Osteoporosis

Definition of Osteoporosis

Bone is a living tissue, comprising mainly calcium and protein. Healthy bone is always being remodeled; that is, small amounts are being absorbed in your body and small amounts are being replaced.

If more bone calcium is absorbed than is replaced, the density or the mass of the bone is reduced. The bone becomes progressively weaker, increasing the risk that it may break.

Osteoporosis means "porous bone." This condition develops when bone is no longer replaced as quickly as it is removed.

Cause

More than 2 million fractures occur related to osteoporosis each year. Most people are unaware that they have osteoporosis until a fracture occurs.

The exact medical cause for osteoporosis is not known, but a number of factors are known to cause osteoporosis, including

  • Aging

  • Physical inactivity

  • Reduced levels of estrogen

  • Heredity

  • Excessive cortisone or thyroid hormone

  • Smoking

  • Excessive alcohol intake

The loss of bone tends to occur most in the spine, lower forearm above the wrist, and upper femur or thigh-the site of hip fractures. Spine fractures, wrist fractures, and hip fractures are common injuries in older persons.

A gradual loss of bone mass, generally beginning about age 35, is a fact of life for everyone. After growth is complete, women ultimately lose 30% to 50% of their bone density, and men lose 20% to 30%.

Women lose bone calcium at an accelerated pace once they go through menopause. Menstrual periods cease because a woman's body produces less estrogen hormone, which is important for the maintenance of bone mass or bone strength. Your family doctor or gynecologist may evaluate and recommend a treatment program of estrogen replacement therapy, calcitonin or other medications. To be most effective, the treatment program should begin at menopause.

Prevention

Although osteoporosis will occur in all persons as they age, the rate of progression and the effects can be modified with proper early diagnosis and treatment.

During growth and young adulthood, adequate calcium nutrition and Vitamin D and regular weightbearing exercises, such as walking, jogging, and dancing, three to four hours a week, build strong bones and are investments in future bone health.

Smoking and consuming excessive amounts of alcohol should be avoided because they increase bone loss. As people age, appropriate intake of calcium and Vitamin D and regular exercise, as well as avoidance of smoking and excessive alcohol use, are necessary to reduce loss of bone mass.

Treatment

Family doctors working with your orthopaedic surgeon can evaluate whether your bone density has been reduced, and can evaluate the cause for the reduction. Early treatment for osteoporosis is the most effective way to reduce bone loss and prevent fractures. However, treatment programs after a fracture also are of value and may help to prevent future fractures.

Current treatment methods can reduce bone loss, but there are no proven methods of restoring lost bone. Building bones through adequate calcium intake and exercise when you are young is an investment that will pay off years later with a reduced risk of hip and other fractures.

Early Prevention of Osteoporosis

Most people think osteoporosis (loss of bone mass) is a disease of the elderly. However, although people normally lose bone mass as they age, the amount of bone growth that occurs during childhood and adolescence is just as important a factor in developing osteoporosis. That's what experts at the National Institutes of Health (NIH) said at a conference on Osteoporosis Prevention, Diagnosis and Therapy in March 2000.

Healthy Bones Begin in Childhood

Bones grow in size during childhood, gaining mass and strength. The amount of bone mass you obtain while you are young determines your skeletal health for the rest of your life. The more bone mass you have after adolescence, the more protection you have against losing bone mass later.

Childhood is critical for developing lifestyle habits that support good bone health. Cigarette smoking often starts in childhood. It has a harmful effect on reaching peak bone mass.

Good nutrition is vital for normal growth. Like all tissues, bone needs a balanced diet, enough calories, and appropriate nutrients, such as calcium. But not everyone follows a diet that is best for bone health. For example, the federal government's Institute of Medicine recommends a calcium intake for children ages 9 to 17 years of 1,300 mg/day (800 mg/day for children ages 3 to 8 years). However, only about 25% of boys and 10% of girls in this age group have a diet that meets these recommendations.

Calcium is the most important nutrient for reaching peak bone mass. It prevents and treats osteoporosis. The body requires Vitamin D to absorb calcium effectively. Most infants and young children in the United States get enough Vitamin D from fortified milk. But adolescents don't consume as many dairy products. They may not get adequate levels of Vitamin D. Dieting and fasting to be thin may harm nutrition and bone health. Teens who diet may need to take calcium and Vitamin D supplements.

Risk Factors

Several groups of children and adolescents are at risk for poor bone health, including:

  • Premature infants and infants with low birth weight who have lower than expected bone mass in the first few months of life.

  • Children who take medications such as steroids to treat respiratory diseases such as asthma.

