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Osteoporosis

Osteoporosis

Osteoporosis, which means "porous bones," causes bones to become weak and brittle — so brittle that even mild stresses like bending over, opening a window, or coughing can cause a painful fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus, and other minerals in your bones. Osteoporosis can also accompany endocrine disorders or result from excessive use of drugs such as corticosteroids.

Although it's often thought of as a women's disease, osteoporosis also affects a significant number of men because of delayed puberty, inadequate calcium intake, smoking, alcoholism, or the use of medications such as glucocorticoids. Approximately 44 million women and men age 50 and older have osteoporosis and/or low bone mass.1 Additionally, 1 in 2 women and 1 in 4 men will experience an osteoporotic fracture during the course of aging.1 Spinal fractures are the most common, with more than 700,000 such fractures occurring each year in the United States alone.2

Causes

Risk factors:3

According to the National Osteoporosis Foundation, a number of factors can increase the likelihood that you'll develop osteoporosis, including:

  • Gender. Fractures from osteoporosis are about twice as common in women as they are in men. That's because women start out with lower bone mass and tend to live longer. They also experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. From age 75 on, osteoporosis is as common in men as it is in women.
  • Age. The older you get, the higher your risk of osteoporosis. Your bones become weaker as you age. One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime.
  • Race. Caucasian and Asian women and men have a greater possibility of osteoporosis. African Americans and Hispanics have a lower but still significant risk.
  • Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater jeopardy, especially if you also have a family history of fractures.
  • Frame size. Those who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.
  • Lifestyle. A sedentary lifestyle, low calcium intake, and tobacco use contribute to weak bones.
  • Alcoholism. This is one of the leading factors for osteoporosis in men. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.
  • Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone, and dexamethasone, is damaging to bone. These medications are common treatments for chronic conditions such as asthma, rheumatoid arthritis, and psoriasis.
  • Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because of an overactive (hyperthyroidism) thyroid or from taking excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
  • Some diuretics. Drugs that prevent buildup of fluids in the body — diuretics — cause the kidneys to excrete more calcium, leading to thinning bones. Diuretics that cause calcium loss include furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), and torsemide (Demadex).
  • Other medications. Long-term use of the blood-thinning medication heparin, the drug methotrexate, some anti-seizure medications, and aluminum-containing antacids can cause bone loss.
  • Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole, letrozole, and exemestane, which suppress estrogen. This isn't true for women treated with tamoxifen, which may reduce the risk of fractures.
  • Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect the body's ability to absorb calcium. So can conditions such as Crohn's disease, hyperparathyroidism, anorexia nervosa, and Cushing's disease — a rare disorder in which the adrenal glands produce excessive corticosteroid hormones.

It's important to know whether or not you have osteoporosis. With proper treatment, you can slow bone loss, reduce back pain, and even improve posture. For more information, please visit the National Osteoporosis Foundation.

Assessment and diagnosis

Telltale signs of osteoporosis or a fracture.

You can’t feel yourself losing bone, but you might feel a spinal fracture – the most common complication from osteoporosis.456 Acute and chronic back pain are outward signs of such fractures (also known as vertebral compression fractures or VCFs)6. It may be hard to believe, but even simple activities like carrying groceries or bending over to pick up your grandchild can cause a VCF.367

Your spine is stacked and structured with the precision of dominoes, allowing you to bend over and twist side to side. And just like dominoes, one VCF can change your spine’s alignment and cause other vertebrae to collapse or fracture. Multiple fractures may lead to loss of height and curvature of the upper back called kyphosis or “dowager’s hump.”8 Over time, kyphosis can cause your back to hunch over so badly that it reduces the space in your chest cavity, making it hard to breathe and eat.6

Don’t lightly dismiss new or unusual back pain as a part of growing old. Your backache could be a VCF. Sudden and severe pain or pain that lasts for more than a week should be seen by a doctor.

Prevention

Bone up on calcium and vitamin D. Calcium-rich foods are the secret to maintaining bone strength. Women age 50 and under need 1,000 milligrams a day. After age 50, daily calcium requirements jump to 1,200 milligrams.9

Lack of calcium has been singled out as a major public health concern because it is critically important to bone health. The average American consumes far less than the amount required. Calcium supplements are a good way to make up the difference.10

How does your diet measure up? Be a spine-smart snacker.

Here are some good sources of calcium: 11

  • 8 oz. low-fat yogurt: 415mg calcium
  • 16 oz. milkshake: 380mg calcium
  • 24 almonds: 75mg calcium
  • 4 oz. instant pudding, made with 2% milk: 159mg calcium
  • 1 oz. cheddar cheese: 204mg calcium
  • 8 oz. 1% milk: 305mg calcium
  • 1 cup spinach (frozen, cooked): 291mg calcium
  • 1 cup Total Raisin Bran® cereal: 1038mg calcium

Don’t forget to include vitamin D in your diet, too. It helps your body absorb that calcium. Aim for 200 to 400 international units (IU) daily if you’re age 50 and under and 400 to 600 IU daily if you’re over 50. 11 12

You can get vitamin D in: 1112

  • 3 1/2 oz. salmon: 447 IU vitamin D
  • 3 oz. canned tuna fish: 154 IU vitamin D
  • 1 cup vitamin D-fortified milk: 120 IU vitamin D
  • 1 whole egg (vitamin D is found in yolk): 41 IU vitamin D
  • 1 whole egg: 20 IU vitamin D

You can also get vitamin D from supplements. Often calcium and vitamin D can be found in the same supplement.

Exercise

Weight-bearing exercises reduce bone loss and help prevent fractures. Activities such as walking, running, climbing stairs, tennis, and weight lifting put stress on your bones, signaling your body that your bones need to be made stronger. New cells are added to strengthen your bones. That’s why if you’re right-handed, the bones in your right arm are slightly larger and stronger – it’s from the extra use. To get the bone-building benefit from exercise, you must do it at least three times per week for 30 to 45 minutes.10

FAQs

Why do people shrink as they age?

As people age, several changes in their bodies can reduce their height by anywhere from one inch to three inches or more. They include VCFs, loss of muscle strength to support the spine, and even weakened arches, which flatten feet and contribute slightly to height loss. The good news is that a diet with enough calcium and vitamin D, together with weight-bearing exercise, can spare your spine from significant height loss.61013

Why should I do physical activities at my age?

Weight-bearing exercises reduce bone loss and help prevent fractures. Activities such as walking, running,= climbing stairs, tennis, and weight lifting put stress on your bones, signaling your body that your bones need to be made stronger. New cells are added to strengthen your bones. That’s why if you’re right-handed, the bones in your right arm are slightly larger and stronger – it’s from the extra use. To get the bone-building benefit from exercise, you must do it at least three times per week for 30 to 45 minutes.10

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