Osteoporosis

Jai Ganesh · Today 16:56:40

Osteoporosis

Gist

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the structure and strength of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures (broken bones).

Osteoporosis is a “silent” disease because you typically do not have symptoms, and you may not even know you have the disease until you break a bone. Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone but happen most often in bones of the hip, vertebrae in the spine, and wrist.

Summary

Osteoporosis is a systemic skeletal disorder characterized by low bone mass (osteopenia), micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in fracture risk. Bones undergo continuous remodeling: osteoclasts resorb old bone, and osteoblasts synthesize new bone. With advancing age, the rate of resorption exceeds that of bone formation, causing bones to lose density and become more susceptible to fractures.

It is the most common reason for a broken bone among the elderly. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, the wrist, and the hip.

Until a broken bone occurs, there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. After the broken bone heals, some people may have chronic pain and a decreased ability to carry out normal activities.

Osteoporosis may be due to lower-than-normal maximum bone mass and greater-than-normal bone loss. Bone loss increases after menopause in women due to lower levels of estrogen, and after andropause in older men due to lower levels of testosterone. Osteoporosis may also occur due to several diseases or treatments, including alcoholism, anorexia or underweight, hyperparathyroidism, hyperthyroidism, kidney disease, and after oophorectomy (surgical removal of the ovaries). Certain medications increase the rate of bone loss, including some antiseizure medications, chemotherapy, proton pump inhibitors, selective serotonin reuptake inhibitors, glucocorticosteroids, and overzealous levothyroxine suppression therapy. Smoking and sedentary lifestyle are also recognized as major risk factors. Osteoporosis is defined as a bone density of 2.5 standard deviations below that of a young adult. This is typically measured by dual-energy X-ray absorptiometry (DXA or DEXA).

Prevention of osteoporosis includes a proper diet during childhood, hormone replacement therapy for menopausal women, and efforts to avoid medications that increase the rate of bone loss. Efforts to prevent broken bones in those with osteoporosis include a good diet, exercise, and fall prevention. Lifestyle changes such as stopping smoking and not drinking alcohol may help. Bisphosphonate medications are useful to decrease future broken bones in those with previous broken bones due to osteoporosis. In those with osteoporosis but no previous broken bones, they have been shown to be less effective. They do not appear to affect the risk of death.

Osteoporosis becomes more common with age. About 15% of Caucasians in their 50s and 70% of those over 80 are affected. It is more common in women than men. In the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected. Rates of disease in the developing world are unclear. About 22 million women and 5.5 million men in the European Union had osteoporosis in 2010. In the United States in 2010, about 8 million women and between 1 and 2 million men had osteoporosis. White and Asian people are at greater risk for low bone mineral density due to their lower serum vitamin D levels and less vitamin D synthesis at certain latitudes. The word "osteoporosis" is from the Greek terms for "porous bones".

Details

Osteoporosis silently weakens your bones. This increases your risk of broken bones without you knowing it. You can prevent bone density loss with treatments and exercise. Ask your healthcare provider about a bone density test if you’re over 65 or have a family history of osteoporosis.

What Is Osteoporosis?

Osteoporosis is a disease that weakens your bones and makes them much more likely to fracture. It makes your bones thinner and less dense than they should be.

Your bones are usually dense and strong enough to support your weight and absorb most kinds of impacts. As you age, your bones naturally lose some of their density and their ability to regrow themselves. If you have osteoporosis, your bones are much more fragile than they should be, and are much weaker.

You might not know you have osteoporosis until it causes you to break a bone. Osteoporosis can make any of your bones more likely to break, but the most commonly affected bones include your:

* Hips
* Wrists
* Spine

Symptoms and Causes:

Symptoms of osteoporosis

Osteoporosis doesn’t have symptoms the way that lots of other conditions do. That’s why healthcare providers sometimes call it a silent disease.

You won’t feel or notice anything that signals you might have it. You won’t have a headache, fever or stomachache that lets you know something in your body is wrong.