  • Children who have cystic fibrosis, celiac disease, and inflammatory bowel disease. These conditions make it difficult for the body to absorb nutrients appropriately.

  • Adolescent girls who have minimal, delayed or irregular menstrual cycles because of strenuous athletic training, emotional stress, or low body weight.

  • Children with cerebral palsy and other conditions that place limits on physical activity, especially those who take chronic medications for seizure control.

Prevention

Many more studies are needed on ways to maximize peak bone mass in girls and boys. Parents and children alike can benefit from following these suggestions:

  • Make sure you get enough calcium and Vitamin D throughout your life.

  • Exercise regularly, using resistance and high-impact activities.

  • Eat a healthy diet and follow a healthy lifestyle.

Osteoporosis Prevention

Definition of Osteoporosis

Bone is a living tissue, comprising mainly calcium and protein. Healthy bone is always being remodeled; that is, small amounts are being absorbed in your body and small amounts are being replaced.

If more bone calcium is absorbed than is replaced, the density or the mass of the bone is reduced. The bone becomes progressively weaker, increasing the risk that it may break.

Osteoporosis means "porous bone." This condition develops when bone is no longer replaced as quickly as it is removed.

Cause

More than 2 million fractures occur related to osteoporosis each year. Most people are unaware that they have osteoporosis until a fracture occurs.

The exact medical cause for osteoporosis is not known, but a number of factors are known to cause osteoporosis, including:

  • Aging

  • Physical inactivity

  • Reduced levels of estrogen

  • Heredity

  • Excessive cortisone or thyroid hormone

  • Smoking

  • Excessive alcohol intake

The loss of bone tends to occur most in the spine, lower forearm above the wrist, and upper femur or thigh-the site of hip fractures. Spine fractures, wrist fractures, and hip fractures are common injuries in older persons.

A gradual loss of bone mass, generally beginning about age 35, is a fact of life for everyone. After growth is complete, women ultimately lose 30% to 50% of their bone density, and men lose 20% to 30%.

Women lose bone calcium at an accelerated pace once they go through menopause. Menstrual periods cease because a woman's body produces less estrogen hormone, which is important for the maintenance of bone mass or bone strength. Your family doctor or gynecologist may evaluate and recommend a treatment program of estrogen replacement therapy, calcitonin or other medications. To be most effective, the treatment program should begin at menopause.

Prevention

Although osteoporosis will occur in all persons as they age, the rate of progression and the effects can be modified with proper early diagnosis and treatment.

During growth and young adulthood, adequate calcium nutrition and Vitamin D and regular weightbearing exercises, such as walking, jogging, and dancing, three to four hours a week, build strong bones and are investments in future bone health.

Smoking and consuming excessive amounts of alcohol should be avoided because they increase bone loss. As people age, appropriate intake of calcium and Vitamin D and regular exercise, as well as avoidance of smoking and excessive alcohol use, are necessary to reduce loss of bone mass.

Treatment

Family doctors working with your orthopaedic surgeon can evaluate whether your bone density has been reduced, and can evaluate the cause for the reduction. Early treatment for osteoporosis is the most effective way to reduce bone loss and prevent fractures. However, treatment programs after a fracture also are of value and may help to prevent future fractures.

Current treatment methods can reduce bone loss, but there are no proven methods of restoring lost bone. Building bones through adequate calcium intake and exercise when you are young is an investment that will pay off years later with a reduced risk of hip and other fractures.

What Is Your Risk for Osteoporosis?

Osteoporosis is a major health threat for more than 28 million Americans. In the United States, eight million women and two million men already have osteoporosis. More than 18 million Americans have low bone mass placing them at increased risk for osteoporosis.

Risk Factors

Genetic Factors

If someone in your family has osteoporosis, you have a 60 to 80 percent chance of getting the condition, too. And, if your mother has broken a hip, your chances double for having a hip fracture—a strong indicator of bone weakness.

You do not get enough calcium

People need to incorporate calcium throughout their lives to prevent osteoporosis. Milk and other dairy products can provide a major boost of bone-building calcium to most diets. Leafy green vegetables are another good source of calcium.

You smoke or drink excessive amounts of alcohol

If you smoke, you double your risk of suffering an osteoporotic fracture. Researchers have found that smoking reduces your ability to absorb calcium. That's because cigarette smoke is thought to damage bone cells and prevent new bone growth. People who drink too much alcohol on a regular basis are prone to bone loss and fractures due to poor nutrition as well as increased risk of falling.

