Osteoporosis is a common condition affecting more than 3 million people each year in the United States. Osteoporosis causes bones to weaken, become brittle, and become easily susceptible to fractures. Even something as simple as coughing or bending over can cause a fracture or compress weakened vertebrae. Osteoporosis-related fractures are most common in the wrist, hip, or spine, but can occur anywhere in your body.
There is no known cure for osteoporosis, but you can manage this condition by stopping or slowing bone loss and improving bone density. Osteoporosis seems to run in families, and although it affects men and women of all races, Asian and Caucasian women over the age of 50 are most at risk. Some other groups of people at a higher risk of developing osteoporosis include people of both sexes who:
- Use tobacco
- Did not build enough bone mass during their youth
- Have overactive parathyroid or adrenal gland
- Have not participated in enough weight-bearing exercises
- Have lowered sex hormones, which usually happens as we grow older
- Have too much thyroid hormone (overactive thyroid or hyperthyroidism)
- Have small body frames because they have less bone mass to draw upon
- Have not eaten many foods with enough calcium and vitamin D or taken enough calcium supplements
- Take or have taken some medications that are used to combat cancer, seizures, gastric reflux, and transplant rejection
- Have a high consumption of alcohol
- Certain medical conditions such as lupus, cancer, celiac disease, kidney or liver disease, inflammatory bowel disease, multiple myeloma, or rheumatoid arthritis
- Have had gastrointestinal surgery to reduce the size of their stomach or remove part of the intestine, which limits the amount of surface area available to absorb calcium
- Are underweight because maintaining an appropriate body weight helps provide bones with enough calcium
- Have a sedentary lifestyle – weight-bearing exercises and activities strengthen bones and include things like walking, running, dancing, jumping, and weightlifting
- Are taking or have taken steroids such as prednisone and cortisone because steroids interfere with the bone-building process
Osteoporosis can progress entirely unnoticed for decades. The first indication of osteoporosis is likely to be the pain of a broken bone or collapsed vertebra, but additional symptoms may include:
Diagnosis of osteoporosis begins with a doctor’s visit, where you will receive an examination, have your medical history and your family’s medical history taken, and discuss your symptoms. Your doctor may order a bone mineral density (BMD) test.
Most doctors recommend women get a BMD test no later than age 65, and men by 70. But if you are younger and have had a broken bone after a minor injury, a BMD test may be in order.
A bone density test is easy, quick, and painless. During this test, you simply lie on a table as a scanner passes over you, using a very low dose of x-rays to determine the proportion of minerals in your bones. Only a few bones are checked in most cases – usually in the hip, spine, and wrist.
There are many options for treating osteoporosis. These include supplements, monoclonal antibody medications, bisphosphonates, bone-building medications, and lifestyle changes. The bone density test estimates the risk of breaking a bone in the next 10 years, and this information will help your doctor determine the best treatment for you.
Because our bones are constantly being broken down and reformed in a process known as bone remodeling, our bodies need certain minerals to complete this process. Supplements such as vitamin D, magnesium, boron, vitamin K, soy isoflavones, zinc, selenium, copper, and calcium, manganese, and silicon are essential to building healthy bones. If you find it challenging to get enough of these vital minerals from your diet, consider taking supplements.
Bisphosphonates are frequently used to treat osteoporosis in men and women. Your doctor may prescribe bisphosphonates, such as alendronate, risedronate, ibandronate, and zoledronic acid. You can take bisphosphonates by mouth or intravenously (in your vein). You will typically take oral medicines once a week. These medications can cause side effects such as heartburn symptoms. For those who cannot tolerate oral medication, bisphosphonates can be administered intravenously. Intravenous forms of bisphosphonates do not upset the stomach but may cause headaches, muscle aches, or fever for up to a few days. After several years of therapy, your doctor may recommend discontinuation for a period of time – a “drug holiday.”
Monoclonal antibody medications*
Drugs such as denosumab have produced promising bone density results and reduced risk of fractures. Denosumab is delivered by injection every six months and is meant to continue as a chronic long-term treatment for osteoporosis.
Drugs, such as teriparatide, abaloparatide, or romosozumab, may be good choices for those who have a very low bone density, or who have had fractures caused by the use of steroids. Teriparatide and abaloparatide require daily injections. Romosozumab is a drug that is taken as a monthly injection at your doctor’s office. Treatment with bone-building medications is completed after 12 to 24 months. These drugs’ benefits go away soon after you stop, so your doctor may prescribe bone-stabilizing medicines such as bisphosphonates to protect the built-up bones.
These suggestions might help reduce your risk of developing osteoporosis and help to strengthen bones:
- Cut back on tobacco – Smoking accelerates bone loss, increasing the chance of fracture.
- Cut back on excessive alcohol – Consuming more than two alcoholic drinks a day might reduce bone formation, and being under the influence of alcohol increases your chance of a fall.
- Avoid falls – Wear shoes with nonslip soles and low heels. Check your house for things like area rugs, electrical cords, and slippery surfaces that could cause you to fall.
- Diet – The foods we eat are a primary source of the nutrients we need to keep our bones strong. You should eat more dark leafy greens, sweet potatoes, citrus fruits, figs, fish, almonds, milk derived from plants, tofu, prunes, and molasses.
- Exercise – Weight-bearing exercises like running, walking, jogging, and jumping rope help build strong bones and slow bone loss. Balance exercises like tai chi will help reduce your risk of falling. Strength training exercises strengthen muscles and bones in your arms and upper spine. Cardio activities like swimming and cycling are suitable for your overall health, but they do not affect your bones.
* With the exception of abaloparatide and teriparatide, you should have a dental examination before starting bisphosphonates, monoclonal antibody medications, and bone-building medications, and you should continue to take good care of your teeth, and see your dentist regularly while on them. Make sure your dentist knows that you are taking these medications.