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Resource Description: 
The National Institute of Arthritis and Musculoskeletal and Skin Diseases, lead organization for research on osteoporosis for the National Institutes of Health, is a good source for information on research, clinical trials, and statistics.
MedlinePlus features a powerful search engine and a wide selection of links to news, patient education features, and resources for medical professionals.
The companion site for the osteoporosis segment of the PBS series, "Chronic Illness in America: Who Cares," provides capsulized information and links to other sites, including one containing a series of online educational videos about osteoporosis and bone health.
The National Osteoporosis Foundation's Website offers useful general information, a section containing recent news items about osteoporosis, a "find-a-doctor" directory, and a good list of frequently asked questions and answers.
FORE, a non-profit resource center dedicated to eliminating osteoporosis, offers a range of consumer-oriented educational resources.
The International Osteoporosis Foundation site features patient stories and a "one-minute risk test," designed to help you determine if you're at risk for osteoporosis.
Episode number: 
109

If you're over 30, it is not too soon to start formulating your personal strategy for dealing with osteoporosis. That is the age when this silent disease usually begins reducing your bone mass and, over a couple of decades, can put you at increased risk for painful and debilitating bone fractures. In this episode of Second Opinion, you'll learn what causes osteoporosis, explore the factors that put you at risk, and learn what you can do to keep your aging bones strong and healthy.

Osteoporosis, which means "porous bones," causes your bones to become so thin and brittle that they can break during activities as routine as lifting a bag of groceries or rolling over in bed.

Ten million Americans have osteoporosis right now, and 34 million more are at risk. With the continued aging of our society, the problem has the potential to get a lot worse if people do not start paying more attention to their bone health.

Osteoporosis is preventable and treatable, and there is a lot you can do at any age to keep the disease from dominating your life. Keeping your bones strong and healthy early on can make the difference between spending the later part of your life as an active, independent adult, or being sidelined in a nursing home with a fractured hip.

Dubbed "the silent thief," osteoporosis creeps up on you slowly. It robs you of bone mass over years and decades, without any obvious symptoms. As you lose bone mass, your bone structure weakens and bones break more easily. For many people, the first clue that they have osteoporosis is a bone fracture, most commonly in the hip, backbone, or wrist.

Osteoporosis is responsible for more than 1.5 million fractures every year. While the disease occurs in both sexes, women are four times as likely as men to get osteoporosis - they get it at an earlier age, and they lose more bone mass at a faster rate. It is estimated that one out of every two women and one in four men over the age of 50 will have osteoporosis-related fractures in their lifetime.

While there is no cure for osteoporosis, the problem is being addressed on many fronts. There is a wealth of medical and scientific knowledge about the disease that is being applied to important tasks such as:

  • Creating high-profile public education programs to teach people how to reduce controllable risk factors and keep bones strong by eating right, exercising, and making healthy lifestyle changes.
  • Research and development of new diagnostic tools and drugs therapies.
  • Preventing injury and improving the quality of life for those already suffering from osteoporosis.

If you have osteoporosis, or want to learn what you can do to guard against it, talk with your doctor to find out what is best for you.

 

Ask Your Doctor

Kevin McCormick, MD, PhD
University of Rochester Medical School
Medical Director, Geriatrics and Medicine Associates, Highland Hospital

This list of questions is a good starting point for discussion with your doctor; however, it is not a comprehensive list.

  1. What is osteoporosis?
  2. What is osteopenia?
  3. Am I at risk for osteoporosis?
  4. What can I do to reduce my risk of osteoporosis?
  5. What will happen if I get osteoporosis?
  6. If I have osteoporosis, what can I do about it?
  7. Is medication the only treatment for osteoporosis?
  8. Should I have a test for osteoporosis? 
  9. How will the test results change my treatment?
  10. How will we determine if the treatment is working?

Key Point 1

Osteoporosis is basically the deterioration of your bones. It can make your bones fragile and it can make you more likely to have fractures, also known as broken bones. It is a major public health threat in our nation.

