There are medications that can help prevent fractures. However, vertebrae that have already collapsed cannot be restored. Some people that have osteoporosis become severely disabled as a result of weak bones. About 50 percent of patients with hip fractures cannot walk independently. Although it does not affect life expectancy, osteoporosis is one of the major reasons people are admitted to nursing homes.
A series of bone mineral density measurements taken every 1-2 years can monitor the response to treatment.
Certain medications can help prevent osteoporosis. Other ways to prevent this disease are:
- get enough calcium to maintain healthy bones,
- get enough vitamin D to help the body absorb calcium,
- do not drink excess alcohol,
- do not smoke, and
- exercise regularly.
Contact a doctor if you have symptoms of osteoporosis or if you want to be screened for it. There are many types of doctors who specialize in treating osteoporosis. Endocrinologists, rheumatologists, geriatricians, and internists are a few.
In the early stages of osteoporosis, there are no symptoms. As the disease progresses to its later stages symptoms will occur.
The following symptoms appear in the later stages of osteoporosis:
- fractures with a small trauma or no injury at all,
- pain or tenderness in the bone,
- height loss over time (up to 6 inches),
- pain in the lower back or neck caused by fractures of the bones of the spine (vertebra), and
- “dowager’s hump” or a stooped posture (kyphosis).
Researchers are currently trying to figure out which genes and bone formation pathways are involved in bone health. Their hope is that they can use these discoveries to develop better ways to treat or prevent osteoporosis. Long-term study results from the elderly, minority populations, and women and men will help researchers create targeted therapies and prevention methods based on individual traits of patients.
For more information about osteoporosis, contact these organizations:
- The National Osteoporosis Foundation (NOF)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- American College of Rheumatology
- American Academy of Orthopedic Surgeons
- International Osteoporosis Foundation
Osteoporosis is a condition that involves the thinning of bone tissue and the loss of bone density over time. This causes the bones to break easily. In the United States, over 40 million people have osteoporosis or at a high risk.
This disease is more common for women than for men. Among women over 50 years old, approximately 1 out of 5 have osteoporosis. In addition, an estimated 50 percent will experience a fracture of the hip, wrist, or bones of the spine (vertebra).
If the body does not form enough new bone and/or if too much old bone is reabsorbed by the body, osteoporosis occurs. Most often, the loss will happen slowly over time. Many people will suffer a fracture before finding out they have osteoporosis. Unfortunately, by this time the disease is already in its advanced stages and the damage is severe.
Two minerals that are needed to form bones normally are calcium and phosphate. The body uses these minerals to form bones throughout childhood. Bone production and bone tissues may suffer if one does not get enough calcium, or if their body does not absorb enough calcium from their diet.
Calcium and phosphate may be reabsorbed from the bones back into the body with age. This makes the bone tissue weaker and may result in brittle, fragile bones that are at greater risk for fractures.
The bones most commonly broken by people with osteoporosis are the hip, spine, and the wrist.
Osteoporosis is usually tested for using a bone mineral density test or a spine CT.
Bone Mineral Density Test
If a patent is at risk for osteoporosis, a doctor may recommend a bone mineral density (BMD) test. This test measures the amount of calcium and other minerals in an area of a bone. This procedure can be done in a few different ways. Most commonly, a dual- energy x-ray absorptiometry (DEXA) scan will be used. This way is the most accurate and uses low-dose x-rays. The two types of DEXA scans are:
- Central DEXA. A patient lays on a soft table, usually dressed. A scanner passes over their hip and lower spine. It is the best scan to test for the risk of fractures.
- Peripheral DEXA (p-DEXA). This test uses smaller machines that measure the bone density in the wrist, fingers, leg, or heel. These machines are commonly found in doctor’s offices, pharmacies, shopping centers, and health fairs.
This test requires that the patient remain still, but it is painless. A patient should inform a doctor if she is pregnant before getting a BMD test.
The test results will most often be reported as a “T-score” and a “Z- score.” A “T-score” shows the patient’s bone density compared to that of a younger woman. A “Z-score” is the patient’s bone density compared to that of other people with the same age, gender, and race. If either score shows a negative number, then the patient has thinner bones than the standard. The further the number is from zero, the greater the patient’s risk for a bone fracture.
Spine CT
If a patient has symptoms in their spine, a doctor may recommend a spine CT (computed tomography). A spine CT is a computed tomography scan of the lower spine and surrounding tissues.
A patient lies on their back on a narrow table that slides into the center of the CT scanner. When the patient is inside the scanner, a machine’s X-ray beam rotates around them. During this processes, detectors inside the scanner measure the amount of X-rays that make it through the spine. With this information, a computer creates several images, called slices. A doctor evaluates the results.
The patient must lie still to prevent blurred images caused by movement. They may also be asked to briefly hold their breath.
Sometimes an iodine-based-dye is injected into the patient’s vein before the procedure. This is done to highlight specific areas inside the body and create a clearer image. This dye may cause a slight burning sensation, a metallic taste in the mouth, or a warm flushing of the body. However, this is normal and the discomfort will go away in a few seconds.
