A Patient's Guide to Osteoporosis
When people age - particularly women -- there often comes a loss of height
and weight, and the development of stooped posture. A bone-thinning disease
called osteoporosis often causes these body changes. This disease is characterized
by loss of bone mass and structural deterioration of bone tissue, which leads
to bone fragility and increased susceptibility to fractures of the spine, hip,
and wrist. In fact, spinal fractures are the most common type of osteoporotic
fractures that exist. Forty percent of all women will have at least one by the
time they are 80 years old. These vertebral fractures can permanently alter
the shape and strength of the spine.
Loss of bone mass begins at around age 30. Although men can be affected by
osteoporosis, the typical sufferers are older women, particularly those who
are past menopause. Bone loss becomes worse in women after menopause because
of the body's lack of estrogen.
When bones lose mass they tend to weaken and become fragile, increasing the
risk of fracture under stress or because of a fall - particularly in the spine
and hip. However, falls in elderly women are often the result, rather than the
cause, of fractures. In severe cases of osteoporosis, the bones can fracture
with any kind of slight movement and patients are sometimes left bedridden.
Most women are likely to feel some effects of osteoporosis in their lifetime,
but the good news is that much can be done to reduce and even prevent loss of
bone mass and fractures. In fact, new treatments for this disease are being
discovered each year, and you can actively work to decrease your chances of
suffering the effects of osteoporosis. The key is prevention and intervention.
This website will offer you valuable information about the following:
- Causes of Osteoporosis
- Risk Factors for Osteoporosis
- Treatment Options and Prevention
Causes of Osteoporosis
Several causes and types of osteoporosis will be explained in this section.
The first is primary osteoporosis, which has two types - (I) and (II). Type
I is an excessive loss of the spongy tissue of the bone (cancellous bone), with
some sparing of outer bone. This type of osteoporosis is six times more common
in women than men, and the onset usually occurs in the 15-20 years following
menopause. The loss of bone is thought to be linked to an estrogen deficiency
in women and a testosterone deficiency in men - both of which are due to aging.
In this type of osteoporosis, vertebral spine fractures are the most common
Type II refers to a simultaneous loss of both the outer bone and the spongy
tissue inside the bone. This type is only two times more common in women than
men. It typically occurs once people reach their 70s and 80s. It is also thought
to be the result of a deficiency in dietary calcium, age-related Vitamin D decline,
or increased activity of the parathyroid glands (secondary hyperparathyroidism).
Hip fractures are the most common result of this type of osteoporosis.
Secondary osteoporosis, also known as "high-turnover osteoporosis", is a condition
of an increased rate of bone remodeling - or an increase in the amount of bone
being remodeled. This condition causes an overall increase in the rate of bone
loss. Bone turnover is caused by two functions: (1) the production of new bone,
and (2) the loss (resorption) of old bone. The amount of bone mass you have
depends on the balance between these functions, which is your bone turnover
rate. If you have a high turnover rate, you are at greater risk for developing
Secondary osteoporosis can also have four hormonal causes:
- Hyperparathyroidism - increased activity of the parathyroid glands
- Hyperthyroidism - an excessive secretion of the thyroid glands
- Diabetes - a disease where the body does not produce or use insulin correctly
(This leads to: hyperglycemia - an increase in blood sugar, increasing susceptibility
to infection, and glycosuria - glucose in the urine.)
- Hypercortisolism - a result of systemic illness or long-term use of oral
Osteoporosis can also be the result of disorders where the bone marrow cavity
expands at the expense of the trabecular bone. The trabecular bones have a honeycomb
appearance and large marrow spaces. They are called cancellous or spongious
bone, and are found along lines of stress created by weight-bearing forces.
If a trabecular bone is affected by increased bone marrow cavities, it loses
some of its strength.
Other links to secondary osteoporosis are:
- Thalassemia - a hereditary form of anemia
- Multiple myeloma - multiple tumors within the bone and bone marrow
- Leukemia - a serious disease that is characterized by unrestrained growth
of white blood cells in the tissues
- Metastatic bone diseases - when malignant tumor cells spread from one part
of the body to another; the disease travels through the blood and settles
in the bones
Risk Factors for Osteoporosis
Osteoporosis does not affect everyone. There are risk factors that help predict
your chances of developing it. Some risk factors are simply genetic, meaning
you inherited them from your biological parents. Some risks are due to medical
factors that you may not be able to avoid, such as use of particular medications.
