WHAT CAUSES OSTEOPOROSIS?
Women who are white or Asian, especially those with a
Osteoporosis occurs when there is an imbalance
between new bone formation and old bone resorption.
The body may fail to form enough new bone, or too much
old bone may be reabsorbed, or both. Two essential
minerals for normal bone formation are calcium and
phosphate. Throughout youth, the body uses these
minerals to produce bones. Calcium is essential for
proper functioning of the heart, brain, and other organs.
To keep those critical organs functioning, the body
reabsorbs calcium that is stored in the bones to maintain
blood calcium levels. If calcium intake is not sufficient or
if the body does not absorb enough calcium from thediet,
bone production and bone tissue may suffer. Thus, the
bones may become weaker, resulting in fragile and
brittle bones that can break easily.
Usually, the loss of bone occurs over an extended period
of years. Often, a person will sustain a fracture before
becoming aware that the disease is present. By then, the
disease may be in its advanced stages and damage may
be serious.
The leading cause of osteoporosis is a lack of certain
hormones, particularly estrogen in women
and androgen in men. Women, especially those older
than 60 years of age, are frequently diagnosed with the
disease. Menopause is accompanied by lower estrogen
levels and increases a woman's risk for osteoporosis.
Other factors that may contribute to bone loss in this
age group include inadequate intake of calcium
and vitamin D, lack of weight-bearing exercise, and other
age-related changes in endocrine functions (in addition
to lack of estrogen).
Other conditions that may lead to osteoporosis include
overuse of corticosteroids (Cushing syndrome), thyroid
problems, lack of muscle use,bone cancer, certain
genetic disorders, use of certain medications, and
problems such as low calcium in the diet.
The following are risk factors for osteoporosis:
Women are at a greater risk than men, especially women
who are thin or have a small frame, as are those of
advanced age.
Medical Author: Catherine Burt Driver, MD
Medical Editor: Melissa Conrad Stppler, MD, Chief Medical Editor
family member with osteoporosis, have a greater risk of
developing osteoporosis than other women.
Women who are postmenopausal, including those who
have had early or surgically induced menopause, or
abnormal or absence of menstrual periods, are at
greater risk.
Cigarette smoking, eating disorders such as anorexia
nervosa orbulimia, low amounts of calcium in the diet,
heavy alcoholconsumption, inactive lifestyle, and use of
certain medications, such as corticosteroids and
anticonvulsants, are also risk factors.
Rheumatoid arthritis itself is a risk factor for
osteoporosis.
Having a parent who has/had osteoporosis is a risk
factor for the offspring.
What Is the Medical Treatment for Osteoporosis?
Treatment for osteoporosis focuses on slowing down or
stopping the mineral loss, increasing bone density,
preventing bone fractures, and controlling the pain
associated with the disease.
Some 40% of women will experience a broken bone
(fracture) due to osteoporosis during their lifetime. In
those who have a vertebral fracture (in their back), one
in five will suffer another vertebral fracture within one
year. This condition potentially leads to more fractures.
This is called a "fracture cascade." The goal of treatment
is to prevent fractures.
Diet: Young adults should be encouraged to achieve
normal peak bone mass by getting enough calcium (1,000
mg daily) in their diet (drinking milk or calcium-fortified
orange juice and eating foods high in calcium such as
salmon), performing weight-bearingexercise such
as walking or aerobics (swimming is aerobic but not
weight-bearing), and maintaining normal body weight.
Specialists: People who have spinal, hip, or wrist
fractures should be referred to a bone specialist (called
an orthopedic surgeon) for further management. In
addition to fracture management, these people should
also be referred to a physical and occupational therapist
to learn ways to exercise safely. For example, someone
with spinal fractures would avoid touching their toes,
doing sit-ups, or lifting heavy weights. Many types of
doctors treat osteoporosis, including internists,
generalists, family physicians, rheumatologists,
endocrinologists, and others.
Exercise: Lifestyle modification should also be
incorporated into your treatment. Regular exercise can
reduce the likelihood of bone fractures associated with
osteoporosis.
