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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Osteoporosis occurs when bones become weak and brittle. If left unchecked, it can lead to fractures. Any bone can be affected. Fractures of special concern are of the hip, spine, and wrist.

Osteoporosis

osteoporosis bone
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Causes

Throughout life, old bone is removed and new bone is added to your skeleton. After age 30, more bone is lost than replaced. If too much bone loss occurs, this may lead to osteoporosis. Osteoporosis is more likely to occur if full bone mass was not achieved during your bone-building years.

Risk Factors

Osteoporosis is more common in women than in men. Other factors that may increase your chance of developing osteoporosis include:

  • Increasing age
  • Low weight
  • Smoking
  • Alcohol abuse
  • History of falls
  • Family history of osteoporosis
  • Postmenopausal status
  • Certain conditions, such as:
  • Use of certain medications, such as antidepressants, long-term heparin, corticosteroids, anticonvulsants, or antacids
  • Low hormone levels (low estrogen levels in women, low testosterone levels in men)
  • Inactive lifestyle
  • Certain restrictive diets that may result in a deficit of calcium or vitamin D
  • Too little sunlight (the effect of sun on the skin is a primary source of vitamin D)
  • Certain cancers, including lymphoma and multiple myeloma

Symptoms

In most cases, people with osteoporosis remain symptom-free until there is a fracture. In those that do have symptoms, osteoporosis may cause:

  • Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
  • Loss of height with stooped posture, a condition called kyphosis

Kyphosis

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Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:

  • Blood tests
  • Urine tests

Osteoporosis can be seen with bone mineral density (BMD) tests of the hip, spine, wrist, or other site. These may include:

Treatment

The treatment and management of osteoporosis involves lifestyle changes and medications. Although osteoporosis is highly preventable, it cannot be cured. Treatment focuses on reducing the incidence of fractures and slowing bone loss.

Decrease your intake of alcohol. Eat a balanced diet rich in calcium and vitamin D. Calcium is in:

  • Dairy products
  • Green leafy vegetables
  • Canned fish with bones
  • Calcium-fortified products

Do not smoke. If you smoke, talk with your doctor about ways to quit.

Exercise improves bone health. It also increases muscle strength, coordination, and balance. Do weight-bearing and strength-training exercises for maximum benefit. Balance training may help prevent falls and fractures.

People who cannot eat enough calcium from food might want to take calcium supplements. Vitamin D and other supplements may also be recommended. Talk with your doctor before taking herbs or supplements.

Falls can increase the chance of fracture in someone with osteoporosis. Here are ways to prevent falls:

  • Floors—Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its accustomed place.
  • Bathrooms—Install grab bars and non-skid tape in the tub or shower.
  • Lighting—Make sure halls, stairways, and entrances are well lit. Install a night light in your bathroom. Turn lights on if you get up in the middle of the night.
  • Kitchen—Install non-skid rubber mats near sink and stove. Clean spills immediately.
  • Stairs—Make sure treads, rails, and rugs are secure.
  • Other precautions—Wear sturdy, rubber-soled shoes. Keep your intake of alcoholic beverages to a minimum. Ask your doctor whether any of your medications might cause you to fall.

Your doctor may prescribe medications to help prevent bone loss, increase bone density, and reduce your risk of fractures. These may include:

  • Bisphosphonates
  • Medications with estrogenic effects
  • Other medications

Prevention

Building strong bones throughout your early years is the best defense against osteoporosis. Getting enough calcium, vitamin D, and regular exercise can keep bones strong throughout life.

To help reduce your chance of developing osteoporosis, take these steps:

  • Eat a balanced diet rich in calcium and vitamin D
  • Perform weight-bearing exercise
  • Live a healthy lifestyle (no smoking, drink alcohol only in moderation)
  • If you are a postmenopausal woman at high risk for bone fractures, medications may be appropriate to prevent osteoporosis
RESOURCES:

NIH Osteoporosis and Related Bone Diseases National Resource Center

http://www.niams.nih.gov

National Osteoporosis Foundation

http://www.nof.org

CANADIAN RESOURCES:

Osteoporosis Canada

www.osteoporosis.ca

Women's Health Matters

http://www.womenshealthmatters.ca

References:

Clinician's guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation website. Available at: http://www.nof.org/files/nof/public/content/file/950/upload/523.pdf. Updated 2013. Accessed July 22, 2013.

Ho-Pham LT, Nguyen ND, et al. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr. 2009;90:943-950.

Khosla L, Melton LJ. Clinical practice: osteopenia. N Engl J Med. 2007;356:2293-2300.

Making a diagnosis. National Osteoporosis Foundation website. Available at: http://nof.org/articles/8. Accessed July 22, 2013.

Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated July 15, 2013. Accessed July 22, 2013.

Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367:2010-2018.

10/6/2006 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Cockayne S, Adamson J, Lanham-New S, et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:1256-1261.

5/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148:680-684.

1/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ. 2009;180:32-39. Epub 2008 Dec 10.

12/29/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ. 2009;339:b4229.

6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: FDA approves new injectable osteoporosis treatment for postmenopausal women. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm214150.htm. Updated April 23, 2013. Accessed July 22, 2013.

Last reviewed June 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.