What is osteoporosis? | Signs & Symptoms | Conditions | Prevention | Treatment
If you’re a woman over fifty, chances are you’ll have osteoporosis in your lifetime. It is also likely you’ll suffer a fracture as a result of the disease. Osteoporosis, a condition marked by weak and brittle bones, affects more than 10 million people in the United States, most of who are female. It is a silent disease until you experience a fracture. Many fractures that are caused by osteoporosis can be prevented.
Osteoporosis is defined as a condition in which the amount of bone and the quality of bone is not normal (quality refers to the structure of the bone which allows it to be strong and flexible at the same time so it can support you and resist fracture).
You are at risk for osteoporosis if any of the following apply to you. You can remember these signs and symptoms by using the mnemonic SLENDER®.
- Slim Build
- Low calcium intake or little exercise
- Early menopause or even a history of irregular periods
- No pregnancies
- Dermatologic / ethnic background (very light skinned people are at greater risk then darker skinned people), external factors such as smoking or excess alcohol consumption and drugs such as steroids and anti seizure medication as well as excess thyroid hormone
- Relatives with osteoporosis (particularly your mother).
There are a number of conditions that cause rapid loss of bone and lead to bones that are more fragile and more likely to fracture. These conditions include calcium and vitamin D deficiency, certain types of cancer, transplanted organs, certain types of liver disease, the prolonged use of the blood thinner heparin (or mast cell disease, a condition in which heparin like substances are made by the body in excess), certain endocrine diseases, including certain pituitary disorders, adrenal disorders, and an overactive thyroid. Certain types of kidney disorders, including one in which the kidneys leak calcium that can lead to kidney stones and bone loss, and inflammatory arthritis such as rheumatoid arthritis are also possible conditions. There are certain rare diseases such as Paget’s disease of bone which causes bone deformity, fracture, and osteogenesis imperfecta, a condition which affects bone collagen, and makes the bone more fragile.
What things make you more likely to have a fracture?
Factors that make you more vulnerable to fracture can be remembered by the pneumonic FAR TRIP®. They include:
- Frailty (such as inability to get out of a chair without help)
- Age (older people are more likely to fracture) and adiposity (thin people are more likely to fracture)
- Relatives who have fractured
- Tendency to fall particularly to the side
- Radiologic (x-ray) evidence of deformity of the spine, including partial painless fracture of the spine
- Increased length of the part of the hip called the femoral neck which can be seen in people of Asian descent
- Prior history of fracture
To help prevent osteoporosis and bone fractures, determine whether you are getting enough calcium in your diet by using the Calcium Calculator.
Age |
Daily Calcium Intake |
1 to 3 |
500 mg/day |
4 to 8 |
800 mg/day |
9 to 18 |
1,300 mg/day |
19 to 50 |
1,000 mg/day |
51 to 64 |
1,200 mg/day |
65 and older |
1,500 mg/day |
Please use the chart below to help you prevent osteoporosis. Begin by examining the situations in the left hand column and proceed to read the center and right hand columns to learn what you need to know and what should happen for preventative care.
