Osteoporosis

Overview

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the quality or structure of bone changes. This leads to a decrease in bone strength that can increase the risk of fractures. Osteoporosis literally means "porous bone," and under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone.

Often called a "silent disease," osteoporosis typically progresses without symptoms until a fracture occurs. It affects approximately 200 million people worldwide and is responsible for more than 8.9 million fractures annually. In the United States, about 54 million people have osteoporosis or low bone mass, placing them at increased risk for fractures. One in two women and up to one in four men over age 50 will break a bone due to osteoporosis.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone. While bone loss is a natural part of aging, osteoporosis speeds up this process. The good news is that osteoporosis is largely preventable, and there are effective treatments available that can slow bone loss and even rebuild bone, reducing fracture risk.

Types of Osteoporosis

Symptoms

Osteoporosis is often called a "silent disease" because bone loss occurs without symptoms. Many people don't know they have it until they break a bone:

Common Symptoms

Early Warning Signs

• Height loss: Losing an inch or more
• Posture changes: Stooped or hunched posture
• Back pain: Caused by fractured or collapsed vertebra
• Fractures: From minor falls or normal activities
• Receding gums: Jaw bone loss
• Weakened grip strength: Indicator of overall bone health
• Brittle fingernails: May indicate bone health issues

Advanced Symptoms

• Dowager's hump: Curved upper back from spinal fractures
• Chronic pain: From multiple compression fractures
• Breathing problems: Reduced lung capacity from spine changes
• Digestive issues: Compressed abdominal cavity
• Limited mobility: Fear of falling, physical limitations
• Loss of independence: Difficulty with daily activities

Common Fracture Sites

• Hip: Most serious, often requires surgery
• Spine: Compression fractures, may be painless
• Wrist: Often first fracture in younger postmenopausal women
• Ribs: From coughing or minor trauma
• Pelvis: Can occur from falls

Causes and Risk Factors

Osteoporosis occurs when bone breakdown exceeds bone formation:

Bone Remodeling Process

• Peak bone mass: Reached around age 30
• Bone turnover: Old bone removed, new bone added
• Imbalance: More removal than addition leads to osteoporosis
• Aging: Natural decline in bone formation

Non-Modifiable Risk Factors

Demographics

• Age: Risk increases after 50
• Gender: Women at higher risk, especially postmenopausal
• Race: White and Asian women at highest risk
• Family history: Genetic predisposition
• Body frame: Small, thin-boned people at greater risk

Medical History

• Previous fractures: Increases future fracture risk
• Early menopause: Before age 45
• Hysterectomy: If ovaries removed
• Low testosterone: In men
• Pregnancy/breastfeeding: Multiple pregnancies

Modifiable Risk Factors

Lifestyle Factors

• Calcium deficiency: Lifelong low intake
• Vitamin D deficiency: Limited sun exposure
• Sedentary lifestyle: Lack of weight-bearing exercise
• Smoking: Interferes with bone formation
• Excessive alcohol: More than 2 drinks daily
• Caffeine: High intake may increase calcium loss
• Low body weight: BMI less than 19

Dietary Factors

• Poor nutrition: Inadequate protein, minerals
• Eating disorders: Anorexia, bulimia
• Excessive dieting: Rapid weight loss
• High sodium: Increases calcium excretion
• High protein: May increase calcium loss if calcium low

Medical Conditions

• Hormonal disorders: Hyperthyroidism, hyperparathyroidism
• Digestive disorders: Celiac disease, IBD
• Rheumatoid arthritis: Inflammation affects bones
• Cancer: Multiple myeloma, breast, prostate
• Kidney disease: Affects vitamin D metabolism
• Liver disease: Impairs vitamin D activation
• COPD: Often associated with bone loss

Medications

• Corticosteroids: Long-term use major risk
• Anticonvulsants: Some epilepsy medications
• Proton pump inhibitors: Long-term use
• Cancer treatments: Chemotherapy, aromatase inhibitors
• Thyroid hormones: Excessive doses
• Antidepressants: Some SSRIs
• Blood thinners: Long-term heparin use

Diagnosis

Early diagnosis is crucial for preventing fractures and maintaining bone health:

Bone Density Testing

Other Diagnostic Tests

Screening Recommendations

• Women 65+: All women should be screened
• Men 70+: All men should be screened
• Younger adults: If risk factors present
• Postmenopausal women <65: With risk factors
• Anyone with fracture: After age 50
• Monitoring: Every 1-2 years if on treatment

FRAX Tool

Fracture Risk Assessment Tool calculates 10-year probability of fracture:

• Combines clinical risk factors with BMD
• Helps guide treatment decisions
• Available online for free
• Validated for many populations

