Osteoporosis

Osteoporosis is a disease that occurs when new bone isn’t built up as quickly as old bone is being lost. As a result, your bones become porous, weaker, and more brittle – so brittle that they might even break (fracture) if you fall or get a minor bump. Osteoporotic fractures usually occur in the hips, spine, and wrists.

Osteoporosis is more common in older people and in women who have gone through menopause.

What causes osteoporosis?

Your bone cells are constantly dying and being renewed. When you’re young, the renewal process happens faster than the bone loss, allowing you to increase your bone mass and grow. After your 30s, the process begins to slow, and then you will start to lose bone faster than you regrow it.

Can osteoporosis be cured?

There is no one “cure” for osteoporosis, but many effective treatments are available.

You and your doctor can decide the best treatment plan for you.

Symptoms of osteoporosis

Osteoporosis is a disease that can sneak up on you. In the early stages of the disease, you may experience no symptoms at all. You might only find out about your osteoporosis because of a screening or because you get a fracture. As osteoporosis progresses, you may experience symptoms like:

  • Back pain. This is usually caused by a vertebral fracture somewhere along your spine.
  • Stooped posture. The bones in your spine may start to collapse or become deformed due to osteoporosis. This causes your upper back to curve forward and your posture to become stooped.
  • Shortness of breath. This may happen if you have a compression fracture that reduces your lung’s ability to expand.
  • Loss of height.
  • More fractures than usual, or getting a broken bone after only a minor fall or bump.

The symptoms of osteoporosis may look like other bone disorders or health problems. Always consult your healthcare provider for an expert diagnosis.

Heart and Vascular Care

Risk factors for osteoporosis

Common risk factors

A risk factor is anything that increases your chance of developing a disease. Risk factors for osteoporosis include:

  • Biological sex. Women are much more likely to develop osteoporosis than men. This is in part due to hormonal differences and differences in peak bone mass.
  • Peak bone mass. People with slight frames and lower peak bone mass are more likely to develop osteoporosis.
  • Hormones. Estrogen and testosterone, two sex hormones, play important roles in bone growth.
    • For women, menopause reduces your estrogen levels, which can contribute to osteoporosis. Additionally, any medical treatment that might affect your estrogen levels, such as some breast cancer treatments or having your ovaries removed surgically (oophorectomy), can contribute to osteoporosis.
    • For men, testosterone levels gradually decline with age. Certain treatments for prostate cancer can also lower your testosterone levels. Both of these things increase your risk of developing osteoporosis.

Other hormone problems

Other hormones also play an important role in bone health and renewal. In particular, hormones produced by your thyroid, parathyroid, and adrenal glands all influence your osteoporosis risk.

The following diseases increase your likelihood of developing osteoporosis:

  • Hyperthyroidism, in which you produce too much thyroid hormone.
  • Hyperparathyroidism, in which you produce too much parathyroid hormone.
  • Cushing’s disease, which means your adrenal glands produce too much stress hormone.

Older couple holding hands on path

Other risk factors

Your genes. Genes play a role in all sorts of things: your height and frame size, your hormones, and your risk for bone disease. If a close family member (a parent or sibling) has osteoporosis, you are more likely to develop the condition yourself.

Other medical problems. A wide variety of other medical problems have been linked to osteoporosis. These include:

  • Blood cancers including multiple myeloma, leukemia, and lymphoma.
  • Digestive disorders, such as celiac disease and inflammatory bowel disease (IBD). Also, certain weight loss surgeries, like gastric bypass, are associated with osteoporosis.
  • Chronic kidney or liver disease.
  • Autoimmune disorders such as lupus and rheumatoid arthritis.
  • Mental illnesses such as depression and eating disorders.

Certain medications. Some medications and treatments can interfere with bone formation. These include:

  • Anti-seizure medications.
  • Certain cancer treatments, especially for treating prostate and breast cancer but also other chemotherapy drugs.
  • Proton pump inhibitors and other medications used to treat acid reflux or gastroesophageal reflux disorder (GERD).
  • Steroids.
  • Certain medications used for treating depression, such as selective serotonin reuptake inhibitors, or SSRIs.

Lifestyle risk factors

Certain lifestyle habits also increase your risk of osteoporosis. These include:

  • Consuming too much alcohol. This is defined as drinking two or more glasses of alcohol a day.
  • Leading a sedentary lifestyle. People who do not exercise and spend a lot of time sitting likely have a greater risk for developing osteoporosis.
  • Poor nutrition. A poor diet can cause calcium and vitamin D deficiencies. We need these nutrients to keep our bones healthy.
  • Using tobacco products or smoking cigarettes.

Diagnosing osteoporosis

You should talk to your doctor if you have symptoms of osteoporosis, have gone through menopause, or if you have any other risks for osteoporosis. Your healthcare provider may recommend that you get regular osteoporosis screenings.

Bone density scan

A bone density test/bone mineral density test (DEXA scan) is most commonly used to diagnose osteoporosis. This test uses an X-ray to measure your bone mass and determine the density of calcium and other minerals in your bones.

Your FRAX score

Based on your bone density test and factors like your sex, weight, and medical history, your doctor may give you a “FRAX score.” This is an estimate of your risk of a fracture within 10 years. It can give you an idea of how severe the disease is and what steps you might need to treat it.

