Osteoporosis

Osteoporosis is the loss of bone density or thinning of the bones. This thinning causes bone weakness, and eventually the involved bone may break.

What is going on in the body?

Bones go through a constant state of bone loss and regrowth. People reach their peak bone mass by about age 30. After the age of 30, bone loss slowly begins to occur. This loss, if it becomes severe, can lead to osteoporosis. The bones become thin and fragile and may break easily.

Initially, bone loss occurs very slowly for both women and men. After the age of 65 to 70, men begin to lose bone more rapidly. Women, on the other hand, begin to lose bone more rapidly after they reach menopause and the body's estrogen level falls. Women may also begin to lose bone more rapidly if they have their ovaries removed during surgery before they reach menopause.

Bone is made up of calcium and proteins. There are two types of bone: compact and spongy. Each bone in the body has both types of bone in different amounts. The first signs of osteoporosis are seen in bones that have a lot of spongy bone. These include the hip, spine, and wrist bones.

What are the causes and risks of the condition?

Some risk factors for osteoporosis cannot be changed. These include:

Other risk factors for osteoporosis can be changed, such as:

Some of the diseases and conditions that can increase an individual's risk for osteoporosis are as follows:

What are the signs and symptoms of the condition?

Bone loss produces few symptoms but leads to reduced bone strength. Symptoms that may occur late in the disease include:

How is the condition diagnosed?

Osteoporosis may be discovered in an X-ray taken for some other problem. X-rays should not be used as the only test. Other tests are more sensitive and reliable, such as the following:

At this time, the most commonly used and reliable test is the DEXA scan.

What can be done to prevent the condition?

Bone loss can be slowed by 30 minutes of moderate weight-bearing exercise a day. Weight-bearing exercise includes low impact aerobics, walking, running, lifting weights, tennis, and step aerobics. A person exercising at a moderate level can talk normally without shortness of breath and is comfortable with the pace of the activity. The 30 minutes a day can be done in one session or several smaller segments.

Low impact aerobics and water aerobics are examples of exercises that minimize joint stress in elderly individuals or people who have arthritis. Recent research has shown that people who do high impact activities such as jogging have less bone loss as they age.

Bone loss can be slowed by eating a well-balanced diet, following the food guide pyramid. It's important to get enough calcium and vitamin D. There is some evidence that a diet high in fat may cause bones to thin more rapidly. Eating 25 grams of soy protein a day can also lower a person's risk for osteoporosis.

Following are some other options for reducing bone loss:

Selected medicines are currently approved by the Food and Drug Administration, or FDA, for prevention of osteoporosis. These medicines that slow or stop bone loss, increase bone density, and help prevent bone fractures are as follows:

What are the long-term effects of the condition?

Untreated osteoporosis can lead to bone fractures that may result in permanent disability. One in five women over the age of 70 and one in three women over the age of 80 will suffer a hip fracture during her lifetime. Nearly one in five women with a hip fracture will die within 6 months of the injury. Death following a hip fracture is usually the result of complications from immobility, such as pneumonia.

One third of women older than 65 years of age will have a fracture of the spine caused by osteoporosis. Chronic back pain resulting from fractures of the spine may prevent some physical activities and affect normal sleeping.

What are the risks to others?

Osteoporosis is not contagious and poses no risk to others.

What are the treatments for the condition?

Treatment cannot eliminate osteoporosis. Certain medicines are currently approved by the FDA for treatment of osteoporosis. These medicines may slow or stop bone loss, increase bone density, and help prevent bone fractures. They include the following:

Parathyroid hormone, on the other hand, works by increasing bone mass rather than slowing bone loss. It is given as an injection under the skin each day. At this time, the FDA has not approved parathyroid hormone for the treatment of osteoporosis. Studies have shown that it may help prevent hip and spine fractures. Research on its effectiveness and safety continues.

What are the side effects of the treatments?

Bisphosphonates can cause nausea, stomach irritation, and heartburn if not taken exactly as prescribed. SERMs can cause leg cramps, hot flashes, and occasional blood clots. HRT can cause bloating, breast tenderness, vaginal bleeding, and rarely, blood clots. Calcitonin may cause runny nose, nausea, and flushing. Parathyroid hormone can cause nausea, headache, dizziness, and leg cramps.

What happens after treatment for the condition?

After a person develops osteoporosis, treatment is lifelong. The home should be made safe to prevent accidents. Ways to increase safety include the following:

Intriguing new research done in older individuals with arthritis found that brisk walking or weight training improved balance in those individuals. Improved balance could very well help individuals with osteoporosis avoid hip fractures and wrist fractures from falls.

How is the condition monitored?

Women on HRT should have yearly physicals and pelvic examinations, mammograms, and PAP smears. Repeat DEXA bone scans may be performed yearly to see the effect of treatment on bone density. Sometimes urine tests may be done to look at bone markers every 3 months during the initial 6 to 12 months of beginning a new treatment. Any new or worsening symptoms should be reported to the healthcare provider.

Author:Eva Martin, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:09/30/01
Reviewer:Melissa Sanders, PharmD
Date Reviewed:09/13/01