Osteoporosis

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Definition

Osteoporosis is when bones become weak and brittle. If left unchecked, it can lead to bone breaks (fracture). Any bone can be affected. Fractures of special concern are of the hip, spine, and wrist.
Osteoporosis
osteoporosis bone
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Causes

Throughout life, old bone is removed and new bone is added to your skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger, and denser. Peak bone mass is reached around age 30. From that point, more bone is lost than replaced. If not treated, bone loss may lead to osteoporosis. Osteoporosis is more likely to occur if full bone mass was not achieved during your bone-building years.
Bone density also plays a role in bone health. Bone density is determined by the amount of minerals within the bone framework. These include calcium, phosphorus, and others. As the mineral content of a bone (especially calcium) decreases, the bone weakens. Getting enough calcium,vitamin D, and regular exercise can keep bones strong throughout life.

Risk Factors

There are many risk factors that may increase your chance of developing osteoporosis. Some of the risk factors include:
  • Increasing age
  • Low weight
  • Smoking
  • Alcohol abuse
  • History of falls
  • Certain conditions, such as:
  • Use of certain medicines (such as antidepressants, warfarin [coumadin], long-term heparin, corticosteroids, thyroid medicine, anticonvulsants, antacids)
  • Low hormone levels (low estrogen levels in women, low testosterone levels in men)
  • Inactive lifestyle
  • Certain restrictive diets (for example, not getting enough calcium or vitamin D)
  • Too little sunlight (the effect of sun on the skin is a primary source of vitamin D)
  • Cancer, including lymphoma and multiple myeloma
More women than men develop osteoporosis. Some specific risk factors that affect women include:
  • Family history of osteoporosis
  • Postmenopausal status
  • Amenorrhea (no menstrual periods)
  • Gastrointestinal malabsorption
  • Having another endocrine disorder (such as thyroid disorder or diabetes)

Symptoms

Symptoms include:
  • Pain when bones break or collapse
  • Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
  • Loss of height with stooped posture (kyphosis)
Kyphosis
IMAGE
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Diagnosis

Your doctor will ask about your symptoms and medical history. He or she will do a physical exam. Early signs of osteoporosis can be seen with bone density testing:
  • Dual-energy x-ray absorptiometry—measures bone density in the entire body
    • For older men, the American College of Physicians (ACP) recommends that your doctor check for risk factors for osteoporosis. The ACP also recommends that you have this test if you are at an increased risk and are a candidate for drug therapy. Ask your doctor about what is right for you.
  • Single-energy x-ray absorptiometry—measures bone density in the arm or heel
  • Dental x-rays of bone
  • Ultrasound bone density measurement—measures bone density in fingers, heels, and leg bones
Other tests may include:
  • Blood and urine tests—to test for calcium levels or substances created when bone is broken down

Treatment

Treatment includes:

Nutrition

Decrease your intake of caffeinated beverages and alcohol. Eat a balanced diet rich in calcium and vitamin D. Calcium is in:
  • Dairy products
  • Green leafy vegetables
  • Canned fish with bones
  • Calcium-fortified products

Smoking

Do not smoke. If you smoke, quit.

Exercise

Exercise improves bone health. It also increases muscle strength, coordination, and balance. Do weight-bearing and strength-training exercises for maximum benefit. Balance training may prevent falls and fractures.

Dietary Supplements

People who cannot eat enough calcium from food might want to take calcium supplements. Calcium citrate has the best absorption and is well-tolerated. Other vitamins and minerals may be recommended, including vitamin D, magnesium, potassium, and vitamin K. A study showed that Japanese postmenopausal women who took vitamin K supplements had a reduced rate of fractures. Talk to your doctor before taking herbs or supplements.

Medications

Your doctor may prescribe medicine to prevent bone loss, increase bone density, and reduce your risk of spine and hip fractures:
  • Raloxifene (such as Evista)
  • Bisphosphonates (alendronate [such as Fosamax], risedronate [such as Actonel], ibandronate [such as Boniva], zoledronic acid [such as Reclast])
  • Calcitonin
  • Fluoride
  • Recombinant parathyroid hormone (such as Teriparatide)
  • Denosumab (Prolia)
Hormone Replacement Therapy (HRT)
HRT (including estrogen replacement therapy [ERT]) can cut your risk of osteoporosis in half. However, research shows a strong association between longer-term HRT and/or ERT and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to find out if it is right for you.
HRT therapy may include:
  • Estrogen alone (ERT)
  • Estrogen and progestin—frequently preferred for women with an intact uterus because ERT slightly increases the risk of uterine cancer
HRT can:
  • Reduce bone loss
  • Increase bone density
  • Reduce the risk of hip and spinal fractures in postmenopausal women

Safety Measures

Falls can increase the chance of fracture in someone with osteoporosis. Here are ways to prevent falls:
  • Use a cane or walker for stability.
  • Wear rubber-soled shoes for traction.
  • Use plastic or carpet runners when possible.
  • Keep rooms free of clutter.
  • Install grab bars in bathrooms.

Prevention

Building strong bones throughout your early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis:
  • Balanced diet rich in calcium and vitamin D
  • Weight-bearing exercise
  • Healthy lifestyle (no smoking, drink alcohol only in moderation)
  • Bone density testing and medicines where appropriate:
    • Fosamax
    • Actonel
    • Evista

RESOURCES

NIH Osteoporosis and Related Bone Diseases National Resource Center http://www.niams.nih.gov/Health%5FInfo/Bone

National Osteoporosis Foundation http://www.nof.org

CANADIAN RESOURCES

Osteoporosis Canada www.osteoporosis.ca

Women's Health Matters http://www.womenshealthmatters.ca

References

Fall prevention. National Osteoporosis Foundation website. Available at: http://www.nof.org/patientinfo/fall%5Fprevention.htm. Accessed June 10, 2008.

Ho-Pham LT, Nguyen ND, et al. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr. 2009;90:943-950.

Khosla L, Melton LJ. Clinical practice: osteopenia. N Engl J Med. 2007;356:2293-2300.

Nelson M. Strong Women, Strong Bones: Everything You Need to Prevent, Treat, and Beat Osteoporosis. New York, NY: Putnam; 2000.

Osteoporosis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated March 2010. Accessed March 12, 2010.

Osteoporosis: frequently asked questions. Womens Health.gov. Available at: http://www.womenshealth.gov/FAQ/osteoporosis.cfm#c. Updated September 22, 2009. Accessed December 22, 2009.

Osteoporosis: risk factors. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/osteoporosis/DS00128/DSECTION=risk-factors. Updated December 2009. Accessed December 22, 2009.

Prevention: who's at risk? National Osteoporosis Foundation website. Available at: http://www.nof.org/patientinfo/fall%5Fprevention.htm. Accessed December 22, 2009.

Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367:2010-2018.

10/6/2006 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Cockayne S, Adamson J, Lanham-New S, et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:1256-1261.

5/16/2008 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148:680-684.

1/30/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ. 2009;180:32-39. Epub 2008 Dec 10.

12/29/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ. 2009;339:b4229.

6/4/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: FDA approves new injectable osteoporosis treatment for postmenopausal women. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm214150.htm. Published June 1, 2010. Accessed June 4, 2010.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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