Osteoporosis

What Is Osteoporosis? What You Need to Know

Osteoporosis is a common disease that weakens bones. As it does, your risk of sudden and unexpected fractures goes up. Osteopenia is the forerunner of osteoporosis. It is a silent but destructive condition that robs bones during a woman's -- even a young woman's -- most productive time.

The bone loss with osteoporosis occurs over many years and is severe. It's so severe that the normal stress on bones from sitting, standing, coughing, or even hugging a loved one can result in painful fractures and immobility. Then, after the first fracture, you are at risk for more fractures. These future fractures may cause you to live with daily chronic pain. They can cause you disability. They may rob you of your independence.

Osteoporosis often progresses without symptoms or pain. Losing height may be noticeable. Or a Dowager's hump may develop with age. Usually, though, a doctor diagnoses osteoporosis after a painful fracture occurs.

That fracture is usually in the back or hips. Painful fractures are debilitating and disfiguring. They can result in loss of mobility and independence.

With osteopenia, there are no warning signs until you fracture a bone. Osteopenia is the forerunner of osteoporosis. If it isn't diagnosed and isn't treated, osteopenia can lead directly to osteoporosis. With osteoporosis, your bones become thin, weaker, and fracture easily.

The good news is if you are diagnosed with osteoporosis, you can get treatments. Those osteoporosis treatments can slow bone loss, increase the amount of bone you have, and lower your chances of fractures. But there's no reason to wait until you can't reverse how weak your bones have become. Detecting osteopenia with a bone density test is easy. From there, making a plan to prevent disfiguring and painful fractures is simple.

Why is there so much concern about osteopenia?

If you're wondering why osteopenia has become such a topic of concern for younger and middle-aged women, consider this. Years ago, people didn't think it was important to treat hypertension (high blood pressure). They didn't think it was important because there were no obvious consequences. We now know, though, that treating high blood pressure in the present lowers the risk of stroke years later.

Again, thirty years ago, blood cholesterol levels that were not over 300 were not considered abnormally high. Now we know that treating cholesterol when the levels are at 200 can prevent heart attacks years later.

A fracture is a break in a bone. If you have osteoporosis, your bones become thin, lose structure, and become fragile. You could lift a bag of groceries and suffer a fracture or a collapsed vertebra in your back. Or you might stoop down to tie your shoe and feel a sudden, severe pain from a fracture.

While the pain from the fracture may subside, you may develop continued chronic pain. As spinal bones collapse, deformities in your spine, such as a dowager's hump, and other areas will become obvious to both you and people around you. You may feel stiff most of the time and have trouble being active.

There are ways to prevent and treat osteoporosis. So no one has to suffer with fractures and chronic pain. Learn more about preventing fractures in this guide. Then you can stay active all your life.

What is the cause of osteoporosis?

We don't know a lot about what causes osteoporosis. We do know how osteoporosis develops throughout a person's life. Bones are complex, living tissue. Your body constantly breaks down old bone and rebuilds new bone. This bone-building process is called "remodeling."

As you are growing up, your body builds more bone than it removes. During childhood, your bones become larger and stronger. Peak bone mass occurs when you have the maximum amount of bone mass you will ever have. For most people, this usually happens during the third decade of life. Then, at a certain age, the bone remodeling process changes. New bone gets laid down at a slower rate. This slowdown results in a decrease in the total amount of bone you have.

If this loss of bone reaches a certain point, you have osteopenia. When bone loss becomes more severe, you have osteoporosis. Both men and women with osteopenia or osteoporosis are at a higher risk of fractures.

It's smart to know the risk factors for osteoporosis. By changing those risk factors you can control, you can reduce your chance of osteoporosis. Key risk factors for fractures include the following.

Family history: Osteoporosis seems to run in families. If your mother had hip fracture or spinal collapse fracture, chances are you are at risk for osteoporosis. That means you are at risk of reduced bone mass and fractures.

Sex: Women are four times more likely than men to get osteoporosis. But men also suffer from osteoporosis.

Age: The risk of osteoporosis increases with age. Women over the age of 50 have the greatest risk of developing osteoporosis. Anyone of any age can have osteoporosis. But the older you are, the more risk you have of fractures and osteoporosis.

Bone structure and body weight. Petite and thin women have a greater risk of developing osteoporosis. Weight loss after age 50 in women also seems to increase the risk of hip fractures. Weight gain decreases the risk. Small-boned, thin men have a greater risk of osteoporosis than men with larger frames and more body weight.

