An Overview of Osteoporosis
Osteoporosis, also known as porous bone, is characterized by progressive bone thinning. The deterioration of bone tissue can lead to bone fragility and fracture, especially of the hip, spine, and wrist. Osteoporosis is very common. Approximately 50 million Americans age 50 and older have osteoporosis or low bone mass,1 and the disease is the cause of 1.5 million fractures each year.
In fact, it has been estimated that one out of every two women and one out of five men over the age of 50 will experience an osteoporosis-related fracture at some point in their life.3 While the majority of cases are in women, both men and women experience the same rate of bone loss by about age 65.
Osteoporosis is sometimes confused with osteoarthritis (the most common type of arthritis), but they are two different diseases.
Osteoporosis is regarded as a “silent disease,” because it rarely causes symptoms as the disease is progressing. Since bone density is lost over a period of years, you can have osteoporosis for a long while without knowing it.
The disease typically remains undiagnosed until it becomes so advanced that the weakened bones are easily fractured. Other subtle signs you may have osteoporosis are:
- Bone pain
- Joint pain
- Loss of height
Since osteoporosis causes few to no symptoms, it’s important to pay attention to your particular risk factors and take steps to build bone health.
Though osteoporosis is thought of as an older person’s disease, it actually can strike at any age.
Throughout your teens and 20s, your body creates new bone faster than it’s broken down. Once you reach your 30s, though, the process reverses: You begin losing bone rather than gaining it. When women reach menopause, the rate of bone loss is further accelerated.
With osteoporosis, the bones become porous, with larger gaps in between the supporting structure of the bone. This creates weak, brittle bones that easily fracture.
It’s important that people develop adequate bone mass throughout their teens and 20s to offset bone loss.
There are certain risk factors that make some people more likely to develop osteoporosis than others:
- Advanced age
- Being female
- Family history of osteoporosis
- Thin or small frame
- Caucasian or Asian race
- Early menopause, either naturally or surgically
- Low testosterone levels (men)
- Anorexia or bulimia
- Thyroid disease
- Rheumatoid arthritis
- Maladies involving blocked intestinal absorption of calcium
- Use of corticosteroid medications
- Use of anticonvulsant drugs
- Diet low in calcium
- Lack of exercise
- Cigarette smoking
- Excessive use of alcohol of caffeine
Early detection of osteoporosis is very important. If your doctor suspects osteoporosis or if you are at high-risk for developing the disease, there are tests that can detect bone density problems:
- Low level X-ray on a finger or wrist
- Ultrasound of the heel
- Computed tomography (CT) scan of the spine
- Dual energy X-ray absorption (DEXA) scan (bone density)
Standard X-rays do not detect osteoporosis until one-quarter of bone mass is already lost. By then susceptibility to fracture already exists. DEXA is an early detection tool and can detect as little as 1% of bone loss.
Bone density tests are non-invasive, simple, and painless. DEXA uses a low level of radiation, focuses on the hip and spine (common sites of fracture), and is considered safe.5
While DEXA has been called the “gold standard” of bone density tests, it may not be covered by some insurance plans. In that case, people at risk for osteoporosis should get one of the less expensive screenings done first. If there is evidence of bone loss, the insurance company will likely pay for a DEXA test since it would then indicated.
Lifestyle changes such as exercise, smoking cessation, avoiding heavy alcohol use, adequate calcium and Vitamin D intake, and fall prevention should all be used to slow the progression of the disease.
The goal of osteoporosis treatment is to prevent continued bone loss and help maintain bone density. Unfortunately, osteoporosis can’t be cured, but the progression can be slowed down.
It should be noted that drug therapy for osteoporosis is generally reserved for people who already have a significant amount of bone loss.There are several categories of drugs used to treat osteoporosis:
- Parathyroid hormones
- Bone formation agents
- Selective estrogen receptor modulators
Depending on what drug is used, you can slow bone loss, promote bone growth, and reduce the risk of fractures. Drugs used for osteoporosis include:
- Actonel (risedronate)
- Boniva (ibandronate)
- Didronel (etidronate)
- Estrogens (hormone therapy)
- Evista (raloxifene)
- Forteo (teriparatide)
- Fosamax (alendronate)
- Miacalcin (calcitonin)
All medications come with the possibility of side effects. You and your doctor will have to weigh the pros and cons of each treatment option.
For osteoporosis-related bone fractures, treatment depends on where the fracture occurs. Simple fractures can be treated with casts or splints and generally heal without long-term issues.
Others, like spine and hip fractures, need significant rehabilitation and can have long-term effects on your health. Nearly all hip fractures require surgical treatment. Because of the impact on mobility, a stay at a residential care facility is often required. Sustained physical therapy can help get those who have had a hip fracture regain strength and mobility.
Obviously, some risk factors, like your race or gender, are out of your control. But many lifestyle factors are effective at reducing your risk.
Prevention of osteoporosis is primarily tied to three things:
- Proper nutrition, with sufficient amounts of calcium and vitamin D through diet or supplementation
- Weight-bearing exercise
- Addressing other modifiable risk actors (e.g., smoking and alcohol consumption)
Osteoporosis is a common disease that can lead to serious bone fractures. Take steps to improve and maintain your bone health by eating a healthy diet and engaging in weight-bearing exercise. Also, understand that when you have osteoporosis, even minor trauma can cause a broken bone. Falling is the number one cause of osteoporosis-related fractures, so take care to minimize your risk of such an accident. Follow the treatment plan your doctor has for you to protect your bone density and slow the progression of your disease.
- Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–2526. doi:10.1002/jbmr.2269
- United States Office of the Surgeon General. “The Frequency of Bone Disease.” In: Bone Health and Osteoporosis: A Report of the Surgeon General. 2004.
- Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46–56. doi:10.5152/eurjrheum.2016.048
- National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Osteoporosis in Men. Updated October 2018.
- National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Osteoporosis Overview. Updated October 2018.
- Hashmi FR, Elfandi KO. Heel Ultrasound Scan in Detecting Osteoporosis in Low Trauma Fracture Patients. Orthop Rev (Pavia). 2016;8(2):6357. doi:10.4081/or.2016.6357
- National Osteoporosis Foundation. Medication and Treatment Adherence. Updated September 7, 2018.
- Black DM, Rosen CJ. Clinical Practice. Postmenopausal Osteoporosis. New England Journal of Medicine. 2016 Jan 21;374(3):254-62. doi: 10.1056/NEJMcp1513724
- Ensrud KE, Crandall CJ. Osteoporosis. Annals of Internal Medicine. 2017 Aug 1;167(3):ITC17-ITC32. doi: 10.7326/AITC201708010
- Tella SH, Gallagher JC.“Prevention and Treatment of Postmenopausal Osteoporosis. The Journal of Steroid Biochemistry and Molecular Biology. 2014 Jul;142:155-70. doi: 10.1016/j.jsbmb.2013.09.008