Osteoporosis: Symptoms, Treatment, Outlook

The main causes of osteoporosis are aging and hormonal changes in women after menopause. Women are at risk for osteoporosis after menopause due to a decrease in estrogen. Men and women over age 70 are also at risk due to a calcium deficiency.

In order for bones to stay strong, they need the mineral calcium. If the body doesn’t get enough calcium from the diet, the bone tissues can weaken. These changes don’t happen overnight, but occur over years. The body also needs enough vitamin D in order to absorb the calcium, so vitamin D deficiency can contribute to osteoporosis.

Many other conditions or factors can cause osteoporosis or worsen existing osteoporosis, including:

• Certain medications, such as glucocorticoids, especially when used over a long time
• Rheumatoid arthritis and other autoimmune diseases
• Lifestyle factors such as smoking, excess alcohol intake, lack of activity, or poor diet
• Other medical conditions, including eating disorders, certain genetic diseases, and diseases that affect the hormones

What are the Symptoms of Osteoporosis?

Osteoporosis may not cause any symptoms early in the disease, but over time symptoms such as the following can occur:

• Pain in the low back and neck
• Stooped (bent forward) shoulders and upper back
• Gradual loss of height
• Bone fracture in the ribs, wrists, or hips
• Flattening or compression of the bones of the spine (vertebrae), which can lead to these bones breaking

People with osteoporosis can fracture a bone and not realize it. Up to two-thirds of osteoporosis-related fractures in the bones of the spine have no symptoms.

Risk Factors

Several factors increase your chance of developing osteoporosis. Some of these cannot be changed, such as:

• Older age
• Female
• Post-menopausal or having had a hysterectomy
• History of osteoporosis in a close relative
• Long-term treatment with glucocorticoids, a type of steroids
• Rheumatoid arthritis

Other factors can be potentially changed, which may reduce your chance of developing osteoporosis. These include:

• Low intake of calcium or vitamin D
• Excessive alcohol use
• Smoking
• Poor nutrition or eating disorder
• Low levels of estrogen
• Frequent falls
• Not getting enough physical activity
• Excessive intake of caffeine
• Poor health or being frail

In addition, people who have had one fracture related to osteoporosis are more likely to have additional ones in the future.

How Common is Osteoporosis?

Osteoporosis is the most common type of metabolic bone disease, affecting 10.3 percent of Americans over age 50 years.

In the United States, osteoporosis causes around 2 million fractures each year. An estimated 40 to 50 percent of women — and 13 to 22 percent of men — will have an osteoporosis-related fracture during their lifetime.

How is Osteoporosis Diagnosed?

Osteoporosis may be diagnosed with:

• Medical history
• Physical examination to look for signs of a deformed spine, loss of height, or tenderness in the spine.
• Blood tests to measure levels of calcium, vitamin D, and other compounds related to bone health.
• Bone mineral density (BMD) test. This is done using a type of x-ray test called a DEXA (dual-energy x-ray absorptiometry) scan. This is usually done to look at the hip or lower spine (lumbar).
• Other tests may be needed to rule out other underlying health conditions.

Doctors also screen women after menopause and older men during routine visits about their risk factors for osteoporosis, such as poor diet, lack of exercise, and long-term use of steroids.

Doctors also screen older adults to see whether they are at higher risk of falling. This includes checking for:

• Eyesight or hearing problems
• Memory or thinking difficulties
• Drop in blood pressure when coming to standing
• Use of sedative drugs
• Obstacles in the home that increase the risk of falls

Treatment and Prevention

Lifestyle changes can help slow down or stop bone loss in people with osteoporosis. The same changes can also be used to prevent osteoporosis from developing in the first place, especially if they are begun earlier in life. These include:

• Getting enough calcium and vitamin D in the diet. The daily adult requirement for vitamin D is 800 to 1,000 International Units (IUs). For men aged 50 to 70, the daily calcium requirement is 1,000 milligrams; for women aged 51 or older and men 71 or older, it is 1,200 milligrams per day. Supplements may be used for some people.
• Weight-bearing and muscle-strengthening exercises at least two times a week.
• Quitting smoking.
• Limiting your intake of alcohol and caffeine.

People with osteoporosis are also at higher risk of bone fracture during a fall. The following steps can help reduce your chance of falling.

• Do weight-bearing and muscle-strengthening exercises at least two times a week.
• Do regular balance training to reduce the risk of falls.
• Make changes in the home to reduce the risk of falls.
• Use walking aids, if needed.
• Correct vision problems.
• Reduce or stop taking sedative drugs.
• Include enough lean protein in your diet to keep the muscles strong.

If you have osteoporosis or are at risk of it, your doctor may prescribe a medication such as alendronate, teriparatide, denosumab to prevent the breakdown of bone and to increase bone density. Other medications are also available. Hormone replacement therapy may also be recommended.

Outlook

• Osteoporosis is a silent disease. Many people will have no symptoms in the beginning, and sometimes a bone fracture is the first sign of disease.
• However, this condition is generally preventable and treatable. Simple lifestyle changes such as eating healthy and exercising can go a long way towards reducing your risk of osteoporosis. These will also slow down bone loss in people who already have this condition.
• There are also several medications and other treatments available for people with osteoporosis. In addition, regular osteoporosis screenings by your doctor as you get older can help catch this condition early on.

Conclusion

• Osteoporosis is a thinning and weakening of the bones. It is most commonly due to aging or hormonal changes after menopause. Other medical conditions can also cause osteoporosis.
• This condition is generally preventable and treatable. Eating a healthy diet, exercising regularly, and other lifestyle changes can help prevent osteoporosis, especially when these are started earlier in life.
• Lifestyle changes can also be used to treat this condition, along with medications and other medical treatments such as hormone replacement therapy.

References

Anderson PA, Devlin VJ and Phillips P. Chapter 64: Metabolic bone diseases of the spine. In: Devlin VJ, ed. Spine Secrets. 3rd ed. Elsevier; 2021:633–647.

Originally published at https://spinenation.com.