Osteoporosis is a disease in which bone density deteriorates and decreases over time, causing weak and brittle bones and increasing the risk of fracture. The wrist, spine, and hip bones are most affected, although any bones are susceptible to the disease. Bones are made up primarily of calcium and protein; it is a living tissue that continuously sheds and reabsorbs old cells and grows new ones. Osteoporosis develops when a newer bone fails to form, or when excessive amounts of bone are reabsorbed by the human body. Osteoporosis often occurs due to a reduction of the estrogen hormone in a woman’s body after menopause, or a loss of testosterone in aging men, however, it can also be caused by a number of other factors, such as taking certain medications. In most cases, osteoporosis develops gradually over many years, and a patient with osteoporosis may not be aware that he or she has the disease until a fracture occurs. At this stage, the disease has already led to a serious thinning and weakening of the bones.
Doctors classify osteoporosis into primary osteoporosis, meaning the condition develops on its own, and second osteoporosis, in which bone loss results from a separate cause, such as certain diseases or medications that reduce bone strength. Within primary osteoporosis, there are three types:
- Juvenile osteoporosis, which occurs in children and young adults, typically between the ages of 8-14.
- Type 1 primary osteoporosis, which results from estrogen deficiency.
- Type 2 primary osteoporosis, also known as age-associated or senile osteoporosis, is marked by a loss of bone density in women and men as they grow older.
Causes & Symptoms
There are a wide variety of causes within the development of osteoporosis. The most common cause is age; people begin to naturally lose bone density as they grow older. Conditions like hyperthyroidism and long-term use of corticosteroids may also cause bone loss. As we grow older, it is more difficult for our bodies to regenerate bone tissue, which is naturally broken down and reformed over time. When our bodies cannot reform bones faster than they break down, our bones become weakened and brittle, making it easier for fractures and breaks to occur.
Osteoporosis is often called a “silent disease” because many people are not aware they have it until they break or fracture a bone. However, there are some common osteoporosis symptoms, which include the following:
- Loss of height
- A curvature of the upper back or stooped posture
- Bones that break or fracture easily
- Weakened hand strength and difficulty grasping objects
Patients living with osteoporosis may also suffer from back and/or neck pain caused by the compression of spinal disks or collapsed vertebra.
Smoking cigarettes is another risk factor for osteoporosis. Profound bone loss has been observed in older women and men who smoke. Researchers have shown a direct link between smoking and decreased bone density. The mechanism is poorly understood; however, researchers suspect smokers may absorb less calcium from their diets. The nicotine in smoke and ‘free radicals’ produced by smoking kill the bone-producing cells, called osteoblasts.
Compared to nonsmokers, women who smoke produce less of the sex hormone estrogen and tend to experience menopause much earlier. Both factors may lead to increased bone loss. Furthermore, smoking damages blood vessels, which may translate into delayed healing of fractures deemed secondary to osteoporosis. Quitting smoking can reduce the risk of osteoporosis and fractures. The overall contribution of smoking to osteoporosis is complicated due to the fact that many individuals possess other risk factors that also increase the risk of osteoporosis.
Excessive alcohol consumption is another controllable risk factor of this disease. Excessive alcohol consumption has a toxic effect on bone-forming cells. Osteoblasts are the cells responsible for the breakdown of bone. As a result of alcohol’s toxic effect, individuals lose more bone mass, which leads to decreased bone density and an increased risk of fractures. Furthermore, excessive alcohol consumption increases the likelihood of falling, especially in the elderly. Therefore, more falls increases the chance of fractures (hip, wrist, and spine), secondary to osteoporosis.
Lastly, medications are another risk for the development of osteoporosis. Certain medications can lead to significant bone loss in men and women. Long-term use of steroids such as cortisone or prednisone may increase an individual’s risk of developing osteoporosis. As a result, it is recommended to take steroids at the lowest possible dose for the shortest period of time to control symptoms.
Generally, osteoporosis itself is not a life-threatening condition, however, the weakness it causes can lead to dangerous falls or bone fractures that could result in a disability or an increased risk of death following the injury. Within the spine, loss of bone density may lead to compression fractures, breakdowns of the vertebrae that can lead to a loss of height, a hunched posture, or back pain.
