Osteoporosis is a chronic disease that makes your bones weak and brittle. It means that your bones have lost density and mass, making them more likely to break or fracture from minor injuries or falls. Osteoporosis can affect any bone in your body, but it usually affects the hip, wrist, or spine.

Osteoporosis is a serious condition that can affect your quality of life and increase your risk of disability and death. According to the World Health Organization (WHO), osteoporosis affects about 200 million people worldwide, mostly women over 50 years of age. It is estimated that one in three women and one in five men over 50 will suffer from an osteoporotic fracture in their lifetime.

Osteoporosis is often called a silent disease because it does not cause any symptoms until a bone breaks. Many people do not know that they have osteoporosis until they experience a fracture or have a bone density test. That is why it is important to know about osteoporosis and how to prevent it or treat it if you have it.

In this article, I will explain what causes osteoporosis, what are the symptoms of osteoporosis, how osteoporosis is diagnosed, how osteoporosis is treated, and how osteoporosis can be prevented. I will also answer some frequently asked questions about osteoporosis at the end of the article.

What causes osteoporosis?

Osteoporosis is caused by an imbalance between bone formation and bone resorption. Bone formation is the process of making new bone cells, while bone resorption is the process of breaking down old bone cells. These processes are regulated by hormones, genes, nutrition, and physical activity.

Normally, your body maintains a balance between bone formation and bone resorption to keep your bones strong and healthy. However, as you age, your body starts to lose more bone than it makes. This leads to a decrease in bone density and mass, which makes your bones more fragile and prone to fracture.

There are many factors that can affect your bone health and increase your risk of developing osteoporosis. Some of these factors cannot be changed, such as your age, sex, family history, or menopause. However, some of these factors can be reduced or modified by making changes in your diet, exercise, lifestyle, or habits.

Risk factors that cannot be changed

Some of the risk factors for osteoporosis that cannot be changed include:

Age:

Your bone density peaks around age 30 and then starts to decline gradually. The older you get, the more likely you are to develop osteoporosis.

Sex:

Women are more likely to develop osteoporosis than men because they have less bone mass to begin with and they lose bone faster after menopause due to lower estrogen levels.

Family history:

If one or both of your parents had osteoporosis or suffered from a hip fracture, you are more likely to inherit genes that make you susceptible to osteoporosis.

Menopause:

Women who go through menopause early (before age 45) or who have their ovaries removed surgically have a higher risk of developing osteoporosis because they lose estrogen sooner than normal.

Ethnicity:

People of Caucasian or Asian descent have a higher risk of developing osteoporosis than people of African or Hispanic descent because they tend to have lower bone mass.

Risk factors that can be reduced

Some of the risk factors for osteoporosis that can be reduced or modified by making changes in your diet, exercise, lifestyle, or habits include:

Physical inactivity:

Not being physically active can lead to muscle loss and bone loss. Regular exercise can help you build muscle mass and strength, which can support your bones and prevent falls.

Low body weight:

Having a low body weight (BMI below 20 kg/m2) or being underweight can increase your risk of developing osteoporosis because you have less bone mass to support your body.

Smoking:

The habit of smoking hinders the body’s calcium absorption and nutrient uptake vital for bone health. Moreover, for women, smoking can result in reduced estrogen levels, compounding the negative impact.

High alcohol intake:

Drinking too much alcohol can impair your liver function and affect your hormone levels. Alcohol can also reduce your calcium absorption and increase your calcium excretion through urine.

Poor nutrition:

Not eating enough energy-rich foods or proteins can affect your bone health by reducing your muscle mass and strength. Not getting enough calcium or vitamin D can also affect your bone health by reducing your bone density and increasing your risk of fractures.

Diseases and medications that can increase the risk of osteoporosis

Some diseases and medications can also increase your risk of developing osteoporosis by affecting your bone metabolism or hormone levels. These include:

Hypogonadism or early menopause:

Having low levels of sex hormones (estrogen in women or testosterone in men) can cause bone loss and increase your risk of developing osteoporosis.

Diseases that cause bone loss:

Such as rheumatoid arthritis, hyperthyroidism, hyperparathyroidism, chronic liver or kidney disease, coeliac disease, inflammatory bowel disease, or Cushing’s syndrome.

Medications that cause bone loss:

For example, steroids (when used for more than 3 months), anti-androgen therapy (drugs that block testosterone from working), aromatase inhibitors (drugs that block estrogen from being produced), thyroid hormone replacement therapy (when used for too long), antidepressant medications (particularly medicines from the SSRI group), anticonvulsants (drugs used to treat epilepsy), heparin (a blood thinner), proton pump inhibitors (drugs used to treat acid reflux), or some cancer treatments (such as chemotherapy or radiation therapy).