Treatment

Treatment aims to prevent fractures, maintain bone strength, and reduce pain:

Medications

Supplements

Non-Pharmacological Treatment

• Exercise: Weight-bearing and resistance training
• Fall prevention: Home safety modifications
• Physical therapy: Improve strength and balance
• Posture training: Reduce spine stress
• Pain management: Heat, ice, gentle stretching
• Assistive devices: Canes, walkers if needed

Prevention

Building strong bones in youth and maintaining them throughout life is key:

Nutrition

• Calcium-rich foods: Dairy, leafy greens, fortified foods
• Vitamin D sources: Fatty fish, egg yolks, fortified milk
• Protein: Adequate but not excessive
• Fruits and vegetables: Provide essential nutrients
• Limit sodium: Reduces calcium loss
• Moderate caffeine: No more than 300mg daily

Lifestyle Modifications

• Regular exercise: Weight-bearing and muscle-strengthening
• Don't smoke: Smoking accelerates bone loss
• Limit alcohol: No more than 1-2 drinks daily
• Maintain healthy weight: Not too thin or overweight
• Sun exposure: 10-15 minutes daily for vitamin D
• Fall prevention: Remove trip hazards

Throughout Life Stages

Childhood and Adolescence

• Encourage physical activity
• Ensure adequate calcium and vitamin D
• Limit soft drinks
• Promote healthy eating habits

Young Adults

• Build peak bone mass by 30
• Weight-bearing exercise crucial
• Avoid extreme dieting
• Address eating disorders

Middle Age

• Monitor bone health
• Address menopause concerns
• Continue exercise program
• Consider screening if risk factors

Older Adults

• Regular bone density testing
• Fall prevention strategies
• Medication review
• Maintain muscle strength

Living With Osteoporosis

Managing osteoporosis requires ongoing attention to maintain quality of life:

Daily Management

• Medication adherence: Take as prescribed
• Supplement routine: Calcium and vitamin D
• Safe movement: Avoid bending, twisting spine
• Proper lifting: Bend knees, not back
• Good posture: Stand and sit tall
• Comfortable shoes: Low heels, good support

Home Safety

• Remove trip hazards: Rugs, cords, clutter
• Improve lighting: Especially stairs, bathrooms
• Install grab bars: Bathroom, stairs
• Non-slip surfaces: Bath mats, stair treads
• Keep items accessible: Avoid reaching high or low
• Emergency plan: Medical alert system

Pain Management

• Heat therapy: For muscle spasms
• Cold therapy: For acute pain
• Gentle stretching: Maintain flexibility
• Massage: Relieve muscle tension
• Acupuncture: May help some people
• Pain medications: As recommended by doctor

Emotional Well-being

• Stay connected: Maintain social activities
• Support groups: Share experiences
• Manage anxiety: About falling or fractures
• Stay positive: Focus on abilities
• Professional help: If depression develops

Complications

Osteoporosis complications can significantly impact quality of life:

Nutrition and Bone Health

Proper nutrition is essential for maintaining strong bones:

Key Nutrients

Other Important Nutrients

• Protein: 0.8-1g per kg body weight
• Magnesium: Whole grains, nuts, seeds
• Vitamin K: Leafy greens, broccoli
• Phosphorus: Meat, dairy, beans
• Vitamin C: Citrus, berries, peppers
• Zinc: Meat, shellfish, legumes

Foods to Limit

• High sodium: Increases calcium loss
• Excessive caffeine: May interfere with absorption
• Alcohol: Interferes with bone formation
• Soft drinks: Phosphoric acid may affect bones
• Very high protein: If calcium intake is low

Exercise Guidelines

Regular exercise is crucial for bone health and fracture prevention:

Weight-Bearing Exercises

• Walking: 30 minutes daily
• Dancing: Fun and effective
• Hiking: On varied terrain
• Stair climbing: Great for bones
• Tennis: If appropriate
• Tai chi: Improves balance

Resistance Training

• Weight lifting: Start light, progress slowly
• Resistance bands: Gentle option
• Body weight exercises: Modified as needed
• Frequency: 2-3 times per week
• All major muscle groups: Legs, arms, core

Balance and Flexibility

• Yoga: Modified poses, avoid extreme flexion
• Balance exercises: Standing on one foot
• Stretching: Gentle, daily
• Posture exercises: Strengthen back

Exercises to Avoid

• High-impact activities if severe osteoporosis
• Forward bending exercises
• Twisting movements of spine
• Heavy lifting without proper form
• Activities with high fall risk

Related Conditions

Several conditions are associated with or increase risk of osteoporosis: