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Osteoporosis is when bones become weak and brittle. If left unchecked, it can lead to bone breaks (fracture). Any bone can be affected, but of special concern are fractures of the hip, spine, and wrist.
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Throughout life, old bone is removed and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger, and denser. Peak bone mass is reached at around age 30. From that point, more bone is lost than replaced. If not treated, bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if full bone mass was not achieved during the bone-building years.
Bone density also plays a role in bone health. Bone density is determined by the amount of calcium, phosphorus, and other minerals within the bone framework. As the mineral content of a bone (especially calcium) decreases, the bone weakens. Getting enough calcium and vitamin D and exercising regularly can keep bones strong throughout life.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
- Sex: female
- Age: risk increases with age
- Body size: small, underweight women
- Race: Caucasian, Asian, and Hispanic women
- Family members with osteoporosis
- Postmenopausal status
- No menstrual periods (amenorrhea)
- Low-calcium diet
- Immunosuppressants, such as prednisone and other steroids, methotrexate, cyclosporine
- Thyroid drugs
- Aluminum-containing antacids
- Cholesterol-lowering drugs
- Long-term heparin therapy
- Antidepressants including selective serotonin reuptake inhibitors (SSRI)
- Inhaled steroids
- Low estrogen levels in women
- Low testosterone levels in men
- Inactive lifestyle
- Too little sunlight
- Cigarette smoking
- Excessive use of alcohol, coffee, and tea
- Liver disease, including cirrhosis
- Marfan's, Ehler-Danlos, and osteogenesis imperfecta syndromes
- Cushing's syndrome
- Cancer, including lymphoma and multiple myeloma
- Gastrointestinal disorders, including celiac disease and other malabsorptive disorders
- Chronic obstructive pulmonary disease (particularly men)
- Inflammatory diseases, including rheumatoid arthritis and lupus
- Pain when bones break or collapse
- Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
- Loss of height with stooped posture (kyphosis)
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The doctor will ask about your symptoms and medical history, and perform a physical exam. Early signs of osteoporosis can be seen with bone density testing:
- Dual-energy x-ray absorptiometry—measures bone density in the entire body
- Single-energy x-ray absorptiometry—measures bone density in the arm or heel
- Dental x-rays of bone
- Ultrasound bone density measurement—measures bone density in fingers, heels, and leg bones
Other tests may include:
- Blood and urine tests—to test for calcium levels or substances created when bone is broken down
For older men, the American College of Physicians (ACP) recommends that your doctor check for risk factors for osteoporosis. The ACP also recommends that you have a dual-energy x-ray absorptiometry done if you are at an increased risk and are a candidate for drug therapy.*
Decrease your intake of caffeinated beverages and alcohol. Eat a balanced diet rich in calcium and vitamin D. Calcium is in:
- Dairy products
- Green leafy vegetables
- Canned fish with bones
- Calcium-fortified products
Do not smoke. If you smoke, quit.
Exercise improves bone health. It also increases muscle strength, coordination, and balance. Do weight-bearing and strength-training exercises for maximum benefit. Balance training may prevent falls and fractures.
People who cannot consume enough calcium from food might want to take calcium supplements. Calcium citrate has the best absorption and is well-tolerated. Other vitamins and minerals may be recommended, including vitamin D, magnesium, potassium, and vitamin K. A study showed that Japanese postmenopausal women who took vitamin K supplements had a reduced rate of fractures. Talk to your doctor or dietician before you begin taking dietary supplements.*
Medications to prevent bone loss, increase bone density, and reduce the risk of spine and hip fractures:
- Raloxifene (Evista)
- Bisphosphonates (alendronate [Fosamax], risedronate [Actonel])
- Recombinant parathyroid hormone (Teriparatide)
Hormone Replacement Therapy (HRT)
Although HRT (including estrogen replacement therapy, or ERT) may cut the risk of osteoporosis in half, research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.
HRT therapy may include:
- Estrogen alone (ERT)
- Estrogen and progestin—frequently preferred for women with an intact uterus because ERT slightly increases the risk of uterine cancer
- Foods containing soy—may improve bone mass because these foods contain plant estrogens
- Reduce bone loss
- Increase bone density
- Reduce the risk of hip and spinal fractures in postmenopausal women
Falls can increase the chance of fracture in someone with osteoporosis. Here are ways to prevent falls:
- Use a cane or walker for stability.
- Wear rubber-soled shoes for traction.
- Use plastic or carpet runners when possible.
- Keep rooms free of clutter.
- Install grab bars in bathrooms.
Building strong bones throughout the early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis:
- A balanced diet rich in calcium and vitamin D
- Weight-bearing exercise
- Healthful lifestyle (no smoking and moderate alcohol)
Bone density testing and medications where appropriate:
The National Institutes of Health Osteoporosis and Related Bone Diseases
National Osteoporosis Foundation
Women's Health Matters
Fall prevention. National Osteoporosis Foundation website. Available at: http://www.nof.org/patientinfo/fall_prevention.htm. Accessed June 10, 2008.
Khosla L, Melton LJ. Clinical practice: osteopenia. N Engl J Med. 2007;356:2293-2300.
Nelson M. Strong Women, Strong Bones: Everything You Need to Prevent, Treat, and Beat Osteoporosis. New York, NY: Putnam; 2000.
Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367(9527):2010-2018.
*10/6/06 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Cockayne S, Adamson J, Lanham-New S, et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:1256-1261.
*5/16/08 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148:680-684.
Last reviewed December 2007 by Jill Landis, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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