Osteoporosis is a disease that thins and weakens bones to the point where they may break easily. This disease most often causes fractures of the bones of the hip, spine, and wrist.
Studies indicate that bones keep their strength by being used, supporting the body’s weight. Bone-forming cells called osteoblasts make new bone all the time. Bone-absorbing cells called osteoclasts dissolve away older bone, making room for new bone. This goes on all the time – the bones are always being remodeled. For unknown reasons, the balance of formation and reabsorption of bones tips slightly in favor of reabsorption as people get older. Too much bone reabsorption leads to osteoporosis.
Bones reach their greatest strength between ages 20 and 35. After 35, your bones slowly get weaker as you get older.
The risk of osteoporosis goes up with age. Osteoporosis starts to develop in women after menopause, between the ages of 45 and 55. After menopause a woman’s body makes much less estrogen, a female hormone. Estrogen helps women's bones stay strong. The bones weaken when estrogen levels are low.
Women have less bone mass than men, and they lose bone mass sooner and faster than men. Osteoporosis is most common in white and Asian women, especially slim women, but it can occur in women of any race.
In addition to aging, other causes of osteoporosis are:
You have a higher risk of osteoporosis if you have a family history of the disease.
Usually, there are no symptoms until a bone breaks. Broken bones are the most common problem for people with osteoporosis. Often it's the hip, arm, or wrist that breaks.
The bones of the spine are also a common area of thinning. Often, over time, the bones of the spine (vertebrae) collapse on themselves. This can cause a loss of height, back pain, and a stooping posture (dowager's hump).
Your healthcare provider will review your medical history, ask about symptoms, and examine you.
The main test used to look for osteoporosis is a bone mineral density test, such as a DEXA scan. This test is a special X-ray exam of the spine, hip, and/or wrist. A DEXA scan is recommended for all women age 65 and older. Women who have a higher risk should have the test by age 60. Repeat testing depends on the results of the first test.
Sometimes, osteoporosis can be measured using ultrasound scans.
Treatment can slow down the loss of bone and rebuild some bone. It does not restore bone strength all the way back to normal.
The 3 essentials of basic treatment for osteoporosis are:
Several medicines slow bone loss and help reduce fractures. These include:
These medicines are prescribed if your bone mineral density tests show that you have osteoporosis even though you are getting enough exercise and calcium and are not smoking. They may also be prescribed if you have had a broken bone because of osteoporosis.
Treatment with the female hormones estrogen and progestin can help prevent bone loss as well as relieve some of the symptoms of menopause. Discuss the risks and benefits of hormone therapy with your healthcare provider. Depending on your age, treatment with estrogen and progestin may increase the risk for heart disease. It may also increase your risk for stroke, breast cancer, blood clots, some gallbladder problems, and possibly dementia. Also, estrogen taken without progestin increases the risk of uterine cancer if you still have your uterus.
Other medicines and therapies have been or are being developed. Check with your healthcare provider about your current choices for treatment.
The risk of a broken bone resulting from osteoporosis gets higher as you get older. Compression fractures in the spine are the most common type of fracture caused by osteoporosis. Treatment can help reduce your risk of broken bones, especially compression fractures and broken hips. However, no treatment has eliminated the risk of these types of fractures.
Once menopause starts, most women, especially Caucasian and Asian women, need to take precautions for the rest of their lives to prevent osteoporosis.
If you have osteoporosis, you can reduce the risk of injury and broken bones if you:
If you have had problems with falling, be sure to let your healthcare provider know. Some medicines increase the risk of falling. You may need physical therapy to improve your balance and walking. In some cases, a nurse or physical therapist may need to do a home safety evaluation.
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