Work the numbers: 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites each year. What these osteoporosis-related injuries add up to is a lot of pain and suffering - plus an estimated national cost of $17 billion annually for hospital and nursing home care.
 
While the exact cause of osteoporosis is not known, we do know that osteoporosis is linked to the natural aging process and decreased production of hormones (estrogen in women and testosterone in men). Insufficient amounts of calcium and phosphorus (two minerals needed to build strong bones) and vitamin D (which helps the body use calcium effectively) also play a key role in development of the disease.

In normal, healthy adults, bone is constantly being broken down and rebuilt. The rate at which this happens increases as you age.

  • During the first 25 to 30 years of your life, new bone is made faster than existing bone is broken down.
  • During the next 10 to 20 years, bone is broken down at about the same rate as bone is made.
  • In women between the ages of 45 and 55 (soon after menopause) and men between the ages of 45 and 50 (when testosterone production decreases), bone begins to break down faster than new bone is made - a loss of about 2% per year after age 40.
    • Bone loss in women varies, but it usually occurs at a faster rate - as much as 6% per year - in the first few years after menopause.
    • In men, osteoporosis usually has little affect until about age 65.

Women are at greater risk for osteoporosis than men because:

  • Men have higher bone mass (bigger bones) than women.
  • Women lose a certain amount of protection against osteoporosis when their bodies stop producing estrogen, usually when they reach menopause.

The most serious consequence of osteoporosis is broken bones. Bones that are fractured most often include:

  • The hip. Hip fractures can be very serious because they occur most often in older adults and usually require surgery. Hip fractures are often caused by falls. Even a slight fall can fracture a weakened hip bone.
  • The spine (vertebrae). About half of broken bones caused by osteoporosis occur in the spine. Vertebrae that are weakened by osteoporosis may also break and collapse on top of each other, resulting in a compression fracture.
  • The wrist and forearm.

Other problems that commonly result from osteoporosis include:

  • Developing a curved upper back, also known as  "dowager's hump."
  • Breathing difficulty, if the ribs are affected and/or if the back is stooped.
  • Long-term bone pain after a bone is broken.
  • Back and other body pain.
  • Reduced mobility due to pain and complications from fractures.
  • Getting shorter in height.
    

Key Point 2

There are many risk factors for osteoporosis - some that you can change and some that you can't.

The risk of osteoporosis for both men and women increases with age because your bones normally become thinner as you get older. The more risk factors you have, the greater your chances are of developing osteoporosis.

Risk factors you can't change include:

  • Age. The older you are, the greater your risk of osteoporosis. That is because your bones get weaker and lose density as you age.  Also, calcium absorption becomes less efficient as you age.
  • Gender. Women have a greater likelihood of developing osteoporosis than men. Women have less bone tissue and lose bone more rapidly than men because of the changes associated with menopause and lower estrogen levels. Also, women who no longer have menstrual periods - either because their ovaries are not working properly (such as when they are very underweight) or because their ovaries have been surgically removed - are more likely to develop the disease.
  • Ethnicity. Caucasians and Asians are more likely to have osteoporosis than people from other backgrounds.
  • Family history of osteoporosis. If your mother, father, or siblings have experienced broken bones from a minor injury, you are more likely to develop osteoporosis.
  • Thin body build. Slender people are more likely to develop osteoporosis because they have less bone tissue and less fat than heavier people. Also, fat tissue stores estrogen, which helps protect women from osteoporosis.
  • Medical conditions such as hyperthyroidism put you at greater risk for osteoporosis.

Risk factors you can control:

  • Diet. A diet low in foods containing calcium, phosphorus, and vitamin D is bad for your bones. Some studies indicate that excessive soda intake also affects bone health.
  • Smoking. Smokers are at higher risk for osteoporosis than non-smokers.
  • Alcohol use. Consuming more than two drinks a day may increase your risk.
  • Lack of exercise. Weight-bearing activities (walking, jogging, stair climbing, dancing, or lifting weights) keep bones strong and healthy by working them against gravity.
  • Overuse of antacids that contain aluminum. These products remove phosphorus and calcium from your body and cause faster than normal bone thinning.
  • Exposure to sun.  About 15 minutes of direct sun exposure daily to hands and face, or alternatively vitamin D supplementation, is good for bone health. Sunscreen blocks the effect of sun on vitamin D metabolism too.

