What is osteoporosis?

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. These  lifestyle factors may increase the risk of osteoporosis:
  • Lack of  physical activity
  • Caffeine use
  • Excessive alcohol use
  • Smoking
  • Dietary calcium and vitamin D deficiency
• Certain medications
• Family history of bone disease

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 over the age of 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 consult your doctor for a diagnosis.

How is osteoporosis diagnosed?

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

• X-rays. This test uses electromagnetic energy beams to make images of tissues, bones, and organs onto film.
• Bone density test (also called 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.

Guidelines from the North American Menopause Society (NAMS) urge the following:

• Women should review lifestyle practices with their doctors regularly.
• A woman's risk for falls should be assessed at least once a year after menopause.
• A woman's height and weight should be checked yearly.
• Women should be checked for kyphoses. This is the development of a rounded humped spines — and back pain.

How is osteoporosis treated?

Your health care provider will figure out the best treatment based on:

• How old you are
• Your overall health and medical history
• How sick you are
• How well you can handle specific medications, 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.

• 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. Vitamin D is also needed because it helps the body absorb calcium.
• Prevent falls in the elderly to prevent fractures. This may include installing hand railings, or assistive devices in the bathroom or shower.
• Ask your doctor about medication.

The FDA has approved these medications 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 consult her doctor first. Research found several important health risks associated with this therapy. For many women, the risks of ERT outweigh the benefits.
• Biophosphonates. These medications reduce bone loss, increase bone density, and reduce the risk of fractures.
• Selective estrogen receptor modulators (SERMS). This medication helps prevent bone loss.
• Parathyroid hormone. This medication is a form of parathyroid hormone. It is approved to treat postmenopausal women and men who are at high risk for fractures. It helps form bone.
• Monoclonal antibody. This medication 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 medications that can weaken bones. 

Living with osteoporosis

Living with osteoporosis includes rehabilitation to return to the best possible bone health and daily living. An osteoporosis rehab program can be vital to a full recovery. The focus of rehab is to decrease pain, help prevent fractures, and minimize further bone loss.

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

• Exercise programs and conditioning to increase weight bearing and physical fitness
• Pain management techniques
• Nutritional counseling to improve calcium and vitamin D intake and decrease caffeine and alcohol intake
• Use of assistive devices to improve safety at home
• Education, especially prevention of falls

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

• Orthopedist/orthopedic surgeon
• Physiatrist
• Internist
• Rehabilitation nurse
• Dietitian
• Physical therapist
• Occupational therapist
• Social worker
• Psychologist/psychiatrist
• Recreational therapist
• Chaplain
• 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 medications to maintain bone health.
• Rehab programs can help regain bone health.

Next steps

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.