Osteoporosis

Osteoporosis is a degenerative condition that causes bones to lose size and strength and become prone to fracture. If osteoporosis is not corrected, even coughing or sneezing can cause a fracture. In the U.S., half of adults age 50 or older have osteoporosis or are well on their way to developing it.

More commonly found in women than men, osteoporosis is a consequence of the loss in bone structure and calcium content that occurs with age and a variety of risk factors. Sadly, most women do not know their bones are fragile until they suffer a fracture, since osteoporosis develops slowly and without symptoms. In women, bone strength and density usually peaks in the early adult years. The rate of bone loss after that depends on several factors, including age, genetics, weight-bearing exercise, hormone balance, nutrition and lifestyle choices.
Behavior:
  • Wear well-fitting shoes, with good traction, that treat your bones (and the rest of you) right. If your shoes are affecting your gait or your balance, it’s time to make a change.
  • If you have weak bones, take measures to prevent falls. Get rid of tripping hazards. Approach stairs mindfully, and use railings and banisters when available. Apply anti-slip treatments to areas around stairs, tubs and shower stalls. Install grab bars in the bathroom. Add nighttime lighting in bedrooms and corridors. Avoid medications that cause dizziness.

Diet:
  • Calculate your typical daily calcium intake, and adjust as needed. Most adults need 1,000 milligrams of calcium per day. Getting calcium from food rather than supplements is preferred. Make calcium-rich foods—such as dairy products; almond or soy milk; and dark, leafy greens (e.g., broccoli, kale and bok choy)—a regular part of your diet. Consider adding a calcium supplement to your daily regime if you have a shortfall in dietary intake.
  • Eat foods fortified with vitamin D (e.g., orange juice, oatmeal, certain cereals, milk and yogurt) or foods naturally rich in vitamin D (e.g., beef liver; egg yolks; and cold-water fish such as tuna, salmon, sardines and mackerel).
  • Have your vitamin D levels checked to determine your current stored vitamin D level. Most women living in the northern part of the U.S. require 2,000 IU (international units) above their dietary intake to achieve optimal vitamin D stores.

Exercise:
  • Regular weight-bearing exercise is necessary to stimulate your bone-building cells to make new bone. Some excellent examples of weight-bearing exercise include walking, hiking, step aerobics, jogging, dancing and strength training.
  • Cultivate balance and strengthen your core with exercises that will not put you at higher risk for falls or fractures, such as yoga and Pilates.

Lifestyle Factors:
  • If you are a smoker, please quit. This is one of the most positive steps you can take to improve your overall health.
  • Avoid excess alcohol. Moderate drinking—which for women consists of one alcoholic drink per day—is considered safe. More than that may elevate your rate of bone density loss.

Bone Testing:
  • Get your bone density tested regularly. Current guidelines recommend bone density tests for women according to their unique risk profile. For most women the best time to screen for bone loss is in the menopausal transition (perimenopause). Declining estrogen levels in menopause have been shown to predict a time of rapid bone loss. It is important to do repeat testing on the same machine to allow for a comparison between past and current tests.
Lifestyle: Getting regular exercise and eating a healthy diet with sufficient amounts of calcium and vitamin D are the foundation of good bone health.

Medication: Medications for osteoporosis fall into two main categories: those that slow bone loss (antiresorptives) and those that promote bone growth (anabolics).
  • Antiresorptives: Including bisphosphonates, which are the most commonly prescribed drugs for osteoporosis.
  • Anabolics: Anabolic agents are an attractive medication option to reverse bone loss and create new bone by stimulating the bone forming cells to lay down new layers of bone.
  • Hormones: Hormones such as estrogen and progesterone can play a role in osteoporosis prevention and treatment.

Physical and Occupational Therapy: Our physical and occupational therapists work with you to minimize your risk of bone injury or reinjury based on your personal needs.

Surgery: In cases of painful spine fractures due to osteoporosis, a procedure called vertebroplasty may be an option. This procedure involves injecting bone cement into the fractured bone to stabilize it and relieve pain.
What causes osteoporosis?
Our bones are constantly recreating themselves through the removal of old bone tissue and the addition of new bone tissue. Our bones add additional mass until we stop growing taller. After this age, our bone mass gradually declines more or less rapidly in response to aging and each person’s unique risk factors.

To some extent, decreasing bone density is the natural result of aging. However, too much bone loss can result in microfractures, major fractures, joint problems, spinal curvature, dental problems, chronic pain and other complications.

Do all women get osteoporosis?
No. While all of us can expect to lose some bone mass as we age, the amount of bone we lose varies greatly and depends on many factors. That said, osteoporosis is extremely common, with as many as 1 in 3 women older than 50 projected to experience an osteoporosis-related fracture.

What are possible complications of osteoporosis?
The most common complication is fractures, with most fractures occurring in the spine, but also in the hip, wrist and upper leg bones. Microfractures can also occur commonly in the spine, resulting in compression and height loss. One lesser-known consequence of osteoporosis is the loss and cracking of teeth and poor healing after dental procedures.

Hip fractures often require surgery and may lead to loss of independence. Vertebral fractures can lead to loss of height; chronic pain; nerve compression; and, sometimes, deformity. As with any surgery, surgeries to address osteoporosis-related fractures carry risks, including putting more force on the remaining spinal bones, immobility, weight gain, muscle weakening, infection, pneumonia, blood clots and even stroke.

My mom had osteoporosis. Am I at higher risk?
A family history of osteoporosis is one risk factor. In combination with other risk factors, it may signal a need for earlier osteoporosis screening, earlier and more regular bone density testing, and more aggressive efforts to build and maintain bone density.

What are the most important risk factors for osteoporosis?
The most common risk factors for osteoporosis include aging, genetics, vitamin D deficiency, poor protein intake, calcium deficiency, inadequate physical activity, excess alcohol or soda intake, smoking, and prolonged exposure to oral steroids.

Other risk factors include being underweight (including during one’s teens and 20s, the time of peak lifetime bone density), history of eating disorders or poor nutrition, absence of regular menstrual cycles, poor absorption of nutrients due to colon conditions (e.g., Celiac disease, Crohn’s disease or ulcerative colitis), cystic fibrosis, metabolic conditions, diabetes, Cushing disease and parathyroid dysfunction.

In addition, a family history of osteoporosis, rheumatoid arthritis, early menopause due to surgery or chemotherapy, or lupus can also increase a woman’s risk of developing osteoporosis.

I’m only in my thirties. Do I need to worry about osteoporosis?
Once you’re in your thirties, you’re likely losing a small amount of bone tissue each year. You probably don’t need to worry, but your future self will thank you for taking steps to boost your bone health now. During perimenopause and for a few years after menopause, most women lose bone quite quickly. In fact, you can lose up to 20% of your bone mass in the first few years after menopause. How troublesome that 20% turns out to be depends, in part, on how much bone mass you had to begin with—which means it’s never too early to start improving your bone health. Early detection means early prevention!

If I’ve already reached menopause, isn’t it too late to do anything about osteoporosis?
Just as it’s never too early to start improving your bone health, it’s also never too late. Adding protein sources, calcium and vitamin D to your diet; increasing your level of physical activity; and obtaining risk assessment to create your own bone health plan may not restore the bone you’ve lost, but it will help sustain and strengthen the bone you have. Medications can add new bone at any time once risk factors have been addressed.

What is osteopenia? Is it different from osteoporosis?
Osteopenia occurs when the bones are thinner than the expected normal bone mass based on a young person’s maximum bone measurement. Having osteopenia doesn’t mean you will definitely get osteoporosis, but it does mean you are already at higher risk for fractures and should start taking actions to boost your bone health.