Osteoporosis is a bone disease that is characterized by a decrease in bone mass, with decreased bone density and enlargement of bone spaces. Osteoporosis is also associated with porosity and fragility in the bone, which makes bones particularly susceptible to fractures .
The Evolution of Osteoporosis
Bones are a vital and renewable organ composed of a combination of minerals, soft tissue and bone marrow. The amount of minerals such as calcium and phosphorous we have to support the underlying soft tissue structure determines how strong our bones are. People reach their peak bone mass in their early thirties. From that time forward, there tends to be a steady loss of bone mass due to a multitude of causes. In other words, after your early thirties, you lose bone more rapidly than your body produces it. In fact, osteoporosis contributes directly to almost 50% of women over 50 developing a bone-loss related fracture during their lives.
Each person has an individual peak bone mass that is dependent on many lifestyle and genetic factors. The loss of bone leads to bone fragility , which can lead to subsequent fracture. The areas of greatest fragility are the hips, wrist and the spine. The more rapidly you lose bone mass, the higher your risk of fracture.
As bone mass deteriorates, with or without bone fracture, the spine becomes curved. This curvature results in a stooped posture that produces back pain and a protruding abdomen. Osteoporosis is a silent condition that is usually diagnosed late, and after maximum bone loss has occurred, but in most cases it is preventable.
Risk Factors for Osteoporosis
There are numerous factors associated with a higher risk of developing osteoporosis. Some of the most common risk factors are listed below.
- Early onset of menopause
- Being a woman over the age of 50
- Family history of osteoporosis
- Thin and small body frame
- Prior bone loss related fracture
- Insufficient physical activity
- Vitamin C and D deficiencies
- Certain anti-cancer treatments (e.g., hormone-blocking agents)
- Presence of thyroid and arthritis conditions
- Use of blood-thinning agents
Osteoporosis is a preventable condition. It's ideal to begin thinking about preventative measures early in life, but the good news is: it is never too late to alter the course of the disease. If you are over age 60 and have any of the predisposing factors listed above, you should get a bone mineral density test (DEXA scan). If it is abnormal, get one every two years after that. In addition, take the following recommendations under consideration.
- Exercise daily, focusing on weight-bearing activities (like walking, jogging, hiking and dancing) and strength-training exercises.
- Avoid smoking and excessive alcohol intake.
- Include cruciferous vegetables, nuts, soy products, and fat-free dairy products in your diet.
- Make sure that you get 1,000 mg of calcium a day.
- Get adequate vitamin D. The current recommendation for most people is to take a supplement with 1000-2000 IU per day of the active form of Vitamin D (D3). Exposing your uncovered arms and legs, without sunscreen to sun for 30 minutes 3 times a week will provide adequate supplemental Vitamin D if you live in a sunny climate.
- Prevent falls by using handrails and walking aids such as a cane or walker, if necessary. (See Fall Prevention 101 and download Tips to Reduce the Risk of Falling for more information.)
Drug Therapy for Osteoporosis
If you have osteoporosis or significant bone density deficiency, drug treatment can help. All drug therapies for bone loss aim to prevent bone resorption. If you have postmenopausal symptoms, short-term hormonal therapy may also be indicated. If bone issues are the only problem, then anti-resorptive biphosphonate drugs that help restore bone density would be the most helpful. Aledronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel) are the strongest anti-resorptive biphosphonate drugs. Weaker anti-resorptive therapies include estrogenic biphosphonates like Raloxifene, and the weakest anti-resorptive drug is Calcitonin. Two experimental anti-resorptive drugs, denosumab and odancatib, are on the horizon and they are also antibodies. Even if you begin drug therapy for the treatment of osteoporosis, it is important to adhere to the preventative measures detailed above—and remember to tell your doctor if you are taking any other medications so you can avoid harmful drug interactions .