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Osteoporosis


Definition

Osteoporosis is a disease that affects your bones. It means you have bones that are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These fractures can be disabling and may make it hard for you to live on your own.

Osteoporosis affects millions of older adults. It usually strikes after age 60. It’s most common in women, but men can get it too.

In a normal, healthy adult, bone is continually absorbed into the body and then rebuilt. During childhood and the teen years, new bone tissue is added faster than existing bone is absorbed. As a result, your bones become larger and heavier until about age 30 when you reach peak bone mass (density). The more bone mass you developed early in life, the less likely you are to develop osteoporosis.

After age 30, both men and women lose a small amount of bone each year. Because most men build greater bone mass than women do, they tend to get osteoporosis later in life.

A person with thinning bones may be diagnosed with lower-than-normal bone mass (osteopenia). Osteopenia sometimes progresses to osteoporosis.

When bones thin, they lose strength and break more easily. The bones that break most often due to osteoporosis are:

In women, bone loss increases when the ovaries reduce production of estrogen, a hormone that protects against bone loss. Studies show that on average, women lose 1% to 3% of their bone mass every year for about 3 to 5 years after menopause.

In men, the hormone testosterone protects against bone loss. Osteoporosis develops most often in men older than 65.


Causes

During childhood and teen years, new bone grows faster than existing bone is absorbed by the body. After age 30, this process begins to reverse. As a natural part of aging, bone dissolves and is absorbed faster than new bone is made, and bones become thinner. You are more likely to have osteoporosis if you did not reach your ideal bone thickness (bone mineral density) during your childhood and teenage years.

In women, bone loss increases around menopause, when ovaries decrease production of estrogen, a hormone that protects against bone loss. Likewise, testosterone protects men from bone loss. Osteoporosis is typically seen in men older than 65, when production of this hormone declines. In both men and women: The older you get, the more likely you are to have osteoporosis. See a picture of healthy bone versus bone weakened by osteoporosis.

Not getting enough calcium and vitamin D contributes to bone thinning. Also, a tendency for lower bone mass may pass from parent to child.


Symptoms

In the early stages of osteoporosis, you probably will not have symptoms. As the disease progresses, you may have symptoms related to weakened bones, including:


Testing

A diagnosis of osteoporosis is based on your medical history, a physical exam, and a test to measure your bone thickness (density). During a physical exam, your doctor will:

A bone mineral density test measures the mineral density (such as calcium) in your bones using a special X-ray, computed tomography (CT) scan, or ultrasound. From this information, your doctor can estimate the strength of your bones. See a picture of a bone mineral density test.

Routine urine and blood tests can rule out other medical conditions, such as hyperparathyroidism, hyperthyroidism, or Cushing's syndrome, that can cause bone loss. In men, blood tests to measure testosterone levels can see whether low levels are causing bone loss.

If you have been diagnosed with osteoporosis, you may need to follow up regularly with your doctor to monitor your condition.


Early Detection

If you or your doctor thinks you may be at risk for developing osteoporosis, you may have a screening test to check your bone thickness. A screening test may be advisable if you have:

The United States Preventive Services Task Force recommends that all women age 65 and older routinely have a bone mineral density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should begin at age 60.

Most experts recommend that the decision to screen women age 60 and younger be made on an individual basis, depending on the risk of developing osteoporosis and whether the test results will help with treatment decisions.

Experts recommend that men older than age 70, or with other risk factors for osteoporosis, have a bone mineral density test.

 

Treatment

The process of bone thinning (osteoporosis) is a natural part of aging. But if you receive treatment early, you may be able to stop or slow the progress of bone loss. Treatment is important to:

Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular exercise, and taking medicine to reduce bone loss and increase bone thickness. It's important to take calcium and vitamin D supplements along with any medicines you take for osteoporosis. Even small changes in diet, exercise, and medicine can help prevent spine and hip fractures. Adults who adopt healthy habits can slow the progress of osteoporosis.


Initial treatment

If you have been diagnosed with osteoporosis, your doctor likely will recommend lifestyle and diet changes. Eat foods rich in calcium and vitamin D, which are necessary for keeping bones healthy and strong. Take supplements if you think you are not getting enough of these nutrients in your diet. Recommendations vary, but the National Osteoporosis Foundation suggests that adults up to age 50 get 1,000 mg of calcium and 400 to 800 IU of vitamin D a day. If you are age 50 or older, the recommended amounts are 1,200 mg of calcium and 800 to 1,000 IU a day of vitamin D.

Your bones need vitamin D to absorb calcium. One study showed that vitamin D may reduce an older person's risk of falling by 22%.The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.

Research studies do not agree about whether calcium plus vitamin D supplements can prevent fractures. Some studies show that calcium and vitamin D supplements reduce the risk of fracture.But other studies show little effect of supplements on fracture risk.The greatest benefit of supplements appears to be for people who have osteoporosis. Calcium and vitamin D supplements are recommended if you have been diagnosed with osteoporosis.

