Ten million Americans over age 50 have osteoporosis, the "brittle bone" condition. Many more are at high risk for the condition. Because of low bone mass, the bones are prone to fracture. About 50% of women and up to 25% of men over age 50 will break a hip or wrist, or suffer a spinal fracture due to osteoporosis.
Here is what you need to know, from risk factors to diagnosis to treatment, along with lifestyle tips for reducing your risk for osteoporosis.
Osteoporosis Risk Factors
Doctors know that some people are more likely than others to develop osteoporosis due to certain risk factors. Some of these risk factors — such as age and gender — are not under your control. Osteoporosis is more likely in older people. Women are more likely than men to get osteoporosis.
Family history increases the chances that you, too, will develop it. The condition may not have been diagnosed in your parents. However, if one or both had a noticeable amount of height loss, they may have had fractures in the spine, and that could be the result of osteoporosis.
If you have a small, thin frame, you are more likely to get osteoporosis.
Bone Health and Your Lifestyle Habits
Your everyday habits — good and bad — affect bone health. How do your habits stack up?
- Vitamin D and calcium. Not getting enough vitamin D or calcium can weaken your bones. The National Osteoporosis Foundation recommends adult women age 50 and younger and adult men age 70 and younger get 400-800 IU of vitamin D and 1,000 mg of calcium daily. Women age 51 and older and men age 71 and older should get 800-1,000 IU of vitamin D and 1,200 mg of calcium daily.
- Fruits and vegetables. Eating plenty of fruits and vegetables provides you with magnesium, potassium, and vitamin K — all good things for bone health.
- Protein. Very high amounts of non-dairy animal protein can weaken the bones. Sufficient protein is important for bone health. Ask your doctor how much protein you should consume each day.
- Caffeine. When used in excess, caffeine can threaten bone health.
- Alcohol. Excess alcohol intake can decrease bone formation. If you are tipsy from the alcohol, you’re more likely to fall. In older people, falls are linked with broken bones.
- Activity level. Physical activity can help keep bones strong. If you’re not an exerciser, ask your doctor for guidance on doing weight-bearing exercises such as fast walking. Ask about lifting weights or other muscle-strengthening exercises. Both types are good for your bones.
- Smoking. Studies show that smoking is bad for the bones.
Osteoporosis Tests and Diagnosis
To make a diagnosis, a doctor will usually take a full medical history, order a bone density test, and possibly other tests.
During an exam, your doctor will:
- Look at your age, consider whether women have reached menopause, whether you have ever broken a bone as an adult, your own family history, and your habits such as drinking, eating, and exercise.
- Ask about which medications you take. Some, such as corticosteroids, can weaken the bones if taken long term.
- Measure you to see if you have lost height. The doctor will inspect your spine. If it abnormally curves forward, that could be a sign that you’ve already had spinal fractures due to osteoporosis.
The bone density test results will help the doctor decide if you have osteoporosis. The test, which is noninvasive, can measure your bone density at the hip and spine. Sometimes the test is done on the forearm.
Your doctor looks at the results, compares them to standards, and can determine if you have low bone density known as osteopenia, or osteoporosis.
Bone-maintenance drugs can help your bone health. These drugs help maintain bone density and can reduce fracture risk.
Examples of bisphosphonate drugs include:
- alendronate (Fosamax)
- alendronate sodium (Binosto)
- ibandronate (Boniva)
- risedronate (Actonel, Atelvia)
- zoledronic acid (Reclast)
Other drug options to protect against bone loss include:
- raloxifene (Evista): an estrogen-like drug that slows bone loss and helps increase bone thickness
- romosozumab-aqqg (Evenity): a new mechanism. it is an antisclerostin antibody, and works to increase bone formation.
- abaloparatide (Tymlos) and teriparatide (Forteo,): a synthetic form of parathyroid hormone for people with osteoporosis who are considered at high risk for fracture based on a doctor’s assessment
- denosumab (Prolia): An antibody that prevents the formation of cells that break down bone, resulting in decreased bone loss.
If you start taking a bone-maintenance drug, be sure your doctor knows about all other medicines you are on. Some drugs can affect the bones, and your doctor may want to switch you to another drug or adjust the dose.
