The body constantly dissolves old bone tissue and replaces it with new bone tissue. However, different factors can disrupt this process and make it difficult for the body to create new bone tissue fast enough to replace the old. The resulting loss of bone mass is called osteoporosis.
Osteoporosis is sometimes referred to as the “silent disease,” because many people don’t realize they have it until a bone breaks.
In early stages, there typically are few or no symptoms. As osteoporosis progresses, signs begin to appear, including back pain, a decrease in height, a loss of posture, and stooping. However, the first indication might be a fracture caused by a minor fall or by basic activity such as bending over, lifting an object or coughing.
Many factors are associated with an increased risk of the disease, including:
Sex, age, race. Women, who tend to have lower bone density than men, are at a higher risk. The risk increases as one ages. White and Asian women face the highest risk.
Family history. Having parents or other relatives with osteoporosis or a hip fracture increases the odds of getting the disease.
Body frame size. Smaller, thinner people have less bone mass to lose, so are more susceptible.
Hormone levels. As estrogen levels drop in women and testosterone drops in men, bone loss can accelerate. Too much thyroid hormone, either from a thyroid problem or thyroid hormone medication, may cause bone loss.
Diet. A diet with low levels of calcium, vitamin D or protein increases risk, as does excessive weight loss.
Steroids and medications. When certain medications are used for long periods of time, it may boost the risk for osteoporosis. These include:
- Hormone treatments
- Antiepileptic medicines
- Cancer medications
- Proton pump inhibitors
- Selective serotonin reuptake inhibitors
Medical conditions. Some conditions increase risk, including: hormonal and endocrine diseases, gastrointestinal diseases, rheumatoid arthritis, some forms of cancer, and HIV/AIDS.
Lifestyle. Low levels of physical activity, excessive alcohol consumption, and tobacco use increase the risk.
Complications from osteoporosis can include: fractures of the hips and spine; increased risk of falling; pneumonia due to difficulty coughing. Research indicates that depression and anxiety may be complications or risk factors.
There is no cure for osteoporosis, but people can take steps to promote bone health and bone density.
- Calcium. This mineral gives bones their hardness and structure, so it’s essential to maintain a healthy level. Dairy products, soy products, kale, broccoli, and canned salmon with bones are good sources. The National Institutes of Health recommends a daily intake of 1,000 mg for men age 51 to 70 and women age 19-50; and 1,200 mg for men over 70 and women over 50. For people who have trouble getting enough calcium through their diet, like people who are lactose intolerant, a doctor may recommend a calcium supplement. Your body absorbs calcium better if you spread the intake throughout the day, so both meals and supplements should be planned accordingly.
- Vitamin D. This vitamin helps the body to absorb calcium. Good sources are oily fish (tuna, whitefish, salmon, trout), fish liver oils, eggs, and vitamin D-fortified milk and other foods. The National Institutes of Health recommends a daily intake of 600 international units (IU) from age 19 to 70; and 800 IU for those over 71. Consult with your doctor on whether you need vitamin D supplements.
- Exercise. Regular weight-bearing exercise, like walking, jogging, dancing, and climbing stairs, stimulates bone formation and builds bone strength. Strength training, such as weight lifting, benefits bone health as it builds muscles. Those exercises, as well as non-weight-bearing exercises like yoga and tai chi, promote good balance and help reduce the risk of falling and fractures.
Several methods are used to look for the low bone mass associated with osteoporosis, including:
- Bone density tests
- CT Scans
- Ultrasound examinations
Because there is no cure, the goal of treatment is to slow down or stop the loss of bone mass and to avoid fractures. Doctors may estimate a patient’s chances of breaking a bone, based on bone density testing and other factors. That is used to help determine the direction of treatment, including whether medications should be used and what type. Common approaches include:
- Lifestyle choices. Health experts recommend that people quit smoking and limit alcohol use. Smoking has been linked to bone mass loss, and nicotine appears to inhibit bone-forming cells. Heavy drinking may reduce bone mass while increasing a person’s chances of falling. In addition to the diet and exercise steps mentioned earlier, health experts recommend maintaining a healthy weight. Being underweight increases the risk of bone loss and fractures.
- Bisphosphonates. This type of medicine is designed to slow down bone loss.
- Denosumab. This medication is taken by injection every six months to improve bone density and prevent fractures.
- Hormone therapy. Estrogen replacement therapy can slow bone density loss in postmenopausal women.
- Bone building medication. If other treatments don’t work, patients may receive drugs such as teriparatide, abaloparatide, and romosozumab to stimulate bone growth.
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