History of fractures: Having one fracture increases the chance of more fractures.

Smoking : Smoking increases the risk of fractures. Studies show that cigarette smokers (past or current smokers) have lower bone densities and higher fracture risks. Women who smoke have lower levels of estrogen -- a key component for having healthy bones -- compared to nonsmokers. They also frequently go through menopause earlier.

Medications: Some medications may increase your risk of osteoporosis. These include long-term use of steroids (prednisone), thyroid medication, anticonvulsants, antacids, and other medications.

How is osteoporosis related to menopause?

At menopause, there's a dramatic decline in the female hormone, estrogen. This decline in estrogen slows the bone remodeling process and causes an accelerated rate of bone loss. This more rapid loss of bone continues for about 10 years after menopause. The rate of bone loss eventually returns to premenopausal levels. But bone formation does not. This causes postmenopausal women to have a much greater chance of having a fracture.

First, check your risk factors. Then, ask your doctor about a bone mineral density (BMD) test or bone scan. A bone mineral density test can provide information about your bone health before problems begin. Bone mineral density tests use very small amounts of radiation to determine the strength of your bones.

How is osteoporosis treated?

Many osteoporosis treatments and osteoporosis medications are successful in stopping bone loss and reducing your risks of fractures. Some osteoporosis treatments include dietary and lifestyle choices. Other treatments include osteoporosis medications. These medications can slow bone loss or build new bone. Osteoporosis treatment can include:

• estrogen replacement therapy
• osteoporosis medications such as Actonel, Boniva, Calcimar, Evista, Fosamax, Reclast, Fortical, Miacalcin
• injectable Forteo or PTH to build bone
• calcium and vitamin D dietary supplements
• weight-bearing exercises (which force your muscles to work against gravity)
• smoking cessation

How can I prevent osteoporosis?

There are several proven ways to prevent osteoporosis and fractures.

Exercise. Establish a regular exercise program. Exercise makes bones and muscles stronger and helps prevent bone loss. It also helps you stay active and mobile. Weight-bearing exercises are best for preventing osteoporosis. They should be done at least three to four times a week.

Walking, jogging, playing tennis or racket sports, and dancing are all good weight-bearing exercises. In addition, strength and balance exercises help build stronger muscles and may help you avoid falls. This will decrease your chances of breaking a bone.

Increase calcium in your diet. Getting enough calcium throughout your life helps to keep bones strong. Experts recommend 1,000 milligrams each day for premenopausal women and 1,200 milligrams a day for postmenopausal women.

Excellent sources of calcium include:

• milk and dairy products (low-fat versions are recommended)
• canned fish with bones, such as salmon and sardines
• dark green leafy vegetables, such as kale, collards, and broccoli
• calcium-fortified orange juice
• breads made with calcium-fortified flour

You can get the recommended amounts of calcium by having four servings of calcium-rich foods each day. Good choices might include:

• yogurt made with low-fat milk or whole milk
• a selected serving of cheese, tofu, or milk
• a selected serving of fish or broccoli
• calcium-fortified juices, breads, and cereals
• calcium-fortified dairy products

Supplement your diet. If you do not get enough dietary calcium, ask your doctor about calcium supplements. Take a 300-milligram calcium supplement to replace each serving of calcium-rich foods you miss each day. Calcium carbonate and calcium citrate are good forms of calcium supplements.

Get plenty of vitamin D. Vitamin D is necessary for the body to absorb calcium. While being out in the sun 20 minutes each day helps your body get vitamin D, more research is showing that people may get too little of this vitamin, particularly in the wintertime. You can also get vitamin D from:

• eggs
• fatty fish like salmon
• cereal
• milk fortified with vitamin D
• supplements

The Daily Value of vitamin D is 400 International Units (IU). Daily Values (DVs) are established by the National Academy of Sciences and National Research Council as the amount necessary to prevent deficiencies. Still, these levels may not be enough to prevent chronic diseases such as osteoporosis and fractures.

Older adults should get at least 800 International Units (IU) daily of vitamin D. Although multivitamins are a convenient and inexpensive way to get vitamin D, many multivitamins contain only 400 IU. Read the label on your multivitamin to see what's available in your supplement.

PT Hawaii Reference from WebMD Medical Reference and eMedicineHealth (June 24, 2009)