Five important facts about osteoporosis

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Normal bones are not solid. They have a honeycomb structure under the microscope, with small pockets of space between a lattice of bone cells. However, people with osteoporosis have bones with abnormally wide spaces. In fact, osteoporosis means “porous bone”.

In osteoporosis, the body loses too much bone, makes too little bone, or both. People with osteoporosis can have such weak bones that minor falls, bumps, or even a strong sneeze can cause a bone to break!

Here are five things you may not know about osteoporosis:

1. Osteoporosis is called the “silent bone disease” because it is often diagnosed only after a bone breaks

Osteoporosis affects mainly people over the age of 65, and women are more likely than men to have it. About 25% (1 in 4) of women aged 65 and over and about 6% (1 in 17) of men aged 65 and over have osteoporosis. However, most of these people are not aware they have the disease until they break a bone.

Broken bones, especially in the hips and spine, can cause a great deal of pain and disability. Many people who break a hip are not able to live independently afterward. In the spine, the small bones, called vertebrae, can accumulate multiple breaks. Over time, this can cause a person to lose height, stoop forward, or have a “hunch back”.

2. Some risk factors for osteoporosis can be changed, and others cannot

Risk factors that cannot be changed include:

  • Gender. Women are much more likely to get osteoporosis than men.
  • Age. The risk increases with increasing age.
  • Body size. Small, thin people are more at risk than heavier, taller people.
  • Ethnicity. Caucasian and Asian people are at higher risk than black and Latino/a people.
  • Family history. Osteoporosis tends to run in families. Having a family member with the disease, especially one who has broken a major bone (hip, wrist, etc.), greatly increases your risk.
  • Having a disease that causes bone loss. There are many such diseases, including lupus, certain cancers, celiac disease, inflammatory bowel disease, chronic kidney disease, chronic obstructive pulmonary disease, thyroid disease, and hormonal conditions, among others.

Risk factors that have the potential to be changed include:

  • Taking a medication that can cause bone loss. These include aluminum-containing antacids, proton pump inhibitors, chemotherapy drugs, certain types of steroids, lithium, heparin, and certain types of hormone therapies.
  • Too low a level of sex hormones. Low levels of estrogen (in women) or testosterone (in men) increase the risk of developing osteoporosis.
  • Anorexia nervosa. This eating disorder can lead to osteoporosis because of poor nutrient intake.
  • Too little calcium and vitamin D. These nutrients are needed to maintain bone.
  • Lack of exercise. Weight bearing exercises (walking, jogging, dancing, lifting weights, hiking, playing tennis, etc.) are best for building up bone mass and preventing bone loss. Lack of exercise increases the risk of bone loss.
  • Smoking. Smokers are at high risk of osteoporosis.
  • Drinking alcohol. Limit drinks to no more than 2 to 3 per day.

3. Screening tests for osteoporosis are readily available

Your doctor or healthcare provider can order a screening test for osteoporosis. The test uses low-level x-rays to look at bone mass, and it is called dual/energy x-ray absorptiometry (DXA). A DXA scan can show whether or not you already have osteoporosis. It can also show whether you have borderline low bone mass, which would put you at much higher risk for developing osteoporosis in the future.

The Centers for Disease Control and Prevention (CDC) recommends that all women who are 65 years old or older be screened with DXA. Younger women, or men of any age, should be screened if they have a certain number of the risk factors described above. Your doctor can use an online risk calculator to determine if you should be screened.

4. Osteoporosis is treated with diet, supplements, exercise, and medication

Eating a diet rich in calcium is especially important for people at risk of osteoporosis, or those who already have it. Good sources of calcium include dairy products, leafy greens, and fortified foods such as cereal or orange juice.

Supplements commonly prescribed for osteoporosis include calcium, if dietary intake is not enough, and vitamin D. There are few foods that naturally contain vitamin D. Our bodies make vitamin D when skin is exposed to sunlight, but many people avoid the sun or use sunscreen to reduce skin cancer risk. Sunscreen blocks the body’s ability to make vitamin D. That is why most people at risk of osteoporosis or those who already have the disease are advised to take vitamin D supplements.

Weight-bearing exercises, such as hiking, jogging, walking, dancing, lifting weights, and climbing stairs, can help build bone mass and protect the bone mass you still have. Your doctor can tell you which exercises are safe and recommended, based upon the strength of your bones. People with very fragile bones should not do high-intensity exercise because of the risk of a break.

Medications for osteoporosis fall into two categories. Antiresorptive medications slow the rate of bone loss in the body. These medications include bisphosphonates (such as alendronate, risedronate, ibandronate, or zoledronic acid), calcitonin, denosumab, oral estrogen, and raloxifene. Anabolic medications increase the rate of new bone formation. There is only one approved anabolic medication at this time, called teriparatide.

5. If you have osteoporosis, it is vital to prevent falls

Falls are the number one cause of fractures in people with osteoporosis. According to the National Institutes of Health, some good ways for preventing falls include:

  • Use a cane or walker
  • Wear rubber-soled shoes
  • Avoid slippery sidewalks or driveways, or spread kitty litter or salt on them
  • Keep rooms free of clutter, especially on floors
  • Use carpet runners on slippery floors
  • Wear low-heeled shoes that provide good support
  • Do not walk in socks, stockings, or slippers
  • Be sure carpets and area rugs have skid-proof backs or are tacked to the floor
  • Be sure stairs are well lit and have rails on both sides
  • Put grab bars on bathroom walls near tub, shower, and toilet
  • Use a rubber bath mat in the shower or tub
  • Keep a flashlight next to your bed
  • Use a sturdy step stool with a handrail and wide steps
  • Add more lights in rooms
  • Do not rush through the house to answer the door or telephone

Further reading

National Osteoporosis Foundation. What is Osteoporosis and What Causes It?

National Osteoporosis Foundation. Medicines Approved to Treat Osteoporosis.

The Centers for Disease Control and Prevention. Does Osteoporosis Run in My Family?

The National Institutes of Health. What Is Osteoporosis? Fast Facts: An Easy-to-Read Series of Publications for the Public.

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