Studies show that exercises requiring muscle to pull on
bones causes the bones to retain, and perhaps even gain,
density.
Researchers found that women who walk a mile a day
have four to seven more years of bone in reserve than
women who don't.
Some of the recommended exercises include weight-
bearing exercise, riding stationary bicycles, using rowing
machines, walking, and jogging.
Before beginning any exercise program, make sure to
review your plan with your doctor.
Are There Home Remedies for Osteoporosis?
If you suspect that you have signs or symptoms of
osteoporosis or have risk factors for osteoporosis, see
your doctor for further evaluation and treatment.
WHAT IS THE DIAGNOSIS?
Osteoporosis is the most common bone disease in
humans and affects both men and women. The clinical
and public health implications of the disease are
substantial because of the mortality, morbidity, and cost
of medical care associated with osteoporotic fractures.
Osteoporosis is diagnosed on the basis of a low-impact
or fragility fracture or low bone mineral density, which
was best assessed by central dual-energy x-ray
absorptiometry. Both nonpharmacological therapy
(calcium and vitamin D supplementation, weight-bearing
exercise, and fall prevention) and pharmacological
treatments (antiresorptive and anabolic agents) may be
helpful in the prevention and treatment of osteoporosis.
Therefore, clinicians need to be vigilant in instituting
primary prevention measures for those at high risk for
osteoporosis and in instituting treatment for patients
diagnosed as having the disease either by screening or a
history of fracture. This article provides an overview of
the diagnosis, screening, prevention, and treatment of
osteoporosis.
What exams and tests do health-care professionals use
to diagnose osteoporosis?
The doctor will usually begin with a careful history to
determine if you have osteoporosis or if you may be at
risk for the disease. You will be asked a variety of
questions regarding lifestyle and other conditions that
you may have. The doctor will also ask if you have a family
history of osteoporosis or a history of previous broken
bones. Often blood tests are used to measure calcium,
phosphorus, vitaminD, testosterone, and thyroid and
kidney function.
Based on a medical examination, the doctor may
recommend a specialized test called a bone mineral
density test that can measure bone density in various
sites of the body. The diagnosis of osteoporosis or
osteopenia can be made based on the results of these
tests. Osteopenia is lower-than-normal bone density not
severe enough to be classified as osteoporosis and is
considered by many experts to be a precursor to
osteoporosis. A bone mineral density test can detect
osteoporosis before a fracture occurs and can predict
future fractures. A bone mineral density test can also
monitor the effects of treatment if the tests are
performed a year or more apart and may help determine
the rate of bone loss.
Several different machines measure bone density. All are
painless, noninvasive, and safe. They are becoming more
readily available. In many testing centers, you don't even
have to change into an examination robe. Central
machines may measure density in the hip, spine, and
total body. Peripheral machines may measure density in
the finger, wrist, kneecap, shinbone, and heel.
The DXA (dual-energy X-ray absorptiometry) measures
the bone density of the spine, hip, or total body. With your
clothes on, you simply lie on your back with your legs on
a large block. The X-ray machine moves quickly over your
lower spine and hip area.
SXA (single-energy X-ray absorptiometry) is performed
with a smaller X-ray machine that measure bone density
at the heel, shinbone, and kneecap. Some machines
use ultrasound waves pulsing through water to measure
the bone density in your heel. You place your bare foot in
a water bath, and your heel fits into a footrest as sound
waves pass through your ankle. This is a simple way to
screen large numbers of people quickly. You might find
this type of screening device at a health fair. Bone loss
at the heel may mean bone loss in the spine, hip, or
elsewhere in the body. If bone loss is found in this test,
you might be asked to have the DXA to confirm the
results and get a better measurement of your bone
density.