Who Gets It?
Women are 4 times more likely than men to develop osteoporosis. Women over the age of 50 have the greatest risk of developing the disease. The higher risk for osteoporosis in women is a direct result of reduced estrogen levels during the menopause. Estrogen is a hormone that helps regulate the menstrual cycle of women, but it also plays a role in keeping bones strong and healthy. The dramatic drop in estrogen production due to menopause translates into a significant loss of bone mass and density. Osteoporosis is one of the most common conditions associated with aging. In general, men and women achieve maximum bone mass around age 30. After age 30, bone mass naturally begins to decline with age. As a result, the risk of developing osteoporosis increases with age. By the age of 75, both men and women lose bone mass at a higher rate. Lastly, family history, or heredity, is some of the most important risk factors for the development of osteoporosis. A patient’s risk of osteoporosis is increased if one or more first-degree relatives (parent, sister, or brother) has developed the disease. The risk of this condition is even greater if a first-degree relative has an osteoporosis-related fracture located in the wrist, hip, or spine.
How Does It Affect You? How Serious Is It?
Chronic diseases are a major factor during the experience of osteoporosis. A variety of chronic diseases may increase the risk of this condition, such as rheumatoid arthritis (an inflammatory joint disease that may also lead to bone loss). Research suggests the disease increases the activity of cells that break down the bone, or osteoblasts. Other joint conditions that may increase the risk of osteoporosis include lupus, spinal arthritis, psoriatic arthritis, and osteoarthritis.
Recommended Treatment & Rehabililtation
Due to osteoporosis being a disease caused by a variety of factors, there are also many different treatment options. Currently, there is no way to cure or reverse osteoporosis. However, many of the treatment options will work to slow down further bone loss. Before starting certain treatments, some doctors may have you modify your diet and exercise routines. This can include starting a diet that focuses on essential nutrients like calcium and vitamin D as well as exercise like light aerobics throughout the week. During these treatment types, your doctor might also prescribe or recommend dietary supplements containing calcium or vitamins such as vitamin D. Additionally, your doctor may prescribe medications that directly impact bone health or hormones like estrogen in the body. These treatment options can be a little more intensive rather than a simple change in diet and exercise, but many patients can often lower their risk of fractures with these medications:
- Bisphosphonates – such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Bonita), and zoledronic acid (Reclast), which can decrease bone loss and possibly increase bone density.
- Calcitonin – which can slow the rate of bone loss and help minimize pain.
- Hormone Replacement Therapy – may be considered in some cases. However, HRT (Hormone Replacement Therapy) is no longer considered as the first line of treatment for osteoporosis due to serious risks, such as the increased risk of blood clots, breast cancer, and uterine cancer.
- Teriparatide – which contains parathyroid hormone and encourages new bone tissue growth and reduces the risk of fractures.
- Raloxifene – which is used to prevent and treat osteoporosis in postmenopausal women, and which can make bones stronger and help reduce the risk of fractures.
- Denosumab – which works to increase bone mass in people at high risk of fracture from osteoporosis.
Estrogen, especially when started soon after the menopause, can help maintain bone density. However, estrogen therapy can increase the risk of blood clots, endometrial cancer, breast cancer, and possibly heart disease. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment. In men, osteoporosis might be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been greatly studied in men to treat osteoporosis, and thus are recommended alone or in addition to testosterone.
Your bones are always growing and changing. After the age of 30, you begin to lose more bone than you usually build. Exercise is one way of encouraging your body to build new bone tissue. Some of these exercises include the following:
- Hip extension – Whilst holding onto the back of a chair for balance, slowly raise your right leg straight out behind you. Lift it as high as you can without bending your knee. Finally, lower the leg. Repeat the same procedure with the left leg.
- Bridge – Lie on your back with your knees bent and your feet flat on the floor. Afterward, put your hands next to your hips with the palms down on the floor. Keeping your back straight, lift your buttocks as high as you can off the mat. Pause for a few seconds, then lower back down slowly.
- Chair stand – Position the chair against a wall. Sit in the chair with your knees bent, feet flat on the floor. Cross your arms and put your hands on your shoulders. Keeping your back and shoulders straight, stand up slowly, using your legs rather than your hands. Finally, you slowly sit back down.