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Osteoporosis

What is osteoporosis?

Osteoporosis, or porous bone, is a condition characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine and wrist, among other sites.

Osteoporosis is often called the silent disease because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse.

People tend to think of osteoporosis as an issue in women's health since an estimated three out of five females acquire this condition. However, the male population is not immune. Approximately two of every five males also develops osteoporosis.

What happens to osteoporotic bones?

Normal bone has small holes within it, but a bone with osteoporosis will have much larger holes. The picture below on the right shows a bone with osteoporosis with large spongy holes. A normal bone with small passageways is shown on the left.

Women are considered at high risk for the disease if they have low body weight, a low calcium intake, poor health or a history of osteoporosis in their immediate family. Women who have had amenorrhea (absence of menstrual periods) and/or experience early menopause are at higher risk, due to insufficient estrogen.

Men with low testosterone levels, prostate cancer, Crohn's disease, thyroid disorders and who take corticosteroid drugs may be at risk for osteoporosis.

Alcohol abuse, smoking and high caffeine intake are also thought to significantly increase the risk of osteoporosis in men and women, as well as diseases that prevent the body's ability
to absorb calcium, like kidney or thyroid gland diseases (hyperthyroidism)

Prevention

Regardless of age, preventing osteoporosis requires a bone healthy diet, modifying lifestyle factors and regular exercise.  A healthy diet including calcium rich foods, such as dairy products, as well as fruits, vegetables and whole grains as well as a vitamin D supplement can help reduce osteoporosis risk. It is recommended that women age 19-49 maintain a daily calcium intake of  1000 mg and women age 50 and above intake 1200 mg daily.  The recommended daily intake of vitamin D3 for women 50 and older is 800- 1000 IU daily.  For women under 50, the recommended daily intake of vitamin D3 is 400-800 IU daily.  

Exercise promotes bone health by decreasing fall risk, improving bone mass and strength, enhancing muscular strength, improving balance, posture and flexibility.  It is recommended that women participate in weight bearing and muscle strengthening exercises (e.g. walking, running, dancing, aerobics, sports, weight training, and yoga) at least 3 times a week. 

There are many FDA approved medications and supplements for the prevention and treatment of osteoporosis.  The decision to treat medically is based on the particular individual’s risk-benefit analysis and should be reviewed annually with your doctor.

Diagnosis

Fractures, loss of height, changes in posture and even changes in the way you walk can be signs of osteoporosis. Osteoporosis is diagnosed with a radiologic procedure called central DEXA (dual energy x-ray absorbitometry) that measures the hip, spine and wrist, which are the areas most prone to bone density loss and future fractures.The DXA can be used to determine the density of minerals in your whole skeleton and in various sites, in particular the hip and spine which are the most reliable areas for diagnosing osteoporosis. The test results can also inform your physician if you have osteopenia, which is reduced bone mass but less severe than osteoporosis. Women over 65 and men over age 70 with risk factors should be screened every 24 months.  For women younger than 65, DEXA scanning may be indicated based on their risk factor profile.

Bone density testing

Bone mineral density (BMD) tests measure bone density in the wrist, spine and/or hip (the most common sites of fractures due to osteoporosis). These tests are painless, noninvasive and safe.

Bone density tests can:

  • Detect low bone density before a fracture occurs
  • Determine your rate of bone loss and/or monitor the effects of treatment if the test is conducted at intervals of a year or more

Bone density testing and comparison from one exam to the next relies on the precision of the technologist performing the exam and the accuracy of the machine that is utilized for testing. Because of these facts only exams performed on the same machine are comparable and have the ability to accurately report the effects of treatment and changes in bone density from one test to the next.

Treatment

Osteoporosis is a preventable and treatable condition. Treatment generally focuses on proper nutrition and exercise, reducing or stopping unhealthy lifestyle habits that increase your risk, and prevention of falls or an activity that can cause fractures.

If your bone loss is due to another condition, such as taking a medication that causes bone loss, your physician may switch you to another medication that is effective at treating that condition.Several medications are available to help slow or stop bone loss or build new bone, increase bone density.