The most common “symptom” is suddenly breaking a bone. Especially after a small fall or minor accident that usually wouldn’t hurt you.

Even though osteoporosis doesn’t directly cause symptoms, you might notice a few changes in your body that can mean your bones are losing strength or density. These warning signs of osteoporosis can include:

* Losing an inch or more of your height
* Changes in your natural posture, like stooping or bending forward more
* Shortness of breath (if disks in your spine are compressed enough to reduce your lung capacity)
* Lower back pain

It might be hard to notice changes in your own physical appearance. A loved one may be more likely to see them, especially your height or posture. People sometimes joke about friends or family members “shrinking” as they age. But this can be a sign that you should visit a healthcare provider for a bone density test.

Around 1 in 3 adults over 50 who don’t have osteoporosis have osteopenia. This means your bone density is lower than it should be for your age. It’s an early sign of osteoporosis. Osteopenia can progress to become osteoporosis if it’s not treated.

Osteoporosis causes

Osteoporosis happens as you age and your bones lose their ability to regrow and reform themselves.

Your bones are living tissue like any other part of your body. They’re constantly replacing their own cells and tissue throughout your life. Up until about age 30, your body naturally builds more bone than you lose. After age 35, bone breakdown happens faster than your body can replace it. This causes a gradual loss of bone mass.

If you have osteoporosis, you lose bone mass faster than usual. People in postmenopause lose bone mass even faster.

Risk factors

Anyone can develop osteoporosis. You may have a higher risk if you:

* Are over 50
* Are female, especially if you’re in postmenopause
* Have a biological family history of osteoporosis
* Are naturally thin or have a “smaller frame”
* Smoke or use tobacco products
* Don’t get enough vitamin D
* Aren’t physically active
* Regularly drink alcohol (having more than two drinks per day)

Certain health conditions can make you more likely to develop osteoporosis, including:

* Endocrine disorders like thyroid disease, hyperthyroidism and diabetes
* Gastrointestinal diseases like celiac disease and inflammatory bowel disease
* Autoimmune diseases that affect your bones, like rheumatoid arthritis or ankylosing spondylitis
* Blood disorders or blood cancers like multiple myeloma

Some medications or surgical procedures can increase your osteoporosis risk as a side effect, including:

* Diuretics
* Corticosteroids
* Some medications used to treat seizures
* Bariatric surgery
* Hormone therapy for cancer
* Blood thinners
* Proton pump inhibitors

Diagnosis and Tests:

How doctors diagnose osteoporosis

A healthcare provider will diagnose osteoporosis with a bone density test. Providers sometimes refer to bone density tests as DEXA scans, DXA scans or bone density scans. All of these are different names for the same test.

A bone density test uses low levels of X-rays to measure how much calcium and other minerals are in your bones. It’s similar to a typical X-ray. There are no needles or injections.

Checking for changes in your bone density is the best way to catch osteoporosis before it causes a fracture. Your provider might suggest you get regular bone density tests if:

* You have a family history of osteoporosis
* You’re over 50
* You have osteopenia
* You’re in postmenopause

Management and Treatment:

Treatment for osteoporosis:

The most important part of treating osteoporosis is preventing broken bones. Your healthcare provider will suggest treatments to strengthen your existing bone tissue and slow down any bone density loss.

The most common osteoporosis treatments include:

Exercise

Staying active can strengthen your bones. It also helps all the tissue connected to them, like your muscles, tendons and ligaments. Your provider might suggest weight-bearing exercise to strengthen your muscles and train your balance. Exercises that make your body work against gravity can improve your strength and balance without putting too much stress on your bones. Some good options include:

* Walking
* Yoga
* Pilates
* Tai chi

You might need to work with a physical therapist to find exercises and movements that are right for you.

