This topic talks about osteoporosis, including how to help prevent it and also how it is diagnosed and treated. For more information about how osteoporosis affects men see the topic Osteoporosis in Men.
What is osteoporosis?
Osteoporosis is a disease that affects your bones. It means that you have
bones that are thin and brittle with lots of holes inside them like a sponge.
This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These
fractures can be disabling and may make it hard for you to live on your
own.
Osteoporosis
affects millions of older adults. It usually strikes after age 60. It's most
common in women, but men can get it too.
What causes osteoporosis?
It's caused
by a lack of bone strength or
bone density. As you age, your bones get thinner
naturally. But some things can make you more likely to have the severe bone
thinning of osteoporosis. These things are called risk factors.
Age, gender, and body type risks
Your age. Your risk goes up
as you get older.
Being a woman who has gone through
menopause. After menopause, the body makes less
estrogen. Estrogen protects the body from bone loss.
Having a
slender body frame
Family history risks
Your family
background. Osteoporosis tends to run in families.
Your race. People of European and Asian
background are most likely to get osteoporosis.
Lifestyle risks
Smoking
Not getting enough
weight-bearing exercise
Drinking too much alcohol
Not getting enough calcium and vitamin D
What are the symptoms?
Osteoporosis can be very
far along before you notice it. Sometimes the first sign is a broken bone in
your hip, spine, or wrist after a bump or fall.
As the disease
gets worse, you may have other signs, such as pain in your back. You might
notice that you are not as tall as you used to be and that you have a
curved backbone.
How is osteoporosis diagnosed?
Your doctor will ask about your symptoms and do a physical exam. You may
also have a test that measures your bone thickness (bone density test) and your
risk for a fracture.
If the test finds that your bone thickness
is less than normal but is not osteoporosis, you may have
osteopenia. It's a less severe type of bone thinning.
It's important to find and treat osteoporosis early to prevent
bone fractures. Experts advise bone density testing for women age 65 and older. If you have a higher
risk for fractures, it's best to start getting the test sooner.
How is it treated?
Treatment for osteoporosis includes medicine to reduce bone loss and to
build bone thickness. Medicine can also give you relief from pain caused by
fractures or other changes to your bones.
It's important to get enough calcium and vitamin D and take prescribed medicine for the
disease. You need calcium and vitamin D to build strong, healthy bones.
You can slow osteoporosis with new, healthy habits. If you smoke,
quit. Get plenty of exercise. Walking, jogging, dancing, and lifting weights
can make your bones stronger. Eat a healthy mix of foods that include calcium
and vitamin D. Try yogurt, cheese, and milk (for calcium). Eat
eggs, fatty fish, and fortified cereal (for vitamin D).
Making
even small changes in how you eat and exercise, along with taking medicine, can
help prevent a broken bone.
When you have osteoporosis, it's
important to protect yourself from falling. Reduce your risk of breaking a bone
by making your home safer. Make sure there's enough light in your home. Remove
throw rugs and clutter that you may trip over. Put sturdy handrails on stairs.
Try exercises to increase your strength and balance.
As a natural part of aging, bone tissue breaks down. It
is absorbed faster than new bone is made, and bones become thinner. You are
more likely to have
osteoporosis if you did not reach your ideal bone
thickness (bone density) during your childhood and
teenage years.
In women, bone loss increases around menopause,
when ovaries decrease production of
estrogen, a hormone that protects against bone loss.
So the older you get, the more likely you are to
have osteoporosis.
Not getting
enough
calcium and
vitamin D contributes to bone thinning. Also, thin bones may run in families.
Symptoms
In the early stages of
osteoporosis, you probably won't have symptoms. As
the disease progresses, you may have symptoms related to weakened bones,
including:
Broken
bones (fractures) that might occur with a minor injury,
especially in the hip,
spine, and wrist.
Compression fractures in the spine that may cause severe back pain. But sometimes
these fractures cause only minor symptoms or no symptoms at all.
What Happens
In a normal, healthy adult,
bone is constantly absorbed into the body and then
rebuilt. During childhood and the teen years, new bone tissue is added faster
than existing bone is absorbed. As a result, your bones become larger and
heavier until about age 30 when you reach peak
bone mass (density). The more bone mass you developed
early in life, the less likely you are to get
osteoporosis.
After age 30, people lose a small amount of bone each year.
A person with thinning bones may be diagnosed with lower-than-normal bone
mass (osteopenia). Osteopenia sometimes
progresses to osteoporosis.
When bones thin, they lose strength
and break more easily. The bones that break most often due to osteoporosis are:
The spine. About half of broken bones caused by
osteoporosis are bones in the spine.footnote 1 Vertebrae that are weak because of
osteoporosis may break and collapse on top of each other. (This is called a compression
fracture.) These fractures of the
spine can cause back pain, stooped posture, loss
of height, and a curved upper back (dowager's hump).
