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Osteoporosis - overview

Definition

Osteoporosis is a disease in which bones become fragile and more likely to fracture.

Alternative Names

Thin bones; Low bone density

Causes

Osteoporosis is the most common type of bone disease.

Osteoporosis increases the risk for breaking a bone. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bone of the spine) during their lifetime.

Bone is living tissue. Existing bone is constantly being replaced by new bone. Your entire skeleton is replaced about every 10 years. Osteoporosis occurs when the body fails to form enough new bone, when too much existing bone is reabsorbed by the body, or both.

The most important cause of osteoporosis is genetic. This means that you inherit the risk from your parents. Other risks include not having enough calcium to build new bone tissue. Calcium is one of the important minerals needed by your body for bones to form. If you do not get enough calcium and vitamin D, or your body does not absorb enough calcium from your diet, your bones may become brittle and more likely to fracture. Other risk factors include smoking and various childhood and adult diseases.

Osteoporosis

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Osteoporosis

A decrease in estrogen in women at the time of menopause and a decrease in testosterone in men is another major cause of bone loss. Other causes of bone loss include:

  • Being confined to a bed
  • Certain medical conditions
  • Taking certain medicines

Other risk factors include:

  • Absence of menstrual periods (amenorrhea) for long periods of time
  • A family history of osteoporosis
  • Drinking a large amount of alcohol
  • Low body weight
  • Smoking

Symptoms

There are no symptoms in the early stages of osteoporosis. Many times, people will have a fracture before learning they have the disease.

Pain almost anywhere in the spine can be caused by fractures of the bones of the spine. These are called compression fractures. They often occur without an injury. The pain occurs suddenly or slowly over time.

There can be a loss of height (as much as 6 inches) over time. A stooped posture or kyphosis (also called a dowager's hump) may develop.

Exams and Tests

Bone mineral density testing (most often with a DEXA scan) measures your bone mineral density. Your health care provider uses this test to:

  • Diagnose bone loss and osteoporosis
  • Predict your risk of future bone fractures
  • See how well osteoporosis medicine is working

A spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of other bones are not very accurate in predicting whether you are likely to have osteoporosis.

You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age.

Low bone mineral density (by DEXA scan) also occurs with osteomalacia, another disorder of bone mineralization

Treatment

Treatment for osteoporosis may involve:

  • Lifestyle changes, such as diet and exercise
  • Taking calcium and vitamin D
  • Using medicines

Medicines are used to strengthen bones when:

  • Osteoporosis has been diagnosed by a bone density study, whether or not you have a fracture and your fracture risk is high.
  • A bone fracture has occurred and a bone density test shows that you have thin bones, but not osteoporosis.

Medicines used to treat osteoporosis include:

  • Bisphosphonates (the main drugs used to prevent and treat osteoporosis in postmenopausal women, alendronate, ibandronate, zolendronate and risedronate)
  • Estrogen and estrogen receptor modulators (raloxifene)
  • Teriparatide (a PTH agonist)
  • Calcitonin (used mainly to treat the sudden pain from a vertebral fracture)
  • Denusomab

Exercise plays a key role in preserving bone density in older adults. Some of the exercises recommended to reduce your chance of a fracture include:

  • Weight-bearing exercises such as walking, jogging, playing tennis, dancing
  • Free weights, weight machines, stretch bands
  • Balance exercises such as tai chi, yoga
  • Rowing machines

Avoid any exercise that presents a risk of falling. Also, do not do high-impact exercises that can cause fractures in older adults.

Your body needs calcium and vitamin D to keep your bones strong. Vitamin D helps your body absorb calcium.

  • Adults under age 50 should have 1,000 mg of calcium and 400 - 800 IU of vitamin D daily.
  • Women ages 51 to 70 should have 1,200 mg of calcium and 400 - 800 IU of vitamin D a day; men ages 51 to 70 need 1,000 mg of calcium and 400 - 800 IU of vitamin D a day.
  • Adults over age 70 should get 1,200 mg of calcium and 800 IU of vitamin D daily.
  • Your doctor may recommend a calcium supplement.
  • Follow a diet that provides the proper amount of calcium and vitamin D.

[Note: Some expert groups are not sure the benefits and safety of this amount of Vitamin D and calcium outweigh their risks. Be sure to discuss with your doctor whether supplements are a good choice for you.]

Stop unhealthy habits:

  • Quit smoking, if you smoke.
  • Limit your alcohol intake. Too much alcohol can damage your bones. This puts you at risk of falling and breaking a bone.

It is important to prevent falls. The following are suggestions on how to do this:

  • Do not take sedating medicines, which can make you drowsy and unsteady. If you must take them, be extra careful when you are up and about. For example, hold on to countertops or sturdy furniture to avoid falling.
  • Remove household hazards, such as throw rugs, to reduce the risk of falls.
  • Leave lights on at night so you can see better when walking around your house.
  • Install and use safety grab bars in the bathroom.
  • Make sure your vision is good. Have your eyes checked once or twice a year by an eye doctor.
  • Wear shoes that fit well and that have heels. This includes slippers. Slippers that do not have heels can cause you to trip and fall.
  • Do not walk outdoors alone on icy days.

Surgery to treat severe, disabling pain from spinal fractures due to osteoporosis include:

Outlook (Prognosis)

Medicines to treat osteoporosis can help prevent future fractures. But spine bones that have already collapsed cannot be reversed.

Osteoporosis can cause a person to become disabled from weakened bones. Hip fractures are one of the main reasons people are admitted to nursing homes.

Prevention

Calcium is important for building and maintaining healthy bone. Vitamin D is also needed because it helps your body absorb calcium. Following a healthy, well-balanced diet can help you get these and other important nutrients.

Other tips for prevention:

  • Do not drink large amounts of alcohol.
  • Do not smoke.
  • Get regular exercise.

Medicines can prevent osteoporosis. Your doctor can tell you if any are right for you.

References

Rosen C. Osteoporosis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 251.

Lorenzo JA, Canalis E, Raisz LG. Metabolic bone disease. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 29.

Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011;155(1):ITC1-1-15;quiz ITC1-16.

The National Osteoporosis Foundation (NOF) Clinician's Guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC. 2013.

Moyer VA; U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 May 7;158(9):691-6.

North American Menopause Society. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010 Jan-Feb;17(1):25-54.

Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305(8):783-789.


Review Date: 11/7/2013
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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