Osteoporosis, or thinning bones, can result in painful fractures. Risk factors for osteoporosis include aging, being female, low body weight, low sex hormones or menopause, smoking, and some medications. Prevention and treatment include calcium and vitamin D, exercise, and osteoporosis medications.
Overview & Facts
Learn about osteoporosis and take action against this silent disease.You may not know you have it until your thinned, weakened bones fracture in a bump or fall.
What Is Osteoporosis?
What Is Osteoporosis?
Osteoporosis weakens bones and increases the risk of unexpected fractures. Serious consequences can occur with some fractures. Read this overview article about osteoporosis and how to keep your bones strong.
Osteoporosis is a common disease that weakens bones. As bones weaken, your risk of sudden and unexpected fractures increases. Osteopenia is the forerunner of osteoporosis. It is a silent but destructive condition that robs bones during a woman's -- even a young woman's -- most productive time.
No matter what your age or sex, osteoporosis and osteopenia can affect you. Your bones might seem sturdy now. You may be very active and doing the things you want. But osteoporosis and osteopenia are quiet, accomplished thieves. In fact, there are usually no visible signs. You may notice a loss of height or a Dowager's hump over time. But chances are good the first sign that you have one of these conditions will be a broken bone.
What Is Osteoporosis Bone Loss?
The bone loss with osteoporosis occurs over many years and can become severe. It may be so severe that the normal stress on bones from sitting, standing, coughing, or even hugging a loved one can result in painful fractures and immobility. Then, after the first fracture, you are at risk for more fractures. These future fractures may cause you to live with daily chronic pain and disability.
Fortunately, there are steps you can take now to help keep your bones strong.
Osteoporosis often progresses without symptoms or pain. Losing height may be noticeable. Or a Dowager's hump in your spine may develop with age. Usually, though, a doctor diagnoses osteoporosis after a painful fracture occurs. That fracture is often in the back or hips.
What Is Osteopenia?
Osteopenia refers to early signs of bone loss that can turn into osteoporosis. With osteopenia, bone mineral density is lower than normal. However, it is not yet low enough to be considered osteoporosis. A bone density test can detect osteopenia.
What Causes Osteoporosis?
We don't know a lot about what causes osteoporosis. We do know how osteoporosis develops throughout a person's life. Bones are complex, living tissue. Your body constantly breaks down old bone and rebuilds new bone. This bone-building process is called "remodeling."
Your bones are alive and constantly growing -- not static. Bones continually change throughout your life, with some bone cells dissolving and new bone cells growing back in a process called remodeling. With this lifelong turnover of bone cells, you replace most of your skeleton every 10 years.
Osteoporosis is the most common bone disease. It can be prevented with a healthy diet and staying physically active. Learn about factors that can make bones stronger or weaker.
Does Osteoporosis Start in Childhood?
In childhood and adolescence, the body constantly breaks down old bone and rebuilds new bone. It does this through a process called "remodeling." During this time, the body builds more bone than it removes, and so bones grow and get stronger.
You often hear how important it is for women to get enough calcium. But it's just as important -- maybe even more important -- that kids and teens get ample bone-boosting calcium. It's also important for them to exercise daily to build strong bones.
When Does Osteoporosis Usually Happen in Women?
For most women, the total amount of bone peaks somewhere between the ages of 25 and 30. It may peak even sooner for some women, depending on their risk factors for osteoporosis.
When the total amount of bone peaks, the tide turns. At some point, usually around the age of 35, women start to lose bone.
While some bone is lost each year, the rate of bone loss increases dramatically in the five to 10 years after menopause. Then, for several years, the breakdown of bone occurs at a much greater pace than the building of new bone. This is the process that eventually causes osteoporosis.
During this time, even though your bones may still be strong enough to prevent unusual fractures and you have no signs to alert you to the disease, bone loss may become detectable with a bone density test.
Do Men Get Osteoporosis?
Yes. Men get osteoporosis too. In fact, about 2 million men over the age of 65 have osteoporosis. Osteoporosis usually starts later and progresses more slowly in men. Still, osteoporosis in men is just as disabling and painful as it is in women.
How Common Is Osteoporosis Today?
With the aging of America, osteoporosis is becoming increasingly common. Among people 50 years of age and older, 55% are at significant risk for osteoporosis. In the U.S., more than 10 million men and women have osteoporosis. And nearly another 34 million are thought to have low bone mass. That places them at increased risk for osteoporosis.
What Causes Compression Fractures?
Most spinal compression fractures are never diagnosed because many patients and families think the back pain is merely a sign of aging and arthritis. These weakened bones cause the spine to collapse. Read more.
If you're nearing age 60 and have back pain, don't assume it's a normal part of getting older. You could be affected by a spinal compression fracture.
Back aches and pains can be a sign that small fractures are occurring in your vertebrae - the bones that form your spine, says Michael Schaufele, MD, a physiatrist and professor of orthopaedics at Emory University School of Medicine in Atlanta.
