Health News
Health News
May 1, 2018
Understanding Osteoporosis

Osteoporosis, a disease caused by excessive bone loss, affects more than 54 million older Americans.  May is Osteoporosis Awareness Month, a time to look at the risk factors and treatments for osteoporosis, as well as some of the steps anyone can take to reduce their risk of developing the disease.  

To understand what osteoporosis does to our bones, we first must think about how our bones work.  Bone is a living tissue, just like our muscles and skin.  Bones are composed of collagen, a protein that helps make them flexible; and calcium, a mineral that hardens the bones and makes them strong. 

Throughout our lives, old bone is removed by the body and new bone is added.  In childhood, new bone is added much faster than the rate at which bone is removed.  This steady increase in bone mass continues into the early thirties, at which age a person reaches peak bone density and strength.  At that point, removal of bone gradually begins to overtake the addition of new bone. 

“While all people gradually experience decreased bone density and strength as they age, an excessive amount of bone loss is indicative of osteoporosis,” says Dr. Danielle Burkett, an obstetrician and gynecologist.   

Symptoms

Osteoporosis is sometimes called a “silent disease,” because it produces no noticeable symptoms.  Many times, the first indication of osteoporosis is an unexpected bone fracture because of a bump, minor fall or similar event that would not ordinarily cause a bone to break.  Because osteoporosis makes the bones weak, fractures can result much more easily.  A hip fracture is one of the most serious injuries that can result from osteoporosis.  The disease can also cause vertebrae to collapse, causing back pain and a stooping posture.    

Risk factors

The biggest risk factors for osteoporosis are age and gender.  As we get older and our bone density naturally decreases, our risk for the disease is higher.  People over the age of 50 are at greater risk for osteoporosis, and women have significantly higher risk than men.  Decreased estrogen levels following menopause elevate the risk of the disease in women.  Other risk factors that we cannot control include:

  • Race:  Caucasians and Asians are at greater risk.

  • Family history:  Osteoporosis can be hereditary.  

  • Body frame: People with smaller, thinner body frames are at increased risk for the disease.

Risk factors that can be controlled or mitigated include:

  • Hormone levels:  The loss of estrogen in women and testosterone in men can contribute to the onset of osteoporosis.  A physician may recommend hormone replacement therapy to reduce risk of osteoporosis, as well as to provide other health benefits. 

  • Thyroid issues:  An overactive thyroid can contribute to osteoporosis.  Diagnosis and treatment of this condition can help reduce risk. 

  • Diet:  Protein and calcium are essential for bone strength.  Getting adequate amounts of both helps reduce risk for osteoporosis.  Most people get plenty of protein in their diets, although vegetarians and vegans need to be intentional about making sure they do.  Many Americans, however, do not get enough calcium, especially as they get older. 

  • Lack of exercise:  An inadequate amount of exercise increases risk of osteoporosis.  Weight-bearing exercises, such as resistance training, lifting weights and walking help to build and maintain bone mass. 

  • Too much alcohol: Excessive alcohol consumption has been linked to bone loss.

  • Smoking:  Tobacco use contributes to bone loss, which is one more reason to stop smoking.

  • Eating disorders:  Eating disorders, such as anorexia nervosa and bulimia nervosa, can contribute to osteoporosis. 

Additionally, there are some medical conditions that elevate risk of osteoporosis, including:

Finally, prolonged use of steroid medications can contribute to bone loss, as do some types of weight-loss surgery. 

Diagnosis

Osteoporosis can be diagnosed and treated by physicians in a variety of fields, including primary care, internal medicine, obstetrics and gynecology, orthopedic medicine, endocrinology and rheumatology. Treatment for osteoporosis generally involves diet, exercise and prescription medication. 

Since osteoporosis has no symptoms, a physician can help determine if a patient is at risk for the disease.  Your provider may recommend a bone mineral density test, especially if you have one or more risk factors for osteoporosis.  This is a painless test, similar to an x-ray, that measures bone density in the hip and spine.  It can detect osteoporosis and predict the rate of future bone loss. 