Other factors are lifestyle-related, meaning you have control over reducing
these risk factors.
The highest biological and medical risk factors are:
- Biological Sex - Women have a greater chance of developing osteoporosis.
- Race - Caucasians and Asians are most likely to suffer this extensive bone
- Age - Since bone loss begins at around age 30, as you age your risk for
- Family History - If others in your family have experienced hip or spine
fractures or become hunched over as they age, you are at greater risk of experiencing
the same symptoms.
- Body Frame - A slight, thin body frame with a low body weight for height
will increase the risk of osteoporosis.
- Post Menopause - Women past menopause have reduced estrogen, so their chances
of losing bone mass increase.
- Low Estrogen - There is more risk if women have had a low rate of estrogen
over their lifetime. The deficiency can be the result of late onset of puberty/getting
their period, early menopause (before 40), or an absence or suppression of
- Medication Use - Certain medications increase the risk of osteoporosis because
they contribute to loss of bone mass when used long term; these drugs include
steroids, inhaled steroids, antiepileptic drugs, immunosuppressants, anticoagulants,
and thyroid hormone suppressive therapy.
- Nutritional Conditions - Conditions such as anorexia nervosa, chronic liver
disease, malabsorption syndromes, or malnutrition can increase the risk of
- Endocrine Disease or Metabolic Causes - These could include thalassemia,
diabetes, or hemochromatosis.
- Other Medical Disorders - These include: Down's syndrome, mastocytosis,
myeloma and some cancers, renal tubular acidosis, rheumatologic disorders,
Lifestyle risk factors that lead to bone loss include:
- Low Calcium Intake - Consumption below 300 mg per day (which is equal to
one glass of milk) is considered low.
- Low (or no) Vitamin D in Your Diet - Vitamin D comes from sunlight and foods
such as egg yolks, fortified milk and cereals, and some types of fish.
- High Caffeine Intake - More than two to three cups of caffeinated coffee
each day is considered high if you have a low calcium intake.
- Tobacco use - This includes current use as well as past use of tobacco.
- Alcohol use - More than 7 oz. of alcohol per week can slightly increase
the risk of hip fractures.
- Low Activity - Your activity rate is considered low if you do not walk or
Perhaps the most common symptom of osteoporosis is a vertebral compression
fracture or hip fracture. The compression fractures in the spine, caused by
weakened vertebrae can lead to pain in your mid-back area. The fractures often
stabilize on their own and the pain goes away, but sometimes the pain persists
because the crushed bone continues to move around and break.
In severe cases of osteoporosis, actions as simple as bending forward can be
enough to cause a "crush fracture", or spinal compression fracture. These vertebral
fractures cause loss of height and a humped back. This disorder (kyphosis or
a "dowager's hump") is an exaggeration of your spine that causes the shoulders
to slump forward and the top of your back to look enlarged and humped.
If you have symptoms of osteoporosis, you should consult with your doctor.
Additionally, older women should discuss their risks of osteoporosis with a
health care provider, even if they are not currently exhibiting any signs of
the disorder. All women should be aware of the many preventative steps to take
to decrease the risk of developing osteoporosis.
To diagnosis osteoporosis, your physician can do several things. Diagnosis
will begin with a physical examination that measures height, weight, and middle
fingertip-to-middle fingertip arm span. This gives a rough estimate of what
your original height might have been in young adult life. Vertebral tenderness
will also be checked.
After a physical, laboratory tests, and bone mineral density might be performed.
First is bone densitometry, which reports the density of your bone mass. This
test is not part of routine screening, but will be done if osteoporosis is suspected
or if you are at high risk for the disease.
As for laboratory tests, the following are conducted to rule out any secondary
disorders that might be causing the osteoporosis. There is testing of urine
and serum to look for concentrations of calcium, serum protein, inorganic phosphorus,
alkaline phosphates, or CBC. These tests are done to exclude the presence of
another disease that may be the cause of secondary osteoporosis. Biochemical
measures of bone turnover can also be looked at along with other clinical information
to evaluate risk of osteoporosis. A complete blood cell count, with a separate
white cell count, can be taken to rule out other diseases. In elderly people,
thyroid function tests, serum, and urinary protein electrophoresis should be
taken to rule out hyperthyroidism and multiple myeloma.