The hip. Hip fractures are often caused by a fall. They can make it very hard for
you to move around. And they usually require major surgery. After a hip
fracture, you may have medical complications such as blood clots,
pressure injuries, or pneumonia. To learn more, see the topic Hip Fracture.
The wrist and forearm. Wrist fractures can make you less active and independent.footnote 2
In women, bone loss increases when the ovaries reduce
production of
estrogen, a hormone that protects against bone loss.
What Increases Your Risk
The risk of
osteoporosis increases with age as bones naturally
become thinner. But it usually doesn't affect people until they are 60 or older.
Family and personal history
Things that increase the risk of osteoporosis include:
Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed
with osteoporosis or has had broken bones from a minor injury, you are
more likely to get osteoporosis.
Completing menopause. Estrogen protects women from bone loss, and estrogen
levels drop after menopause. Women whose ovaries aren't working properly or have been removed also are at risk because of lower estrogen
levels.
Lifestyle risks
Smoking. People who smoke lose bone
thickness faster than nonsmokers.
Alcohol use.
Heavy alcohol use can decrease bone formation, and it
increases the risk of falling. Heavy alcohol use is more than 2 standard drinks
a day for men and more than 1 drink a day for women.
Getting little or no exercise. Weight-bearing
exercises include walking, jogging, stair climbing, dancing, and lifting
weights. They keep bones strong and healthy by working the muscles and bones against
gravity. Exercise may improve your balance and decrease your risk of
falling.
Poor diet. A diet low in foods containing
calcium and
vitamin D increases your risk of thinning bones.
Other things that increase risk
Other risk factors include:
Taking
corticosteroids or certain other medicines.
Being inactive or bedridden for long periods of
time.
Dieting excessively or having an eating disorder, such as
anorexia nervosa.
Being a female athlete
if you have few or irregular
menstrual cycles due to low body fat.
Find out your fracture risk
Your doctors might use the FRAX tool to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool too. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can enter your score. If you haven't had that test, you can leave the score blank.
When To Call a Doctor
Call your doctor right away if you:
Think you have a broken bone, notice a
deformity after a fall, or cannot move a part of your body.
Have
sudden, severe pain when bearing weight.
Call your doctor for an appointment if you:
Want to discuss your risk for
osteoporosis.
Have symptoms of
menopause or have completed menopause and want to
discuss whether you should take medicine to prevent osteoporosis.
Have been treated for a fracture caused by a minor injury, such as
a simple fall, and want to discuss your risk of osteoporosis.
If you are nearing age 65, have
osteopenia, or think that you are at high risk for
osteoporosis, talk with your doctor about your concerns.
Watchful waiting
If you do not have any
risk factors for osteoporosis and you are already taking preventive measures,
such as taking adequate calcium and vitamin D, you may only need routine
screening.
Who to see
Health professionals who can evaluate your symptoms
and risk of osteoporosis include:
A diagnosis of
osteoporosis is based on your
medical history, a physical exam, and a test to
measure your bone thickness (density).
Medical history and physical exam
Your
doctor will:
Take a medical history by asking questions about your family's health history and your own.
Measure your height and compare the results
with past measurements.
Examine your body for signs of previous
broken bones, such as changes in the shape of your long bones and
spine.
Tests
You will have a
bone density test. It helps your doctor estimate the
strength of your bones.
Routine urine and blood tests can
rule out other
medical conditions, such as
hyperparathyroidism,
hyperthyroidism, and
Cushing's syndrome. These conditions can cause bone loss.
Early detection
If you or your doctor thinks that you may be at risk
for osteoporosis, you may have a screening test to check your bone
thickness. A screening test may be a good idea if you have:
A
fracture from a minor injury that may have been caused
by osteoporosis.
Another medical condition that is known to cause
bone thinning.
Risk factors for or symptoms that
suggest osteoporosis.
Experts recommend that all women age 65 and older routinely have a
bone density test to screen for osteoporosis.
If you are at increased risk for fractures caused by osteoporosis, routine
screening should start sooner.footnote 3 The U.S. Preventive Services Task Force (USPSTF) recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.
The FRAX tool can help predict your risk of having a fracture related to osteoporosis in the next 10 years. The tool is meant for people who are not already being treated with medicine for osteoporosis. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.
Screening in younger women
Most
experts recommend that the decision to screen younger women be made
on an individual basis. The need for testing will depend on the risk for osteoporosis and
whether the test results will help with treatment decisions.
Ultrasound tests
Ultrasound is sometimes offered at events such as health fairs as a quick screening for osteoporosis. Ultrasound by itself is not a reliable test for diagnosing osteoporosis. But if results of an ultrasound screening find low bone density, your doctor can help you decide whether you should have a bone density test.
