Osteoporosis

Osteoporosis is a gradual thinning of the bones in the body. The disease is characterized by weak and brittle bones caused by decreasing bone mass, density, and quality. If left unchecked, osteoporosis can lead to bone fractures. Fractures of the hip, spine, and wrist are of special concern. These are often called fragility fractures. There is no cure for osteoporosis, but it is both treatable and preventable.

Causes of Osteoporosis

Osteoporosis is caused by an imbalance between bone loss and bone formation, known as bone remodeling. Throughout life, old bone is lost and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger, and more dense. Peak bone mass is reached around age 30. From that point on, more bone is lost than is replaced, usually at a slow rate. When women reach menopause and their estrogen level drops, bone loss begins to happen faster than bone replacement. If not treated, excessive bone loss can lead to osteoporosis. Osteoporosis is more likely to occur if optimal bone mass was not achieved during the bone-building years.

In addition to bone loss, density also plays a role in bone health. Bone density is determined in part by the amount of calcium, phosphorus, and other minerals contained within the framework of the bone. As the mineral content of a bone (especially calcium) decreases, the bone becomes weaker. Getting enough calcium and vitamin D, as well as exercising regularly help ensure that bones stay strong throughout life. An estimated 10 million Americans have osteoporosis, 80% of whom are women. 

Risk Factors for Osteoporosis

A risk factor is something that increases your chances of developing a certain disease or condition. Osteoporosis is more common in:

• Older adults
• Women
• People of Caucasian, Asian, or Hispanic ethnicity

Osteoporosis is more likely to occur if full bone mass was not achieved during the prime bone-building years. Other factors that may increase the risk of developing osteoporosis include: 

• Low weight and small body frame
• Smoking
• Alcohol abuse
• History of falls
• Family history of osteoporosis
• Postmenopausal status
• Certain health conditions, such as:
  • Rheumatoid arthritis
  • No menstrual periods— amenorrhea
  • Hyperthyroidism
  • Type 2 diabetes
  • Asthma
  • Liver disease
  • Eating disorder
  • Depression
  • Crohn's disease
  • Celiac disease
  • Female athlete triad 
• Certain medications, such as antidepressants, corticosteroids, anticonvulsants, or long-term use of heparin or proton-pump inhibitors
• Low hormone levels (low estrogen levels in women, low testosterone levels in men)
• Inactive lifestyle
• Certain restrictive diets that may result in a deficit of calcium or vitamin D
• Too little sunlight—the effect of sun on the skin is a primary source of vitamin D
• Certain cancers, including lymphoma and multiple myeloma 

Symptoms of Osteoporosis

In most cases, people with osteoporosis remain symptom-free until there is a fracture. In those who do have symptoms, osteoporosis may cause: 

• Severe back pain
• Loss of height with stooped posture, called kyphosis

Diagnosing Osteoporosis

The purpose of screening is early diagnosis and treatment with the end goal of preventing fractures. Screening tests are administered to people without current symptoms, but who may be at high risk for certain diseases or conditions. The National Osteoporosis Foundation (NOF) suggests the following guidelines for an initial osteoporosis screening: 

• All women age 65 and older and men age 70 and older, regardless of risk factors
• Postmenopausal women and men age 50-69, with one or more risk factors
• Any adult age 50 years and older with a fracture
• Any adult with a health condition or taking medication associated with low bone density or loss 

The main screening test for osteoporosis is called a bone mineral density test (BMD). This is a painless, non-invasive method of measuring bone mass. A BMD test can detect osteoporosis before a fracture occurs and estimates the risk of having a fracture in the future.

With a BMD test, bone mass is measured and compared to either (1) a healthy 30-year-old adult (T-score) or (2) the expected bone mass of someone your age (Z-score). Because low BMD is common among older adults, comparison to peers your age can be misleading.

The results of a BMD test will indicate whether you have normal bone density, low bone density (osteopenia), or full-blown osteoporosis. There are several types of BMD tests that are used to screen for or diagnose osteoporosis. The decision whether to screen is usually made on an individual basis based on an individual’s risk factors.

 Supplemental tests may include: 

• Blood tests
• Urine tests

Treating Osteoporosis

Although osteoporosis is highly preventable, it cannot be cured. Treatment focuses on reducing the incidence of fractures and slowing bone loss, usually with a combination of lifestyle changes and medications. 

Lifestyle Changes

Lifestyle changes can help to stave off the effects of osteoporosis and make living with the condition more manageable. These changes may include:

1. Nutrition

   Decrease alcohol consumption. Eat a balanced diet rich in calcium and vitamin D. Calcium is found in: 

   • Dairy products
   • Green leafy vegetables
   • Canned fish with bones
   • Calcium-fortified products 
2. Smoking

   Do not smoke. If you smoke, talk with your doctor about ways you can successfully quit. 

3. Exercise

   Exercise improves bone health and increases muscle strength, coordination, and balance. Do weight-bearing and strength-training exercises for maximum benefit. Balance training also helps prevent falls and fractures. 

4. Dietary Supplements

   People who do not eat enough calcium from food might want to take calcium supplements. Vitamin D and other supplements also may be advised, but talk with your doctor before taking any herbs or supplements to ensure that there is no harm in taking them. 

5. Safety Measures

   Falling increases the chance of a bone fracture in someone with osteoporosis. Ways to prevent falls at home include: 

   • Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place. 
   • Bathrooms: Install grab bars and non-skid tape in the tub or shower. 
   • Lighting: Make sure halls, stairways, and entrances are well lit. Install a night light in the bathroom. Turn lights on if you get up in the middle of the night. 
   • Kitchen: Install non-skid rubber mats near sink and stove. Clean spills right away. 
   • Stairs: Make sure treads, rails, and rugs are secure. 
   • Other precautions: Wear sturdy, rubber-soled shoes. Keep alcohol intake to a minimum. Ask your doctor whether any of your medications have side effects that might cause you to fall. 
6. Medications

   Certain medications can help prevent bone loss, increase bone density, and reduce your risk of fractures. These include: 

   • Bisphosphonates to prevent the loss of bone
   • Parathyroid hormone therapy to stimulate bone growth
   • Selective estrogen receptor modulators to prevent bone loss, improve density, and decrease the potential for fractures 

Preventing Osteoporosis

Building strong bones throughout your early years is the best defense against osteoporosis. Getting enough calcium, vitamin D, and regular exercise helps keep bones strong throughout life. To help reduce your chance of getting osteoporosis: 

• Eat a balanced diet rich in calcium and vitamin D.
• Perform weight-bearing exercises.
• Live a healthy lifestyle—avoid smoking and drink alcohol only in moderation (up to 2 drinks per day for men, up to 1 drink per day for women).
• If you are a postmenopausal woman at high risk for bone fractures, medication may be useful in to help prevent osteoporosis. 

If you are expensing symptoms of osteoporosis, please see your healthcare provider. Dr. Abdurrahman Kandil of Stone Springs Orthopedics can answer all of your questions regarding symptoms, diagnosis, and treatment options. You can call the practice at (703) 665-2720 or schedule an appointment online via the button below. He is currently welcoming new patients.