Osteoporosis is a medical condition which causes bones to become so weak & brittle that falls or even mild stresses like coughing or bending over can cause fractures. Fractures related to osteoporosis most commonly are found to occur in wrist, spine or hip areas. Bone is also a living tissue which is constantly being broken down & replaced by newer tissue. Osteoporosis generally occurs when creation of newer bone is unable to keep up with removal of older bone. Osteoporosis equally affects men & women of all races, but Asian & white women especially older who are past menopause, are at the highest risk of developing this condition. Healthy diet, weight-bearing exercise & medications can however strengthen weak bones or help prevent bone loss in prospective patients.
Signs & Symptoms of Osteoporosis
Typically, there are no signs & symptoms in early symptoms of osteoporosis. However, once bones have weakened by this condition, patients may have signs & symptoms which include the following.
- Back pain which is caused by collapsed or fractured vertebra.
- Loss of height over a period of time.
- Stooped posture.
- Bone fractures which occur far more easily than expected.
Causes of Osteoporosis
Bones are in a constant state of renewal throughout life. Newer bone is being made & older one is broken down. When people are younger, body makes new bone much faster than it breaks down older bone & therefore bone mass is able to increase. Most people reach peak bone mass by 20 years of age. Subsequently, as people age loss of bone mass is much faster than it is created. How likely is it that a person to develop osteoporosis will depend upon how much bone mass have they attained in youth. Higher bone mass will ensure that that the person is having more bone ‘in the bank’, & are therefore less likely to develop osteoporosis as they age.
Risk Factors Associated with Osteoporosis
There are a number of risk factors which can increase likelihood of a person developing osteoporosis. These include race, age, lifestyle choices, medical conditions & their treatments.
- Unchangeable Risk Factors
There are certain risk factors for osteoporosis which are beyond the control of an individual, including the following.
- Gender – Women are found to be far more likely to develop osteoporosis than men are.
- Age – Greater is the risk of developing osteoporosis as people get older.
- Race – People are at greater risk of developing osteoporosis if they are white or of Asian descent.
- Family History – Having a sibling or parent with osteoporosis puts an individual at greater risk of developing this condition, especially in case either the mother or father have experienced hip fracture.
- Size of Body Frame – Men & women having smaller body frames generally tend to have higher risk of developing osteoporosis, simply because they have lesser bone mass to draw upon as they age.
- Risk Factors from Hormone Levels
Osteoporosis is found to be more common among people who are having too much or too little of certain hormones within their bodies. Common examples include the following.
- Sex Hormones – Lowered levels of sex hormones generally tend to weaken bones. Reduction in estrogen levels in women following menopause is one of the strongest risk factors for them developing osteoporosis. Moreover, men also experience a gradual reduction in levels of testosterone as they age. Medical treatments for prostate cancer also reduce levels of testosterone in men while treatments for breast cancer are also found to reduce estrogen levels in women. These factors are most likely to accelerate bone loss in people.
- Thyroid Problems – Too much of thyroid hormone can also cause loss of bone. This usually occurs among people whose thyroid gland is overactive or when too much of thyroid hormone medications are taken as treatment for underactive thyroid glands.
- Other Glands – Risk of osteoporosis has also been associated with overactive adrenal or parathyroid glands.
- Dietary Risk Factors
Quite often osteoporosis is more likely to occur among people having the following conditions.
- Low Calcium Intake – Lacking calcium throughout the life plays a key role in the development of osteoporosis. Lower intake of calcium contributes to diminished levels of bone density, early loss of bone & increased risk of having fractures.
- Eating Disorders – This includes severe restrictions on food intake & being underweight which eventually weakens bone in both men & women.
- Gastrointestinal Surgery – Bariatric surgeries which are performed to reduce size of stomach or to remove parts of intestine so as to limit surface area for absorption of nutrients, will include lower intake of calcium as well.
- Risk Factors from Steroids & Other Medications
Long term usage of orally administered or injected corticosteroids like cortisone & prednisone will eventually interfere with the natural bone-rebuilding process. Osteoporosis is also found to be associated with use of medications to combat or prevent the following conditions.