Other risk factors may include:

  • Certain medications. Using corticosteroids to treat conditions such as asthma and chronic obstructive pulmonary disease (COPD) for six months or longer can lead to steroid-induced osteoporosis.  
  • Being inactive or bedridden for extended periods of time.
  • Excessive dieting or eating disorders, such as anorexia. People with eating disorders usually have low body fat and low levels of estrogen, which increases their risk for osteoporosis.
  • Being a female athlete. Female athletes are at risk for developing osteoporosis if they have infrequent menstrual cycles due to low body fat. This can lower estrogen production, which can eventually weaken bones.
    

Key Point 3

If you have osteoporosis, secondary prevention works. Drugs, exercise, and a diet rich in calcium and vitamin D strengthen bones at any age and at any stage of osteoporosis.

If you suspect that you have osteoporosis or that you may be at risk, see your doctor.  Following a comprehensive medical assessment, your physician may want to test  your bone density . Screening tests include dual energy X-ray absorptiometry (DEXA), ultrasound, and quantitative CT scanning. These and certain other non-invasive procedures allow your doctor to measure the density of bones in your spine, hip and wrist - the areas most likely to be affected by osteoporosis - and to accurately follow changes in your bones over time.

Depending on the severity of your condition, your doctor may recommend drug therapy, prevention measures, or both.

Drug therapy for osteoporosis centers on medications that work to slow the rate of bone loss or increase the rate of bone growth. These include:

  • Hormone Therapy (HT), once the best-known way to prevent osteoporosis in women, uses estrogen alone or in combination with progestin. Some women and their doctors opt for other types of treatments due to the health risks associated with HT.
  • Bisphosphonates . This group of drugs can inhibit bone breakdown, preserve bone mass, and even slowly increase bone density in your spine and hip. These drugs may be especially beneficial for men.
  • Selective estrogen receptor modulators (SERMs) , such as Raloxifene, mimic estrogen's beneficial effects on bone density in postmenopausal women - without some of the risks associated with estrogen therapy.
  • Calcitonin . A hormone produced by the thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spinal fractures, though it doesn't appear to protect against hip fractures.
  • Tamoxifen. Used for years to treat breast cancer, this synthetic hormone has an estrogen-like effect on bone cells and appears to reduce the risk of fractures, especially in women over age 50.
  • Parathyroid Hormone Therapy (PTH) is approved for post-menopausal women and men who are at high risk of fracture.  PTH stimulates new bone formation and increases bone density. 

As with all medications, be sure to ask your doctor about risks, side effects, and interactions with other drugs you may be taking.

Prevention measures can greatly reduce your risk of osteoporosis. If you already have osteoporosis, these steps can help prevent your bones from getting weaker and, in some cases, may even help replace bone you have lost. These include:

  • Stop smoking. Although scientists are not sure why, smoking increases bone loss.
  • Avoid excess alcohol consumption. More than two drinks a day may decrease bone formation and reduce your body's ability to absorb calcium.
  • Exercise regularly. Maintain bone strength by engaging in weight-bearing exercises (walking, jogging, stair climbing, dancing, or lifting weights). Consult with your doctor before beginning any exercise program.
  • Eat healthy foods and get adequate calcium and vitamin D. Calcium is a mineral that is important in the formation of strong healthy bone tissue. Get it through the food you eat or, if necessary, from a supplemental source. Your body needs vitamin D so that you can absorb calcium. Good sources include fortified low-fat milk, oily fish (such as salmon, tuna, herring, sardines), liver, and egg yolk. Your body also produces vitamin D when your skin is exposed to sunlight.
Recommended Daily Calcium Intake
Age groupDaily intake in milligrams
Children 1 to 3500
Children 4 to 8800
Preteens and teens 9 to181300
Adults 19 to 501000
Adults 51 and older1200

Medline Plus

Medline Description: 

Conduct an off-site search for Osteoporosis information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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