Osteoporosis

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Osteoporosis is a disease affecting many millions of people around the world. It occurs when bones lose minerals, such as calcium, more quickly that the body can replace them. As a result, your bones become weak and may fracture extremely easily.

Osteoporosis is not a normal part of aging. You are never too young or too old to improve the health of your bones. To learn some essential steps to keep your bones healthy for life, see the section Prevention.

Osteoporosis is often called a silent disease because most people with osteoporosis don’t have symptoms. If you have been diagnosed with osteoporosis or have a high risk of fracture, your doctor will first ensure that you have adequate calcium, vitamin D and exercise to support bone health, and that you make the necessary lifestyle changes that may impact your bones. There are also a number of effective medications that are approved for the treatment of osteoporosis. 

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Osteoporosis is often called a silent disease because most people with osteoporosis don’t have symptoms. They often do not know they have osteoporosis until it shows up in a bone density test or a fracture occurs. But once bones have been weakened by osteoporosis, you may have symptoms that include:

  • Loss of height over time
  • A stooped posture causing your upper back to curve forward
  • Back pain, caused by a fractured or collapsed vertebra
  • A bone fracture that occurs much more easily than expected, even during everyday movements such as bending or coughing

If you are experiencing any of the above symptoms, be sure to talk to your doctor right away as this may indicate that the disease is already in an advanced stage.

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Osteoporosis, which literally means porous bone, is a disease of the bones. Bone is a living tissue, which is constantly being absorbed and replaced. Osteoporosis occurs when bones lose minerals, such as calcium, more quickly that the body can replace them, leading to a loss of bone thickness.

As a result, your bones become weak and may fracture from a minor fall or, in serious cases, even during every day movements, like sneezing or bending. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.

Fracturing a bone is a serious complication of osteoporosis, especially when you’re older. It may cause long-lasting and severe pain.  It may also hinder your mobility, especially when the fracture involves the hip. 

Osteoporosis risk factors

You are more likely to develop osteoporosis if you:

  • Are female
  • Are age 50 or older
  • Are postmenopausal
  • Are Caucasian or of Asian descent
  • Have low calcium intake
  • Have poor nutrition
  • Have an intestinal problem that prevents calcium and vitamins from being absorbed
  • Have an overactive thyroid (hyperthyroidism) or take too much thyroid hormone medication
  • Suffer from an eating disorder, such as anorexia nervosa
  • Lead a sedentary lifestyle
  • Have a small body frame
  • Take certain medications, such as corticosteroid medications
  • Smoke or drink alcohol regularly
  • Have a family history of osteoporosis
  • Have had at a previous fracture 
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A bone density scan is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. The National Osteoporosis Foundation recommends a bone density scan of the hip and spine by a dual-energy x-ray absorptiometry (DEXA), widely considered the most accurate measure of bone density.

The test is conducted with a machine that uses low levels of radiation to determine the proportion of mineral contained in your bones. It often takes less than 15 minutes and you simply lie on a padded table as a scanner passes over your body.

What do my results mean?

A bone density scan will determine if any action is needed to improve your bone health. The results will indicate if your bones are in the range of either normal, osteopenia (low bone density) or osteoporosis. Below is a table of the measures.

T-score

Result

Outcome

-1 or above

Normal

To maintain healthy bones, ensure you have adequate calcium and vitamin D, and that you exercise regularly

-1 to -2.5

Osteopenia

At risk of developing osteoporosis

Take immediate action to prevent further bone loss

-2.5 or lower

Osteoporosis

Fracture risk is high

Your doctor will start osteoporosis-specific treatment immediately

 

If the results of your bone mineral density (BMD) test show osteopenia or osteoporosis, it does not automatically mean that you will have a fracture. There are lifestyle changes and a number of available therapies that your doctor might prescribe to help slow down bone loss or treat osteoporosis.

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If you have been diagnosed with osteoporosis or have a high risk of fracture, your doctor will first ensure that you have adequate calcium, vitamin D and exercise to support bone health, and that you make the necessary lifestyle changes that may impact your bones.

