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Osteoporosis is a bone disease in which bones become thinner and more porous (see diagram 1). It is usually a painless disease until a bone breaks or fractures. Fractures are the most common result of osteoporosis. More than 1.5 million osteoporosis-related fractures occur each year in the United States, mostly in older women. These fractures are usually in the spine, hip and wrist.

What causes osteoporosis?

Although not all causes of osteoporosis are known, loss of estrogen, due to menopause, is a known factor for women. Osteoporosis is most common in older women. About 25% of women older than 60 years have osteoporosis. Women who either have had early menopause or their ovaries surgically removed before age 45, without receiving estrogen treatment, also are more likely to develop osteoporosis. Other factors that make you likely to get osteoporosis include small body frame, excessive use of alcohol, smoking cigarettes, and doing excessively strenuous exercise that stops menstrual periods.

Additional factors known to cause or lead to osteoporosis include:

A family history of the disease
Low dietary intake of calcium
The use of some medications such as prednisone or other steroids
Certain hormonal disorders such as hyperthyroidism, hyperparathyroidism and Cushings disease
Other diseases such as chronic liver disease and intestinal disorders
Aging is another factor in the cause of osteoporosis (see diagrams 2a and 2b). Without treatment, men and women lose one to three percent of their bone mass each year after age 50. As life expectancies increase, osteoporosis may become even more prevalent unless preventive measures are taken.

Do men get osteoporosis?

Yes, but much less commonly than women. The cause of osteoporosis in men is often chronic alcoholism. Loss of testosterone (a male hormone similar to estrogen in women) is another cause.

How is osteoporosis diagnosed?

Bone density testing is used to diagnose osteoporosis. X-rays are used to rule out other bone or arthritic conditions. Thin bones may be detected on an X-ray, but bone density testing is more accurate.

A bone density test measures bone mineral content. The greater the bone mineral content, the stronger or more dense the bone is. If you have a low bone density, you may be at risk for fractures in the future. The test also can be used to show rate of bone mineral loss in those not receiving treatment, and rate of bone gain in those being treated.

The most common bone density test (also considered to be the most accurate) is a DEXA (dual energy X-ray absortiometry) test. This painless test is similar to having an X-ray. A miniature X-ray of the spine or hip is done along with measuring bone mineral content. A person may have osteoporosis if the amount of bone mineral content is below normal.

People who are at risk of osteoporosis, as well as those who have thin bones or evidence of spinal fractures, should be tested for osteoporosis.

Some Risk Factors for Osteoporosis

Early menopause (before age 45)
Caucasian race or Asian ethnicity
Small body frame
Family history of osteoporosis
Certain medications (prednisone, for example)
Certain conditions (malabsorption, for example)
Your healthcare provider may recommend that you be tested for osteoporosis, but if not, and you feel you are at risk, ask that you be tested. Some insurance plans may cover the cost of bone density testing. Ask your healthcare provider or medical center about this.

Does back pain mean I have osteoporosis?

No, having back pain does not mean you have osteoporosis. The most common cause of back pain is muscle strain and other conditions such as arthritis.

What can I do to prevent osteoporosis?

You can do several things to maintain strong bones and prevent osteoporosis.

Exercise — Doing weight-bearing exercise daily helps reduce bone mineral loss, as well as maintains good muscle tone and heart function. Walking or jogging one to two miles a day are ideal; playing tennis and cross country skiing are also good. Swimming, although excellent exercise, is not weight-bearing, so its benefit for bones is minimal. Ask your healthcare provider if you may begin an exercise program.
Nutrition — The mineral calcium, along with vitamin D, is needed for healthy bones. Taking the recommended amounts of calcium and vitamin D is important for people of all ages as peak bone mass is reached during the late 20′s and into the 30′s. Most adults need 1,000 to 1500 mg of calcium and at least 400 units of vitamin D each day. This is found in four to five 8-ounce glasses of milk (vitamin D fortified). The main source of vitamin D is sunlight, but it is also found in some foods or in vitamin supplements. See below for more information about calcium.

Eating a balanced diet of nutritious food is important in maintaining an appropriate weight, which is another way to help prevent osteoporosis.

Tobacco and alcohol — Tobacco and alcohol use also increases your risk of developing osteoporosis. Do not use any type of tobacco and limit alcohol intake to no more than two drinks a day.

Physical examinations — See your healthcare provider for general physical examinations regularly, especially after age 50. Talk with him or her about your risk for osteoporosis and the need for bone density testing.

Is there a way to treat osteoporosis with medication?

Although there is no cure for osteoporosis, there are several medications that slow, and sometimes stop, bone mineral loss. These drugs are called antiresorptive drugs.

Estrogen — Estrogen treatment is considered to be the most effective way to regain lost bone mineral and prevent fractures. Women who are past menopause, no matter what their age, may be candidates for estrogen treatment.
Use of estrogen strengthens the spine and reduces the number of fractures in the spine and the rest of the skeleton. In addition to preventing fractures, taking estrogen reduces the risk of developing heart disease, as well as having a stroke.

Women who are thinking of starting estrogen treatment should be aware of associated side effects such as uterine bleeding and breast soreness. (However, treatments are available to reduce these side effects.) There is also a slightly increased risk of developing breast cancer. Discuss the risks and benefits of using estrogen with your healthcare provider.

Because estrogen stimulates the uterus, menstrual periods may resume during treatment. However, if you have gone through menopause, estrogen does not cause the ovaries to release eggs so you cannot become pregnant.

There are different forms of estrogen, such as a patch and tablet. All forms, in the proper dose, have equivalent effects on bones. Since estrogen helps bones only when you take it, you may need to take estrogen for many years to receive full benefit. If you have not had your uterus removed, progestin is usually prescribed along with estrogen to prevent any increased risk of uterine cancer. Discuss with your healthcare provider which form of estrogen would be best for you and the length of your treatment.

Bisphosphonates — Bisphosphonates are another treatment for osteoporosis. Alendronate (FosamaxTM) is currently the only approved bisphosphonate. These drugs provide an increase of bone mineral density and reduce bone loss similar to estrogen. Bisphosphonates are not hormones and do not prevent hot flashes, heart attacks, or strokes.

Daily use of bisphosphonates for three years strengthens the spine and hip bones and reduces the chance of having a spinal fracture. Bisphosphonates have few side effects (nausea, abdominal pain). Although bisphosphonates do not reduce the risk of heart disease as estrogen does, they do not increase the risk of breast or uterine cancer.

Bisphosphonates may help those with steroid-induced osteoporosis, as well as men and young people who have osteoporosis. However, research is ongoing.

Calcitonin — Calcitonin is a hormone that helps to prevent bone loss. It is given either by injection or nasal inhalation. Calcitonin does not strengthen the hip and has not been shown to prevent fractures. Side effects include nausea and skin rash. It also is more expensive than other treatments. Calcitonin is prescribed in special circumstances when estrogen or bisphosphonate treatment is not advisable.