May is National Osteoporosis Awareness and Prevention Month
Approximately 54 million Americans have low bone density or osteoporosis. This May, we commemorate National Osteoporosis Awareness and Prevention Month to promote good bone health through the prevention, detection, and treatment of osteoporosis.
Through Osteoporosis Awareness and Prevention Month, people are encouraged to understand the risk factors associated with this condition. Preventative measures which promote healthy bones include sufficient calcium intake, achieving adequate levels of vitamin D, and performing bone-healthy exercises.
What is Osteoporosis?
Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the quality or structure of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).
Osteoporosis is more common in women than in men; approximately 80% of osteoporosis cases are in women. Women are often the main focus of these awareness campaigns as are people with a family history of osteoporosis.
Osteoporosis is a “silent” disease because you typically do not have symptoms, and you may not even know you have the disease until you break a bone. Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone but happen most often in bones of the hip, vertebrae in the spine, and wrist.
However, you can take steps to help prevent the disease and fractures by:
- Staying physically active by participating in weight-bearing exercises such as walking.
- Drinking alcohol in moderation.
- Quitting smoking, or not starting if you don’t smoke.
- Taking your medications, if prescribed, can help prevent fractures in people who have osteoporosis.
- Eating a nutritious diet rich in calcium and vitamin D helps maintain good bone health.
Who are at risk for Osteoporosis?
Osteoporosis affects women and men of all races and ethnic groups. Osteoporosis can occur at any age, although the risk of developing the disease increases as you get older. For many women, the disease begins to develop a year or two before menopause. Other factors to consider include:
- Osteoporosis is most common in non-Hispanic white women and Asian women.
- African American and Hispanic women have a lower risk of developing osteoporosis, but they are still at significant risk.
- Among men, osteoporosis is more common in non-Hispanic whites.
- Certain medications, such as some cancer medications and glucocorticoid steroids, may increase the risk of developing osteoporosis.
Women are more at risk of developing osteoporosis than men because the hormone changes that happen during menopause directly affect bone density. But because more women get osteoporosis than men, many men think they are not at risk for the disease.
However, both older men and women from all backgrounds are at risk for osteoporosis.
Some children and teens develop a rare form of idiopathic juvenile osteoporosis. Doctors do not know the cause; however, most children recover without treatment.
What are the symptoms of Osteoporosis?
Osteoporosis is called a “silent” disease” because there are typically no symptoms until a bone is broken or one or more vertebrae collapse (fracture). Symptoms of a vertebral fracture include severe back pain, loss of height, or spine malformations such as a stooped or hunched posture (kyphosis).
Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of
- Minor falls, such as a fall from standing height that would not normally cause a break in a healthy bone.
- Normal stresses such as bending, lifting, or even coughing.
Causes of Osteoporosis
Osteoporosis occurs when too much bone mass is lost and changes occur in the structure of bone tissue. Certain risk factors may lead to the development of osteoporosis or can increase the likelihood that you will develop the disease.
Many people with osteoporosis have several risk factors, but others who develop osteoporosis may not have any specific risk factors. There are some risk factors that you cannot change, and others that you may be able to change. However, by understanding these factors, you may be able to prevent the disease and fractures.
Factors that may increase your risk for osteoporosis include:
- Sex. Your chances of developing osteoporosis are greater if you are a woman. Women have lower peak bone mass and smaller bones than men. However, men are still at risk, especially after the age of 70.
- Age. As you age, bone loss happens more quickly, and new bone growth is slower. Over time, your bones can weaken and your risk for osteoporosis increases.
- Body size. Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger boned women and men.
- Race. White and Asian women are at highest risk. African American and Mexican American women have a lower risk. White men are at higher risk than African American and Mexican American men.
- Family history. Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.
- Changes to hormones. Low levels of certain hormones can increase your chances of developing osteoporosis. For example:
- Low estrogen levels in women after menopause.
- Low levels of estrogen from the abnormal absence of menstrual periods in premenopausal women due to hormone disorders or extreme levels of physical activity.
- Low levels of testosterone in men. Men with conditions that cause low testosterone are at risk for osteoporosis. However, the gradual decrease of testosterone with aging is probably not a major reason for loss of bone.
- Diet. Beginning in childhood and into old age, a diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures. Excessive dieting or poor protein intake may increase your risk for bone loss and osteoporosis.
- Other medical conditions. Some medical conditions that you may be able to treat or manage can increase the risk of osteoporosis, such as other endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.
