Definition

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

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Causes

Throughout life, old bone is removed and new bone is added to the 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 at around age 30. From that point, more bone is lost than replaced. If not treated, bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if full bone mass was not achieved during the bone-building years.

Bone density also plays a role in bone health. Bone density is determined by the amount of calcium, phosphorus, and other minerals within the bone framework. As the mineral content of a bone (especially calcium) decreases, the bone weakens. Getting enough calcium and vitamin D and exercising regularly can keep bones strong throughout life.

Risk Factors    TOP

There are many risk factors that may increase your chance of developing osteoporosis. Some of the risk factors include:

• Age (risk increases with age)
• Low weight
• Smoking
• Alcohol abuse
• History of falls
• Certain conditions, such as:
  • Rheumatoid arthritis
  • Cardiovascular disease
  • Type 2 diabetes
  • Asthma
  • Liver disease
  • Eating disorder
  • Depression
• Use of certain medicines (eg, 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 (eg, 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
• Amenorrhea (no menstrual periods)
• Gastrointestinal malabsorption
• Having another endocrine disorder (eg, thyroid disorder, diabetes)

Symptoms    TOP

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)

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Diagnosis    TOP

The doctor will ask about your symptoms and medical history, and perform 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    TOP

Treatment includes:

Prevention    TOP

Building strong bones throughout the early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis:

• A balanced diet rich in calcium and vitamin D
• Weight-bearing exercise
• Healthy lifestyle (eg, no smoking, drinking alcohol only in moderation)
• Bone density testing and medicines where appropriate:
  • Fosamax
  • Actonel
  • Evista