Osteoporosis

Osteoporosis means "porous bone." It is a process in which your bone density decreases and bones become weaker and more easily broken (fractured). Osteoporosis is the leading cause of fractures in older adults and is most common in people older than 70 and in women who have gone through menopause. Women are four times more likely than men to develop the osteoporosis.

Causes

Bones change constantly throughout a person’s life. Specialized cells (osteoclasts) in the bones break down old or worn bone, leaving cavities in the bone. Other specialized cells (osteoblasts) make new bone material and fill in the cavities. When the amount of new bone being made equals the amount being dissolved, bones remain dense and strong. When the balance of bone formation and destruction shifts so that more bone is lost than is made, bone density decreases. This balance shifts as a person ages, or in certain conditions. After about age 40, men and women lose around 1 percent of their bone mass each year. Some people lose more bone than others or lose bone at a faster rate. Women can lose up to 20 percent of their bone mass in the five to seven years following menopause. Recognizing the risk factors for osteoporosis is important because you may be able to prevent it from occurring or slow down the loss of bone and reduce the risk for fractures.

Risk factors that cannot be changed:

• Being female

• Thin or small frame

• Low body weight

• Over age 65

• Family history of fracture with minor trauma in parent or sibling

• Family history of osteoporosis or thin bones

• Being Caucasian or Asian; African American and Hispanic women are also at risk, however

• Some medical conditions: alcoholism, diabetes, hyperthyroidism, epilepsy, chronic liver or kidney disease, celiac disease, rheumatoid arthritis, leukemia

Risk factors that may be changed:

• Diet low in calcium

• Diet low in vitamin D or limited exposure to the sun

• Use of certain medications, such as corticosteroids, excess thyroid medication or some anticonvulsants

• Inactivity

• Cigarette smoking

• Excessive use of alcohol

• Low estrogen levels in women; low testosterone levels in men

• Anorexia or being underweight

Symptoms

Bone begins to thin without symptoms. You may not know you have osteoporosis until a fall or an accident causes the hip or another bone to fracture. Sometimes the signs of osteoporosis are seen in the back and spine. These symptoms include pain, loss of height, a stooped posture and spinal deformities.

Diagnosis

Tests can measure bone mass density (BMD) in the spine, hip or wrist and compare it with the average bone density for adults. Osteoporosis is diagnosed when BMD is more than 2.5 standard deviations lower than the average BMD for a young adult. The most common test is called dual-energy X-ray absorptiometry (DXA or DEXA). It is safe and painless. In addition to diagnosing osteoporosis, a BMD test can:

• Detect low bone density before a fracture occurs

• Estimate your chances of bone fracture in the future

• Determine your rate of bone loss when compared with a previous DEXA test

• Monitor the effects of medication on bone density

In some cases, a BMD test may not be necessary. For most women, BMD tests are not needed until after menopause. Insurance usually covers the cost. The U.S. Preventive Services Task Force (USPSTF) recommends that women ages 65 and older be screened routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for fractures caused by osteoporosis. The USPSTF makes no recommendation for or against routine osteoporosis screening in postmenopausal women who are younger than 60 or in women ages 60 to 64 who are not at increased risk for these fractures. Talk to your health provider about whether the test is right for you.

Self-Care Steps for Osteoporosis

There is no cure for osteoporosis, but you can learn to live with it and to strengthen your bones. Steps for living with osteoporosis include:

• Weight-bearing activities. Walking, jogging, or dancing puts healthy stress on bones, making them stronger. Activity also can help you be steadier on your feet by improving muscle strength, coordination and balance.

• Healthy diet with adequate calcium, vitamin D and plenty of fruits and vegetables. It is especially important to make sure you are getting adequate calcium, vitamin D and other important nutrients either from the food you eat (such as low-fat dairy products fortified with vitamin D) or supplements. The USDA 2005 Dietary Guidelines for Americans recommends you drink 3 cups of low-fat or fat-free vitamin D-fortified milk every day. Low-fat yogurt and/or low-fat cheese (1½ ounces of cheese equals 1 cup of milk) can be a substitute for milk. Skim milk and yogurt may not have as much vitamin D as milk. For children ages 2 to 8, the recommendation is 2 cups of milk a day. If you can't consume dairy products, choose lactose-free milk products and/or calcium-fortified foods and beverages. If you have been diagnosed with osteoporosis, you should have 1,500 mg of calcium and 400 to 800 IU of vitamin D per day.

• Medication. For those at risk for fractures, calcium and vitamin D supplements (after menopause) alone are not enough to protect against fractures. Additional medicines may be necessary. Ask your doctor about medications that can slow bone loss or help new bone to form. There are several new medications that treat osteoporosis by reducing bone loss and increasing bone density.

Preventive Care for Osteoporosis

Starting early is a key to preventing osteoporosis. Bone thinning happens over time. It's best to start good habits long before you become concerned about osteoporosis through the aging process.

• Exercise regularly, especially weight-bearing exercises such as walking, jogging, and aerobics.

• Make sure there is calcium in your diet, or if you can't tolerate dairy products, take calcium supplements.

• Get enough vitamin D by spending about 15 minutes several times a week in natural sunlight without sunscreen, and by eating foods rich in vitamin D. If you can't get enough in your diet, or if you can't get into the sun regularly, you may take vitamin D supplements of 400 to 800 IU, the amount found in most multivitamins.

• Stop smoking. Women who smoke have lower levels of estrogen, and that increases the loss of bone density.

• Control drinking. People who drink heavily tend to have more bone loss and more fractures.

The National Academy of Sciences and the National Osteoporosis Foundation recommend the following amounts of calcium (2003 recommendation):