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Osteoporosis

What is osteoporosis?

Osteoporosis is a disease that causes weak, thinning bones. This leaves the bones at greater risk of breaking. The bones most often affected are the hips, spine, and wrists.

What causes osteoporosis?

The exact cause for osteoporosis is unknown. But a number of factors contribute to the disease including:

  • Aging. Bones become less dense and weaker with age.
  • Race. White and Asian women are most at risk. But, all races may get the disease.
  • Body weight. People who weigh less and have less muscle are more at risk for this condition.
  • Lifestyle factors. Lack of physical activity, caffeine use, excessive alcohol use, smoking, dietary calcium, and vitamin D deficiency may all increase your risk.
  • Certain medicines. Some medicines may increase your risk.
  • Family history. Having a family history of bone disease may increase your risk.

Who is at risk for osteoporosis?

Osteoporosis affects over 10 million Americans over the age of 50. Women are 4 times more likely to get osteoporosis than men.

Another 34 million Americans older than age 50 have low bone mass (osteopenia). This group is at a greater risk for osteoporosis.

Low estrogen is one of the main causes of bone loss in women during and after menopause. Women may lose up to 20% of their bone mass in the 5 to 7 years after menopause.

What are the symptoms of osteoporosis?

People with osteoporosis may not get any symptoms. Some may have pain in their bones and muscles, particularly in their back. Sometimes, a collapsed vertebra may cause severe pain, decrease in height, or spinal deformity.

The symptoms of osteoporosis may look like other bone disorders or medical problems. Always talk with your healthcare provider for a diagnosis.

How is osteoporosis diagnosed?

Your healthcare provider will review your personal and family medical history and do a physical exam. Other tests include:

  • Bone density test (bone densitometry). Measurement of the mass of bone in relation to its volume to find the risk of getting osteoporosis.
  • Blood tests. These tests are done to measure calcium and potassium levels.
  • FRAX score. A score given to estimate the risk of a fracture within 10 years. The score uses the results of a bone density test as well as other factors.
  • X-rays. This test uses electromagnetic energy beams to make images of tissues, bones, and organs onto film.

Women are encouraged to do the following:

  • Review lifestyle practices with their healthcare providers regularly.
  • Have their personal risk for falls checked at least once a year after menopause.
  • Have their height and weight checked yearly.
  • Get checked for the development of a rounded humped in the spine and back pain (kyphosis).

How is osteoporosis treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goals of managing osteoporosis are to:

  • Decrease pain
  • Prevent fractures
  • Minimize further bone loss

Some of the ways to treat osteoporosis are also ways to prevent it. They include:

  • Maintain a proper body weight.
  • Increase walking and other weight-bearing exercises.
  • Cut down on caffeine and alcohol.
  • Stop smoking.
  • Get enough calcium through diet and supplements, including Vitamin D.
  • Prevent falls in older adults by installing hand railings, or assistive devices in the bathroom or shower.
  • Ask your healthcare provider about medicines that may help.

The FDA has approved these medicines to maintain bone health in women with osteoporosis at menopause:

  • Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT). ERT reduces bone loss, increases bone density, and reduces the risk of hip and spinal fractures in postmenopausal women. However, a woman considering ERT should talk with her healthcare provider first. Research found several important health risks associated with this therapy. For many women, the risks of ERT outweigh the benefits.
  • Biophosphonates. These medicines reduce bone loss, increase bone density, and reduce the risk of fractures.
  • Selective estrogen receptor modulators (SERMS). This medicine helps prevent bone loss.
  • Parathyroid hormone. This medicine is a form of parathyroid hormone. It is approved to treat men and postmenopausal women who are at high risk for fractures. It helps form bone.
  • Monoclonal antibody. This medicine is given by injection under the skin. It’s approved for women with osteoporosis at high risk for fractures. It’s also used for women who are being treated with cancer medicines that can weaken bones. 

Living with osteoporosis

An osteoporosis rehab program can be vital to a full recovery. It can help you obtain the best possible bone health and quality of life. The focus of rehab is to decrease pain, help prevent fractures, and minimize further bone loss.

To help reach these goals, programs may include the following:

  • Exercise programs and conditioning to increase weight-bearing and physical fitness
  • Techniques to manage your pain
  • Nutritional counseling to improve calcium and vitamin D intake and decrease caffeine and alcohol intake
  • Use of assistive devices to make you safer at home
  • Education, especially prevention of falls

These rehab programs can be done on an inpatient or outpatient basis. Many skilled people are part of the team, including:

  • Chaplain
  • Dietitian
  • Internist
  • Occupational therapist
  • Orthopedist/orthopedic surgeon
  • Physiatrist
  • Physical therapist
  • Psychologist/psychiatrist
  • Recreational therapist
  • Rehabilitation nurse
  • Social worker
  • Vocational therapist

Key points about osteoporosis

  • Osteoporosis is a disease that causes weak, thinning bones. This leaves the bones at greater risk of breaking. The bones most often affected are the hips, spine, and wrists.
  • Women are 4 times more likely to get osteoporosis than men due to a decrease in estrogen.
  • Risk factors for osteoporosis include aging, race, body weight, and taking certain medicines.
  • The goals of managing osteoporosis are to decrease pain, prevent fractures, and minimize further bone loss.
  • For postmenopausal osteoporosis in women, the FDA has approved medicines to maintain bone health.
  • Rehab programs can help regain bone health.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions.