Osteoporosis

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

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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:
  • Rheumatoid arthritis
  • Cardiovascular disease
  • Type 2 diabetes
  • Asthma
  • Liver disease
  • Eating disorder
  • Depression
  • Crohn's disease
• 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

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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:

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