OSTEOPOROSIS

-OSTEOPOROSIS-

What Is Osteoporosis?

A Bone Disease

Osteoporosis is a disease that thins and weakens the bones to the point that they become fragile and break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but any bone can be affected. You can't "catch" osteoporosis or give it to someone else.

In the United States, more than 40 million people either already have osteoporosis or are at high risk due to low bone mass, placing them at risk for more serious bone loss and fractures. Although osteoporosis can strike at any age, it is most common among older people, especially older women.

How Bone Loss Occurs

Bone is living tissue. Throughout our lives, the body breaks down old bone and replaces it with new bone. But as people age, more bone is broken down than is replaced.

The inside of a bone normally looks like a honeycomb, but when a person has osteoporosis, the spaces inside this honeycomb become larger, reflecting the loss of bone density and strength. The outside of long bones -- called the cortex -- also thins, further weakening the bone. In fact, the word "osteoporosis" means "porous bone."

Sometime around the age of 30, bone mass stops increasing, and the goal for bone health is to keep as much bone as possible for as long as you can. In most women, the rate of bone loss increases for several years after menopause, then slows down again, but continues. In men, the bone loss occurs more slowly. But by age 65 or 70, most men and women are losing bone at the same rate.

Osteoporosis is often called "silent" because bone loss occurs without symptoms. People may not know that they have osteoporosis until a sudden strain, bump, or fall causes a bone to break. This can result in a trip to the hospital, surgery, and possibly a long-term disabling condition.

Prevention and Treatment

The good news is that osteoporosis can often be prevented and treated. Healthy lifestyle choices such as proper diet, exercise, and treatment medications can help prevent further bone loss and reduce the risk of fractures.

Risk Factors

Risk Factors You Can't Change

Some risk factors for osteoporosis cannot be changed. These include

Gender. Women are at higher risk for osteoporosis than men. They have smaller bones and lose bone more rapidly than men do because of hormone changes that occur after menopause. Therefore, if you are a woman, you are at higher risk for osteoporosis.
Age. Because bones become thinner with age, the older you are, the greater your risk of osteoporosis.
Ethnicity. Caucasian and Asian women are at the highest risk for osteoporosis. This is mainly due to differences in bone mass and density compared with other ethnic groups. African-American and Hispanic women are also at risk, but less so.
Family History. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too.
History of Previous Fracture. People who have had a fracture after the age of 50 are at high risk of having another.

Risk Factors You Can Change

Other risk factors for osteoporosis can be changed. These include

Poor diet. Getting too little calcium over your lifetime can increase your risk for osteoporosis. Not getting enough vitamin D -- either from your diet, supplements, or sunlight -- can also increase your risk for osteoporosis. Vitamin D is important because it helps the body absorb calcium. An overall diet adequate in protein and other vitamins and minerals is also essential for bone health.
Physical inactivity. Not exercising and being inactive or staying in bed for long periods can increase your risk of developing osteoporosis. Like muscles, bones become stronger with exercise.
Smoking. Smokers may absorb less calcium from their diets. In addition, women who smoke have lower levels of estrogen in their bodies.
Medications. Some commonly used medicines can cause loss of bone mass. These include a type of steroid called glucocorticoids, which are used to control diseases such as arthritis and asthma; some antiseizure drugs; some medicines that treat endometriosis; and some cancer drugs. Using too much thyroid hormone for an underactive thyroid can also be a problem. Talk to your doctor about the medications you are taking and what you can do to protect your bones.
Low body weight. Women who are thin -- and small-boned -- are at greater risk for osteoporosis.

Symptoms

Fractures -- A Possible Warning Sign

Osteoporosis does not have any symptoms until a fracture occurs. Women and men with osteoporosis most often break bones in the hip, spine, and wrist. But any fracture in an older person could be a warning sign that the bone is weaker than optimal.

Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spine fractures due to osteoporosis. Multiple spine fractures can cause a curved spine, stooped posture, back pain, and back fatigue.

Women and men who have had a fracture are at high risk of experiencing another one. A fracture over the age of 50 or several fractures before that age may be a warning sign that a person has already developed osteoporosis. People over the age of 50 who have experienced a fracture should talk to their doctor about getting evaluated for osteoporosis.

Treatment

Who Treats Osteoporosis?

Although there is no cure for osteoporosis, it can be treated. If your doctor does not specialize in osteoporosis, he or she can refer you to a specialist. There is not one type of doctor who cares for people with osteoporosis.

Many family doctors have been learning about osteoporosis and can treat people who have it. Endocrinologists, rheumatologists, geriatricians, and internists are just a few of the specialists who can provide care to people with osteoporosis.

The Goal of Treatment

The goal of treatment is to prevent fractures. A balanced diet rich in calcium, adequate vitamin D, a regular exercise program, and fall prevention are all important for maintaining bone health.

Several medications are approved by the Food and Drug Administration for the treatment of osteoporosis. Since all medications have side effects, it is important to talk to your doctor about which medication is right for you.

Bisphosphonates

Alendronate, risedronate, ibandronate, and zoledronic acid are from a class of drugs called bisphosphonates that slow bone loss, reduce fracture risk, and in some cases increase bone density. These drugs decrease the activity of bone-dissolving cells.

Alendronate is an oral medication in pill or liquid form and is available in daily and weekly doses. It is approved for use in postmenopausal women and men .
Risedronate is available in pill form in daily, weekly, twice monthly, and monthly doses. It is approved for use in postmenopausal women and men.
Ibandronate is available in a pill as a monthly dose or as an intravenous injection given once every 3 months for treating postmenopausal women.
Zoledronic acid is available as an intravenous injection given once a year, and once every two years. It is approved for use in postmenopausal women and men.