Osteoporosis is a bone disease that increases the risk of developing fractures (broken bones). It is defined as a decrease in bone mineral density (BMD) and bone strength.
Osteoporosis is the major cause of fractures in postmenopausal women and the elderly. (See How Bones Work)
Fractures related to osteoporosis are most likely to occur in the bones of the hip, spine and wrist, but any bone can be affected. Hip fractures are especially disabling.
Osteoporosis can progress slowly without any symptoms until a bone breaks or one or more vertebrae (bones in the spine) collapse. Collapsed vertebrae can result in severe back pain, loss of height, or a hunched posture. Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of minor trauma or movement.
Osteoporosis is largely preventable and people who already have osteoporosis can slow its progression and reduce their risk of developing fractures.
Who gets Osteoporosis?
The risk of developing osteoporosis increases with age. 4 out of 5 people who develop osteoporosis are women. 50% of women and as many as 25% of men over age 50 will have a fracture related to osteoporosis some time in the lives.
Consider talking to your doctor about osteoporosis if:
- You are a man or woman over age 45 or a postmenopausal woman and you break a bone.
- You are a woman age 65 or older.
- You have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent
- You have been taking a corticosteroid, such as prednisone, for 2 months or longer or are taking other medications known to
- You have had anorexia nervosa or a history of this eating disorder.
- You are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty.
Causes of Osteoporosis
The major cause of osteoporosis is less than optimal bone growth during childhood and adolescence. This results in a failure to reach optimal peak bone mass.
People who enter early adulthood with greater reserves of bone (higher peak bone mass) are less likely to develop osteoporosis later in life when bone mass decreases as result of aging, menopause, or other factors. Conversely, those who reach their early adulthood with insufficient bone reserves are at greater risk of developing osteoporosis in their fifties and sixties.
Other causes of osteoporosis are bone loss due to a greater than expected rate of bone resorption, a decreased rate of bone formation, or both.
A major contributor to bone loss among women later in life is the reduction in estrogen production that occurs with menopause. This is referred to as postmenopausal osteoporosis.
In men, sex hormone levels also decline after middle age, but the decline is more gradual. These declines probably also contribute to bone loss in men after around age 50.
Osteoporosis can also result from bone loss that may accompany a wide range of disease conditions, eating disorders, and certain medications and medical treatments. For instance, osteoporosis may be caused by long-term use of some anti-epileptic medications (anticonvulsants) and glucocorticoid medications such as prednisone and cortisone. Glucocorticoids are anti-inflammatory drugs used to treat many diseases, including rheumatoid arthritis, lupus, asthma, and Crohn's disease. Other causes of osteoporosis include alcoholism, anorexia nervosa, abnormally low levels of sex hormones, hyperthyroidism, kidney disease, and certain gastrointestinal disorders. Sometimes osteoporosis results from a combination of causes.
In the past, osteoporosis could only be detected if you broke a bone. Today, several tests are available for the diagnosis of osteoporosis, including the following:
- Bone Mineral Density Test (BMD). The most widely used bone mineral density test is called a dual-energy x-ray absorptiometry, or DXA test. Although no bone density test is 100% accurate, this type of test is the single most important predictor of whether a person will have a fracture in the future.
- Bone Scans
- X-Ray of the Spine. An x-ray of your spine may be ordered to determine whether you have had a fracture.
Medications for Osteoporosis
The primary goal in treating people with osteoporosis is preventing bone fractures. A comprehensive treatment program includes a focus on proper nutrition, exercise, and prevention of falls that may result in fractures.
Your doctor may also prescribe one of several medications that have been shown to slow or stop bone loss or build new bone, increase bone density, and reduce fracture risk.
The most commonly prescribed medications are categorized as bisphosphonates.
If you take medication to prevent or treat osteoporosis, it is still essential that you also obtain the recommended amounts of calcium and vitamin D. Exercising and maintaining other aspects of a healthy lifestyle are also important.
Reference: The National Institute of Arthritis and Musculoskeletal and Skin Diseases