Exercises, including weight-bearing exercise (walking, jogging, stair climbing, dancing, or lifting weights), aerobics, and resistance exercises are all effective in increasing bone mineral density and strength of the spine. Walking also increases bone mineral density of the hip. And exercise increases strength and balance so you are less likely to fall. Start out at an exercise level that you are comfortable with and work up gradually. To be most effective, weight-bearing exercises should be done for 30 minutes most days of the week, and resistance exercises 2 to 3 days a week. If you stop exercising, your bones weaken and may be more likely to break.

Along with exercise and diet, your doctor will recommend that you not smoke and limit alcohol to no more than 2 drinks a day for men and 1 drink a day for women. For more information on quitting smoking, see the topic Quitting Tobacco Use.

In some cases, medicines are prescribed to protect against bone loss. These medicines include raloxifene (Evista), bisphosphonates such as risedronate (Actonel) and alendronate (Fosamax), and parathyroid hormone (Forteo). It's important to take calcium and vitamin D supplements along with any medicines you take for osteoporosis.

If you take corticosteroids longer than 6 months for asthma or other conditions, you may be at greater risk for developing steroid-induced osteoporosis. If you begin to have bone loss, you may need to take osteoporosis medicines, such as bisphosphonates, while you are taking steroids.

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.


Ongoing treatment

After you have been diagnosed with bone loss, whether it is mild or severe, you will need to have regular follow-up tests to monitor the disease. Osteoporosis is a progressive disease: both men and women lose approximately 0.4% of bone each year after age 30. It is never too late to develop and then maintain healthy habits that can slow the progression of the disease.

When you have osteoporosis, it is especially important to protect yourself from falling. When bones lose mass and become more brittle, they lose strength and break more easily. Women of European and Asian ancestry are more likely to have osteoporosis than those with African ancestry. An estimated 17% of white women will break a hip sometime after age 50, as will 6% of white men.To reduce your chances of breaking bones, take steps to prevent falls, such as having your vision and hearing checked regularly and wearing slippers or shoes with a nonskid sole. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling.

If your tests indicate continuing bone loss, your doctor likely will recommend that you take medicine to increase bone density and decrease your risk of spine and hip fractures. These medicines include bisphosphonates, such as risedronate (Actonel) or alendronate (Fosamax). It's important to take calcium and vitamin D supplements along with any medicines you take for osteoporosis.

Calcitonin may be prescribed for women who are more than 5 years beyond menopause and who cannot take bisphosphonate medicines, or for men who are not receiving testosterone treatment. Calcitonin has the added advantage of helping reduce pain from spinal fractures. But studies show that calcitonin is less effective than bisphosphonate medicines at stopping bone loss.

Raloxifene (Evista) may be prescribed for women, especially if you are 55 to 65 years old. Raloxifene has been proved to reduce the risk of spinal fractures but not hip fractures. Raloxifene may also reduce the risk of breast cancer, although it is not approved for this purpose. Raloxifene can cause hot flashes, so it is not often used in early menopause (45 to 55 years) when hot flashes are frequent.

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

Treatment if the condition gets worse

It is never too late to build and then keep healthy habits that can slow bone thinning.

Medicines called bisphosphonates, such as alendronate (Fosamax) or zoledronic acid (Reclast), may be used to slow the rate of bone loss and increase bone thickness and strength. This will reduce the risk of broken bones.

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

If your osteoporosis is severe or you continue to have bone loss while taking a bisphosphonate:

It's important to take calcium and vitamin D supplements along with any medicines you take for osteoporosis.

Compression fractures resulting from osteoporosis can cause significant back pain that lasts for several months. Treatments available to relieve your pain include:

One of two surgical treatments, vertebroplasty or kyphoplasty, may relieve pain from spinal compression fractures. In these procedures, a surgeon injects bone cement through a needle into the crushed spinal bones (vertebrae).

If you experience a fractured bone related to osteoporosis, treatment to slow your bone thinning becomes very important. If you have had a spinal fracture, you are at risk of having another.


What to think about

Although HRT and ERT have been used to prevent or slow bone loss, currently they are not recommended for women as the first choice for prevention or treatment of osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

Because taking estrogen alone increases the risk of developing cancer of the lining of the uterus (endometrial cancer), ERT is only used if a woman has had her uterus removed.

Researchers are studying the effects of low-dose estrogen on women 65 and older. An early small study indicates that a low estrogen dose (one-quarter that of conventional ERT) may provide the same benefit (increased bone density and decreased fractures) as the higher dose. In the same study, about one-third of the women were given the low estrogen dose and progesterone (because these women had not had hysterectomies). This group of women also experienced increased bone density. But the long-term risks of taking low-dose estrogen (and progesterone in one-third of the cases) were not studied and are unclear.

It's important to take calcium and vitamin D supplements along with any medicines you take for osteoporosis.

 

This infomation was taken from the University of Michigan Health System's Health Library.