- Gastric Influx
- Rejection of Transplantation
- Risk Factors from Other Medical Conditions
Risk of developing osteoporosis is higher among people who are having certain medical problems including the following.
- Celiac Disease
- Liver or Kidney Disease
- Inflammatory Bowel Disease
- Rheumatoid Arthritis
- Multiple Myeloma
- Risk Factors from Lifestyle Choices
There are some bad habits among individuals which can increase risk of developing osteoporosis. Some common examples include the following.
- Sedentary Lifestyle – People spending more time sitting & doing nothing pose higher risk of developing osteoporosis than people who are more active in life. Weight bearing exercises & activities which promote balance & better posture are beneficial for maintaining healthy bones, especially activities like weightlifting, dancing, running, jumping & walking seem to be particularly helpful.
- Excessive Alcohol Consumption – Regularly consuming more than two drinks of alcohol everyday increase risk of developing osteoporosis.
- Use of Tobacco – Exact role of tobacco played in development of osteoporosis is not yet clearly understood, but it has been observed that use of tobacco contributes in weakening of bones.
Complications Associated with Osteoporosis
- Compression Fractures – Bone fractures which are particularly located in spine or hip are some of the most serious complications of osteoporosis. Fractures in hips which are caused by falls can often result in disability & also increase risk of death within the first year following injuries. Moreover, in some cases of osteoporosis, spinal fractures are found to occur even without incidences of falls. Vertebral bones which make up the spine can weaken due to osteoporosis to the point that they crumple & which can eventually result in back pain and/or loss of height along with a hunched forward posture.
Initial Appointment for Osteoporosis
Preparing for the initial appointment is the first step a patient can make towards addressing this problem. People should talk to doctors about osteoporosis in case they have gone through early menopause or have taken corticosteroids for several months at a stretch or if either of their parents have had hip fractures in the past. Doctors most often suggest suspected osteoporosis patients to undergo bone density testing. Screening for osteoporosis is also recommended for all women who are above 65 years of age. Then there are some guidelines which also recommend screening for men above 70 years of age, especially when they are having health issues which are most likely to cause osteoporosis. Whenever bone density tests have proved to be abnormal, or when patients have other complicated health issues, they may be referred to specialist doctors (endocrinologists) in metabolic disorders or to doctors specializing in diseases of bones, joints or muscles (rheumatologists). Following information can be helpful for patients to stay ready for initial appointment & as to what they can expect from their specialist doctors.
- What Patients Can Do in Preparation of Initial Appointment
- Write Down Symptoms Experienced – Though it is possible that some patients may have some symptoms, many may not have any.
- Write Down Key Personal Information – This would include any major stresses bothering the individual along with any recent changes in life.
- Make a List of Medications – This list will include all medications, vitamins & supplements which patients are currently taking or have been taking in the past. It is especially useful in recording the type & dosage of calcium & vitamin D supplements mostly because several different preparations are available in the market. Whenever patients are unsure about what information is required, it would be sensible that they take the bottles along with them to the initial appointment.
- Write Down Questions to Ask Doctors – Preparing a list of questions will help the patient make the most of his time at the initial appointment since time with specialist doctors is limited. This list can sequence questions from the most important to the least important in case time would run out. Some basic questions which osteoporosis patients can ask specialist doctors include the following.
- Will I need to be screened for osteoporosis?
- What type of tests will I need to confirm diagnosis?
- Which treatment options are available & what would you recommend?
- Which types of side effects are expected from treatment?
- Are there any generic alternatives available to the medicines you are prescribing for my condition?
- What alternatives are available for the primary approach of treatment you are suggesting?
- How can I best manage osteoporosis with my other health conditions?
- Are you suggesting any activity restrictions which I need to follow?
- Will I need to make any changes in my diet?
- Will I also need to take any supplements?
- Will I need to undertake any physical therapy program that can be beneficial?
- What can I do in order to prevent falls?