There are also a number of effective medications that are approved for the prevention and treatment of osteoporosis. These medicines either rebuild bone, or slow or stop bone loss. They must be tailored to your specific needs and used in conjunction with recommended lifestyle changes. Some of the most common osteoporosis medications include:

  • Bisphosphonates: For both men and women, the most widely prescribed osteoporosis medications are bisphosphonates. According to Harvard Health , these are also used most often to treat osteoporosis in postmenopausal women. Bisphosphonates prevent the breakdown of bone and may even increase bone density. Most are taken as orally as tablets, but some may be given intravenously. Examples include:
    • Alendronate (Fosamax, Binosto)
    • Risedronate (Actonel, Atelvia)
    • Ibandronate (Boniva)
    • Zoledronic acid (Reclast, Zometa)
  • Possible side effects include nausea, abdominal pain, difficulty swallowing and irritation of the esophagus. A rare side effect linked to long-term bisphosphonate use is the death and deterioration of a section of the jawbone, caused by poor blood supply.
  • Selective estrogen receptor modulators (SERMs): These medications treat osteoporosis by mimicking the effects of estrogen to increase bone density. Raloxifene (Evista) is an example.
  • Calcitonin (Miacalcin): Calcitonin is a hormone produced by the thyroid gland. Given as a nasal spray, Calcitonin inhibits bone breakdown.
  • Denosumab (Prolia): Denosumab is a type of biological therapy. It is an antibody that targets a protein involved in bone breakdown. By attacking this protein, it helps stop bone loss.
  • Estrogen replacement therapy: As estrogen slows the breakdown of bone, this therapy replaces estrogen lost during menopause. However, estrogen replacement therapy is rarely recommended because of its associated risk of heart disease, stroke, and breast and endometrial cancer. 
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Osteoporosis is not a normal part of aging. You are never too young or too old to improve the health of your bones. Some essential factors to keep your bones healthy throughout your life include:

  • Getting an adequate amount of calcium intake: Eat foods rich in calcium, such as low fat dairy products, sardines, salmon, and dark green leafy vegetables. Until age 50, men and women need 1,000 milligrams of calcium a day according to the National Osteoporosis Foundation . This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70. If you find it difficult to get enough calcium from your diet, consider taking calcium supplements.
  • Maintaining an adequate supply of vitamin D: Your body requires vitamin D to absorb calcium. Many people get adequate amounts of vitamin D from sunlight, but depending on where you live, vitamin D production may decrease or be completely absent during the winter. Many people also avoid direct sun exposure because of the very real risk of skin cancer. Because vitamin D is naturally available in only a few foods, such as fatty fish like wild-caught mackerel, salmon and tuna, it is very difficult to get all the vitamin D you need from food alone. You may need to take vitamin D supplements to get enough of the nutrient needed for bone health. Scientists don't yet know the optimal daily dose of vitamin D. A good starting point for adults is 600 to 800 international units a day. If your blood levels of vitamin D are low, your doctor may suggest higher doses.
  • Doing weight-bearing exercises regularly: Exercise can help you build strong bones and slow bone loss. The most important type of exercise for preventing osteoporosis is weight-bearing exercises, done while on your feet so you bear your own weight. These include brisk walking, jogging, stair climbing, skipping rope, tennis and dancing, which mainly help to improve bone health in your legs, hips and lower spine. Strength training also helps strengthen muscles and bones in your arms and upper spine.
  • Avoiding smoking and limiting alcohol and caffeinated drinks: Avoid smoking and second-hand smoke. While the exact role tobacco plays in osteoporosis isn't clearly understood, researchers do know that tobacco use contributes to weak bones. Limit alcohol intake to no more than 2 – 3 drinks per day as heavy drinking can lead to bone loss. Caffeinated drinks, such as coffee and tea, may decrease calcium absorption and contribute to bone loss. Drink these in moderation.
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