Treatment Overview
Treatment for osteoporosis is important to prevent fractures and help you get around and function well. It usually includes lifestyle changes and medicine. It is never
too late to build and then keep healthy habits that can slow bone
thinning.
Lifestyle changes
Take calcium and vitamin D
Your doctor likely will recommend that you eat foods rich in
calcium and
vitamin D. These nutrients keep bones
healthy and strong.
Your bones need vitamin D to absorb calcium. Getting more vitamin D may help prevent falls in older people who are low in vitamin D.footnote 4 And some studies show that taking vitamin D may reduce the chances of breaking a bone.footnote 5 Talk to your doctor about measuring your vitamin D to be sure you are getting enough.
Get weight-bearing exercise
Get
regular weight-bearing exercise, such as walking,
jogging, stair climbing, dancing, lifting weights, aerobics, and resistance
exercises. These activities keep bones healthy by working the
muscles and bones against gravity. To be most effective, weight-bearing exercises should be
done for 30 minutes most days of the week. Resistance exercises should be done 2 or 3 days
a week.
Limit alcohol, and don't smoke
Along with exercise and diet, your
doctor will recommend that you not smoke. And it's best to limit alcohol to no more than 2
drinks a day for men and no more than 1 drink a day for women. For help with
quitting smoking, see the topic
Quitting Smoking.
Medicines
In some cases,
your doctor will prescribe medicines such as bisphosphonates to protect against bone loss.
Follow-up visits
After you have been diagnosed
with bone loss, you will need to have regular
follow-up tests to monitor the disease.
If you've had a fracture, your doctor may suggest that you see a fracture liaison service. In this program, health professionals will work with you to help prevent future fractures.
Treatment for compression fractures
Compression fractures from osteoporosis can
cause significant back pain that lasts for several months. Treatments to relieve your pain include over-the-counter medicines such as acetaminophen and nonsteroidal anti-inflammatory drugs as well as stronger prescription medicine.
If you have a fractured bone related to
osteoporosis, treatment to slow your bone thinning becomes very important. If
you have had a spinal fracture, you are at risk of having another.
Prevention
You can build strong bones and help prevent osteoporosis with weight-bearing exercise and a diet rich in calcium and vitamin D. Young women in particular need to be aware of their risk for
osteoporosis. They can take steps early to slow its progress and prevent
complications.
A lot of physical activity during the preteen and teen years
increases bone mass and greatly reduces the risk of osteoporosis in adulthood.
Along with diet and exercise, prevention includes not smoking and limiting alcohol. For more information, see Home Treatment.
Home Treatment
You can do a lot to slow bone loss and
prevent broken bones.
Get enough calcium and vitamin D
Getting enough calcium and vitamin D is one of the first steps toward
preventing or reducing the effects of osteoporosis. Vitamin D helps your body
absorb calcium. Calcium is found in many foods, including dairy products such as milk
and yogurt.
If you think you may not be getting enough calcium in your diet, check with your doctor about taking
calcium supplements.
Experts recommend that you choose supplements that
are known brand names with proven reliability. Most brand-name calcium products
are absorbed easily by the body. The U.S. Food and Drug Administration (FDA)
has taken action against companies that praise the benefits of coral calcium as a
superior source of calcium and a cure for disease. There is no scientific
proof to support these claims.
Get exercise
Weight-bearing exercises (walking, jogging, stair
climbing, dancing, or weight lifting), aerobics, and
resistance exercises (using weights or elastic bands
to help improve muscle strength) are all effective in increasing bone
density and strength. These kinds of exercise may also help reduce the risk of falling or of breaking a bone. For more information, see the topic
Fitness.
Limit alcohol use
Heavy alcohol use can decrease bone formation. It also
increases the risk of falling. Heavy alcohol use is more than 2
drinks a day for men and more than 1 drink a day for women.
Don't smoke
Smoking reduces your bone density
and speeds up the rate of bone loss. For information on how to stop, see the
topic
Quitting Smoking.
Prevent falls
Learn ways to prevent falls that might result in broken bones. Have your vision and
hearing checked regularly. Wear slippers or shoes that have nonskid soles.
Exercises that improve balance and coordination, such as
tai chi, can also reduce your risk of falling. You can also make changes in
your home to prevent falls.
Medicines are used to both prevent and
treat
osteoporosis. Some medicines slow the rate of bone
loss or increase bone thickness. Even small amounts of new bone growth can
reduce your risk of broken bones.
Denosumab (Prolia). It's used to treat people who are at high risk for bone
fractures related to decreased bone density.
Raloxifene (Evista). This medicine is a selective
estrogen receptor modulator (SERM).
Teriparatide (Forteo). It's used for the treatment of men and postmenopausal women who have severe
osteoporosis and who are at high risk for bone
fracture.