If you’re taking a bisphosphonate, you may be switched to another drug after five years. That is to avoid the risk, although low, of getting an uncommon thigh bone fracture linked with long-term use of bisphosphonates.
Hormone replacement therapy (HRT) — either estrogen alone or a combination of estrogen and progestin — can prevent and treat osteoporosis. The drug Duavee (estrogen and bazedoxifene) is a type of HRT approved to treat menopause-related hot flashes. Duavee may also prevent osteoporosis in high-risk women who have already tried non-estrogen treatment.
However, research has shown that hormone replacement therapy increases the risk of breast cancer, heart disease, and stroke in some women. So HRT isn’t generally recommended for initial treatment of osteoporosis in most women, because the health risks are thought to outweigh the benefits.
In women who have been on menopausal hormone therapy in the past and then stopped taking it, the bones begin to thin again — at the same pace as during menopause.
What to Expect After a Fracture
Fractures from osteoporosis often occur at the hip, wrist, and/or spine. Hip fractures often require surgery. Wrist fractures may need casting and/or surgery.
Spine fractures are the most common. About 700,000 spinal fractures occur a year. Weak bones can lead to a compression fracture in the vertebrae, the bones that form your spine. Over time, these fractures can change the strength and shape of your spine. You may lose height. Spine fractures sometimes can lead to chronic back pain. Soft, weak bones are the root of this problem.
Pain Relief Options for Fractures
Pain medicine and other therapies can help. Options include:
- Aspirin or acetaminophen (Actamin, Anacin AF, Tylenol).
- Non-steroidal anti-inflammatory medicines. Examples are ibuprofen ( Advil, Motrin, Nuprin) and naproxen (Aleve, Anaprox, Naprelan, Naprosyn). Both can reduce pain and swelling.
- If you need a stronger painkiller, your doctor can prescribe opioid pain medicines, such as codeine or morphine. However, doctors may discourage you from staying on these potent medicines.
- Physical therapy can help you learn how to move properly, reducing risk for more fractures.
Two surgical procedures, both minimally invasive, can be done for fracture-related back pain:
- Kyphoplasty involves inserting a balloon to expand the fractured vertebrae. The space created by the balloon is then filled with bone cement. The balloon is withdrawn.
- Vertebroplasty involves injection of the cement, but without the use of the balloon.
When considering these procedures, discuss the benefits and risks with your doctor. The procedures can have significant risk, such as the cement leaking, and other side effects, such as tissue damage, blood clots in the lung, and respiratory failure. However, the surgeries can provide pain relief if patients are good candidates for the procedures.
Complications of Osteoporosis Bone Fractures
Fractures due to osteoporosis can interfere with daily activities such as bending, walking downstairs, or cooking. Prompt treatment, physical therapy, and your commitment to a healthy lifestyle can improve your well-being.
Referenced on 18/05/2021
- National Institutes of Health: “The Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You."
- American Academy of Orthopaedic Surgeons: “Low Back Pain" and “Osteoporosis and Spinal Fractures."
- Chad Deal, MD, head, Center for Osteoporosis and Metabolic Bone Disease, Cleveland Clinic. Deal reports serving as an advisor, consultant or speaker for Amgen and Lilly, which make osteoporosis drugs.
- National Osteoporosis Foundation: “About Osteoporosis: Moving Safely;" “Calcium/Vitamin D," “What Is Osteoporosis," “Recovering from Broken Bones;" “Factors to Consider When Choosing a Treatment;" “About Osteoporosis: Bone Health Basics;" “Why Healthy Living is Important;" “Factors That Put You At Risk;" “Vitamin D and Bone Health; “Diagnosing Osteoporosis;" and “Fast Facts."
- Sherri Betz, PT, physical therapist, Santa Cruz, Ca.; chair, American Physical Therapy Association Bone Health Special Interest Group.
- Lenchik, L. American Journal of Roentgenology, October 2004.
- National Institutes of Health: "Osteoporosis Handout on Health."
- American Society for Surgery of the Hand: “Wrist Fractures."
- News release, FDA.