Osteoporosis

Overview

Definition

Osteoporosis is a disease that reduces bone mass, bone density, and bone quality. It makes bones weak and brittle. Osteoporosis can lead to broken bones. Breaks in the hip , spine , and wrist are common but breaks can happen anywhere.

Osteoporosis
osteoporosis bone
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Causes

Osteoporosis happens when bone loss happens faster than bone growth. The cycle of bone loss and growth is normal throughout life. However, bone loss happens faster after age 30. There are many other things over a lifetime that increase the chance of osteoporosis.

Risk Factors

Osteoporosis is more common in older adults and women. It’s also more likely to happen if full bone mass was not reached in childhood or early adult years.

The risk of osteoporosis is also higher if you have 1 or more of the following:

  • Low body weight
  • Smoking
  • Alcohol use disorder
  • A history of falls
  • A family history of osteoporosis
  • Being in menopause
  • Regular use of some medicine, such as long term use of blood thinners or stomach acid reducers
  • Low estrogen levels in women or low testosterone levels in men
  • Inactivity
  • Certain diets that can result in a lack of calcium or vitamin D
  • Too little sunlight—sun on the skin is a main source of vitamin D
  • Certain cancers such as lymphoma and multiple myeloma

Some health conditions also increase the risk of osteoporosis:

  • Rheumatoid arthritis
  • No menstrual periods— amenorrhea
  • Hyperthyroidism
  • Type 2 diabetes
  • Asthma
  • Liver disease
  • Eating disorders
  • Depression
  • Crohn disease
  • Celiac disease
  • Female athlete triad

SymptomsandDiagnosis

Symptoms

Many do not know they have osteoporosis until a bone breaks. Other symptoms that may appear are:

  • Severe back pain
  • Loss of height with stooped posture— kyphosis
Kyphosis
IMAGE
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Diagnosis

The doctor will ask about your symptoms and past health. A physical exam will be done. Blood and urine tests may be done to rule out other problems such as a hormone imbalance. Images bones may be taken with:

  • Dual-energy x-ray absorptiometry (DXA)
  • Quantitative ultrasound (QUS)
  • Quantitative CT scan (QCT)

Treatments

Treatment

The goal of treatment is to lower the chance of breaks and slow more bone loss. Both lifestyle changes and medicine can help.

Lifestyle Changes

Daily habits can both impact bones. For example:

  • A diet rich in calcium and vitamin D can help to build stronger bones. They can be found in dairy products, leafy greens, or canned fish. Many other products now add vitamin D or calcium.
  • Alcohol can cause hormonal changes that may harm bones.
  • Smoking is a known risk factor for osteoporosis. Quitting can help.
  • Exercise improves bone health. Weight-bearing and strength-training have the best benefits for your bones. Balance training may help lower the chances of falls and breaks.
  • Calcium and vitamin D supplements may be needed for those that cannot get enough from food. The doctor should be involved in the decision to take them.

Medicines

Medicines can help prevent bone loss, increase bone density, and lower the risk of breaks. Medicine choices may include:

  • Bisphosphonates to prevent the loss of bone
  • Parathyroid hormone therapy to stimulate bone growth
  • Selective estrogen receptor modulators to prevent bone loss, improve density, and lower the risk of breaks

Safety Measures

Falls can raise the chance of breaks in someone with osteoporosis. Steps to lower the chances of falls include:

  • Floors—Remove all loose wires, cords, and throw rugs. Reduce clutter. Make sure rugs are anchored and smooth. Don’t move furniture around.
  • Bathrooms—Put grab bars and non-skid tape in the tub or shower.
  • Lighting—Make sure halls, stairways, and entrances are well lit. Put a night light in your bathroom. Turn lights on if you get up in the middle of the night.
  • Kitchen—Put non-skid rubber mats near the sink and stove. Clean spills right away.
  • Stairs—Make sure treads, rails, and rugs are secure.
  • Other precautions—Wear sturdy, rubber-soled shoes. Ask your doctor whether any of your medicines might cause you to fall.

Prevention

It is important to build strong bones throughout childhood and early adult years. This will build a better bone supply for later years.

Other ways to decrease the risk of osteoporosis include:

  • Eat a balanced diet rich in calcium and vitamin D.
  • Perform weight-bearing exercises.
  • Live a healthy lifestyle—avoid smoking and drink alcohol only in moderation (2 drinks or less a day for men, 1 drink or less a day for women).
  • Talk to your doctor about risk for osteoporosis if you have gone through menopause. Medicine may help to prevent osteoporosis.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

RESOURCES

National Institute of Arthritis and Musculoskeletal and Skin Diseases https://www.niams.nih.gov 

National Osteoporosis Foundation https://www.nof.org 

CANADIAN RESOURCES

Osteoporosis Canada https://osteoporosis.ca 

Women's College Hospital—Women's Health Matters http://www.womenshealthmatters.ca 

References

Clinician's guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation website. Available at: https://www.nof.org/prevention/. Accessed September 24, 2020.

Diagnosis information. National Osteoporosis Foundation website. Available at: https://www.nof.org/patients/diagnosis-information. Accessed September 24, 2020.

Ho-Pham LT, Nguyen ND, Nguyen TV. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr. 2009;90(4):943-950.

Khosla L, Melton LJ. Clinical practice: osteopenia. N Engl J Med. 2007;356(22):2293-2300.

Osteoporosis. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/osteoporosis  . Accessed September 24, 2020.

Osteoporosis causes and risk factors. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/osteoporosis-causes-and-risk-factors  . Accessed September 24, 2020.

Osteoporosis tests. Ortho Info—American Academy of Orthopedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/osteoporosis. Accessed September 24, 2020.

Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367(9527):2010-2018.