What are the symptoms of osteoporosis?

Osteoporosis does not cause any symptoms until a bone breaks or fractures. This is why it is often called a silent disease. However, some signs that may indicate that you have low bone density or osteoporosis include:

Fractures and broken bones

The most common symptom of osteoporosis is breaking or fracturing a bone because of a mild injury or minor fall. The most common sites for fractures are the hip, wrist, or spine. However, any bone in your body can be affected by osteoporosis.

Fractures due to osteoporosis can be very painful and take a long time to heal. They can also lead to complications such as infection, bleeding, nerve damage, deformity or disability.

Height loss and back pain

Another symptom of osteoporosis is losing height over time due to compression fractures in your spine. Compression fractures occur when the vertebrae (the bones that make up your spine) collapse due to low bone density.

Compression fractures can cause back pain, stiffness, difficulty standing up straight or hunched posture.

Stress fractures and joint pain

Another symptom of osteoporosis is having stress fractures or tiny cracks in your bones that can feel like joint or muscle pain. Stress fractures usually occur in areas where there is repeated stress on the bones, such as the feet, ankles, shins or hips.

Stress fractures can cause pain, swelling, bruising, or difficulty walking or running.

How is osteoporosis diagnosed?

Osteoporosis is diagnosed by measuring your bone density using a special X-ray test called dual-energy X-ray absorptiometry (DXA or DEXA). This test uses low doses of radiation to scan different parts of your body, such as your hip, spine, or wrist, and compare them with normal values for healthy young adults.

The result of this test is expressed as a T-score, which indicates how much lower or higher your bone density is compared to the average bone density of healthy young adults. A normal T-score is between -1 and +1. A T-score between -1 and -2.5 indicates low bone density or osteopenia. A T-score below -2.5 indicates osteoporosis.

Your doctor may also use another measure called a Z-score, which compares your bone density with the average bone density of people of your age, sex, and ethnicity. A Z-score below -2 may indicate that you have a secondary cause of osteoporosis, such as a disease or medication that affects your bone health.

They may also ask you about your medical history, family history, lifestyle, and habits to assess your risk factors for osteoporosis. They may also perform a physical examination to check for signs of fractures, height loss, or hunched posture.

How is osteoporosis treated?

Osteoporosis is treated with medications and lifestyle changes that aim to slow or stop bone loss, and to improve bone density and strength. The treatment plan depends on your age, sex, bone density, fracture risk, and personal preferences.

Medications to prevent bone loss and improve bone density

There are different types of medications that can help prevent bone loss and improve bone density. Some of the most common ones are:

Bisphosphonates:

These are drugs that slow down the process of bone resorption by inhibiting the activity of cells called osteoclasts. They can be taken orally (such as alendronate or ibandronate) or by injection (such as zoledronic acid). They can reduce the risk of fractures in the spine, hip, and other bones.

Hormone therapy:

These are drugs that mimic or replace the hormones that are important for bone health. For women, estrogen therapy can help prevent bone loss after menopause by maintaining estrogen levels. For men, testosterone therapy can help prevent bone loss by maintaining testosterone levels. However, hormone therapy also has some risks and side effects, such as increased risk of blood clots, stroke, breast cancer (for women), or prostate cancer (for men). Therefore, hormone therapy should be used with caution and under close supervision by your doctor.

Raloxifene:

This is a drug that belongs to a class of drugs called selective estrogen receptor modulators (SERMs). It acts like estrogen on some tissues (such as bones) but blocks estrogen on other tissues (such as breasts or uterus). It can help increase bone density in women after menopause and reduce the risk of spine fractures. However, it can also increase the risk of blood clots and hot flashes.

Denosumab:

This is a drug that belongs to a class of drugs called monoclonal antibodies. By inhibiting the protein RANKL, which promotes osteoclast function and formation, this treatment effectively raises bone density and decreases fracture susceptibility in individuals, regardless of gender, suffering from osteoporosis. Administered through biannual injections.

Teriparatide:

This is a drug that belongs to a class of drugs called parathyroid hormone analogs. By activating osteoblasts, this treatment triggers bone formation, leading to increased bone density and reduced fracture risk in individuals with severe osteoporosis. Particularly beneficial for those who have experienced previous fractures or are unable to tolerate alternative medications, it involves daily injections for a maximum of 2 years.

Supplements to improve bone health

In addition to medications, you may also need to take supplements to improve your bone health. The most important supplements for bone health are calcium and vitamin D.