Hormone therapy
Hormone therapy is typically not recommended for most women
who have osteoporosis. But if you are at high risk and cannot take other medicines,
your doctor may recommend it under certain circumstances.
Hormone therapy for osteoporosis
in women includes:
Estrogen. Estrogen without progestin
(estrogen therapy, or ET) may be used to treat osteoporosis in
women who have gone through
menopause and do not have a uterus. Because taking
estrogen alone increases the risk for cancer of the lining of the
uterus (endometrial cancer), ET is only used if a woman has had her uterus
removed (hysterectomy).
Estrogen and progestin. In rare cases, the combination of estrogen and progestin
(hormone therapy, or HT) is recommended for women who have
osteoporosis.
Medicine for pain from fractures
Compression fractures and other broken
bones resulting from osteoporosis can cause significant pain that lasts for
several months. Medicines to relieve this pain include:
Nonprescription
nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen and naproxen. If you take NSAIDs regularly, your doctor may recommend that you also take a medicine such as a proton pump inhibitor (PPI) to protect your digestive system. But there is also a chance that PPIs can help cause osteoporosis. Talk to your doctor about taking NSAIDs and PPIs for long periods of time.
An
opioid pain reliever, such as codeine or
morphine.
If spinal compression fractures are causing nerve roots to be compressed, your doctor may talk with you about having surgery to stabilize the crushed spinal bones
(vertebrae).
If you get a hip fracture because of osteoporosis,
you may need surgery to repair your hip. For more information, see the topic
Hip Fracture.
Soy products have been tried to help reduce the chance of broken bones due to osteoporosis, but there is not strong evidence that these products help. But soy is a good source of nondairy protein, so many people still choose to include it in their diets. (For example, 1 cup of soy milk contains 7 to 11 grams of soy protein.)
There is
not enough evidence to show if other natural products, such as black cohosh,
work to reduce bone loss.
Other Places To Get Help
Organizations
National Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.)
www.niams.nih.gov
NIH Osteoporosis and Related Bone Diseases National Resource Center (U.S.)
Chapman-Novakofski K (2012). Nutrition and bone health. In LK Mahan, S Escott-Stump, eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 531-546. St. Louis: Saunders.
Edwards BJ, et al. (2010). Functional decline after incident wrist fractures-Study of Osteoporotic Fractures: Prospective cohort study. BMJ. Published July 8, 2010 (doi:10.1136/bmj.c3324).
U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
Gillespie LD, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (11).
Bischoff-Ferrari HA, et al. (2009). Prevention of nonvertebral fractures with oral vitamin D and dose dependency. Archives of Internal Medicine, 169(6): 551-561.
Other Works Consulted
Avenell A, et al. (2014). Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database of Systematic Reviews (4). DOI: 10.1002/14651858.CD000227. Accessed October 22, 2014.
Bell KJL, et al. (2009). Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: Secondary analysis of trial data. BMJ. Published online June 23, 2009 (doi:10.1136/bmj.b2266).
Heiss G, et al. (2008). Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA, 299(9): 1036-1045.
Howe TE, et al. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews (7).
National Osteoporosis Foundation (2014). Clinician's guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation. http://nof.org/hcp/clinicians-guide. Accessed October 22, 2014.
National Osteoporosis Foundation (accessed November 2012). Exercise for strong bones. Available online: http://www.nof.org/articles/238.
Nelson HD, et al. (2010). Screening for osteoporosis: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 153(2): 99-111.
Newberry SJ, et al. (2012). Treatment to Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report. Comparative Effectiveness Review No. 53 (AHRQ Publication No. 12-EHC023-EF). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1006&pageaction=displayproduct.
North American Menopause Society (2010). Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause, 17(1): 23-54. Also available online: http://www.menopause.org/aboutmeno/consensus.aspx.
Qaseem A, et al. (2008). Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 149(6): 404-415. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.
Qaseem A, et al. (2017). Treatment of low bone density or osteoporosis to prevent fractures in men and women: A clinical practice guideline update from the American College of Physicians. Annals of Internal Medicine, 166(11): 818-839. DOI: 10.7326/M15-1361. Accessed October 2, 2017.
Credits
ByHealthwise Staff Primary Medical ReviewerKathleen Romito, MD - Family Medicine Martin J. Gabica, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Specialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine
Chapman-Novakofski K (2012). Nutrition and bone health. In LK Mahan, S Escott-Stump, eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 531-546. St. Louis: Saunders.
Edwards BJ, et al. (2010). Functional decline after incident wrist fractures-Study of Osteoporotic Fractures: Prospective cohort study. BMJ. Published July 8, 2010 (doi:10.1136/bmj.c3324).
U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
Gillespie LD, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (11).
Bischoff-Ferrari HA, et al. (2009). Prevention of nonvertebral fractures with oral vitamin D and dose dependency. Archives of Internal Medicine, 169(6): 551-561.
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