Provider and patient having a discussion

If you have untreated osteoporosis, you may develop complications. These include:

  • More frequent bone fractures, especially hip fractures, wrist fractures, or spine fractures. These can happen after you fall. In extreme cases, they can even happen after you cough or sneeze.
  • Compression fractures. A compression fracture is a type of spinal fracture that can happen when the bones in your spine become so weak that they practically crumble under the pressure of you standing. This can lead to back pain, stooping, and decreased height.
  • Loss of mobility or disability. This can happen as a result of fractures. Hip fractures and spine fractures can impair your ability to walk and do physical activities, diminishing your quality of life.

Woman and provider looking at tablet

You can’t stop the progression of osteoporosis without medication. However, you can make some lifestyle changes to reduce bone loss and improve your bone health.

  • Stop smoking. Smoking is linked to osteoporosis and many other medical conditions. Stopping is a good step towards improving your health.
  • Limit alcohol consumption. Drinking more than two drinks a day increases both your risk for osteoporosis and your risk of falling. Limit your consumption, and consider getting professional help.
  • Eat well. Prevent nutrient deficiencies and maintain your strength by eating a varied diet full of fruits, vegetables, whole grains, and lean proteins. Try to up your calcium intake by drinking a cup of skim milk or including more vegetables like broccoli in your diet. For vitamin D, try foods like salmon, mushrooms, and eggs. If you have a dietary condition like celiac disease, irritable bowel disease (IBD), or others, you may want to talk to a dietician about how you can maximize your nutrition.
  • Exercise. Exercise is a great way to combat bone loss in everyone. Consider taking up weight-bearing or resistance exercise, like weight lifting, walking or jogging, or aerobic activities like dancing. Start slow and work up to more exercise. Yoga and balance exercises are also good ways to reduce your risk of falls. Be sure to talk to your doctor about your exercise routine as well. They can recommend safe, effective ways to exercise.

Many people with osteoporosis need to take medications to reverse the bone loss and maintain bone strength long term. There is no “best” medication for osteoporosis; you may need different medications based on your age, your risks, and your overall health.

  • Bisphosphonates are antiresorptive drugs, or drugs that stop your body from reabsorbing bone tissue. They are widely prescribed for people at risk for osteoporotic fractures. Your doctor may recommend you take them daily, weekly, or monthly. They can be taken by mouth (as a pill), through an IV infusion, or by injection. Side effects include flu-like symptoms, headaches, abdominal pain, and heartburn-like symptoms. But these often go away, and taking your medication properly can reduce them.
  • Hormone therapy. Many hormones are involved in osteoporosis, so the exact medications you receive will depend on your underlying risk factors.
    • If you have gone through menopause, your doctor may recommend estrogen therapy, which involves taking pills with a synthetic form of estrogen. Estrogen therapy is also used to manage symptoms of menopause. However, if you have a history of breast cancer or are at risk for breast cancer, estrogen therapy may not be right for you.
    • Another option is Raloxifene, a drug that mimics the effect of estrogen on your bones without the risks associated with estrogen therapy. However, hot flashes are a common side effect, and Raloxifene increases your risk for blood clots.
    • If you are a man with low testosterone, your doctor may recommend testosterone replacement therapy. Often, this will be combined with other osteoporosis medications, which are generally more effective.

  • Denosumab (Prolia). This therapy works by preventing your body from breaking down and reabsorbing bone tissue. It is an injection that you get every six months continuously, and it’s often used when other treatments fail. Since it’s a newer therapy, the long-term outcomes of denosumab use aren’t fully known.
  • Bone-building medications (anabolic agents). These medications work by increasing your body’s rate of bone formation. Often, you will only take these medications for a few years before switching to another medication to maintain your new bone growth. Common anabolic agents are:
    • Teriparatide (Forteo) and Abaloparatide (Tymlos). These drugs mimic your parathyroid hormone to increase new bone growth. They are usually given as a daily injection for two years.
    • Romosozumab (Evenity). This is a newer drug that also mimics your parathyroid hormone. It is given as a monthly injection for one year.
  • Supplements. Your doctor may prescribe or recommend that you take calcium and vitamin D supplements in addition to other treatments and medications. Be sure to follow your doctor’s instructions and take the right dose of these supplements. Your body can only absorb a small amount of calcium at a time, and taking more calcium than you need doesn’t help with osteoporosis.

Be supplement-aware. Many calcium and vitamin D supplements are available over-the-counter, but you should be careful with these. They may claim to be ‘natural,’ but this does not necessarily mean they are better. Over-the-counter supplements are not strictly regulated, and the dosing may not be correct for your body.

Be sure to talk to your doctor about any supplements you take or are planning to take.

Reducing the risks of osteoporosis

You can’t always prevent osteoporosis. However, you can reduce your risk by controlling your lifestyle habits and getting regular screenings as you get older. Take the following steps to help reduce your risk of osteoporosis:

  • Lead an active life. Exercise is a great way to increase your bone strength throughout your life. No matter your age, try to go for regular walks and take up other exercises like jogging, swimming, dancing, or weight lifting. If you have reduced mobility, talk to your doctor about seeing a physical therapist or exercise specialist who can help you find workouts that are right for you.
  • Get outside. Sunshine is important for vitamin D production, so spend some time outdoors exercising! Just don’t forget a hat and sunscreen.
  • Eat well. Get plenty of nutrients from whole foods like grains, fruits, vegetables, and lean proteins.
  • Prevent falls inside and outside your home. If you have osteoporosis or low bone density, consider fall-proofing your home. Tuck cables and wires under carpets or duct tape, keep rooms well-lit, add rugs or floor traction to slippery spots, and consider installing grab bars in your shower or bath.