You are thinner than normal

Low body weight is an important risk factor for osteoporosis and increased risk of fractures. Being too thin means you have less padding of muscle and fat to protect your bones which are more vulnerable to injury. Frequent dieting can be risky because when you lose weight, you also lose fat, muscle and bone density. Fat and muscle may eventually come back, but bone could be gone forever.

You have chronic medical problems

If you suffer from rheumatoid arthritis, hyperthyroidism (excessive production of thyroid hormones), hyperparathyroidism (a condition caused by excessive amounts of parathyroid hormone), diabetes, or liver disease, your chances of having osteoporosis increase.

You have persistent back pain

Back pain that will not quit could be a sign that you have a spinal fracture. Spinal fractures occur when bones in your back become so weak that they fracture and collapse. This can happen without warning even during ordinary activities, such as bending over to pick up a newspaper.

You are shorter than you used to be

If you fracture a bone in your spine, it could collapse onto itself causing you to shrink. Multiple fractures also can cause the spine to form a curve causing the disfigurement known as a dowager's hump. However, not all height loss is caused by osteoporosis. As you age, the disks in your back lose their elasticity causing your frame to shift downward. It is not uncommon to lose anywhere from one half to 1 inch in height between the ages 60 and 80.

First Fracture May Be a Warning Sign

A fracture can be more than a just a broken bone. It may be a warning sign that you have osteoporosis.

Osteoporosis, or "porous bone" is a medical condition that weakens bone by making it more porous and less dense. Bone density is one of the factors that determine bone strength, so individuals with low bone density have a higher risk for fracture and refracture.

Osteoporosis is a contributing factor in as many as 1.5 million fractures each year, including:

  • About 300,000 hip fractures

  • About 700,000 vertebral (spine) fractures

  • About 250,000 wrist fractures

  • About 300,000 fractures at other sites

The risk of a serious fracture can double after a first fracture in certain high-risk groups. Additionally, many patients, particularly those who suffer hip fractures, are at high risk for premature death or loss of independence after the fracture. Consider these facts:

  • One out of four people who have an osteoporotic hip fracture will need long-term nursing home care.

  • Half of those who experience osteoporotic hip fractures are unable to walk without assistance.

  • Those who experience the trauma of an osteoporotic hip fracture have a 24% increased risk of dying within one year following the fracture.

  • Clearly identifying osteoporosis early and initiating treatment is essential.

Who Should Be Concerned?

Osteoporosis should not just be a concern for aging white women. Recent data indicates that osteoporosis occurs in all racial groups.

  • Hispanic women may be among those at highest risk. Between 13 percent and 16 percent of Hispanic women have osteoporosis. As many as 49% of Mexican-American women 50 years of age or older have low bone density.

  • Although the rate of hip fractures is lower in Asian-American women, the rate of vertebral fractures is about equal between Asian-American and Caucasian women.

  • About 10 percent of African-American women over 50 have osteoporosis. An additional 30 percent have low bone density. Between 80 percent and 95 percent of all fractures experienced by African-American women over age 64 are related to osteoporosis.

Men should also be concerned about osteoporosis. Approximately one in eight men will have an osteoporotic fracture. Men with a history of hypogonadism, thyroid dysfunction, long-term steroid therapy, high alcohol consumption or low physical activity are especially at risk. One-third of all hip fractures experienced by men are related to osteoporosis, and one-third of these men will die within the first year after the fracture.

A fracture in adulthood does not always mean an individual has osteoporosis. However, every adult who suffers a fracture should discuss the need for bone density testing with a physician. If your bone density is low, you may need additional medical tests. Medical conditions other than osteoporosis can cause low bone density.

What Can Be Done?

There is no specific cure for osteoporosis. However, if you have been diagnosed with it, diet and lifestyle changes can reduce your risk of refracture. You should also discuss medical therapy with your physician. Even individuals without osteoporosis should follow these four simple guidelines.

  • Make sure you get enough calcium and Vitamin D in your diet. The National Academy of Sciences recommends 400 to 800 units of Vitamin D and 1,000 to 1,500 mg of Calcium per day.

  • Participate in activities that will strengthen bone and muscle. Regular exercise is one of the best things you can do to prevent osteoporosis. Weight-bearing exercises like walking, jogging and tennis and low-impact exercise classes are best for building and maintaining strong bones.

  • Because falls are the most common cause of fractures, do some balance activities to reduce your risk. The benefits of tai chi in particular have been documented. Tai chi decreases falls among older individuals by 47%.

  • If you have had a broken bone, talk to your doctor about a bone density test. You may also wish to discuss other steps you can take to reduce the risk of a second fracture.