Treatment

“The first thing we want to ensure for a patient who has osteoporosis is that she is getting plenty of calcium in her diet, as well as Vitamin D,” says Dr. Jamie Erwin, an obstetrician and gynecologist.  “Calcium helps make our bones stronger and Vitamin D helps the body better absorb calcium – this is especially important as we get older, as our bodies absorb calcium less readily than in our younger years.”

Calcium is found in dairy products, such as milk, cheese and yogurt.  It is also contained in dark leafy greens, such as broccoli and spinach.  Salmon and sardines provide calcium, as do almonds and tofu.  In addition, some foods contain added calcium, such as orange juice and certain breakfast cereals.  Another option is a calcium supplement, but it is best to ask your physician before beginning any supplement regimen. 

Vitamin D is produced through exposure to sunlight and is naturally present in some foods, such as fatty fish like tuna and salmon.  Vitamin D is also added to milk and some types of orange juice and breakfast cereal.  Your physician may check your Vitamin D level to help determine if an over-the-counter or prescription oral supplement is needed.

Exercise provides a number of health benefits, including stronger bones.  “While we want patients with osteoporosis to get plenty of exercise, we also want to be careful they don’t do anything that increases their risk of a bone fracture,” says Dr. James Herd, an obstetrician and gynecologist.  “Therefore, it is important that you talk with your physician about what types of exercise would be safest and most appropriate.”  Strength training with light weights and low-impact resistance training can help to gradually build strength and bone mass.  In fact, any weight-bearing exercise – including walking – helps bone strength, especially in the back and hips.

Additionally, exercises such as yoga and tai-chi help to improve balance and flexibility, which in turn help reduce the risk of falling.  Avoiding falls is very important for anyone with osteoporosis, given the heightened risk of a bone fracture. 

Medication is often a component of treatment for osteoporosis, helping to halt the progression of bone loss.  For women, hormone therapy to replace estrogen following menopause is a common treatment.  Similarly, testosterone replacement may be an option considered for a man.  Treatment of any thyroid conditions is also important and there are a multitude of other prescription medications for osteoporosis. 

Guard Against Falls

“Anyone with osteoporosis needs to be especially mindful of avoiding falls,” says obstetrician and gynecologist, Dr. Gerry Hoffman.  “Fall hazards are everywhere and it’s important to guard against them, both in and outside the home.”

Here are some of the most important things you can do to reduce your risk of falling:

  • Always use the handrail when walking up or down stairs.

  • Install a grab bar in the shower/bathtub.

  • Use a rubber mat in and outside the shower.

  • Wear shoes with a rubber sole and avoid walking in socks or slippers.

  • Maintain floors that are free of clutter and make sure rugs are secured to the floor.

  • Keep your rooms well-lit and avoid trying to walk in the dark.  Keep a flashlight near your bedside. 

  • If you have pets, always be mindful of where they are.  Don’t let your dog or cat get under your feet. 

  • Use a cane or walker for additional stability and control.

Reduce Your Risk

“Decreased bone strength and density is a natural part of the aging process.  While not everyone is able to prevent osteoporosis, due to risk factors beyond their control, there are steps we can all take to reduce the amount of bone we lose,” explains Dr. Mickey Hooper, an obstetrician and gynecologist.  “Just as with treatment for people who have osteoporosis, maintaining a good diet and exercise routine are two of the most important things we can do to cut our risk.”

“In addition, if you drink alcohol, drink only in moderation and avoid tobacco use,” adds Dr. Hooper. “Doing these things will help keep your bones stronger and healthier for a longer time.”

If you are over the age of 50, ask your health care provider about your risk for osteoporosis the next time you are in.  It’s a good idea to review your risk factors with your provider and assess whether a screening is appropriate.

This article contains information sourced from:

The National Institutes of Health

The Mayo Clinic

The American Academy of Orthopaedic Surgeons

National Osteoporosis Foundation