Vitamin and mineral supplements

You might need over-the-counter or prescription calcium or vitamin D supplements. Your provider will tell you:

* Which type is best
* How often you should take them
* Which dosage you’ll need

Medications for osteoporosis

Your provider may suggest prescription medications. Some of the most common osteoporosis medications include:

* Hormone therapies, like replacement estrogen or testosterone
* Bisphosphonates

If you have severe osteoporosis or a high risk of fractures, you might need other medications, like:

* Parathyroid hormone (PTH) analogs
* Denosumab
* Romosozumab

These medications are usually given as injections.

When should I see my healthcare provider?

Visit a healthcare provider if you notice any changes in your body that might be osteoporosis warning signs. Tell your provider about any other symptoms you’re experiencing, especially if you have bone pain or trouble moving.

Outlook / Prognosis:

What can I expect if I have this condition?

You’ll need regular appointments with a healthcare provider. They’ll tell you how often you’ll need follow-up bone density tests. Your provider will monitor any changes in your bone density and will adjust your treatments as needed.

Broken bones can always cause complications. And that’s especially true as you age. Some fractures, like broken hips, can have a big impact on your life. Talk to your healthcare provider if you’re worried about your risk of falls or bone fractures. They’ll help you stay safe and healthy.

Prevention:

Can this be prevented?

Staying physically active and making sure you get enough calcium and vitamin D are the best ways to support your bone health. But osteoporosis isn’t always preventable. Your provider will help you find a combination of treatments that’s best for your unique needs.

Additional Information:

Overview

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a break. Osteoporosis-related breaks most commonly occur in the hip, wrist or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.

Osteoporosis affects people of all races. But women who are white or of Asian descent, especially older women who are past menopause, are at highest risk. Medicines, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.

Symptoms

There often are no symptoms in the early stages of bone loss. But once osteoporosis weakens your bones, you might have symptoms of a fracture that include:

* Back pain caused by a broken or collapsed bone in the spine.
* Loss of height over time.
* A stooped posture.
* A bone that breaks much more easily than expected.

When to see a doctor

Talk with your healthcare professional about osteoporosis if you went through early menopause or took corticosteroids for several months at a time. Also see your care team if you have a parent or sibling with osteoporosis. This puts you at greater risk, especially if either of your parents had hip fractures.

Causes

Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. After the early 20s this process slows, and most people reach their peak bone mass by age 30. As people age, bone mass is lost faster than it's created.

How likely you are to develop osteoporosis depends partly on how much bone mass you built in your youth. Peak bone mass is partly inherited and also varies by race. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age.

Risk factors

A number of factors can increase the likelihood that you'll develop osteoporosis. Risk factors include your age, race, lifestyle choices, and medical conditions and treatments.

Risks you can't change

Some risk factors for osteoporosis are out of your control, including:

* sex assigned at birth. Women are much more likely to develop osteoporosis than are men.
* Age. The older you get, the greater your risk of osteoporosis.
* Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.
* Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.
* Body frame size. People who have small body frames tend to have a higher risk. This may be because they have less bone mass to draw from as they age.

Hormone levels

Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

* sex hormones. Lowered sex hormone levels tend to weaken bone. The fall in estrogen levels at menopause is one of the strongest risk factors for developing osteoporosis. Treatments for prostate cancer that reduce testosterone levels and treatments for breast cancer that reduce estrogen levels are likely to speed up bone loss.
* Thyroid hormone. Too much thyroid hormone can cause bone loss. This can occur if your thyroid makes too much hormone or if you take too much thyroid hormone medicine to treat a thyroid that doesn't make enough hormone.
* Hormones from other glands. Osteoporosis also has been associated with having too much of the hormones from the parathyroid and adrenal glands.

Dietary factors

Osteoporosis is more likely to occur in people who have:

* Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to lower bone density, early bone loss and an increased risk of fractures.
* Eating disorders. Severely restricting food intake and being underweight weakens bone in all people.
* Gastrointestinal surgery. Surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. These surgeries include those to help you lose weight and those that treat other gastrointestinal conditions.

Steroids and other medicines

Long-term use of corticosteroid medicines, such as prednisone and cortisone, interferes with the bone-rebuilding process. These medicines are taken by mouth or shot. Osteoporosis also has been associated with medicines used to combat or prevent:

* Seizures.
* Gastric reflux.
* Cancer.
* Transplant rejection.

