What is Osteoporosis?

calcium and osteoporosisOsteoporosis is a disease of the bones. It happens when you lose too much bone, make too little bone or both. As a result, bones become weak and can break from a minor fall or, in serious cases, even from simple actions, like sneezing or bumping into furniture.

Osteoporosis means “porous bone.” If you look at healthy bone under a microscope, you will see that parts of it look like a honeycomb. If you have osteoporosis, the holes and spaces in the honeycomb are much bigger than they are in healthy bone. This means your bones have lost density or mass and that the structure of your bone tissue has become abnormal. As your bones become less dense, they also become weaker and more likely to break. If you’re age 50 or older and have broken a bone, talk to your doctor or other healthcare provider and ask if you should have a bone density test..

Osteoporosis Is Common

About 9 million Americans have osteoporosis and an estimated 48 million have low bone density. This means that nearly 60% of adults age 50 and older are at risk of breaking a bone and should be concerned about bone health. Studies also suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.

Osteoporosis Is Serious

Breaking a bone is a serious complication of osteoporosis, especially when you’re older. Broken bones due to osteoporosis are most likely to occur in the hip, spine and wrist, but other bones can break too. Broken bones can cause severe pain that may not go away. With osteoporosis some people lose height and become shorter. It can also affect your posture, causing you to become stooped or hunched. This happens when the bones of the spine, called vertebrae, begin to break or collapse.
Osteoporosis may even keep you from getting around easily and doing the things you enjoy. This can make you feel isolated and depressed. It can also lead to other health problems. Twenty percent of seniors who break a hip die within one year from problems related to the broken bone itself or surgery to repair it. Many of those who survive need long-term nursing home care.

Osteoporosis Is Costly

Osteoporosis is responsible for two million broken bones and $19 billion in related costs every year. By 2025, experts predict that osteoporosis will be responsible for approximately three million fractures and $25.3 billion in costs each year.

Osteoporosis Can Sneak up on You

osteoporosisOsteoporosis is often called the “silent disease,” because you could have it now or be at-risk without even realizing it. You can’t feel your bones becoming weaker. Breaking a bone is often the first clue that you have osteoporosis or you may notice that you are getting shorter or your upper back is curving forward. If you are experiencing height loss or your spine is curving, talk to a doctor or healthcare professional right away as the disease may be advanced.

Making a Diagnosis

A medical evaluation to diagnose osteoporosis and estimate your risk of breaking a bone may involve one or more of the following steps:

  • Medical history
  • Physical examination
  • Bone density test
  • FRAX® score
  • Laboratory tests

Other tests that may be used to get information about your bone health, but are not used to diagnose osteoporosis include biochemical marker tests, x-rays, vertebral fracture assessments (VFAs), and bone scans.

Medical History
Your healthcare provider will ask questions to better understand your risk. Factors he or she may consider include:

  • Your age
  • Your gender
  • Whether you have reached menopause (women)
  • Your personal history of broken bones as an adult
  • Your family history of broken bones and osteoporosis
  • Your smoking or drinking habits
  • Your diet, including how much calcium and vitamin D you get
  • Your exercise and physical activity
  • Whether you have had an eating disorder such as anorexia nervosa
  • Whether you have had regular periods (premenopausal women)
  • Your testosterone levels (men)
  • Whether you take any medicines or have any medical conditions that may cause bone loss. (below)

Medicines that May Cause Bone Loss

  • Aluminum-containing antacids
  • Antiseizure medicines (only some) such as Dilantin® or Phenobarbital
  • Aromatase inhibitors such as Arimidex®, Aromasin® and Femara®
  • Cancer chemotherapeutic drugs
  • Cyclosporine A and FK506 (Tacrolimus)
  • Gonadotropin releasing hormone (GnRH) such as Lupron® and Zoladex®
  • Heparin
  • Lithium
  • Medroxyprogesterone acetate for contraception (Depo-Provera®)
  • Methotrexate
  • Proton pump inhibitors (PPIs) such as Nexium®, Prevacid® and Prilosec®
  • Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro®, Prozac® and Zoloft®
  • Steroids (glucocorticoids) such as cortisone and prednisone
  • Tamoxifen® (premenopausal use)
  • Thiazolidinediones such as Actos® and Avandia®
  • Thyroid hormones in excess

