Osteoporosis

What is osteoporosis?

Osteoporosis is a disease that causes your bones to become weak and brittle. Normally your body constantly breaks down and replaces bone. But when it can no longer build enough new bone to fully replace what’s lost, you start to lose bone mass (density).

Osteoporosis is diagnosed when your bones have lost a certain amount of density. That makes them very fragile, meaning you’re more likely to fracture a bone if you fall or have other injuries. The most common fractures are in the hip, back, and wrist. Osteoporosis is also a common cause of height loss in older adults, as people lose bone density in their spine.

An estimated 10 million people in the U.S. have osteoporosis, according to the National Osteoporosis Foundation. Osteoporosis is more common in older women but it occurs in men as well.

There is no cure for osteoporosis but it is possible to slow its progression and strengthen weak bones with medication, diet, and exercise.

Most common symptoms

Osteoporosis is considered a silent disease because there are usually no symptoms until you break a bone. But you may experience symptoms as it gets worse.

Main symptoms

• Height loss of an inch or more
• Changes in posture, such as stooping
• Shortness of breath (can occur if you stoop, which adds pressure to your airway and limits your lungs’ ability to expand)
• Bone fractures
• Lower back pain

Next steps

See your doctor if you have any symptoms of osteoporosis. The condition is diagnosed using a bone density test (DXA), which measures your bone mass.

This test can also detect osteopenia, a less severe condition in which your bone mass is low—but not so low that your bones are fragile and easily broken. Osteopenia can progress to osteoporosis. Blood and urine tests can determine whether your bone loss is caused by a medical condition.

Since it is a silent disease, women 65 and older and young women with an increased risk of osteoporosis (including having osteopenia) should have regular screening DXA exams.

Causes of osteoporosis

Several factors can increase your risk of osteoporosis. Some of them are factors that increase your likelihood of having less dense bones to begin with. Other factors affect your body’s ability to rebuild bone faster than it breaks down.

• Being white or of Asian descent
• Sex (postmenopausal women are the most vulnerable)
• Aging leads to bone loss.
• Obesity increases your risk for osteoporosis by reducing your bone mass.
• Smoking
• Drinking alcohol excessively (more than three drinks a day).
• A family history of osteoporosis
• Eating disorders such as anorexia and bulimia
• A diet low in calcium and vitamin D—both are needed to build and maintain strong bones
• Certain medical conditions, including overactive thyroid (hyperthyroidism), overactive parathyroid glands (hyperparathyroidism), celiac disease, inflammatory bowel disease, multiple myeloma, and menstrual disorders
• Some types of medications, such as steroids, for seizure disorders and breast and prostate cancer, and ones given to organ-transplant patients

Treatment of osteoporosis

You can help slow the progression of osteoporosis with a combination of dietary changes, exercise, and medications.

Medication

Most medications for osteoporosis slow the rate that your bones break down. Others work by speeding up bone building. Both types make your bones stronger and reduce your risk of fracture.

Bisphosphonates

Bisphosphonates are a class of drugs that slow the loss of bone tissue. They improve bone health and reduce fracture risk by up to 50%. They may have side effects, so discuss the risks and benefits of taking these medications.

Common medications include:

• Alendronate: Fosamax, Fosamax Plus D, Binosto
• Ibandronate: Boniva
• Risedronate: Actonel, Atelvia
• Zoledronic acid: Reclast

Hormone and hormone-related therapy

This class of medications includes estrogen and testosterone and selective misogynist sector modulators such as raloxifene (Evista). Potential complications include blood clots and heart disease.

Biologics

Denosumab (Prolia) is given as an injection every six months. This class of medication shares a similar side effect profile as bisphosphonates.

Diet and supplements

Getting enough calcium and vitamin D is important because both improve bone health. You can get calcium by eating 3 to 4 daily servings of dairy products, like milk, yogurt, and cheese. Dark, leafy greens are also a good source of calcium. If you don’t or cannot eat dairy, your doctor may recommend a calcium supplement.

Many people are deficient in vitamin D. Sun exposure is the best natural source, but exposure is also a risk factor for skin cancer. It can be difficult to get vitamin D from food and sun alone, so your doctor may recommend supplements.

Exercise

Start a regular exercise program. Weight-bearing exercises (walking, aerobics, jogging, hiking) and strength training can improve bone health, according to the National Osteoporosis Foundation. Balance exercises are also recommended to reduce your risk of falling and fracturing a bone.

Follow up

Doctors recommend having another DXA scan after 1 to 2 years of treatment. Your vitamin D levels will be measured regularly to make sure they’re high enough.

Preventative tips

You can’t control some risk factors for osteoporosis, such as family history. But there are some changes you can make to reduce your risk. These include:

• Lose weight if you’re overweight.
• Quit smoking.
• Limit the amount of alcohol you drink.
• Get enough calcium and vitamin D.
• Do weight-bearing exercises.

To reduce your risk of falling and fracturing a bone

• Wear low-heeled shoes with nonslip soles.
• Fall-proof your home. Check for any loose area rugs, electrical cords, and slippery surfaces that could cause you to trip and fall.
• Consider installing grab bars in your shower and beside the toilet that you can hold on to.
• Do exercises that improve balance.