Osteoporosis is a common condition that occurs when the bones become thin and brittle because more bone is lost than formed. Osteoporosis affects at least 10 million Americans, the majority of which are women. Each year, more than 1.5 million fractures related to osteoporosis occur in the United States. One in two women older than 50 years will have a fracture related to osteoporosis in their lifetime. Fractures can be crippling and painful and cause lifelong disability. Thus prevention of osteoporosis is extremely important.
Bone is made up of calcium and protein. Bone is dynamic, and it is always changing. Old bone is removed in a process called resorption, and new bone is formed in a process called formation. From childhood until age 30 years, bone is formed faster than it is broken down. Then after age 30 years, the process is reversed and bone is broken down faster than it is made. A small amount of bone loss is expected after age 35. However, too much bone loss can make the bones thinner and weaker, resulting in osteoporosis.
Women are more at risk of osteoporosis than men because of menopause and because their bones are smaller and lighter than men’s bones.
The following factors can increase the risk of fractures caused by osteoporosis:
- Personal history of fracture
- Family history of osteoporosis
- Caucasian race
- Poor nutrition
- Low body weight
- Early menopause – younger than 45 years
- Removal of ovaries
- Frequently missing periods prior to menopause
- Diet low in calcium
- History of falls
- Lack of exercise
- Vision problems
Certain medications such as anticonvulsants, aluminum, immunosuppressants, blood thinners, lithium, anti-cancer drugs, excess thyroid hormones, GnRH agonists, Depo-Provera, and drugs that affect the adrenal and pituitary glands.
Most of the time women with osteoporosis do not have symptoms. Thus they are unaware that they are at significant risk for a fall or fracture. Sometimes symptoms are present and these include back pain or tenderness. Signs include a loss of height more than what is normal for your age group, and a slight curving of the upper back. Since many women do not know they have osteoporosis it is important to have your healthcare provider screen you for risk factors and order a bone density study. Various medical organizations have different recommendations for when to begin screening for osteoporosis. Timing will also depend on your personal and family history. Thus ask your health care provider when you should begin screening and how often testing is advised.
Osteoporosis is not inevitable. You can try to prevent it from occurring by maximizing your bone potential in your bone building years and slowing bone loss as you age. In order to prevent or decrease your risk of osteoporosis, it is important to perform regular weight-bearing exercises and follow a diet rich in calcium and vitamin D. If you don’t get enough of these vitamins in your diet, supplements are usually recommended. If your bone density testing reveals osteopenia (thin bones) or osteroporosis, your healthcare provider may advise you to take medication to slow or even reverse the process.
There are several medication options for preventing bone loss, such as bisphosphonates, selective estrogen receptor modulators (SERMs), calcitonin, and parathyroid hormone. In addition, Estrogen—a female hormone—protects against bone loss. As a woman nears menopause, her body produces less estrogen. Hormone therapy slows bone loss after menopause. Estrogen has been shown to decrease the risk of hip fractures and spinal deformities. In women who have a uterus, estrogen is given along with another hormone—progestin. This decreases the risk of endometrial cancer, which occurs when estrogen is given alone. However, hormone replacement therapy is not advised just to protect against or treat bone loss. Ask your healthcare provider to discuss these options with you if treatment is advised.