The result of the bone mineral density is compared to two
standards, or norms, known as "age matched" and
"young normal." The age-matched reading compares
your bone mineral density to what is expected of
someone of your age, sex, and size. The young normal
reading compares your density to the optimal peak bone
density of a healthy young adult of the same sex. The
information from a bone mineral density test enables the
doctor to identify where you stand in relation to others
your age and to young adults (which is presumed to be
your maximum bone density). Scores significantly lower
than "young normal" indicate you have osteoporosis and
are at risk for bone fractures. The results will also help
the doctor to decide the best way to manage your bone
health. For patients who have borderline results, an
especially helpful new method of determining the 10-year
probability of fracturing bone can be determined using a
program called FRAX. This computation method is
available online and takes into account all risk factors for
a given individual to determine their personal risk for
fracture and, therefore, need for treatment.
WHAT IS THE MEDICAL TREATMENT FOR OSTEOPOROSIS?
Treatment for osteoporosis focuses on slowing down or
stopping the mineral loss, increasing bone density,
preventing bone fractures, and controlling the pain
associated with the disease.
Some 40% of women will experience a broken bone
(fracture) due to osteoporosis during their lifetime. In
those who have a vertebral fracture (in their back), one
in five will suffer another vertebral fracture within one
year. This condition potentially leads to more fractures.
This is called a "fracture cascade." The goal of treatment
is to prevent fractures.
Diet: Young adults should be encouraged to achieve
normal peak bone mass by getting enough calcium (1,000
mg daily) in their diet (drinking milk or calcium-fortified
orange juice and eating foods high in calcium such as
salmon), performing weight-bearingexercise such
as walking or aerobics (swimming is aerobic but not
weight-bearing), and maintaining normal body weight.
Specialists: People who have spinal, hip, or wrist
fractures should be referred to a bone specialist (called
an orthopedic surgeon) for further management. In
addition to fracture management, these people should
also be referred to a physical and occupational therapist
to learn ways to exercise safely. For example, someone
with spinal fractures would avoid touching their toes,
doing sit-ups, or lifting heavy weights. Many types of
doctors treat osteoporosis, including internists,
generalists, family physicians, rheumatologists,
endocrinologists, and others.
Exercise: Lifestyle modification should also be
incorporated into your treatment. Regular exercise can
reduce the likelihood of bone fractures associated with
osteoporosis.
Studies show that exercises requiring muscle to pull on
bones causes the bones to retain, and perhaps even gain,
density.
Researchers found that women who walk a mile a day
have four to seven more years of bone in reserve than
women who don't.
Some of the recommended exercises include weight-
bearing exercise, riding stationary bicycles, using rowing
machines, walking, and jogging.
Before beginning any exercise program, make sure to
review your plan with your doctor.
Are There Home Remedies for Osteoporosis?
If you suspect that you have signs or symptoms of
osteoporosis or have risk factors for osteoporosis, see
your doctor for further evaluation and treatment.
IS IT POSSIBLE TO PREVENT OSTEOPOROSIS?
Building strong bones during childhood and adolescence
can be the best defense against developing osteoporosis
later. The average woman has acquired 98% of her
skeletal mass by 30 years of age.
There are four steps to prevent osteoporosis. No one
step alone is enough to prevent osteoporosis.
Eat a balanced diet rich in calcium and vitamin D and high
in fruits and vegetables.
Engage in weight-bearing physical exercise.
Adopt a healthy lifestyle with nosmoking or excessive
alcohol intake.
Take medication to improve bone density when
appropriate.
WHAT IS THE PROGNOSIS FOR OSTEOPOROSIS?

With adequate treatment, the progression of

osteoporosis can be slowed, stopped, or reversed.
Nevertheless, some people become severely disabled as
a result of weakened bones. Some patients will fracture
their hip, pelvis, vertebrae, wrist, humerus, or leg in the
year following an osteoporotic vertebral fracture. Hip
fractures are a frequent fracture and leave about half of
those who break a hip unable to walk independently.
Women who have a hip fracture are at fourfold greater
risk for a second hip fracture. There is a significant
overall increase in mortality (death rate) in the year
after a hip fracture. By 80 years of age, 15% of women
and 5% of men have hip fractures. Thus, osteoporosis is
a serious disease that requires better efforts at
prevention, detection, and treatment.

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Medical Author: Catherine Burt Driver, MD
Medical Editor: Melissa Conrad Stppler, MD,
Chief Medical Editor