Osteoporosis

We often think about osteoporosis as a disease that only women need to worry about. But men can be affected too. Osteoporosis is characterized by weak, brittle and porous bones. (Read about "Skeletal System") The National Institutes of Health (NIH) say it's the leading cause of hip fractures, a disabling problem that affects many seniors. (Read about "Hip Fractures")

According to the National Osteoporosis Foundation (NOF), 10 million Americans already have osteoporosis and 18 million more have low bone mass, which places them at an increased risk for developing osteoporosis. (Osteopenia is a term used to describe the early demineralization of bone that can develop into osteoporosis.) Eighty percent of those affected by osteoporosis - 8 million Americans - are women. In fact, NOF says one in two women and one in eight men over age 50 will have an osteoporosis-related fracture in their lifetime.

Our spines are another part of the body that is seriously at risk from osteoporosis. The Society of Cardiovascular and Interventional Radiology (SCVIR) says that osteoporosis causes 700,000 fractures of the vertebrae each year. (Read about "The Spine") An exaggerated curve in the back, called kyphosis, is a common problem. (Read about "Curvature of the Spine")

How it develops

We may think our bones are solid and unchanging, but they're not. Bone is living tissue. The National Institute on Aging (NIA) says special cells called osteoclasts are constantly breaking down old bone as other cells known as osteoblasts are replacing it with new tissue. As people age, more bone is broken down than is replaced. As a result, the insides of the bones become more porous, because much more bone is destroyed than is replaced. This makes the bones weaker.

Although osteoporosis usually becomes a problem in older people, it often has its roots in the habits of our youth. The good news is that by developing positive habits, younger people can help reduce their risk of getting osteoporosis later on. NIH says the best habits to develop in our teens, 20's and 30's (while our bodies are still building bone density faster than it's being broken down) include:

• getting enough calcium and vitamin D (Read about "Calcium" "Vitamins & Minerals")
• getting enough exercise, especially weight-bearing exercise such as walking (Read about "Walking for Health")
• avoiding alcohol and smoking

Who's at risk

Although osteoporosis is often thought of as affecting older people, it can strike at any age. NOF says there are also certain things that can put us at a higher risk.

• women have a higher risk because their bones are often smaller to begin with than a man's
• thin, small-boned people are more at risk for the same reason
• those with a family history of osteoporosis are more at risk (Read about "Family Health History")
• certain racial or ethnic groups have more risk, including white and Asian women (Read about "Minority Health")
• age increases our risk (Read about "Age & Bone Loss")
• smoking increases the risk (Read about "Quit Smoking")

In addition, NIA says certain medications can also decrease bone density and increase our risk. These include glucocorticoids (corticosteroids) used to treat diseases such as arthritis, some antiseizure drugs, certain sleeping pills, some hormones used to treat endometriosis, and some cancer drugs. (Read about "Arthritis & Rheumatic Diseases" "Seizures" "Endometriosis") An overactive thyroid gland or parathyroid glands can also be a problem. (Read about "Thyroid" "Parathyroid Glands") In addition, 90 percent of dialysis patients have bone problems, according to NIH. (Read about "Bone Loss and Kidney Disease") If you are taking medicines and have concerns, ask your doctor what can be done to protect your bones.

Unfortunately, NIA says many people with osteoporosis don't know they have it until it's in its advanced stages. Many find out they have osteoporosis only after they fall and fracture a hip, rib or wrist. Screening techniques can detect osteoporosis before it gets to this point. Special scanning machines that measure bone density can help a doctor determine if a patient has a higher than normal risk, and if so what can be done to help.

Reducing our risk

Although some risk factors for developing osteoporosis, such as age and family history, are out of our hands, others, such as diet and exercise, can be controlled. For example, the National Institutes of Health (NIH) say that a lifestyle that includes regular weight-bearing exercise (such as walking) can help strengthen bones. (Read about "Getting Started on Fitness") If you've already been diagnosed with osteoporosis, ask your doctor about the best forms of exercise.

NIH says you can also help reduce your risk of osteoporosis by avoiding alcohol and by not smoking. (Read about "Quit Smoking") In addition, it's important to get adequate amounts of calcium in our diet. (Read about "Calcium and Osteoporosis") For those over the age of one, the Institute of Medicine (IOM) recommends, depending on your age, sex and other health issues, between 700 and 1300 milligrams per day of calcium. You should discuss with your healthcare provider what your needs are. For those over the age of one, IOM also says the upper intake level for calcium is between 2000 and 3000 milligrams per day. Once again, it depends on your age and other health factors how much calcium you should be getting. Upper intake levels represent the upper safe boundary and should not be misunderstood as amounts people need or should strive to consume, according to IOM. If your diet doesn't provide enough, supplements and fortified foods can be useful. Use of supplements should always be discussed with a doctor first.