Calcium: Calcium is a mineral that is essential for building and maintaining strong bones. Your body cannot make calcium on its own, so you need to get it from your diet or supplements. The recommended daily intake of calcium for adults over 50 is 1200 mg per day. You can get calcium from foods such as dairy products, green leafy vegetables, nuts, seeds, tofu, fortified cereals, or orange juice. You can also take calcium supplements in the form of tablets or chewable gummies. However, you should not take more than 500 mg of calcium at a time because your body cannot absorb more than that amount at once. You should also avoid taking calcium supplements with iron supplements or foods rich in iron because they can interfere with each other’s absorption.

Vitamin D: Vitamin D is a vitamin that helps your body absorb calcium from your diet or supplements. Your body can make vitamin D when your skin is exposed to sunlight,but many people do not get enough vitamin D from this source due to factors such as living in areas with less sunlight, wearing sunscreen, or having darker skin.

The recommended daily intake of vitamin D for adults over 50 is 800 IU per day.

You can get vitamin D from foods such as fatty fish, egg yolks, cheese, mushrooms, or fortified milk, or juice. You can also take vitamin D supplements in the form of capsules or drops.

However, you should not take more than 4000 IU of vitamin D per day because too much vitamin D can cause toxicity and harm your kidneys or heart.

How can osteoporosis be prevented?

Osteoporosis can be prevented by adopting healthy habits that promote bone health throughout your life. Some of the ways you can prevent osteoporosis are:

Diet and nutrition tips

– Eat a balanced diet that provides enough calories and proteins to support your muscle mass and strength.

– Eat foods that are rich in calcium and vitamin D or take supplements if needed.

– Avoid foods that are high in salt or caffeine because they can increase your calcium excretion through urine and reduce your calcium absorption.

– Limit your alcohol intake to no more than one drink per day for women and two drinks per day for men because alcohol can impair your liver function and affect your hormone levels.

– Avoid smoking because smoking can interfere with your body’s ability to absorb calcium and other nutrients that are essential for bone health.

Exercise and physical activity tips

– Engage in regular exercise that includes both weight-bearing exercises and resistance exercises. Weight-bearing exercises are activities that make you work against gravity, such as walking, jogging, dancing, or climbing stairs. Resistance exercises are activities that make you use your muscles against some form of resistance, such as lifting weights, using elastic bands, or doing push-ups or squats. These types of exercises can help you build muscle mass and strength, which can support your bones and prevent falls.

– Aim for at least 30 minutes of moderate-intensity exercise on most days of the week, or at least 150 minutes per week. You can break up your exercise into shorter sessions throughout the day if you prefer. For example, you can do 10 minutes of exercise three times a day.

– Start slowly and gradually increase the intensity and duration of your exercise as you become more fit and comfortable. You should always warm up before exercising and cool down after exercising to prevent injuries or soreness.

– Choose exercises that are appropriate for your age, fitness level, and medical conditions. You should consult with your doctor before starting any new exercise program, especially if you have osteoporosis or other health problems.  Your doctor may recommend specific exercises or precautions for you based on your individual needs.

Lifestyle and habits tips

– Maintain a healthy body weight that is neither too low nor too high for your height and age. Being underweight can increase your risk of developing osteoporosis because you have less bone mass to support your body. Being overweight can also increase your risk of developing osteoporosis because it puts extra stress on your bones and joints.

You can calculate your body mass index (BMI) by dividing your weight in kilograms by your height in meters squared. A normal BMI range is between 18.5 and 24.9 kg/m2.

– Avoid smoking because smoking can interfere with your body’s ability to absorb calcium and other nutrients that are essential for bone health. If you are a woman smoking can also reduce your estrogen levels . If you smoke, you should quit as soon as possible or seek help from your doctor or a smoking cessation program. Quitting smoking can improve your overall health and reduce your risk of many diseases, including osteoporosis.

– Limit your alcohol intake to no more than one drink per day for women and two drinks per day for men because alcohol can impair your liver function and affect your hormone levels. Alcohol can also reduce your calcium absorption and increase your calcium excretion through urine. Drinking too much alcohol can also increase your risk of falling and fracturing a bone due to impaired balance and coordination.

Preventing falls tips

One of the main complications of osteoporosis is fracturing a bone due to a fall. Therefore, preventing falls is an important part of preventing osteoporosis-related injuries and disabilities. Some of the ways you can prevent falls are:

– Wear low-heeled shoes with rubber soles and warm boots in winter to avoid slipping on wet or icy surfaces.

– Use support devices such as handrails, grab bars, walkers, or canes when using stairs or walking on uneven terrain.

– Avoid walking on slippery floors or rugs that may cause you to trip or slide.

– Keep your home well-lit and free from clutter or obstacles that may block your way or cause you to stumble.

– Install night lights in hallways, bathrooms, bedrooms, or stairs to help you see better at night.