- Medications. Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as:
- Glucocorticoids and adrenocorticotropic hormone, which treat various conditions, such as asthma and rheumatoid arthritis.
- Antiepileptic medicines, which treat seizures and other neurological disorders.
- Cancer medications, which use hormones to treat breast and prostate cancer.
- Proton pump inhibitors, which lower stomach acid.
- Selective serotonin reuptake inhibitors, which treat depression and anxiety.
- Thiazolidinediones, which treat type II diabetes.
- Lifestyle. A healthy lifestyle can be important for keeping bones strong. Factors that contribute to bone loss include:
- Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. They also leave you in poor physical condition, which can increase your risk of falling and breaking a bone.
- Chronic heavy drinking of alcohol is a significant risk factor for osteoporosis.
- Studies indicate that smoking is a risk factor for osteoporosis and fracture. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis.
How is Osteoporosis diagnosed?
Doctors usually diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for women over 65, and women of any age who have factors that increase the chance of developing osteoporosis.
During your visit with your doctor, remember to report:
- Any previous fractures.
- Your lifestyle habits, including diet, exercise, alcohol use, and smoking history.
- Current or past medical conditions and medications that could contribute to low bone mass and increased fracture risk.
- Your family history of osteoporosis and other diseases.
- For women, your menstrual history.
The doctor may also perform a physical exam that includes checking for:
- Loss of height and weight.
- Changes in posture.
- Balance and gait (the way you walk).
- Muscle strength, such as your ability to stand from sitting without using your arms).
The most common test for measuring bone mineral density is dual-energy x-ray absorptiometry (DXA). It is a quick, painless, and noninvasive test. DXA uses low levels of x-rays as it passes a scanner over your body while you lie on a cushioned table. The test measures the BMD of your skeleton and at various sites that are prone to fracture, such as the hip and spine. Bone density measurement by DXA at the hip and spine is generally considered the most reliable way to diagnose osteoporosis and predict fracture risk.
Some people have a peripheral DXA, which measures bone density in the wrist and heel. This type of DXA is portable and may make it easier for screening. However, the results may not help doctors predict your risk for fractures in the future or monitor the effects of your medications on the disease.
Your doctor will compare your BMD test results to the average bone density of young, healthy people and to the average bone density of other people of your age, sex, and race. If your test results show that you have osteoporosis, or if your bone density is below a certain level and you have other risk factors for fractures, your doctor may recommend both lifestyle approaches to promote bone health and medications to lower your chance of breaking a bone.
Sometimes, your doctor may recommend a quantitative ultrasound (QUS) of the heel. This is a test that evaluates bone but does not measure BMD. If the QUS indicates that you have bone loss, you will still need a DXA test to diagnose bone loss and osteoporosis.
How is Osteoporosis treated?
The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures. Your health care provider may recommend:
- Proper nutrition.
- Lifestyle changes.
- Exercise.
- Fall prevention to help prevent fractures.
- Medications.
People who develop osteoporosis from another condition should work with their health care provider to identify and treat the underlying cause. For example, if you take a medication that causes bone loss, your doctor may lower the dose of that medication or switch you to another medication. If you have a disease that requires long-term glucocorticoid therapy, such as rheumatoid arthritis or chronic lung disease, you can also take certain medications approved for the prevention or treatment of osteoporosis associated with aging or menopause.
How can I prevent Osteoporosis?
There are things you should do at any age to prevent weakened bones. Eating foods that are rich in calcium and vitamin D is important. So is regular weight-bearing exercise, such as weight training, walking, hiking, jogging, climbing stairs, tennis, and dancing.
If you have osteoporosis, avoid activities that involve twisting your spine or bending forward from the waist, such as conventional sit-ups, toe touches, or swinging a golf club.
Those are the best ways to keep your bones strong and healthy. Learn more about keeping your bones strong to prevent falls.
What can I do for my Osteoporosis?
Treating osteoporosis means stopping bone loss and rebuilding bone to prevent breaks. Healthy lifestyle choices such as proper diet, exercise, and medications can help prevent further bone loss and reduce the risk of fractures.
But, lifestyle changes may not be enough if you have lost a lot of bone density. There are also several medicines to think about. Some will slow your bone loss, and others can help rebuild bone. Talk with your doctor to see if medicines might work to treat your osteoporosis.
In addition, you'll want to learn how to fall-proof your home and change your lifestyle to avoid fracturing fragile bones.
Sources:
https://www.bones.nih.gov/health-info/bone/osteoporosis/overview