Osteoporosis

Osteoporosis causes bones to become weak and brittle so that a fall or even mild stresses like bending or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone does not keep up with the removal of old bone.

Osteoporosis affects men and women of all races, but white and Asian women — especially older women who are past menopause — have the highest risk or developing this condition. Medications, a healthy diet, and weight-bearing exercise can help prevent bone loss and strengthen already weak bones.

Osteoporosis is often called a silent disease because bone loss occurs without symptoms and people may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis (severely stooped posture).

Your bones are in a constant state of renewal: new bone is made and old bone is broken down. When you are young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Most people reach their peak bone mass by their early 20s. As people age, bone mass is lost faster than it is created. Your likelihood of developing osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have and the less likely you are to develop osteoporosis as you age.

Certain risk factors are linked to the development of osteoporosis and contribute to an individual’s likelihood of developing the disease. Many people with osteoporosis have several risk factors, but others who develop the disease have no known risk factors. Some risk factors cannot be changed, but you can change others.

Risk factors include:

• getting older
• being small and thin
• having a family history of osteoporosis
• taking certain medicines such as glucocorticoids and some anticonvulsants
• being a white or Asian woman
• having osteopenia (low bone density)
• consuming a diet low in calcium and vitamin D
• smoking cigarettes
• having an inactive or sedentary lifestyle
• consuming excessive amounts of alcohol

Osteoporosis is diagnosed with a bone density test. Bone mineral density (BMD) can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked, usually in the hip, wrist and spine.

BMD tests can:

• detect low bone density before a fracture occurs
• confirm a diagnosis of osteoporosis if you already have one or more fractures
• predict your chances of fracturing in the future
• determine your rate of bone loss, and monitor the effects of treatment if the test is conducted at intervals of a year or more

Several lifestyle changes may help reduce your risk of developing osteoporosis or experiencing broken bones if your bones are already weakened.

Do not smoke. Smoking increases rates of bone loss and the chance of experiencing a fracture.

Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation. Being under the influence also can increase your risk of falling.

Prevent falls. Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get into and out of your bed easily.

Eat a healthy diet. Calcium and vitamin D are needed for strong bones and for your heart, muscles, and nerves to function properly. Food sources of calcium include low-fat dairy products, such as milk, yogurt, cheese, and ice cream; dark green, leafy vegetables, such as broccoli, collard greens, bok choy, and spinach; sardines and salmon with bones; tofu; almonds; and foods fortified with calcium, such as orange juice, cereals, and breads. Food sources of vitamin D include egg yolks, saltwater fish, and liver. If you do not consume enough calcium or vitamins from your diet, supplements are available.

Exercise. Exercise improves your bone health, and it increases muscle strength, coordination, and balance, and leads to better overall health. Your doctor or a physical therapist can recommend specific exercises to strengthen and support your back.

Several medications are available for the prevention and/or treatment of osteoporosis.

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. These drugs reduce bone loss. Common bisphosphonates include:

• alendronate (Fosamax)
• risedronate (Actonel, Atelvia)
• ibandronate (Boniva)
• zoledronic acid (Reclast)

Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman's risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health only if menopausal symptoms also require treatment. Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may also reduce the risk of some types of breast cancer. Raloxifene may increase the risk of blood clots.

In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help increase bone density, but osteoporosis medications have been better studied in men with osteoporosis and are recommended alone or in addition to testosterone.

Other treatments for osteoporosis include:

• denosumab (Prolia), which is a monoclonal antibody that decreases bone loss, reduces fractures, and increases BMD
• teriparatide (Forteo), which is a synthetic form of a naturally occurring hormone that causes new bone to form