Osteoporosis

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Osteoporosis

What is osteoporosis?

Osteoporosis is a chronic (long-term) bone disease that occurs when the body loses too much bone or makes too little bone, or both. Osteoporosis means “porous bone,” and causes bones to become weak, brittle and break easily. 

Bones are living, growing tissue that are constantly being broken down and rebuilt. Bones are built with calcium, vitamin D, phosphorus and protein. When the growth of new bone doesn’t keep up with the loss of old bone, osteoporosis or osteopenia usually occurs. The most common place for osteoporosis-related fractures are hips, wrists or spine, although bones can break anywhere in your body. 

What is osteopenia?

Osteopenia is low bone density and, without treatment, it often develops into the more damaging and serious disease of osteoporosis. 

How common are osteoporosis and osteopenia? 

About 54 million Americans have osteoporosis or osteopenia. About 80% of osteoporosis patients are women. Half of all women in the United States will have a bone fracture due to osteoporosis during their lifetime. About 25% of men aged 50 and older will have a osteoporotic fracture. Of the more than 34 million people with osteopenia in the United States, cases are almost evenly divided between women and men. 

What is secondary osteoporosis?

Secondary osteoporosis can cause the same problems as osteoporosis, but it’s caused by a number of medical problems. These can include endocrine disorders (diabetes and thyroid disease among others), side effects of medication, lack of exercise, stomach and intestinal disorders, kidney disease or failure, cancer, and pituitary diseases, such as Cushing’s disease, hyperprolactinemia, acromegaly, and hypopituitarism.

Is osteoporosis an endocrine gland disorder?

Endocrine disorders can play a causative role in the development of osteoporosis and osteopenia. Endocrine diseases can disrupt hormone production. If this disruption happens, it can directly affect bone growth, and the normal process of bone being broken down and rebuilt, called remodeling. Osteoporosis is the most common metabolic bone disease. Bone density often increases after an endocrine disorder is diagnosed and treated. 

Why should I worry about osteoporosis or osteopenia?

Untreated osteoporosis increases your risk of bone fractures, bone deformities, permanent pain, disability, lack of mobility and death. Breaking a bone, especially a hip, is especially serious for older patients. It often results in permanent disability, requiring nursing home or community-based long-term care. Osteoporosis causes some patients to lose height. When osteoporosis causes broken spinal vertebrae, it often causes a permanently stooped posture.   

Causes

What are the symptoms of osteoporosis?

There are no symptoms when osteoporosis begins. For many patients, breaking a bone is their first symptom. As the damage progresses, patients may notice they are getting shorter or their upper back is rounding forward. Fractures in the spinal vertebrae can cause it to bend forward, causing sloping shoulders, loss of height, back pain and a hunched posture.

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Symptoms

What causes osteoporosis?

The main cause of osteoporosis is bone loss, which can be caused by menopause. The production of bone-building estrogen slows and stops after menopause. Without enough estrogen, bones lose their ability to rebuild.

What causes bone loss?

Bone loss is caused when minerals, such as calcium, that the body needs in order to function properly, are absorbed from the bones. This robs the bones of the minerals they need to remodel and stay strong. Bone loss can occur if you’re not getting enough calcium in your diet. Your body pulls the calcium it needs from your bones. 

There are also many health problems that can contribute to bone loss, including:

  • Autoimmune disorders (rheumatoid arthritis, lupus, ankylosing spondylitis or multiple sclerosis)
  • Weight-loss surgery, celiac disease or inflammatory bowel disease
  • Breast or prostate cancer
  • Blood disorders (leukemia, lymphoma, multiple myeloma or sickle cell disease)
  • Stroke, spinal cord injuries or Parkinson’s disease
  • Bone marrow disorders (thalassemia)
  • Eating disorders, depression, or excessive exercise
  • Endocrine disorders (diabetes, hyperparathyroidism, hyperthyroidism, irregular periods, Thyrotoxicosis, premature menopause, and low testosterone and estrogen levels in men)
  • HIV/AIDS
  • COPD
  • Kidney or liver disease
  • Organ transplant
  • Polio and post-polio syndrome
  • Scoliosis
  • Poor diet, malnutrition or weight loss
  • Medications can also cause bone loss (antacids containing aluminum, some antiseizure medicines, aromatase inhibitors, chemotherapy drugs, heparin, methotrexate, proton pump inhibitors, SSRIs, steroids, thyroid hormones in excess). The higher the dose of these meds, the greater the loss of bone. 

Who’s at risk for osteoporosis and osteopenia?

Your risk of developing either is higher if you:

  • Are a woman over age 50, or a man over age 70
  • Have a small and thin body (less than 127 pounds)
  • Are a White, Asian or Mexican woman
  • Are from a family with a history of osteoporosis
  • Have low bone density
  • Have a history of bone fractures
  • Are a smoker
  • Are not physically active
  • Drink too much alcohol, which is more than one drink a day for women
  • Have any of the conditions that cause bone loss listed above

Diagnosis

Who treats osteoporosis? 

Osteoporosis can be treated by your primary care doctor or an endocrinologist (a specialist who treats problems with your metabolism and endocrine system). Endocrinologists treat diabetes, thyroid and pituitary gland diseases, which can cause osteoporosis. Endocrine disorders affect hormones that are essential to bone growth. Without these hormones, the bone loss and fracture risks associated with osteoporosis are accelerated. 

How is osteoporosis diagnosed?

It’s important to know how dense your bones are to accurately diagnose bone problems. Screening is important to identify weakened bones before it’s too late to stop the damage. The current screening recommendations are to have a dual-energy X-ray absorptiometry (DEXA) scan if you are a female over age 65, a male over age 70, or age 50 or older for anyone who’s had a broken bone. People who have any of the bone-loss conditions listed above may also need a DEXA scan.

Treatment

What are treatment options for osteoporosis?

Your doctor may prescribe medications to slow or stop bone loss. There are also actions you can take to avoid osteoporosis:

  • Eat a healthy diet rich in calcium and vitamin D, but low in salt and caffeine.
  • Exercise regularly with activities that support your weight. Weight-bearing activities keep bones strong by pushing them to remodel.
  • Quit smoking.
  • Avoid falls by wearing supportive shoes, removing fall hazards in and around your home and checking with your doctor about medications that could increase your fall risk. Falls are the major cause of fractures in older people.
  • Limit alcohol to one drink a day for women; two drinks a day for men. 

Is osteoporosis curable?

It’s not curable, but with long-term treatment, it can be managed and often the deterioration can be stopped or at least slowed. Some treatments can increase the growth of new bone.

Information

Medically reviewed by:

Jodi B. Nagelberg, MD, MHA

Dr. Jodi Nagelberg is an endocrinologist, with board certification in Interal Medicine. She also holds a masters in Health Administration and Policy. She joins TeleMed2U as Endocrinology Director and supports our mission to increase access to healthcare for patients everywhere.Postgraduate: University of Southern California Sol Price School of Public Policy Los Angeles, CA  Masters, Health Administration and Policy, 2011

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