USF-COM Department of Family Medicine

Patient Education Information on... Index of Patient Education Topics

What is Osteoporosis?

Osteoporosis:   A debilitating disease that can be prevented and treated. It is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist. Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.

Incidence:  As many as 25% of women older than 65 have osteoporosis.

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What Causes Osteoporosis?

The cause of osteoporosis is not known. However, many factors are known to contribute to the development of this condition. Certain people are more likely to develop osteoporosis than others. Factors that increase your likelihood of developing osteoporosis are called "risk factors." If you have several risk factors, that does not mean you will definitely develop osteoporosis or get a fracture, but rather your chances of this happening are increased. On the other hand, some individuals who do not appear to be at risk might end up with a fracture caused by osteoporosis. Several risk factors have been identified.

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Risk Factors

SEX Women are four times more likely than men
AGE The longer you live, the greater the chance of osteoporosis because after peak bone mass is reached at age 30, we lose roughly 10% of our bone mass per decade.
THIN SMALL FRAMED BODY Petite women are at greater risk because they have less bone to lose than larger, big boned women.
EARLY MENOPAUSE Estrogens protect against bone loss. Around menopause the amount of estrogen produced sharply declines.
LACK OF CALCIUM Inadequate amounts of Calcium in diet lead to osteoporosis. Calcium is needed to build strong bones during childhood and early adulthood and to prevent losses there after.
LACK OF PHYSICAL ACTIVITY Individuals who are inactive, immobilized, or bedridden for a long time are at a higher risk for osteoporosis. Weight bearing exercises such as walking, running, tennis, and other exercises that cause muscles to work against the force of gravity play an important role in preventing bone loss.
HEREDITY Susceptibility to fracture may be, in part, hereditary. Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass.
CIGARETTE SMOKING Some studies indicate that women who smoke have lower levels of serum estrogen in their body compared with nonsmokers, and smoking is believed to bring about menopause earlier than usual.
CERTAIN MEDICATIONS When taken for a long time, high doses of glucocorticoids, a group of antiinflammatory medications used to treat a variety of conditions (such as asthma, arthritis, and certain cancers), can lead to a loss of bone tissue. High doses of antiseizure drugs taken for a long time can result in less calcium being available to the bones. Individuals receiving thyroid hormone must be monitored by their doctor because if these hormone levels are elevated, bone loss can result.
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How Can I Tell the Health of My Bones?

To determine if you have osteoporosis or may be at risk for the disease, your doctor will ask you a variety of questions about your lifestyle and medical history. Based on a comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. A bone mass measurement is the only way to tell if you have osteoporosis. Specialized tests called bone density tests can measure bone density in various sites of the body. A bone density test can:
  1. Detect osteoporosis before a fracture occurs.
  2. Predict your chances of fracturing in the future.
  3. Determine your rate of bone loss and/or monitor the effects of treatment if the test is conducted at intervals of  a year or more.
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How Can I Prevent/Treat Osteoporosis?

Although there is no cure for osteoporosis, there are steps you can take to slow its progress. Think of your bones as a savings account. There is only as much bone mass in your account as you deposit. The critical years for building bone mass are from prior to adolescence to about age 30. Some experts believe that young women can increase their bone mass by as much as 20 percent - a critical factor in protecting against osteoporosis.

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MEDICINES:
Estrogen
Alendronate
Calcitonin

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 Both estrogen and alendronate (Fosamax) are approved by the Food and Drug Administration (FDA) for the prevention of osteoporosis. 

Experts recommend  estrogen replacement therapy (ERT) for women at high risk for osteoporosis, especially if their ovaries were removed before age 50.  ERT should also be considered by women who have experienced natural menopause and have multiple osteoporosis risk factors. 

In clinical trials, alendronate slowed or stopped bone loss, increased bone density, and reduced fracture risk. 

For both men and women already suffering from osteoporosis, doctors will often prescribe calcitonin.  It is also a treatment for women who cannot or choose not to take estrogen.  In women who are at least 5 years beyond menopause, calcitonin slows bone loss, increases spinal bone density, and, according to anecdotal reports, relieves the pain associated with bone fractures.  Calcitonin may reduce the risk of spinal and hip fractures as well, but studies on fracture reduction are on-going

CALCIUM
 

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 Making sure you get an adequate amount of calcium may help in protecting you against osteoporosis. Experts recommend 1,000 mg of calcium a day for women on estrogen replacement therapy and 1,500 mg of calcium daily for women not receiving estrogen therapy

As a guide, each of the following contain an estimated 300 mg of calcium

  • 8-ounce glass of whole or skim milk
  • 1 1/2 ounces of cheddar cheese
  • 2 cups of cottage cheese
  • 1 cup of yogurt
As you increase your calcium intake, try to eat foods that are low in fat  Keep track of your daily calcium intake and discuss this record with your doctor.

EXERCISE
 
 

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 Exercise can be helpful in building and maintaining strong bones. The benefits of exercise last only as long as you maintain the program.

If you have osteoporosis, you might be wondering if you should exercise at all. While exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones.  Care should be taken when lifting heavy objects, such as bags of groceries, young children, etc.  If you have osteoporosis, it's important to minimize your chances of breaking a bone.  Take steps to prevent falls. 

As extra insurance against fractures, you should speak with your doctor to learn what type of exercises you can do safely not only to preserve bone, but also to strengthen your back and hips and maintain flexibility. Keep in mind, however, that exercise alone cannot prevent or cure osteoporosis.

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Are there any side effects to these medicines?

There are risks as well as benefits associated with estrogen use, including increased risk of uterine and breast cancer.  The risk of cancer of the uterus can be offset by the addition of another hormone, progesterone, to the estrogen therapy.  With long-term use of estrogen (more than 10 years), there may be an increased risk of developing breast cancer. Side effects with alendronate are uncommon but may include irritation of the esophagus, abdominal or muscle/bone pain, nausea, and heartburn.  Calcitonin may cause side effects. As with all drugs, the decision to use estrogen, alendronate or calcitonin should be made after discussing the benefits and risks and your own situation with your physician.

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