Osteoporosis - overview
Osteoporosis is a disease in which bones become fragile and more likely to fracture. Usually the bone loses density, which measures the amount of calcium and minerals in the bone.
Thin bones; Low bone density
Osteoporosis is the most common type of bone disease.
Because of osteoporosis 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. Osteoporosis occurs when the body fails to form enough new bone, when too muchexisting bone is reabsorbed by the body, or both.
Calcium is one of the important minerals needed for bones to form.If you do not get enough calcium and vitamin D, oryour body does not absorb enough calcium fromyour diet, your bones may become brittle and more likely to fracture.
Sometimes bone loss occurs without any cause.Caucasian women are more likely to have bone loss. Sometimes the tendency to have bone loss and thin bones is passed down through families.
- 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
There are no symptoms in the early stages of osteoporosis. Many times, people will have a fracture before learning that 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.
Therecan 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.
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
Aspine 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.
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.
- 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)
- Estrogens, teriparatide, raloxifene, and calcitonin
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 -- walking, jogging, playing tennis, dancing
- Free weights, weight machines, stretch bands
- Balance exercises -- tai chi, yoga
- Rowing machines
Avoid any exercise that presents a risk of falling. Also, do not do high-impact exercises thatcan 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.
- Womenages 51 to 70 should have 1,200 mg of calcium and 400 - 800 IU of vitamin D a day; menages 51 to 70need 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 andvitamin D.
Stop unhealthy habits:
- Quit smoking, if you smoke.
- Limit your alcohol intake. Too much alcohol can damage your bones. Thisputs you at riskof falling and breaking a bone.
It isimportant to prevent falls. The following are suggestions on how to do this:
- Do not takesedating 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 orsturdy furnitureto 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. Slippersthat do not have heelscan cause you to trip and fall.
- Do not walk outdoorsalone on icy days.
Surgery to treat severe, disabling pain from spinal fractures due toosteoporosis include:
Medicines to treat osteoporosis can help prevent future fractures. Butspine bones that have already collapsed cannot be reversed.
Osteoporosis can cause a person to become disabled from weakened bones. Hip fracturesare one of the main reasons people are admitted to nursing homes.
Calcium isimportant 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 drinklarge amounts ofalcohol.
- Do notsmoke.
- Get regular exercise.
Medicinescan preventosteoporosis. Your doctor can tell you if any are right for you.
Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011;155(1):ITC1-1-15;quiz ITC1-16.
National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.
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.
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.