Note: This list may not include all medicines that may cause bone loss

Diseases and Conditions that May Cause Bone Loss

Many health problems can increase your chance of getting osteoporosis. Ask your healthcare provider if you have any diseases or conditions that can cause bone loss. If you do, it’s important to take action to keep your bones healthy. In some cases, when you treat a health problem that causes bone loss, you can improve your bone health. Diseases and conditions that may cause bone loss include:

Autoimmune Disorders

  • Rheumatoid Arthritis (RA). RA is a form of arthritis that is associated with an increased risk for osteoporosis. Steroid medicines, which are used to treat RA, can also increase the risk of osteoporosis.
  • Lupus. People with lupus may need to take medicines, including steroids, to control their symptoms. These medicines can lead to bone loss and osteoporosis.
  • Multiple sclerosis
  • Ankylosing spondylitis

Digestive and Gastrointestinal Disorders

  • Celiac Disease. People with celiac disease have trouble digesting foods with gluten. Gluten is found in grains such as wheat, rye and barley. People with celiac disease also have problems absorbing nutrients, including calcium and vitamin D. Celiac disease doesn’t always cause noticeable symptoms. Ask your doctor if you should have a test for celiac disease.
  • Inflammatory Bowel Disease (IBD). Different forms of IBD, such as Crohn’s disease andulcerative colitis, can cause bone loss. Steroid medicines are often used to treat these conditions, which can also contribute to bone loss.  People with IBD may also have trouble absorbing the calcium and vitamin D needed for healthy bones.

Weight Loss Surgery

  • Weight loss procedures such as gastric bypass surgery can help people lose a large amount of weight in a short period of time. This weight loss may lead to bone loss. These procedures can also interfere with the body’s ability to properly absorb the vitamins and minerals needed for bone health.

Gastrectomy

Gastrointestinal bypass procedures

Endocrine/Hormonal Disorders

  • Diabetes. People with diabetes have a higher risk of developing osteoporosis. While type 1 diabetes seems to cause the greatest amount of bone loss, people with both type 1 and type 2 diabetes have an increased risk of breaking bones.
  • Hyperparathyroidism is a condition in which the parathyroid glands (two pairs of small glands located behind the thyroid in the neck) produce too much parathyroid hormone (PTH). Having too much PTH causes bone loss. This condition is more common in women after menopause. A simple blood test can detect this problem.
  • Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone. This can lead to weak muscles and fragile bones. Bone loss can also occur if a person takes too much thyroid hormone medicine for an underactive thyroid.
  • Cushing’s syndrome
  • Thyrotoxicosis
  • Missing Periods. If you are a young woman and don’t have regular periods, this could mean low estrogen levels. There could be many reasons for this, such as exercising too much or eating so little that you become too thin. Other causes of irregular periods could include disorders of the ovaries or pituitary. Loss of estrogen and extreme thinness can harm bones and affect other body systems. Young women who don’t have regular periods should talk to their healthcare provider about their bone health.
  • Premature Menopause
  • Testosterone and Estrogen Levels in Men. Testosterone protects bone. Very low levels of testosterone suggest that there is an underlying disorder that needs to be evaluated. Estrogen levels in men are also important. Low levels of these hormones can lead to bone loss. A number of factors can cause levels to be low, such as an eating disorder or drinking too much alcohol. A blood test can tell you if your hormone levels are normal.

Hematologic/Blood Disorders

  • Leukemia and Lymphoma. Many of the medicines, including chemotherapy, used to treat these two forms of cancer can lead to bone loss and osteoporosis.
  • Multiple Myeloma. Multiple myeloma is a cancer of the bone marrow. Its first symptoms may be back pain and broken bones in the spine. Blood and urine tests can detect the problem. Other forms of cancer that affect bones or bone marrow can also cause broken bones.
  • Sickle Cell Disease. People with sickle cell disease may need to take medicines, including steroids, to control their symptoms. These medicines can lead to bone loss and osteoporosis.