Other Tests
A spine or hip X-ray may show fracture or collapse of the spinal bones in severe cases. However, X-rays of bones are not very accurate in testing for osteoporosis.
Other blood or urine tests may be recommend if it is suspected that the osteoporosis is being caused by a medical condition as opposed to the normal bone loss caused by aging.
Osteoporosis is most often caused by a drop in estrogen in women during menopause or a drop in testosterone in men. Women 50 years and older and men 70 years and older have a greater chance of getting osteoporosis.
Other possible causes of osteoporosis are:
- chronic rheumatoid arthritis
- chronic kidney disease
- eating disorders
- corticosteroid medications (prednisone, methylprednisolone), taken every day for more than 3 months
- antiseizure medications
- confinement to a bed, and
- vitamin D deficiency.
The people with the greatest risk of getting this disease are white women, especially if they have a family history of osteoporosis. Women have smaller bones than men and lose bone faster because of hormone changes that happen after menopause. This makes it more likely for them to develop osteoporosis.
Other risk factors of osteoporosis are:
- not consuming enough calcium,
- smoking,
- alcohol abuse,
- low body weight,
- amenorrhea (absence of menstrual periods) for long periods of time,
- family history of osteoporosis, and
- history of hormone treatment for prostate cancer or breast cancer.
Individuals living with osteoporosis should eat a well balanced diet, exercise, and prevent falls.
Diet
People with osteoporosis should consume at least 1,200 mg/day of calcium. They should also get 800-1,000 international units of vitamin D3 to help their body absorb calcium. A doctor may recommend a calcium or vitamin D supplement. It is also important to eat enough protein.
Eating a healthy diet will not stop bone loss completely but will make the body has the materials it needs to form and maintain bones.
Examples of high-calcium food include:
- cheese,
- ice cream,
- green leafy vegetables (spinach, collard greens),
- low-fat milk,
- salmon,
- sardines (with bones),
- tofu, and
- yogurt.
Exercise
People with osteoporosis can reduce the risk of bone fractures with regular exercise. Some of the exercises recommended are:
- weight-bearing exercises such as walking, jogging, playing tennis, or dancing,
- resistance exercises like free weights, weight machines, or stretch bands,
- balance exercises, including tai chi and yoga,
- riding a stationary bicycle, and
- using rowing machines.
Prevent Falls
Preventing falls is very important for people with osteoporosis to reduce risk of fractures. A few ways to prevent an accident are:
- stay away from sedating medicines,
- remove household hazards,
- have good vision or get corrective lenses,
- avoid walking alone on icy days,
- use bars in the bathtub for stability, and
- wear shoes that fit well.
The goals of the doctor treating osteoporosis are to:
- reduce pain caused by the condition,
- stop or slow down bone loss,
- strengthen bone to prevent bone fractures, and
- decrease the risk of injuries that might cause fractures.
Medications can be used to strengthen bones. Doctors prescribe medication after osteoporosis or osteopenia (thin bones but not osteoporosis) have been diagnosed by a bone density study .
Biphosphonates
In postmenopausal women, biphosphonates are the primary drugs used either to prevent or treat osteoporosis. They are most commonly taken by mouth, but they can also be given through a vein. Biphosphonates include alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel). All of these are taken by mouth, usually once a week or once a month.
Calcitonin
Calcitonin is used to decrease the bone loss rate and relieve pain in the bones. It can be injected or taken through a nasal spray. Side effects include nasal irritation from the spray or nausea from the injection. It may not be as effective as biphosphonates.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) is not approved to treat women who have been diagnosed with osteoporosis and is rarely used anymore in its prevention. However, if estrogen has helped a patient and there is not another option to prevent osteoporosis, a doctor may recommend the patient continue its use.
If a woman is thinking about taking HRT to prevent osteoporosis, it is important that she discuss the risks with her doctor.
Parathyroid Hormone
Women who have severe osteoporosis and are at a high risk for fractures may be prescribed teriparatide (Forteo). Taken through shots underneath the skin, this medication is given daily at home.
Raloxifene
Similar to the breast cancer medicine tamoxifen, raloxifene (Estiva) is used for both prevention and treatment of osteoporosis. This drug is able to reduce the risk of spinal fractures by almost 50%, but it does not appear to prevent other fractures. Although there have not been enough studies, there is a chance that this medication can protect against heart disease and breast cancer. The side effects of this medicine are a slight risk of blood clots in the leg veins or the lungs.
Surgery
There are not any surgeries to treat osteoporosis. However, there is a procedure called vertebroplasty that can be used to treat any small fractures in the spinal column caused by osteoporosis. By strengthening the bones in the spinal column, in can also prevent weak vertebrae from becoming fractured. During this surgery, a fast-hardening glue is injected into the areas that are fractured or weak. Kyphoplasty is a similar procedure that uses balloons to widen the spaces that need the glue. The balloons are taken out during the surgery.