Osteoporosis

Our bones may seem rock-solid, but the tissue is constantly being created and destroyed. As we age, the process can skew toward bone destruction, leading to porous, weak bones that break easily. The good news is that there are many ways to prevent osteoporosis.
Updated June 10, 2020

Our bones may seem rock-solid, but the tissue is constantly being created and destroyed. As we age, the process can skew toward bone destruction, leading to porous, weak bones that break easily. The good news is that there are many ways to prevent osteoporosis.

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What Is It

Under a microscope, healthy bone looks a lot like honeycomb, but if you have osteoporosis, your bones can't hold onto enough calcium and minerals. This makes the natural holes and spaces in your bone structure noticeably larger, decreasing their strength and stability, and raising your risk of fractures. In extreme cases of osteoporosis, even a sneeze or slight bump against the wall can lead to a broken bone.

In the U.S., about 8 million women and 2 million men live with osteoporosis. The vast majority are older adults, but you can be young and have this condition, too. Spine, hip, and wrist fractures are the most common complication, but other bones can break as well. Besides being painful, osteoporosis can lead to problems with mobility, affecting your quality of life.

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Types

There are three different types of osteoporosis.

The vast majority of people have what's called primary osteoporosis — bone loss that occurs as a natural part of aging. A lack of estrogen — in both women and men — is often to blame. When you're low on estrogen, your bone cells break down more rapidly than they should. This can happen even faster if you're low on vitamin D and calcium, which are both vital for bone health. Secondary osteoporosis, in which a medical condition or medication reduces your bone density, is less common. Among the health issues that can cause bone loss are:

Many prescription drugs can cause secondary osteoporosis, too. Idiopathic osteoporosis is the rarest form of this disorder. It can affect premenopausal women, men under the age of 50, adolescents, and children, and doesn't have a known cause.

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Symptoms

Osteoporosis is often called a "silent" disease, since you can't feel your bone structure changing or getting weaker. In the early stages, most people aren't aware of any symptoms. It's only later that you could notice:

  • Sudden back pain.
  • A feeling that you've gotten shorter.
  • Change in posture.
  • A hunched upper back.
  • Your bones break more easily than they used to, and take longer to heal.

It's not uncommon for a fractured hip or wrist to be the first indicator that you have osteoporosis. You could also start to have "fragility fractures" — fractures that come from a minor injury that normally wouldn't break a bone. These are most likely to happen in your upper arm, pelvis, thigh bone, and spine, and once you have an osteoporosis-related fracture, you're likely to have more.

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Causes

Many different factors can raise your risk for osteoporosis, including:

  • A family history of osteoporosis.
  • Being white or Asian.
  • Poor general health.
  • Not getting regular exercise.
  • A sedentary lifestyle.
  • Low body weight.
  • A diet that's low in calcium and vitamin D.
  • Falling
  • Long-term alcohol use (more than 2 drinks per day).
  • Tobacco use.
  • Excessive caffeine use.
  • Gastrointestinal surgery (which can reduce vitamin absorption).
  • Certain medications (including aluminum-containing antacids, corticosteroids, immunosuppressants, antiseizure medications, progesterone, and some chemotherapy drugs).

Other risk factors for women include going through early menopause (before age 45). Low testosterone can be a risk factor for men.

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Diagnosis

A bone density test measures the amount of bone you have throughout your skeleton. (The lower your bone density, the weaker your bones and the higher the likelihood that they'll fracture or break.)

Your bone density can be measured with:

A screening test: This type of test measures bone density at your heel, wrist, finger, or upper arm and predicts your overall bone strength and risk for fractures. It can't diagnose osteoporosis, but can alert you if a more thorough test needs to be done.

DXA (Dual x-ray absorptiometry): Most people have their bone density measured with a DXA machine, which uses low-energy X-rays to quickly scan your bones.

Sometimes, other tests are done to look for fractures. These include traditional X-rays of your upper and lower spine, and special CT scans which can provide cross-sections of some of your vertebrae.

Your doctor may also order blood tests to check your vitamin D, calcium, and hormone levels.

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Treatment

Plenty of prescription medications can help slow down the progression of osteoporosis. For instance:

Bisphosphonates slow the speed at which your body breaks down old bone cells.

Calcitonin is a hormone that helps your body use calcium more efficiently. It can be given via injection or as a nose spray.

Estrogen therapy is sometimes used to prevent osteoporosis, but could raise your risk of other health issues like blood clots, breast cancer, and stroke. Its use is only approved for post-menopausal women.

Estrogen agonists/antagonists were created to offer the benefits of estrogen therapy but without as many side effects. Like hormone therapy, these drugs are only available to women.

Biologic drugs increase bone density by blocking a protein that helps decompose bone cells.

Anabolic agents reduce your risk of fractures by increasing bone growth and density.

Some over-the-counter supplements, including soy and vitamin K-2 claim to help treat osteoporosis, but more studies need to be done.

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Prevention 

It's much easier to prevent bone loss from osteoporosis than it is to try to restore it. Some easy things you can do include:

Add weight-bearing exercises to your routine. Weight-bearing exercises are particularly good for your bones since they push you to work against gravity. Try brisk walking, hiking, jogging, stair-climbing, dancing, or tennis.

Resistance-train. Work out with an opposing force like weights, an elastic exercise band, or water, and you encourage your bones to get stronger. Try swimming, biking, or lifting weights.

Cut out smoking. If you need help quitting, ask your doctor for suggestions.

Get enough calcium. If you're under the age of 50, you need 1,000 mg each day. Women over the age of 50 and men over the age of 70 need 1,200 mg. Calcium-rich foods include dairy products; dark, leafy greens like spinach and kale; soy; and fortified products like cereal and orange juice. If you're not getting enough calcium from food, talk to your doctor about a supplement.

Don't overlook vitamin D. Aim for 800-1,000 international units (IUs) each day. (If a blood test shows that you're deficient, your doctor may suggest that you take more.) sources of vitamin D include fortified foods and fatty fish, like salmon.

Get to a healthy weight. A thin build raises your risk of osteoporosis, but carrying extra weight isn't a better option. It could make some bone fractures more likely, too.

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