Osteoporosis

Causes

Osteoporosis occurs when bone loss happens faster than bone growth. The cycle of bone loss and growth is normal throughout life. However, bone loss happens faster after age 30. There are many other things over a lifetime that increase the risk of osteoporosis.

Risk Factors

Osteoporosis is more common in older adults and women. It is also more likely to happen if full bone mass was not reached in childhood or early adult years.

Things that raise the risk of osteoporosis are:

• Low body weight
• Smoking
• Alcohol use disorder
• A history of falls
• A family history of osteoporosis
• Long term use of certain medicines, such as blood thinners or stomach acid reducers
• Low estrogen levels in women, as with menopause, or low testosterone levels in men
• Lifestyle factors, such as:
  • A low level of physical activity
  • A diet low in calcium or vitamin D
  • Too little sunlight—sun on the skin is a main source of vitamin D

Some health conditions also raise the risk of osteoporosis:

• Certain cancers such as lymphoma and multiple myeloma
• Rheumatoid arthritis
• No menstrual periods— amenorrhea
• Hyperthyroidism
• Type 2 diabetes
• Asthma
• Eating disorders and female athlete triad
• Depression
• Digestive diseases, such as:
• Crohn disease
• Celiac disease
• Liver disease

Symptoms

Many people do not know they have osteoporosis until a bone breaks. Other symptoms that may appear are:

• Severe back pain
• Loss of height with stooped posture— kyphosis

Kyphosis

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Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. Blood and urine tests may be done to rule out other problems such as a hormone imbalance. Images of bones may be taken with:

• Dual-energy x-ray absorptiometry (DXA)
• Quantitative ultrasound (QUS)
• Quantitative CT scan (QCT)

Treatment

The goal of treatment is to lower the risk of breaks and to slow bone loss. Both lifestyle changes and medicine can help.

Daily habits that may help are:

• A diet rich in calcium and vitamin D
• Not drinking alcohol, or limiting alcohol to:
  • 2 drinks or less a day for men
  • 1 drink or less a day for women
• Quitting smoking
• Regular exercises to strengthen bones, such as:
  • Weight bearing exercises—walking, jogging, and dancing, for example
  • Strength training exercises—using weights or resistance bands
• Balance training—to help lower the risk of falls and breaks
• Calcium and vitamin D supplements as advised by a doctor—for people who cannot get enough from food

Medicines that may help 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 lower the risk of breaks

Falls can raise the risk of broken bones in someone with osteoporosis. Safety measures can lower the risk of falls. They may involve:

• Making simple changes in the home, such as:
  • Reducing tripping and slipping hazards
  • Making sure halls, stairways, entrances, and other areas are well lit
• Wearing sturdy, rubber-soled shoes
• Asking the doctor if medicines could raise the risk of falling

Prevention

It is important to build strong bones throughout childhood and early adult years. This will build a better bone supply for later years.

Other ways to decrease the risk of osteoporosis include:

• Eat a balanced diet rich in calcium and vitamin D.
• Perform weight-bearing exercises. These are performed
• Live a healthy lifestyle—avoid smoking and drink alcohol only in moderation (2 drinks or less a day for men, 1 drink or less a day for women).
• Talk to the doctor about risk for osteoporosis after menopause. Medicine may help to prevent osteoporosis.