X-rays might be taken if your bone mass is suspected to be 30%-50%. If bone
loss is not thought to be this high, X-rays are not beneficial in determining
Treatment Options and Prevention
Though there is no cure for osteoporosis, in recent years many effective treatments
and prevention plans have been discovered. The most common are listed below:
The most fundamental suggestion is to increase your calcium intake, either
through dietary changes or supplemental pills. It is best for people to begin
adequate calcium intake at an early age, as bone mass begins to decrease around
the age of 30. After age 30, calcium helps decrease bone loss, strengthen bones,
and decrease the risk of fractures. The recommended daily intake for women,
25-50 years of age, and women over 50 who take hormone replacements, is 1,000
mg per day. Women over 50 who do not take hormone replacements should have 1,500
mg per day. Men 25-65 years should have 1,500 mg per day, and men and women
over 65 should have 1,500 mg per day. If you take calcium supplements, make
sure they contain Vitamin D, as this helps with absorption. In addition, calcium
citrate is better absorbed than calcium carbonate, which has to be taken with
A vitamin D deficiency may contribute to bone loss and fracture, and at least
800 mg per day is recommended for all adults. Many calcium supplements contain
vitamin D. You can also get vitamin D through foods such as: egg yolks; fortified
milk and cereals; and fish, such as halibut, mackerel, sardines, shrimp, pink
salmon, and cod liver oil.
Exercise five days a week for at least 30 minutes helps reduce bone loss. The
best exercises for maintaining bone mass are weight-bearing exercises. This
Currently, four medications have approval from the Food and Drug Administration
Hormone Replacement Therapy (HRT)
Hormone/estrogen replacement therapy is used for both prevention and treatment
of osteoporosis. HRT can reduce bone loss, increase bone density in the spine
and hip, and reduce the risk of hip and spinal fractures in postmenopausal women.
HRT is usually given as a pill or skin patch. It is effective even when started
after age 70. However, when estrogen is taken alone, it can increase the risk
of developing endometrial cancer (cancer of the uterine lining). For this reason,
the hormone, progestin, is usually prescribed in combination with estrogen for
women whose uterus is intact.
Side effects of HRT can include: nausea, bloating, breast tenderness, and high
blood pressure. Some studies indicate a relationship between estrogen use and
breast cancer, while other studies do not. Please discuss the pros and cons
of estrogen replacement therapy with your health care provider.
These compounds inhibit breakdown of bone and slow down bone removal. They
are also shown to increase bone density and decrease the risk of fractures at
both the hip and spine. The bisphosphonate that has been approved by the FDA
for preventing and treating osteoporosis in postmenopausal women is alendronate.
The strongest side effect of alendronate is gastrointestinal problems. For
this reason, it has to be taken on an empty stomach. To minimize side effects,
take it with a full glass of water and remain in an upright position for at
least one half hour after taking the medication.
This is used for women who cannot, or choose not to, take estrogen. For women
who are at least five years past menopause, calcitonin can increase spinal bone
density and slow bone loss. Calcitonin is a protein, so it cannot be taken orally
- otherwise it would digest before it could work. Calcitonin is available as
an injection or nasal spray.
Selective Estrogen Receptor Modulators (SERMs)
These compounds have effects similar to estrogen in some parts of the body,
such as the spine and hip. SERMs seem to prevent bone loss at the spine, hip,
and total body. Raloxifene is the SERM drug currently approved by the FDA for
prevention of osteoporosis. However, its impact on the spine does not appear
to be as powerful as either estrogen replacement therapy or alendronate. There
are no common side effects with raloxifene, but sometimes women have experienced
hot flashes and deep vein thrombosis (DVT).
Remember that osteoporosis is a highly preventable and treatable disease. If
you are at risk for osteoporosis, please consult with your health care provider
to develop a prevention and treatment plan.
Copyright © 2003 DePuy Acromed.
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