Medical conditions

The risk of osteoporosis is higher in people who have certain medical conditions, including:

* Celiac disease.
* Inflammatory bowel disease.
* Kidney or liver disease.
* Cancer.
* Multiple myeloma.
* Rheumatoid arthritis.

Lifestyle choices

Some habits can increase your risk of osteoporosis. Examples include:

* Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Weight-bearing exercise and activities that promote balance and good posture are good for your bones. Walking, running, jumping, dancing and weightlifting seem particularly helpful.
* Excessive alcohol use. Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.
* Tobacco use. The exact role tobacco plays in osteoporosis isn't clear, but tobacco use has been shown to contribute to weak bones.

Complications

Bone breaks, particularly in the spine or hip, are the most serious complications of osteoporosis. Hip fractures often are caused by a fall. A hip fracture can result in disability and even an increased risk of death within the first year after the injury.

In some cases, broken bones in the spine can occur even if you haven't fallen. The bones that make up the spine, called vertebrae, can weaken to the point of collapsing. This can result in back pain, lost height and a hunched posture.

Prevention

Good nutrition, regular exercise and a healthy lifestyle are essential to keep your bones healthy throughout your life. In early stages of bone loss, many people can manage their bone health with supplements, diet and exercise.

There is a lot of misinformation about supplements for bone health. Not all products that claim to prevent or treat osteoporosis are safe or effective. Talk with your healthcare professional about which supplements can help improve bone health.

Steps you can take to help prevent bone loss include:

Calcium

People between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

Good sources of calcium include:

* Low-fat dairy products.
* Dark green leafy vegetables.
* Canned salmon or sardines with bones.
* Soy products, such as tofu.
* Calcium-fortified cereals and orange juice.

If you find it hard to get enough calcium from your diet, consider taking calcium supplements. But too much calcium has been linked to kidney stones. Some experts suggest that too much calcium, especially in supplements, can increase the risk of heart disease. Research is ongoing.

The Food and Nutrition Board at the National Academies of Sciences, Engineering, and Medicine recommends that total calcium intake from supplements and diet combined should be no more than 2,000 milligrams daily for people older than 50.

Vitamin D

Vitamin D improves the body's ability to absorb calcium and improves bone health in other ways. People can get some of their vitamin D from sunlight. But this might not be a good source if you live in a high latitude, if you're housebound, or if you regularly use sunscreen or avoid the sun because of the risk of skin cancer.

Dietary sources of vitamin D include cod liver oil, trout and salmon. Many types of milk and cereal have been fortified with vitamin D.

Most people need at least 600 international units (IU) of vitamin D a day. That recommendation increases to 800 IU a day after age 70.

People without other sources of vitamin D and especially those with limited sun exposure might need a supplement. Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

Exercise

Exercise can help you build strong bones and slow bone loss. Exercise can benefit your bones no matter when you start. But you gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life.

Combine strength training exercises with weight-bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, running, stair climbing, skiing and impact-producing sports — affect mainly the bones in your legs, hips and lower spine. Balance exercises such as tai chi can reduce your risk of falling especially as you get older.

Healthy lifestyle

These healthy lifestyle suggestions might help reduce your risk of developing osteoporosis or breaking bones:

* Don't smoke. Smoking increases the rate of bone loss and the chance of fracture.
* Limit alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation. Alcohol use also can increase your risk of falling.
* Prevent falls. Wear low-heeled shoes with nonslip soles. Check your house for electrical cords, area rugs and slippery surfaces that might cause you to fall. Keep rooms brightly lit. Install grab bars just inside and outside your shower door, and make sure you can get into and out of your bed easily.

Even when taking steps to prevent bone loss, some people continue to lose bone or have fractures. In these situations, treatment with medicines may become necessary. Even when medicines are used, diet, exercise and lifestyle choices still play an important role in bone health.

Math Is Fun Forum

#1 Today 16:56:40

Osteoporosis

Board footer