Blood and bone marrow disorders

  • Thalassemia

Neurological/Nervous System Disorders

  • Stroke, Parkinson’s disease and multiple sclerosis (MS) reduce mobility. People with these conditions are more likely to be inactive, fall and have low vitamin D levels.
  • Spinal cord injuries

Mental Illness

  • Depression. Research suggests that people with depression are more likely to have low bone density or osteoporosis. This link is probably due to multiple factors, including the use of selective serotonin reuptake inhibitors (SSRIs) medicines. More studies will help us better understand the relationship between depression and osteoporosis.
  • Eating Disorders. In women with anorexia nervosa, estrogen levels decrease to such an extent that menstrual periods either become irregular or stop. This drop in estrogen can cause bone loss and osteoporosis. In addition to causing low estrogen levels, anorexia nervosa and other eating disorders can lead to bone loss in females and males for other complex reasons.

Cancer

  • Breast Cancer. Aromatase inhibitors are commonly used to treat women with estrogen-sensitive breast cancer. Because these medicines reduce the amount of estrogen in the body, they can lead to bone loss and broken bones.
  • Prostate Cancer. Androgen deprivation therapy is commonly used to treat men with prostate cancer. Because these medicines reduce the amount of male sex hormones in the body, they can lead to bone loss and broken bones.

AIDS/HIV

  • Chronic obstructive pulmonary disease (COPD), including emphysema
  • Female athlete triad (includes loss of menstrual periods, an eating disorder and excessive exercise)
  • Kidney disease that is chronic and long lasting
  • Liver disease that is severe, including biliary cirrhosis
  • Organ Transplants. People who have organ transplants must take medicines to prevent their bodies from rejecting their new organs. Some of these drugs can weaken bones.
  • Polio and post-polio syndrome
  • Poor diet, including malnutrition
  • Scoliosis
  • Weight loss

Note:  This list may not include all diseases and conditions that may cause bone loss.

Are Osteoporosis and Osteoarthritis Connected?

Many people confuse osteoporosis and osteoarthritis, the most common form of arthritis. However, although people can have both of these diseases, they have very different causes and treatments.

Physical Examination

Your healthcare provider may measure you to see if you have lost height and examine your spine. After age 50, you should have your height checked without shoes every year at the same healthcare provider’s office.

Bone Density Test

bone density testA bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. NOF recommends a bone density test of the hip and spine by a central DXA machine to diagnose osteoporosis. DXA stands for dual energy x-ray absorptiometry.

FRAX® – The WHO Fracture Risk Assessment Tool

The FRAX® tool uses information about your bone density and other risk factors for breaking a bone to estimate your 10-year fracture risk. Your FRAX® score estimates your chance of breaking a hip as well as your combined chance of breaking a hip or other major bones over the next ten years. Other major bones include the spine, hip, forearm and shoulder.

The FRAX® tool can be used to guide treatment decisions in people who meet the following three conditions:

  • Postmenopausal women or men age 50 and older
  • People with low bone density (osteopenia)
  • People who have not taken an osteoporosis medicine
  • If you have low bone density (osteopenia), your DXA report may include your FRAX® score along with your bone density. If it doesn’t, your healthcare provider can find out your FRAX® score using a web-based version.
  • Laboratory Tests
  • Blood and urine tests can be used to identify possible causes of bone loss. Some of these tests include:
  • Blood calcium levels
  • 24-hour urine calcium measurement
  • Thyroid function tests
  • Parathyroid hormone levels
  • Testosterone levels in men
  • 25-hydroxyvitamin D test to determine whether the body has enough vitamin D
  • Biochemical marker tests, such as NTX and CTX

Some of the tests listed above can help to identify if you have another medical condition that is causing bone loss. This is called secondary osteoporosis. Depending on your symptoms and other risk factors, your healthcare provider may want to test you for other conditions that can cause bone loss. If you have another condition that is causing bone loss, treating that condition will usually help your bone health. But, for many people, there is often no known cause for their bone loss or osteoporosis.

Other Tests to Evaluate Bone Health

Biochemical marker tests of the blood and/or urine may help to estimate how fast you’re losing or making bone. X-Rays and Vertebral Fracture Assessments (VFAs) can show breaks in the spine.

Nuclear bone scans, CT Scans or MRIs can show changes that may be caused by cancer, bone lesions, inflammation, new broken bones or other conditions. They are often used to help find the cause of back pain or to follow up on abnormalities seen on an x-ray.