Soft, weakened bones are at the heart of this problem. Compression fractures are often caused by bone-thinning osteoporosis, especially if you are a postmenopausal woman over age 50.
When bones are brittle, everyday activities can trigger minor spinal compression fractures. When you bend to lift an object, miss a step, slip on a carpet, for instance, you can put your spinal bones at risk of fracture. Even coughing or sneezing can cause compression fractures in more severe cases of osteoporosis.
After a number of small compression fractures, your body begins to show the effects. The small hairline fractures can eventually cause a vertebra to collapse -- called spinal compression fracture.
These tiny fractures can permanently alter the strength and shape of the spine. You lose height because your spine is shorter. Most compression fractures occur in the front of the vertebra, which causes the front part of the bone to collapse -- creating a wedge-shaped vertebra. The back of the bone is unchanged because it's made of harder bone. This creates the stooped posture called kyphosis, or dowager's hump.
About two-thirds of spinal compression fractures are never diagnosed because many patients and families think the back pain is merely a sign of aging and arthritis. In fact, many people put off seeing a doctor because they don't realize what's wrong, says Rex Marco, MD, chief of spine surgery and musculoskeletal oncology at the University of Texas Health Science Center in Houston.
"They have pain, but they don't realize what they have is a spinal fracture," he tells WebMD. "And if their osteoporosis doesn't get treated, it can lead to future fractures -- and possibly more severe compression fractures." Osteoporosis treatment significantly reduces but does not eliminate the chance of developing another compression fracture.
Each spinal compression fracture can cause increased lung and breathing problems and even early death, Marco says. "If the fracture doesn't heal, the patient gets depressed because they're in pain. They keep taking pain medication, get constipated, get more depressed. They often have more fractures, and sometimes they get put in a nursing home. It's a terrible problem."
Who Is at Highest Risk for Spinal Compression Fractures?
Two groups of people are at highest risk for spinal compression fractures:
• People with the bone-weakening disease osteoporosis.
• People with cancer that has spread to their bones.
If you have been diagnosed with certain kinds of cancer -- including multiple myeloma and lymphoma -- your doctor may monitor you for compression fractures. However, "sometimes a spinal fracture is the first indication of cancer," Marco says.
But if you have osteoporosis, you may not even know it.
Here are the leading risk factors for osteoporosis:
• Race: White and Asian women have the greatest risk.
• Age: The risk rises rapidly in women over 50 and increases with age.
• Weight: Thin women are at higher risk.
• Early Menopause: Women who went through menopause before age 50
• Smokers: People who smoke lose bone thickness faster than nonsmokers
• Alcohol. Heavy alcohol use can lead to thinning of the bones and increase your risk of fracture.
• Certain Diseases. Some diseases such as rheumatoid arthritis increase the risk for osteoporosis.
• Certain medications. The use of some medications -- for example, the long term use of steroids such as prednisone -- can also increase your risk of developing osteoporosis.
• Family history. Heredity is one of the most important risk factors for osteoporosis. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be at greater risk of developing the disease.
Statistically, among people over age 50, osteoporosis strikes:
• 20% of white and Asian women
• 10% of Hispanic women
• 5% of black women
• 5% of men
What's a bone density test for osteoporosis?
A bone density test measures a small part of one or a few bones to evaluate the strength of your bones and potential risk for osteoporosis. The bones most commonly measured by a bone density test include the hip, the spine, and the heel.
The most widely used bone density test is the DXA test of the hip and lower spine. DXA stands for dual energy X-ray absorptiometry. The DXA test is painless and takes about 10 minutes. It uses only a fraction of the radiation needed for a chest X-ray. Your doctor can order the DXA bone density test and give you your T-score, which represents the overall strength of your bone.
A T-score is a measurement of how you compare to young adults of the same sex and race. If you fall below average, the T-score will be a negative number. A T-score between -1 and -2.5 indicates low bone mass, a condition called osteopenia, which is mild thinning of bone. It is not, however, as severe as osteoporosis. A T-score below -2.5 (for example, -3) indicates your bone mass is more than 2.5 times thinner than that of a young adult. This is a sign that you have osteoporosis.
Since you’ve recently been diagnosed with osteoporosis, ask your doctor these questions at your next visit.
- Are there ways to keep osteoporosis from worsening?
- Can medications taken for other illnesses cause bone loss?
- How can I prevent fractures?
- How frequently should I have a bone density test?
- How much calcium and vitamin D do I need every day, and how can I get enough of these nutrients?
- How much exercise do I need to boost bone strength, and which exercises do you recommend?
- Is hormone replacement therapy safe for preventing osteoporosis?
- What osteoporosis medications are available that prevent bone loss?
- What are some other lifestyle changes I should make now to keep my bones strong?
- What does my T-score mean? (A T-score is the result of a bone density test.)