What is osteoporosis?
Your body regularly replaces the components of your bones. When those components are lost too rapidly or not replenished quickly enough (or both), osteoporosis occurs.Osteoporosis affects more than 10 million Americans. While women are at higher risk for the disease, men can develop it, too. Studies suggest that among those 50 and older:
- Up to 1 in 2 women will break a bone due to osteoporosis — equal to the risk of breast, ovarian and uterine cancer combined.
- Up to 1 in 4 men will break a bone due to osteoporosis — a risk greater than prostate cancer.
Fortunately, osteoporosis is preventable. When it does occur, your doctor can diagnose and treat it before it causes a broken bone. Even after a fracture, further problems are avoidable with the right steps.
What are the symptoms of osteoporosis?
Osteoporosis is often called the silent disease because it may not cause symptoms. Some patients experience:
- Bone and muscle pain, particularly in the back if a fracture has occurred
- Broken bones (mainly hips, spine or wrists), even from minor falls or bumps
- Collapsed vertebrae — leading to severe pain, a decrease in height or a spine deformity
Such symptoms can also come from other bone disorders or medical problems. Always consult your doctor for a diagnosis.
What are the risk factors for osteoporosis?
While the exact cause of osteoporosis remains unknown, several factors appear to increase the risk of developing the disease:
Age: Risk increases after 50
Gender: Women are 4 times more likely to develop osteoporosis
Race: The disease can affect anyone, but white and Asian women are most at risk.
Menopause: Estrogen deficiency causes bone loss
- Family history of bone disease
- Low body weight, or being small and thin
- Not getting enough calcium or vitamin D
- Not eating enough fruits and vegetables for other nutrients (magnesium, potassium, vitamins C and K)
- Not getting enough protein
- Consuming too much alcohol, sodium or caffeine
- Having an inactive lifestyle
Certain medications (prednisone, e.g.) and diseases can also cause bone loss and increase the risk of osteoporosis.
How is osteoporosis prevented?
If you’re a woman who has gone through menopause or a man older than age 50, your doctor should follow National Osteoporosis Foundation guidelines and:
- Talk to you about your risk of osteoporosis and related fractures
- Recommend a diet rich in fruits and vegetables that includes adequate vitamin D and calcium, with supplements prescribed as necessary
- Recommend regular weight-bearing and muscle-strengthening exercises
- Assess fall risk and offer appropriate preventions
- Ask whether you smoke and how much alcohol you drink
- Measure your height each year
A bone density test (also called bone densitometry or DXA) involves a special X-ray machine and is the only way for doctors to determine whether you have osteoporosis. Such scans are recommended for:
- Certain postmenopausal women, depending on risk factors
- Certain men ages 50-69, depending on risk factors
- Certain patients who have fractured a bone, depending on their background
Bone density tests can also identify patients with osteopenia — decreased bone mass that has not yet reached the level of osteoporosis. Ask your doctor if you should get tested.
Other tools and tests include:
FRAX score: combines your bone density test with other factors to estimate your risk of a fracture within the next 10 years
- Personal and family medical history
- Additional scans with other machines
Early treatment of osteoporosis and osteopenia can ease pain, limit or halt bone loss, and prevent fractures. Appropriate treatment can also help fracture patients avoid another injury.Our doctors recommend treatments based on:
- Your age, overall health and medical history
- Extent of the disease and how it’s likely to progress
- Your tolerance for specific medications, procedures or therapies
- Your opinion or preference
Many osteoporosis treatment tools are similar to prevention methods, such as recommending changes to diet and lifestyle.
The FDA has also approved a number of injections, IV infusions, tablets, nasal sprays and patches — all shown to reduce fractures in randomized studies. Make sure to discuss possible side effects with your doctor.
Side effects: Possible calcium increases in the blood and urine and reactions at the injection site like itching and redness.
Drug: Teriparatide (a form of parathyroid hormone)
Use: Treats postmenopausal women and men who are at high risk for fractures
Form: Daily injection administered by the patient at home
Side effects: Risks vs. benefits should be discussed with a doctor. Typically used for a short period of time earlier in menopause, due to long-term risks of breast cancer and blood clots.
Drugs: Estrogen Therapy (ET) and Hormone Therapy (HT)
Use: Increases bone density in the spine and hip and decreases fractures at both sites. Typically used for prevention in postmenopausal women.
Form: Commonly available as tablets or skin patches
Side effects:Oral bisphosphonates can cause upper stomach issues like heartburn. Patients can get flu-like symptoms after the first dose of intravenous bisphosphonates. With all bisphosphonates, there are rare side effects: Difficulty healing after dental work like a root canal or implant that involves the jaw bone (approximately 1 in 50,000 patients), and stress fractures after long term, continuous use (approximately 1 in 75,000 patients). Most doctors will prescribe these medications for 5-8 years, then consider taking their patients off the treatment for a year before reevaluating.
Drug: Alendronate Sodium
Use: Prevents and treats osteoporosis in postmenopausal women and treats the disease in men, while reducing the risk of spine, hip and other broken bones
Form: Weekly pill
Drug: Risedronate Sodium
Use: Prevents and treats osteoporosis in postmenopausal women and treats the disease in men, while reducing the risk of spine and hip fractures
Form: Weekly or monthly pill
Drug: Ibandronate Sodium
Use: Prevents and treats osteoporosis in postmenopausal women and reduces the risk for spine fractures
Form: Monthly pill or IV infusion every 3 months
Drug: Zoledronic Acid
Use: Prevents and treats osteoporosis in postmenopausal women, treats the disease in men, and prevents additional broken bones for fracture patients with low bone density. It reduces the risk of fractures of the hips, spine and other areas like the wrists and arms.
Form: Annual IV infusion
Selective Estrogen Receptor Modulators
Side effects: Possible hot flashes and a small increased risk of blood clots
Use: Prevents and treats osteoporosis in postmenopausal women while reducing the risk of spinal fractures
Form: Daily pill
Side effects: Approximately 6 percent of patients will have some mild nose irritation. The FDA reviewed the medication in 2013 because there may be a 1 percent increase in skin cancers. The agency determined it should remain available, but you should discuss the risks and benefits with your doctor.
Use: Treats osteoporosis in women who are at least 5 years past menopause and reduces the risk of spine fractures.
Form: Nasal spray or injection
Side effects: Possible skin changes like rashes and eczema and a small increased risk of infection
Use: It reduces the risk of broken bones in the spine, hips and other areas for high-risk men and postmenopausal women with osteoporosis. It also prevents bone loss during some breast and prostate cancer treatments.
Form: Injected by a doctor every six months