Situation |
You Need |
What Should Happen |
Woman nearing menopause, or postmenopausal |
Complete medical evaluation to ensure good health, Bone mineral density test (BMD); assessment for skeletal risk factors |
Discussion with your doctor about the effects of menopause; 1500 mgs of calcium daily, daily exercise program, multi vitamins; consider treatment for osteopenia if BMD t-score is less than 1.5, for osteoporosis if t-score 2.5 or less |
Growing teenager |
Assess diet, exercise, lifestyle |
Regular exercise; no smoking; maintain normal weight; avoid unhealthy foods like soft drinks |
Adult Taking thyroid hormone |
Thyroid stimulating hormone (TSH) test |
Adjust thyroid dose to normalize thyroid level (normalize TSH) |
Anyone taking cortisone or related drugs |
BMD test |
Take medications that counteract effect of these drugs on bone- bisphosphonates, calcium, vitamin D |
Male over 55 with sexual dysfunction and/or history of osteoporosis in male family members |
BMD test; endocrinologist evaluation for cause of sexual dysfunction |
I500 mg calcium daily, vitamin D 1000 units daily, regular exercise. Treat if BMD indicates osteopenia / osteoporosis; treat |
Teenager with delayed or absent sexual development |
Complete medical and endocrine evaluation; diet assessment |
Treat hormone deficiency if present; 1500 mg calcium, vitamin D 400 IU daily, regular vigorous exercise; monitor growth and development |
Middle aged woman whose mother just had a hip fracture |
BMD test and risk factor assessment |
Discussion about good bone health measures (1500 mg calcium, 400 to 1000 IU vitamin D); treat osteopenia / osteoporosis if BMD indicates |
Anyone with chronic illness, persistent unexplained weight loss, malignant disease |
Complete medical evaluation for diagnosis of illness; BMD |
Treat chronic disease: 1500 mg calcium; vitamin D 1000 IU daily; treat osteoporosis / osteopenia if present |
Anyone taking cortisone related drugs (for example dexamethasone, prednisone, hydrocortisone |
Medical and endocrine evaluation to assess indication for cortisone and dose |
Doctor to determine if dose used is equivalent to more than 5 mg of prednisone; and, if so, a bisphosphonate (for example Actonel, Fosamax), calcium and vitamin D supplements will be prescribed to protect your skeleton from the effects of your medication |
Anyone with calcium levels that are higher than normal |
An endocrinology evaluation for abnormal parathyroid function, vitamin D metabolism, or other causes of high calcium levels; BMD, tests for kidney function and for kidney stones |
Cause of high calcium levels will be determined and treatment options fully discussed and considered |
Prevent another fracture
If you have had a fracture that was not caused by severe trauma, as might occur in an auto accident, you are at increased risk to experience another fracture and additional measures may be required to avoid further fracturing.
To find out if you and your doctor are doing all you can to prevent another fracture, find the situation that closest describes you in the left hand column.
Situation |
You need |
What should happen |
Growing healthy child with a fracture suffered at play |
Only to be more careful |
|
Growing child with multiple fractures |
Pediatric endocrinology evaluation |
Possibility of a congenital cause of osteoporosis will be explored |
Teen or young adult with sports-related stress fractures |
Medical and endocrine evaluation for possible osteoporosis |
BMD in some cases; hormone tests to check for normal sexual development and maturity |
Any adult with a low trauma fracture |
X-rays; BMD test; evaluation for causes of osteoporosis if BMD low or x-ray suspicious for osteoporosis |
1500 mg calcium and multivitamins prescribed and osteoporosis / osteopenia treated if present |
Patient 65 or older treated for a hip fracture |
BMD medical evaluation |
Will be treated for osteoporosis regardless of BMD result |
Anyone who fractures while on approved treatment for osteoporosis |
Evaluation by an endocrinologist or other specialist in metabolic bone disease |
Other bone diseases, such as osteomalacia will be excluded; change in medication will be considered |
Anyone who has multiple fractures and can't take prescribed treatment |
Evaluation by endocrinologist or other specialist in metabolic bone diseases |
Medications will be changed to a more tolerable drug, or intravenous or intramuscular drugs will be considered |
If you have been diagnosed with osteoporosis, are at high risk for fractures or have suffered a low-trauma fracture, you should begin treatment. In addition to exercise, calcium, and vitamin D supplements, you may also require one or more of the following medications:
Bisphosphonates (alendronate and risedronate)
Bisphosphonates increases BMD and reduces fracture risk
Calcitonin
Calcitonin minimizes bone loss and reduces fracture risk. It can also reduce pain from acute spinal fractures.
Estrogen
Estrogen is perhaps the most effective means of stopping bone loss. Estrogen is often prescribed to women entering menopause.
Selective Estrogen Receptor Modulators or SERMS (raloxifene)
This medication reduces spine fractures and may have beneficial effects on other tissues.
Thank you section author:
Donald A. Bergman, MD, FACE
