Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.
Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the removal of old bone.
Osteoporosis affects men and women of all races. But white and Asian women — especially older women who are past menopause — are at highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.
There typically are no symptoms in the early stages of bone loss. But once bones have been weakened by osteoporosis, you may have signs and symptoms that include:
When to see a doctor
You may want to talk to your doctor about osteoporosis if you went through early menopause, took corticosteroids for several months at a time, or either of your parents had hip fractures.
Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Most people reach their peak bone mass by their early 20s. As people age, bone mass is lost faster than it's created.
How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age.
Some risk factors for osteoporosis are out of your control, including:
Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:
Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often result from a fall and can result in disability and even death from postoperative complications, especially in older adults.
In some cases, spinal fractures can occur even if you haven't fallen. The bones that make up your spine (vertebrae) can weaken to the point that they may crumple, which can result in back pain, lost height and a hunched forward posture.
Three factors essential for keeping your bones healthy throughout your life are:
Your family doctor may suggest bone density testing because screening for osteoporosis is recommended for all women by age 65. Some guidelines also recommend screening men by age 70, especially if they have health issues likely to cause osteoporosis.
If the bone density test is very abnormal or you have other complex health issues, such as kidney dysfunction, you may be referred to a doctor who specializes in metabolic disorders (endocrinologist) or a doctor who specializes in diseases of the joints, muscles or bones (rheumatologist).
Here's some information to help you get ready for your appointment and to know what to expect.
What you can do
- Write down any symptoms you've noticed, though it's possible you may not have any.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you're currently taking or have taken in the past. It's especially helpful if you record the type and dose of calcium and vitamin D supplements, because many different preparations are available. If you're not sure what information your doctor might need, take the bottles with you.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For osteoporosis, some basic questions to ask your doctor include:
- Do I need to be screened for osteoporosis?
- What kinds of tests do I need to confirm the diagnosis?
- What treatments are available, and which do you recommend?
- What types of side effects can I expect from treatment?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any activity restrictions that I need to follow?
- Do I need to make changes in my diet?
- Do I need to take supplements?
- Is there a physical therapy program that would benefit me?
- What can I do to prevent falls?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- Have you experienced any fractures or broken bones?
- Have you noticed a loss of height?
- How is your diet, especially dairy intake? Do you think you get enough calcium? Vitamin D?
- Do you take any vitamins or supplements?
- How often do you exercise?
- Did you exercise more or less in the past?
- Does either of your parents have osteoporosis?
- Has anyone in your family had bone fractures, especially hip fractures?
- Have you ever had stomach or intestinal surgery?
- Do you have chronic diarrhea?
- Have you taken corticosteroid medications (prednisone, cortisone) as pills, injections, suppositories or creams?
Treatment recommendations are based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If the risk is not high, treatment might not include medication and might focus instead on lifestyle, safety and modifying risk factors for bone loss.
For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:
- Alendronate (Fosamax)
- Risedronate (Actonel, Atelvia)
- Ibandronate (Boniva)
- Zoledronic acid (Reclast)
Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed esophagus or esophageal ulcers. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don't cause stomach upset. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so.
Using bisphosphonate therapy for more than five years has been linked to a rare problem in which the middle of the thighbone cracks and might even break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition that can occur after a tooth extraction in which a section of jawbone dies and deteriorates. You should have a recent dental examination before starting bisphosphonates.
Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman's risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health only if menopausal symptoms also require treatment.
Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may also reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.
In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help increase bone density, but osteoporosis medications have been better studied in men with osteoporosis and are recommended alone or in addition to testosterone.
Other osteoporosis medications
If you can't tolerate the more common treatments for osteoporosis — or if they don't work well enough — your doctor might suggest trying:
- Denosumab (Prolia). Compared with bisphosphonates, denosumab produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months. The most common side effects are back and muscle pain.
- Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It's given by injection under the skin. After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth. This drug is reserved for patients with severe osteoporosis.
These suggestions may help reduce your risk of developing osteoporosis or experiencing broken bones:
- Don't smoke. Smoking increases rates of bone loss and the chance of experiencing a fracture.
- Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation. Being under the influence also can increase your risk of falling.
- Prevent falls. Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get into and out of your bed easily.