Osteoporosis is a disease of progressive bone loss associated with an increased risk of fractures. It literally means 'porous bone.' The disease often develops unnoticed over many years, with no symptoms or discomfort, until a fracture occurs. Osteoporosis often causes a loss of height and dowager's hump (a severely rounded upper back region).
Osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women. In the U.S. today, 10 million individuals already have osteoporosis and 18 million more have low bone mass, placing them at increased risk for this disease. One out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime
More than 2 million American men suffer from osteoporosis, and millions more are at risk. Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites.
Doctors do not know the exact medical causes of osteoporosis, but they do know many of the major factors that can lead to the disease.
Aging. Everyone loses bone with age. After age 35, the body builds less new bone to replace losses of old bone. In general, the older you are, the lower your total bone mass and the greater your risk for osteoporosis.
Heredity. A family history of fractures; a small, slender body build; fair skin; and a Caucasian or Asian background can increase the risk for osteoporosis. Heredity also may help explain why some people develop osteoporosis early in life.
Nutrition and lifestyle. Poor nutrition, including a low calcium diet, low body weight and a sedentary lifestyle has been linked to osteoporosis, as have smoking and excessive alcohol use.
Medications and other illnesses. Osteoporosis has been linked to some medications, including steroids, and to other illnesses, including some thyroid problems.
The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests. If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia (a vitamin D deficiency) or hyperparathyroidism (overactivity of the parathyroid glands).
Bone densitometry is a safe, painless x-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at its highest.
It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam X-ray absorptiometry (DXA) is one of the most accurate methods, but other techniques can also identify osteoporosis, including single photon absorptiometry (SPA), quantitative computed tomography (QCT), radiographic absorptometry and ultrasound. Your doctor can determine which method would be best suited for you.
Because lost bone cannot be replaced, treatment for osteoporosis focuses on the prevention of further bone loss. Treatment is often a team effort involving a family physician or internist, orthopedist, gynecologist, and endocrinologist.
While exercise and nutrition therapy are often key components of a treatment plan for osteoporosis, there are other treatments as well.
Estrogen replacement therapy (ERT) is often recommended for women at high risk for osteoporosis to prevent bone loss and reduce fracture risk. A measurement of bone density when menopause begins may help you decide whether ERT is for you. Hormones also prevent heart disease, improve cognitive functioning, and improve urinary function. It should be discussed with your doctor.
New anti-estrogens known as SERMs have been introduced. They increase bone mass, decrease the risk of spine fractures, and lower the risk of breast cancer.
Calcitonin is another medication used to decrease bone loss. A nasal spray form of this medication increases bone mass, limits spine fractures, and may offer some pain relief. Bisphosphonates, including Alendronate, markedly increase bone mass and prevent both spine and hip fractures. HRT, Alendronate, SERMs, and calcitonin all offer the osteoporosis patient an opportunity to not only increase bone mass, but also to significantly reduce fracture risk. Prevention is preferable to waiting until treatment is necessary.
There is a lot you can do throughout your life to prevent osteoporosis, slow its progression, and protect yourself from fractures.
Include adequate amounts of calcium and vitamin D in your diet.
Calcium. During the growing years, your body needs calcium to build strong bones and to create a supply of calcium reserves. Building bone mass when you are young is a good investment for your future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life.
Whatever your age or health status, you need calcium to keep your bones healthy. Calcium continues to be an essential nutrient after growth because the body loses calcium every day. Although calcium cannot prevent gradual bone loss after menopause, it plays an essential role in maintaining bone quality. Even if you have gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fracture.
How much calcium you need will vary depending on your age and other factors. The National Academy of Sciences makes the following recommendations regarding daily intake of calcium:
Males and females 9 to 18 years: 1300 mg per day
Women and men 19 to 50 years: 1000 mg per day
Pregnant or nursing women up to age 18: 1300 mg per day
Pregnant or nursing women 19 to 50 years: 1000 mg per day
Women and men over 50: 1500 mg per day
Dairy products, including yogurt and cheese, are excellent sources of calcium. An eight-ounce glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones, and green leafy vegetables, including broccoli and collard greens.
If your diet does not contain enough calcium, dietary supplements can help. Talk to your doctor before taking a calcium supplement.
Vitamin D. Vitamin D helps your body absorb calcium. The recommendation for vitamin D is 400 IU daily for adults and 800 IU daily for the elderly. Supplemented dairy products are an excellent source of vitamin D. (A cup of milk contains 100 IU. A multivitamin contains 400 IU of vitamin D.) Vitamin supplements can be taken if your diet does not contain enough of this nutrient. Again, consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic.
Exercise regularly. Like muscles, bones need exercise to stay strong. No matter what your age, exercise can help you minimize bone loss while providing many additional health benefits. Doctors believe that a program of moderate, regular exercise (3 to 4 times a week) is effective for the prevention and management of osteoporosis. Weight-bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting are probably best. Falls account for 50% of fractures, therefore, even if you have low bone density you can prevent fractures if you avoid falls. Programs that emphasize balance training, especially, Tai Chi, should be emphasized. Consult your doctor before beginning any exercise program.