What is osteoporosis?

Osteoporosis is a disease that causes weak, thinning bones. This puts the bones at greater risk of breaking. The bones most often affected are the hips, spine, and wrists.

What causes osteoporosis?

Researchers don't know the exact cause for osteoporosis. But a number of factors contribute to the disease.

Who is at risk for osteoporosis?

Women are 4 times more likely to get osteoporosis than men. Here are other things that may put you at risk for osteoporosis:

• Older age. Bones become less dense and weaker with age.
• Race. White and Asian women are most at risk. But all races may get the disease.
• Body weight. People who weigh less and have less muscle are more at risk for this condition.
• Lifestyle factors. Lack of physical activity, caffeine, heavy alcohol use, smoking, dietary calcium, and vitamin D deficiency may all increase your risk.
• Certain medicines. Some medicines may increase your risk.
• Family history. Having a family history of bone disease may increase your risk.

Having low bone mass (osteopenia) also puts you at a greater risk for osteoporosis.

Low estrogen is one of the main causes of bone loss in women during and after menopause. Women may lose up to 20% of their bone mass in the 5 to 7 years after menopause.

What are the symptoms of osteoporosis?

People with osteoporosis may not have any symptoms. Some may have pain in their bones and muscles, particularly in their back. Sometimes a collapsed vertebra may cause severe pain, decrease in height, or spinal deformity.

The symptoms of osteoporosis may look like other bone disorders or health problems. Always talk with your healthcare provider for a diagnosis.

How is osteoporosis diagnosed?

Your healthcare provider will review your personal and family health history and do a physical exam. Other tests include:

• Bone density test (bone densitometry). This test measures the mass of bone and its volume to find the risk of getting osteoporosis.
• Blood tests. These tests measure calcium and potassium levels.
• FRAX score. This is a score given to estimate the risk of a fracture within 10 years. The score uses the results of a bone density test as well as other things.
• X-rays. This test uses energy beams to make images of tissues, bones, and organs on film.

Women are encouraged to:

• Review lifestyle practices with their healthcare provider regularly.
• Have their personal risk for falls checked at least once a year after menopause.
• Have their height and weight checked yearly.
• Get checked for the development of a rounded humped in the spine and back pain (kyphosis).

How is osteoporosis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

The goals of managing osteoporosis are to:

• Decrease pain
• Prevent fractures
• Minimize further bone loss

Some of the ways to treat osteoporosis are also ways to prevent it. They include:

• Staying at a healthy body weight
• Doing more walking and other weight-bearing exercises
• Limiting caffeine and alcohol
• Stopping smoking
• Getting enough calcium and vitamin D through diet and supplements
• Installing hand railings, or assistive devices in the bathroom or shower to prevent falls
• Asking your healthcare provider about medicines that may help

Medicines that help maintain bone health in women with osteoporosis at menopause include:

• Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT).  ERT reduces bone loss, increases bone density, and reduces the risk for hip and spinal fractures in postmenopausal women. But talk with your healthcare provider before taking them. Research found several important health risks linked to this therapy. For many women, the risks of ERT outweigh the benefits.
• Bisphosphonates. These medicines reduce bone loss, increase bone density, and reduce the risk for fractures.
• Selective estrogen receptor modulators (SERMS).  These medicines help prevent bone loss.
• Parathyroid hormone. This medicine is a form of parathyroid hormone. It helps form bone.
• Monoclonal antibody. This medicine is given by shot (injection) under the skin. It’s approved for women with osteoporosis at high risk for fractures. It’s also used for women who are being treated with cancer medicines that can weaken bones. 
• Calcitonin. This hormone may help slow bone loss. It's available as a nose spray or shot (injection) to treat postmenopausal osteoporosis.

Living with osteoporosis

An osteoporosis rehab program can be vital to a full recovery. It can help you obtain the best possible bone health and quality of life. The focus of rehab is to decrease pain, help prevent fractures, and reduce further bone loss.

To help reach these goals, programs may include:

• Exercise programs and conditioning to increase weight-bearing and physical fitness
• Methods to manage your pain
• Nutritional counseling to improve how much calcium and vitamin D you get and to limit caffeine and alcohol
• Assistive devices to make you safer at home
• Education, especially on ways to prevent falls

These rehab programs can be done as an outpatient or inpatient. Many skilled people are part of the team. They include:

• Dietitian
• Internist
• Occupational therapist
• Orthopedist/orthopedic surgeon
• Physiatrist
• Physical therapist
• Psychologist/psychiatrist
• Recreational therapist
• Rehabilitation nurse
• Social worker
• Vocational therapist

Key points about osteoporosis

• Osteoporosis is a disease that causes weak, thinning bones. This leaves the bones at greater risk of breaking. The bones most often affected are the hips, spine, and wrists.
• Women are 4 times more likely to get osteoporosis than men because of a decrease in estrogen after menopause.
• Risk factors for osteoporosis include aging, race, body weight, and certain medicines.
• The goals of managing osteoporosis are to decrease pain, prevent fractures, and reduce further bone loss.
• For postmenopausal osteoporosis in women, medicines can maintain bone health.
• Rehab programs can help regain bone health.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.

Preventing Osteoporosis: Stopping Bone Loss

Certain factors can speed up bone loss or decrease bone growth. For instance, alcohol, cigarettes, and certain medicines reduce bone mass. Some foods make it hard for your body to absorb calcium.

Things to stay away from

Here are things to stay away from to help prevent osteoporosis:

• Alcohol. This is toxic to bones. It is a major cause of bone loss. Heavy drinking can cause osteoporosis even if you have no other risk factors.

• Smoking. This reduces bone mass. Smoking may also interfere with estrogen levels and cause early menopause.

• Inactivity. Not being active makes your bones lose strength and become thinner. Over time, thin bones may break. Women who aren't active are at a high risk for osteoporosis.

• Certain medicines. Some medicines, such as cortisone, increase bone loss. They also decrease bone growth. Ask your healthcare provider about any side effects of your medicines and how to prevent them.

• Protein-rich or salty foods. Eaten in large amounts, these foods may deplete calcium.

• Caffeine. This increases calcium loss. People who drink a lot of coffee, tea, or soda lose more calcium than those who don't.

Living with Osteoporosis: Preventing Fractures

If you have osteoporosis, you can do a lot to reduce its effect on your life. Knowing how to prevent fractures and spinal curvature can help you live more comfortably and safely with this disease.

Reducing your risk for fractures

The most common fracture sites in people with osteoporosis are the wrist, spine, and hip. These fractures are often caused by accidents and falls. All fractures are painful and may limit what you can do. But hip fractures are very serious. They often need surgery, and it can take months to recover. To reduce your risk for fractures:

• Get regular exercise. Try walking, swimming, or weight training.

• Eat foods that are rich in calcium, or take calcium supplements.

• Make your home safe to help avoid accidents.

• Take extra precautions not to fall in risky areas, such as icy sidewalks.

Understanding spinal fractures

Your spine is made up of many bones called vertebrae. Osteoporosis can cause the vertebrae in your spine to collapse. As a result, your upper back may arch forward, creating a curvature. Spine fractures may also result from back strain and bad posture. You will also lose height. Your lower spine must then adjust to keep your body balanced. This can cause back pain. To prevent or lessen these spinal changes:

• Practice good posture.

• Use proper techniques if you need to lift heavy objects.

• Do back exercises to help your posture.

• Lie on your back when you have pain.

• Ask your healthcare provider about these and other ways to help your spine.