Osteoporosis is a disease marked by reduced bone strength due to bone mass and bone quality. It is often called a “silent disease” because it usually progresses without any symptoms until a bone fracture occurs or one or more vertebrae collapses.
Osteoporosis is the major underlying cause of fractures in postmenopausal women and the elderly. Fractures occur most often in bones of the hip, spine, and wrist, but any bone can be affected. Some fractures can be permanently disabling, especially when they occur in the hip. Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of minor bumps, falls, or normal stresses and strains such as bending, lifting, or even coughing.
Collapsed vertebrae may first be felt or seen when a person develops severe back pain, loss of height, or spine malformations such as a stooped or hunched posture.
In the United States today, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass. Osteoporosis can occur at any age, although the risk for developing the disease increases as you get older. In general, osteoporosis is more common in women, and they often develop it at a younger age.
Many people think that osteoporosis is a natural and unavoidable part of aging. However, medical experts now believe that osteoporosis is largely preventable. People who already have osteoporosis can take steps to prevent or slow further progress of the disease and reduce their risk of future fractures. Although osteoporosis was once viewed mainly as a disease of old age, it is now recognized as a disease that can stem from less than optimal bone growth during childhood and adolescence, as well as from bone loss later in life.
In addition to a healthy diet, a healthy lifestyle is important for optimizing bone health. You should avoid smoking and, if you drink alcohol, do so in moderation (no more than one drink per day is a good general guideline). It is also important to recognize that some prescription medications can cause bone loss or increase your risk of falling and breaking a bone. Talk to your doctor if you have concerns about any medications you are taking.
What are some of the causes of osteoporosis?
A major contributor to bone loss in women during later life is the reduction in estrogen production that occurs with menopause. Estrogen is a sex hormone that plays a critical role in building and maintaining bone. Decreased estrogen, whether due to natural menopause, surgical removal of the ovaries, or chemotherapy or radiation treatments for cancer, can lead to bone loss and eventually osteoporosis. After menopause, the rate of bone loss speeds up as the amount of estrogen produced by a woman’s ovaries drops dramatically. Bone loss is most rapid in the first few years after menopause but continues into the postmenopausal years.
In men, sex hormone levels also decline after middle age, but the decline is more gradual. These declines probably also contribute to bone loss in men after around age 50.
Osteoporosis can also result from bone loss that may accompany a wide range of disease conditions, eating disorders, and certain medications and medical treatments. For instance, osteoporosis may be caused by long-term use of some antiseizure medications (anticonvulsants) and glucocorticoid medications such as prednisone and cortisone. Glucocorticoids are anti-inflammatory drugs used to treat many diseases, including rheumatoid arthritis, lupus, asthma, and Crohn’s disease. Other causes of osteoporosis include alcoholism, anorexia nervosa, abnormally low levels of sex hormones, hyperthyroidism, kidney disease, and certain gastrointestinal disorders. Sometimes osteoporosis results from a combination of causes.
When should you talk to your doctor about osteoporosis?
- You are a man or woman over age 50 or a postmenopausal woman and you break a bone.
- You are a woman age 65 or older.
- You are a woman younger than age 65 and at high risk for fractures.
- You are a man age 65 or older and at high risk for fractures.
- You have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause.
- You have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss.
- You have a chronic illness or are taking a medication that is known to cause bone loss.
- You have anorexia nervosa or a history of this eating disorder.
- You are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty.
- What are some types of medications for the treatment of osteoporosis?
Bisphosphonates are approved for the prevention or treatment of osteoporosis. These medications reduce the activity of cells that cause bone loss.
Parathyroid hormone: A form of human parathyroid hormone (PTH) is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Use of the drug for more than 2 years is not recommended.
RANK ligand (RANKL) inhibitor is approved for postmenopausal women with osteoporosis and men who are at high risk for fracture.
Estrogen agonists/antagonists (also called a selective estrogen receptor modulator or SERM) is approved for the prevention and treatment of osteoporosis in postmenopausal women. SERMs are not estrogens, but they have estrogen-like effects on some tissues and estrogen-blocking effects on other tissues.
Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. Calcitonin is a hormone involved in calcium regulation and bone metabolism.
Estrogen and hormone therapy are approved for the prevention of postmenopausal osteoporosis as well as the treatment of moderate to severe hot flashes and vaginal dryness that may accompany menopause. Estrogen without an added progestin is recommended only for women who have had a hysterectomy because estrogen increases the risk of developing cancer of the uterine lining and progestin reduces that risk.
The Food and Drug Administration has recommended that women use hormone therapy at the lowest dose and for the shortest time, and carefully consider and discuss with their doctor other approved osteoporosis treatments.