Osteoporosis is a disease that increases the risk of bone fractures in older adults, especially women. May is National Osteoporosis Awareness and Prevention Month, a time to look at the risk factors and treatments for osteoporosis, as well as some of the steps we can take to reduce our risk of developing the disease.
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 when a person reaches peak bone density and strength. At that point, removal of bone gradually begins to overtake the addition of new bone.
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. Because osteoporosis makes the bones weak, fractures result 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.
The biggest risk factors for osteoporosis are age and gender. As we get older and our bone density naturally decreases, the 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.
The 2017-2018 National Health and Nutrition Examination Survey found that among adults 50 and older, 19.6% of women and 4.4% of men had osteoporosis. Decreased estrogen levels following menopause elevate the risk of the disease in women, who have smaller bone structures to begin with.
Other risk factors include:
- Race: Caucasians and Asians are at greater risk, though African American and Hispanic women also have significant risk.
- Family history: Osteoporosis can be hereditary.
- Body frame: People with smaller, thinner body frames are at increased risk.
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.
- 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 the 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 the risk of osteoporosis.
- 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:
- Inflammatory Bowel Disease
- Rheumatoid arthritis
- Kidney or liver disease
- Parathyroid diseases
Finally, prolonged use of steroid medications can contribute to bone loss, as do some types of weight-loss surgery.
Diagnosis & Screenings
Osteoporosis can be diagnosed and treated by physicians in a variety of fields, including internal and family 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.
The U.S. Preventive Services Taskforce recommends osteoporosis screenings for:
- All women over the age of 65 and
- Women of any age who have other risk factors for osteoporosis.
“A patient who has osteoporosis needs plenty of calcium in her diet, as well as Vitamin D,” says Dr. Lori Atkins, 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 have a harder time absorbing calcium.”
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 taking supplements.
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 a supplement is needed.
Exercise provides numerous 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,” explains Dr. James Bothwell, an orthopedic surgeon. “That’s why 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.
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,” warns Dr. Mark Presley, an orthopedic surgeon. “Fall hazards are everywhere and it’s important to protect 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 some risk factors for osteoporosis are beyond our control, there are steps we can all take to reduce the amount of bone we lose,” says Dr. Rajiv Dattatreva, an endocrinologist in Irving.
“Maintaining a good diet and getting exercise help keep your bones healthy. In addition, if you drink alcohol, drink only in moderation and avoid tobacco use,” adds Dr. Jamie Wiebel, an endocrinologist in Dallas. “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 has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
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