Osteoporosis - Causes, Symptoms, and Diagnosis

OSTEOPOROSIS

What is osteoporosis?

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).

How common is osteoporosis?

More than 50 million people in the U.S. live with osteoporosis. It is common in people over 50. Experts estimate that half of all people assigned female at birth and 1 in 4 people assigned male at birth over 50 have osteoporosis.

Studies have found that 1 in 3 adults over 50 who don’t have osteoporosis yet have some degree of reduced bone density (osteopenia). People with osteopenia have early signs of osteoporosis. If it’s not treated, osteopenia can become osteoporosis. (https://my.clevelandclinic.org/health/diseases/4443-osteoporosis) 

What causes osteoporosis?

The inside of the bones becomes more porous during the aging process due to the loss of calcium and phosphate. The loss of these minerals makes the bones more prone to fracture even during routine activities, like walking, standing, or bathing. Often, a person will sustain a fracture before becoming aware of the presence of the disease. Prevention is the best measure for treating osteoporosis, by eating a recommended balanced diet including foods with sufficient amounts of calcium, phosphorous, and vitamin D. In addition, maintaining a regular exercise program as approved by your health care provider will help to keep the bones strong. Various medicines can be used as part of the treatment for osteoporosis and should be discussed thoroughly with your health care provider.

A major risk is not having enough calcium to build new bone tissue. It is important to eat/drink enough high-calcium foods. You also need vitamin D, because it helps your body absorb calcium. Your bones may become brittle and more likely to fracture if:

• If you do not eat enough food with calcium and vitamin D
• Your body does not absorb enough calcium from your food, such as after gastric bypass surgery (https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteoporosis) 

What are the risk factors of getting osteoporosis? 

Anyone can develop osteoporosis. Some groups of people are more likely to experience it, including:

• Anyone over 50.
• People assigned female at birth (AFAB), especially people AFAB in post menopause.
• People with a family history (if someone in your biological family) has osteoporosis.
• People who are naturally thin or who have “smaller frames.” People with thinner statures often have less natural bone mass, so any losses can affect them more.

People who smoke or use tobacco products.

Some health conditions can make you more likely to develop osteoporosis, including:

• Endocrine disorders — any condition that affects your parathyroid glands, thyroid gland and hormones (like thyroid disease and diabetes).
• Gastrointestinal disease (like celiac disease and inflammatory bowel disease [IBD]).
• Autoimmune disorders that affect your bones (like rheumatoid arthritis or ankylosing spondylitis — arthritis that affects your spine).
• Blood disorders (or cancers that affect your blood like multiple myeloma).

Some medications or surgical procedures can increase your risk of osteoporosis:

• diuretics (medications that lower your blood pressure and clear extra fluid from your body.
• corticosteroids (medications that treat inflammation).
• Medications used to treat seizures.
• Bariatric (weight loss) surgery.
• Hormone therapy for cancer (including to treat breast or prostate cancer).
• Anticoagulants.
• Proton pump inhibitors (like those that treat acid reflux, which can affect your calcium absorption).

Certain aspects of your diet and exercise routine can make you more likely to develop osteoporosis, including:

• Not getting enough calcium or vitamin D in your diet.
• Not getting enough physical exercise.
• Regularly drinking alcohol (more than two drinks per day).

(https://my.clevelandclinic.org/health/diseases/4443-osteoporosis) 

What are the symptoms of osteoporosis? 

Osteoporosis is called a “silent” disease” because there are typically no symptoms until a bone is broken. Symptoms of vertebral (spine) 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.

(https://www.niams.nih.gov/health-topics/osteoporosis) 

How is osteoporosis diagnosed?

A DEXA scan is a low-radiation x-ray that measures the density of the minerals in your bones. Most often, it measures density in the spine and hip bones. Your health care provider uses this test to:

• Diagnose bone loss and osteoporosis.
• Predict your risk for future bone fractures.

See how well osteoporosis medicine is working. (The DEXA is most often repeated every 2 years.)

A simple spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of other bones are not very accurate in predicting whether you are likely to have osteoporosis. A low-radiation spine x-ray called a vertebral fracture assessment (VFA) can be done with a DEXA to better identify fractures that do not have any symptoms. Trabecular bone score (TBS) can also be performed to gauge bone quality and help evaluate fracture risk.

You may need blood and urine tests if your provider thinks the cause of your osteoporosis is a medical condition, rather than the slow bone loss that occurs with aging.

DEXA scan results compare your bone mineral density with both a young adult who has no bone loss and with people your age and sex. This means that at age 80, almost one third of women with normal age-related bone loss would have osteoporosis, based on their DEXA scan results. 

What is the treatment for osteoporosis?

Medicines used to treat osteoporosis include:

• Bisphosphonates -- the main drugs used to prevent and treat osteoporosis in postmenopausal women. They can be given by mouth or by IV.
• Denosumab -- lessens bone loss and increases bone density. Given by injection under the skin.
• Teriparatide or abaloparatide -- man-made forms of a hormone your body makes that increases bone density.
• Romosozumab -- a newer drug for more severe bone thinning.
• Estrogen receptor modulators.
• Calcitonin -- a man-made form of a hormone your body makes that increases bone density. Used mainly to treat the acute pain from a spine fracture.

Follow these guidelines for getting enough calcium and vitamin D:

• Women ages 51 to 70 should have 1,200 mg of calcium and 400 to 800 IU of vitamin D a day.
• Men ages 51 to 70 should have 1,000 mg of calcium and 400 to 800 IU of vitamin D a day.
• Adults over age 70 should have 1,200 mg of calcium and 800 IU of vitamin D a day.
• Your provider may recommend a calcium supplement.
• Follow a diet that provides the proper amount of calcium and vitamin D. Use supplements to make up for the shortage only if your diet does not have the recommended amounts.
• Your provider may recommend higher doses of vitamin D if you have risk factors for osteoporosis or a low level of this vitamin. (https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteoporosis) 

Adults age 50 and under should have 1,000 mg of calcium and 400 to 800 International Units (IU) of vitamin D a day.

How can physical therapy help to manage osteoporosis? 

Exercise plays a key role in preserving bone density in older adults. Some of the exercises recommended to reduce your chance of a fracture include:

• Weight-bearing exercises, such as walking, jogging, playing tennis, or dancing for at least 30 minutes, three times per week.
• Strengthening exercises using free weights, weight machines, stretch bands.
• Balance exercises, such as tai chi and yoga.
• Rowing machines, cross trainer and resistance bike helps with strengthening. 

Avoid any exercise that presents a risk of falling. Also, do not do high-impact exercises that can cause fractures in older adults.

How can one prevent getting osteoporosis? 

Exercise and making sure you get enough calcium and vitamin D in your diet are usually all you’ll need to prevent osteoporosis. Your provider will help you find a combination of treatments that’s best for you and your bone health.

Follow these general safety tips to reduce your risk of an injury:

• Always wear your seatbelt.
• Wear the right protective equipment for all activities and sports.
• Make sure your home and workspace are free from clutter that could trip you or others.
• Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
• Follow a diet and exercise plan that’s healthy for you.
• Use a cane or walker if you have difficulty walking or have an increased risk for falls. (https://my.clevelandclinic.org/health/diseases/4443-osteoporosis)