Vitamin D is also needed to help your body absorb calcium. We get vitamin D from exposure to sunshine, as well as from foods including eggs, fatty fish, and cereal and milk fortified with vitamin D in their diet. For those over the age of one, IOM recommends, depending on your age, sex and other health issues, between 600 and 800 international units (IUs) of vitamin D per day to maintain health. Once again, you should discuss with your healthcare provider what your needs are. For those over the age of one, IOM also says the upper intake level for vitamin D is between 2500 and 4000 IUs per day, depending on your age and other health factors.

Many healthcare providers have begun treating women in the early stages of bone loss known as osteopenia. This can help prevent women from entering the higher bone fracture risk category of osteoporosis.

Screening and treatment

If you're concerned about osteoporosis, a doctor can measure your bone mass to determine your risk. The Food and Drug Administration (FDA) says bone density tests are useful for confirming a diagnosis of osteoporosis if a person has already had a suspicious fracture, or for detecting low bone density so that preventive steps can be taken. In addition, the U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis in women 65 years and older and in postmenopausal women younger than 65 years at increased risk of osteoporosis. Readings repeated at intervals of a year or more can determine the rate of bone loss and help monitor treatment effectiveness. However, estimates are not necessarily comparable between machine types because they use different measurement methods, so FDA suggests that you return to the same machine, if possible, for your tests.

There are different ways to measure bone density. According to the North American Spine Society, a bone density scan is a non-invasive painless test that measures bone mass. A scan can detect osteoporosis before a fracture occurs, 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 annually. FDA says the commonly used DEXA (Dual Energy X-ray Absorptiometry) scan exposes you to far less radiation than a chest x-ray. (Read about "DEXA Scan - Dual Energy X-Ray Absorptiometry/Densitometry" "X-rays") During this type of exam, you lie fully clothed on a padded table while the machine scans one or more areas of bone (generally the lower spine or hip). In addition to x-ray-based bone densitometers, FDA says ultrasound scanning machines can also be used. (Read about "Ultrasound Imaging") Ultrasound machines for testing osteoporosis are smaller than traditional x-ray-based systems. They measure bone mineral density in different regions of the body, such as the heel of the foot.

If osteopenia or osteoporosis is present, NOF says there are a number of treatment options, ranging from calcium supplements and exercise to prescription medications. Since bone loss increases after menopause (Read about "Menopause"), hormone replacement therapy (HRT) may be considered an option; however recent studies have raised concerns about HRT and an increased risk of cancer and stroke (Read about "Clinical Studies" "Cancer: What It Is" "Stroke"), so you should carefully discuss the benefits and the risks with your doctor.

There are a number of other types of prescription medications that have been approved for treating osteoporosis. These include:

• bisphosphonates - act by slowing the turnover of bone, rather than stimulating new bone formation. FDA says increases in bone mass are most pronounced in the first year or two after treatment with the drugs begins.
• teriparatide - stimulates new bone growth to increase bone mass.
• raloxifene - a drug in a class known as selective estrogen receptor modulators, or SERMs, which have been shown to reduce the risk for fracture of the spine.
• calcitonin - a hormone that plays a role in calcium and bone metabolism. When used regularly, it can slow the loss of bone.
• denosumab - a drug that decreases the breakdown of bone.

As with any medication, there are both benefits as well as disadvantages to all these treatments, so it's important to discuss all options with a qualified healthcare professional who knows your medical history. It is also important that you take your medications as directed. For example, bisphosphonates should be taken with plenty of water, and you should remain upright for half an hour after taking the medication to avoid irritating your esophagus. (Read about "Medicine Safety" "Medication and Digestion") Bisphosphonates have also been linked with severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain, so it is important that if you are taking medication, you report any side effects to your doctor.

Keep in mind too that medication alone isn't enough. Calcium and vitamin D supplements are an integral part of all treatments for osteoporosis. Since calcium can interfere with the absorption of some medications, however, ask your doctor about the best time to take your supplements. Attention to diet is important not only for treatment, but also for prevention. In addition, weight-bearing exercise, such as walking or biking, also helps build and maintain strong bone. Therefore, you should talk to your doctor about the level of exercise that is appropriate for you, and then follow his or her directions. A rehabilitation specialist can provide information on physical therapies that may be helpful. (Read about "Rehabilitation")

Related Information:

    Age and Bone Loss

    Accidental Falls

    Bone Fractures

    Rehabilitation

    Senior Home Safety