach and collard greens
  • Low-fat milk
  • Salmon
  • Sardines (with the bones)
  • Tofu
  • Yogurt

Stop unhealthy habits
Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

Prevent falls
It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good.

Other ways to prevent falling include:

  • Avoiding walking alone on icy days
  • Using bars in the bathtub, when needed
  • Wearing well-fitting shoes

Monitoring
Your response to treatment can be monitored with a series of bone mineral density measurements taken every one to two years.