Osteoporosis

What is osteoporosis?

Osteoporosis is a condition of low bone quantity and/or poor bone quality. It means that the bones are fragile and prone to fractures. Osteoporosis is a “silent disease,” since there are no warning signs or symptoms until bone fractures occur. In the United States alone, an estimated 1.5 million bone fractures each year are attributed to low bone density.

Who gets osteoporosis?

Osteoporosis and osteopenia can affect people of all ages but become more likely as we age. Women, especially post-menopausal women, have the greatest risk, accounting for about 80% of all cases. A rare but severe form of the disease known as pregnancy and lactation-associated osteoporosis (PLO) affects younger women, usually in the third trimester of pregnancy or during lactation. In these cases, women may develop one or more vertebral fractures of the spine.

What are the risk factors for osteoporosis?

Women get osteoporosis more often than do men, and people of Northern and Western European or Asian descent at higher risk than those of other ethnicities.

Other risk factors include:

• Advancing age.
• Family history of osteoporosis.
• Hormonal changes such as low estrogen states in women (for example, post-menopause) and low testosterone states in men.
• Lifestyle factors, including:
  
  • Smoking.
  • Consuming excess alcohol.
  • Poor nutrition (especially calcium and vitamin D deficiencies).
• The use of certain medications such as corticosteroids.

In addition, people of low weight (less than 127 lbs/57kg) or who have endocrine disorders (such as hyperparathyroidism or hyperthyroidism) or inflammatory disorders are prone to developing osteoporosis.

What are common osteoporosis symptoms?

Osteoporosis is clinically silent – the "silent thief" as doctors call it. The first "symptom" is a broken bone (fracture). However, 2/3 to 3/4 of vertebral fractures of the spine are clinically silent (causing no pain or mobility symptoms) – the silent crime of the silent thief. This is the reason healthcare providers regularly check a person’s height over time and image the entire spine if height loss is detected. Without proactive screening for at-risk patients, osteoporosis will go undetected until a fracture occurs.

Avoiding complications during orthopedic surgery

One study by HSS spine surgeons found that a high number of their lumbar spine surgery patients had previously undiagnosed osteoporosis, highlighting the need for orthopedic surgeons to be watchful for metabolic bone disease in their patients. Perioperative bone health optimization lowers the rate of complications during or after surgery.

What are the complications of osteoporosis?

Complications include loss of height, spinal deformity such as degenerative scoliosis, pain and dysfunction as a result of fractures and/or the surgery needed to repair same. Spinal fractures can lead to kyphosis, and severe kyphosis can cause organ dysfunction (lung capacity restriction, digestive issues) and make people more prone to falls due to their altered center of gravity from being bent over.

Osteoporosis increases the risk of hip fractures, which have a higher risk of mortality (death) from complications than does a myocardial infarction (heart attack)

Animation on osteoporosis of the spine

What causes osteoporosis?

Low bone density in adolescence and early adulthood can be a result of a failure to attain peak bone mineral density. Accelerated bone loss may be particularly noted around menopause and in later years. Many factors, including diet (for example, insufficient levels of calcium and vitamin D intake) and the lack of proper exercise, contribute to low bone density during these periods.

It may also be the result of numerous underlying conditions, many of which are often not readily apparent during a typical doctor visit. Laboratory testing, including blood and urine studies, is helpful in determining possible secondary and contributing causes.

How do you prevent osteoporosis?

Many studies have shown that calcium and vitamin D are essential for bone health. The amount of calcium that individuals need varies, but adults typically require about 1,200 to 1,500 milligrams daily. It is especially important that growing adolescents get adequate calcium in their diets, in order to prevent osteoporosis later in age.

Every day, approximately 10,000 milligrams of calcium move in and out of the skeleton to renew and repair the bone. Food remains the best source of calcium, but some people may need to get additional calcium by taking supplements.

Also crucial for good bone health are:

• Exercise – weightbearing and resistance exercises help build bone and maintain healthy bone.
• Fall prevention – good balance and removing potential dangers around the house.
• Maintaining a healthy weight.
• Quitting or avoiding smoking tobacco.
• Limiting alcohol intake – two or more drinks a day increases the risk of fracture.

How is osteoporosis diagnosed?

A dual-energy X-ray absorptiometry (DXA or "DEXA") bone mineral density test will help your doctor determine whether or not you have osteoporosis. In addition, a blood and urine test will rule out underlying conditions and medical concerns.

How is osteoporosis treated?

Along with continuing the lifestyle involved in preventing osteoporosis such as healthy eating, calcium and vitamin D supplements and limiting risky behavior, your doctor might suggest special medications to increase bone mineral density. The most important goal is to lower risk of fracture. If needed, your doctor will explain the risks and benefits of the various medications offered and work with you on deciding what's best.

For more information, contact the Osteoporosis and Metabolic Bone Health Center at HSS, which was founded to help prevent and treat osteoporosis, and explore the articles below.

Can osteoporosis be reversed?

We now have osteo-anabolic (bone-growing) agents that improve bone density tremendously, in addition to the more traditional anti-resorptive agents that maintain bone density and prevent fractures. Osteoporosis is not yet curable, but our treatments are robustly effective.