In addition to these questions, patients should not hesitate to ask any additional questions which come to their mind during the initial appointment.
- What Specialist Doctors Usually Ask Patients During Initial Appointment
Specialist doctors are most likely to ask a number of questions to patients during the initial appointment. Staying prepared to answer them will reserve time for other points which patients would like to spend more time upon. Doctors would most often ask the following questions during initial appointment for suspected cases of osteoporosis.
- Have you experienced any broken bones or fractures/
- Have you noticed any loss of height?
- How is your diet, especially intake of dairy products?
- Are you getting enough quantities of calcium or vitamin D?
- Are you taking any supplements or vitamin D?
- How often do you exercise & what are the types of exercises you do?
- How are you keeping with balance & have you experienced any falls lately?
- Are you having any family history of osteoporosis?
- Did anyone in your family have had bone fractures, especially hip fractures among parents?
- Did you ever undergo stomach or intestinal surgery?
- Did you ever use corticosteroid medications like cortisone, prednisone in form of oral pills, cream or injections?
Bone density is usually measured by a machine which uses lower levels of x-rays in order to determine proportion of minerals in bones. This is a painless test during which patients lie on a padded table while a scanner passes over their bodies. However, in most cases only few bones are checked usually involving the wrist, spine & hip.
Treatment Options for Osteoporosis
Treatment recommendations for osteoporosis are most often based upon estimate of risk of breaking bones within the next 10 years by using information like the bone density test.
- Medications for Osteoporosis
Whenever risks are not high, treatments usually include medications & may eventually focus on modifying risk factors for falls & bone loss. Most widely prescribed medications for both men & women are bisphosphonates for increased risk of fractures. Some common examples include the following.
- Zoledronic Acid (Reclast)
- Ibandronate (Boniva)
- Risedronate (Atelvia, Actonel)
- Adendronate (Fosamax)
Side effects of these bisphosphonates include abdominal pain, nausea & heartburn-like symptoms. However, these are less likely to occur when medications are taken properly. Moreover, IV administered bisphosphonates do not cause any type of stomach upset but can usually cause headaches, fever & muscle aches for up to 3 days & can be easier to schedule quarterly or yearly injections rather than remembering to take weekly or monthly pills. Nevertheless, this could be a little expensive option. But then, using bisphosphonate therapy for more than 5 years is linked to a rare problem which involves cracking of the middle of the thighbone & which may eventually completely break down. Bisphosphonates also have a potential to affect jawbones. However, osteonecrosis of jaw is a rare condition which can typically occur after tooth extraction in which sections of jawbone fail to heal where teeth are pulled. Patients should therefore undergo recent dental examination before starting bisphosphonate therapies.
- Hormone-Related Therapy for Osteoporosis
It is estrogen, which is usually started soon after menopause in women & which can effectively help maintain bone density. However, estrogen therapy is found to increase risk of breast cancer, endometrial cancer, risk of developing blood clots & possibly heart disease. This is the reason as to why estrogen is typically utilized for bone health among younger women or in women whose symptoms of menopause also require to be treated. Raloxifene (Evista) usually mimics beneficial effects of estrogen on bone density among postmenopausal women without some risks that are commonly associated with estrogen therapy. Treatment with this drug will also reduce risk of developing some types of breast cancers. However, raloxifene may increase risk of developing blood clots alongside hot flashes which are a common side effect. Osteoporosis in men is linked to gradual age-related decline in levels of testosterone. Application of testosterone replacement therapy usually helps in improving symptoms of lower testosterone, but medications for osteoporosis in men are better understood to treat osteoporosis in men & therefore are recommended alone or sometimes in addition to testosterone therapy.
- Other Medications for Osteoporosis
When patients are unable to tolerate common treatments for osteoporosis, or when these treatments fail to work properly, orthopedists may suggest trying the following.
- Denosumab (Prolia) – In comparison to bisphosphonates, denosumab produces similar, if not better, bone density results while reducing possibility of all types of fractures. Denosumab is typically delivered through shots under skin every 6 months.
- Teriparatide (Forteo) – This is a powerful drug stimulating new bone growth & which is similar to parathyroid hormone. This is administered through daily subcutaneous injections. However, after 2 years of treatment with teriparatide, there is another osteoporosis drug which needs to be taken in order to maintain newer bone growth.
- Alternative Medicine for Osteoporosis
This includes soy protein which promotes activity which is similar to estrogen on bone tissue. It is also indicated that risk of bone fracture is lessened among postmenopausal Asian women who are consuming higher amounts of soy protein. However, soy needs to be used with caution by women having a personal or family history of breast cancer. Moreover, soy products which are commonly available in the market have also not proved to reduce chances of fractures. Ipriflavone, is a useful product which is made in laboratories from isoflavones found in soy. When this is combined with calcium, ipriflavone is found to prevent bone loss while reducing pain which is commonly associated with compression fractures in spine.
- Lifestyle Changes & Home Remedies for Osteoporosis
These are self-management techniques which may help in reducing risk of experiencing broken bones or developing osteoporosis.
- Do Not Smoke – Smoking is generally found to increase rate of bone loss & thereby increasing chances of experiencing fractures.
- Avoid Excessive Consumption of Alcohol – Consuming two alcoholic drinks per day may decrease bone formation. Moreover, influence of alcohol may also increase risk of falling.
- Preventing Falls – Checking living areas for loose electrical cords, area rugs & slippery surfaces & wearing low-heeled shoes which can make a person trip or fall will go a long way in preventing falls. Moreover, rooms should be brightly lit & grab bars installed inside & outside shower doors will ensure proper safety to prevent falls at home.
Preventive Measures for Osteoporosis
Prevention is always better than cure. Therefore, good nutrition & a regular exercise program are essential to keeping bones healthy throughout life.
- Protein – Although most people get plenty in their diets, protein is one of the most important building blocks of bones. Vegans & vegetarians get enough protein in their diets only when they intentionally seek suitable sources like legumes, nuts, soy & dairy products including eggs. While protein supplementation is an option, older adults may eat less protein for various other reasons.
- Body Weight – Being underweight largely increases chances of bone loss & fractures as well. While excessive weight is also known to increase risk of fractures in wrists & arms, it would therefore be sensible to maintain appropriate body weight for bone health, just as it is for overall health in general.
- Calcium – Both men & women, between ages of 18 – 50 years require 1,000 milligrams of calcium every day. This is a daily amount which increases to 1,200 milligrams when women reach 50 years & men 70 years of age. However, good sources of calcium are aplenty including the following.
- Low Fat Dairy Products
- Soy Products like Tofu
- Dark-Green Leafy Vegetables
- Canned Sardines with Bones
- Canned Salmon
- Calcium-Fortified Cereals
- Calcium-Fortified Orange Juice
Whenever people find it difficult to get adequate amount of calcium in diet, they should consider taking calcium supplements. Attention must be paid towards the right quantity as too much calcium is also linked to developing kidney stones. Some medical experts also suggest that too much calcium, especially through supplements can also increase risk of developing heart disease.
- Vitamin D – Vitamin D generally improves the ability of the system to absorb calcium & thereby improve bone health. Normally, people can get adequate amounts of vitamin D from sunlight especially for people who are living in high latitudes. Although scientists yet do not know the oprimal daily dose of vitamin D, a good starting point is 600 – 800 international units (IU) everyday through normal food or supplements. Supplements may be essential for people with limited sun exposure or without other sources of vitamin D.
Exercise – Exercise can also be useful for people to build stronger bones & slow bone loss as well. Combining strength exercises with balance & weight-bearing techniques will help tone muscles & bones in arms & upper spine. Weight bearing exercises like skiing, skipping rope, climbing stairs, running, jogging, walking & impact producing sports can mainly affect bones in lower spine, hips & legs. Other balancing exercises like Tai Chi can effectively reduce risk of falling, especially among older adults. Cycling, swimming & exercising on machines like elliptical trainers will provide good cardiovascular workouts, but they may not be helpful in improving bone health.