– Use nonslip mats or stickers in your bathtub or shower to prevent slipping on wet surfaces.

– Review your medications with your doctor or pharmacist to make sure they are not causing any side effects that may affect your balance, vision, or alertness. Some medications may cause drowsiness, dizziness, low blood pressure, or blurred vision that can increase your risk of falling.

– Have your eyesight checked regularly and wear glasses or contact lenses if needed. Poor vision can make it harder for you to see obstacles or hazards that may cause you to fall.

– Do exercises that improve your balance, coordination, and flexibility, such as tai chi, yoga, or pilates. These exercises can help you maintain your posture and stability and prevent falls.

Conclusion

In summary, osteoporosis is a chronic condition that weakens bones, making them prone to fractures. It can affect any bone, with the hip, wrist, and spine being common sites. Diagnosis is done through a bone density test called DXA or DEXA, which provides a T-score indicating bone health.

Various factors contribute to osteoporosis risk, including age, sex, family history, and menopause. While some risk factors are uncontrollable, adopting a healthy lifestyle can help mitigate the risk. Treatment involves medication and lifestyle changes to slow bone loss, improve bone density, and strengthen bones.

Prevention of osteoporosis involves consuming a balanced diet rich in calcium and vitamin D, regular weight-bearing and resistance exercises, maintaining a healthy body weight, avoiding smoking and limiting alcohol, and taking precautions to prevent falls.

Osteoporosis is a serious condition impacting quality of life, disability, and mortality. By understanding the condition and implementing preventive or treatment measures, individuals can manage it effectively, promoting bone health and reducing fractures.

FAQs

Q: How common is osteoporosis?

 A: Osteoporosis affects about 200 million people worldwide, mostly women over 50 years of age. It is estimated that one in three women

  and one in five men over 50 will suffer from an osteoporotic fracture in their lifetime.

Q: How can I tell if I have osteoporosis?

A: The only way to tell if you have osteoporosis is to have a bone density test using a special X-ray machine called DXA or DEXA. This test measures how much bone mass you have in different parts of your body, such as your hip, spine, or wrist, and compares it with the average bone mass of healthy young adults. The result of this test is expressed as a T-score, which indicates how much lower or higher your bone mass is compared to the average.

  A normal T-score is between -1 and +1.

  A T-score between -1 and -2.5 indicates low bone mass or osteopenia.

  A T-score below -2.5 indicates osteoporosis.

Q: What are the complications of osteoporosis?

A: The main complication of osteoporosis is fracturing or breaking a bone due to a mild injury or minor fall.  The most common sites for fractures are the hip, wrist, or spine. However, any bone in your body can be affected by osteoporosis. Fractures due to osteoporosis can be very painful and take a long time to heal. They can also lead to complications such as infection, bleeding, nerve damage, deformity, or disability.

Fractures in the hip can hinder mobility and heighten the likelihood of falls, infections, blood clots, or even mortality. Meanwhile, spinal fractures contribute to back pain, diminished height, or a stooped posture. Additionally, wrist fractures can impede everyday tasks like writing, typing, or cooking.

Q: How can I prevent osteoporosis?

A: You can prevent osteoporosis by adopting healthy habits that promote bone health throughout your life. Some of the ways you can prevent osteoporosis are:

  – Eat a balanced diet that provides enough calories and proteins and is rich in calcium and vitamin D or take supplements if needed.

  – Engage in regular exercise that includes both weight-bearing exercises and resistance exercises.

  – Maintain a healthy body weight that is neither too low nor too high for your height and age.

  – Avoid smoking and limit alcohol intake.

  – Prevent falls by wearing appropriate footwear, using support devices, keeping your home safe and well-lit, reviewing your medications, having your eyesight checked regularly, and doing exercises that improve your balance, coordination, and flexibility.

Q: How can I treat osteoporosis?

A: Osteoporosis can be treated with medications and lifestyle changes that aim to slow or stop bone loss and improve bone density and strength. The treatment plan depends on your age, sex, bone density, fracture risk, and personal preferences. Some of the medications that can help prevent bone loss and improve bone density are bisphosphonates, hormone therapy, raloxifene, denosumab, and teriparatide. Some of the lifestyle changes that can help improve your bone health are eating a balanced diet that is rich in calcium and vitamin D or taking supplements if needed; engaging in regular exercise that includes both weight-bearing exercises and resistance exercises; maintaining a healthy body weight that is neither too low nor too high for your height and age; avoiding smoking and limiting alcohol intake; and preventing falls by wearing appropriate footwear, using support devices, keeping your home safe and well-lit, reviewing your medications, having your eyesight checked regularly, and doing exercises that improve your balance, coordination, and flexibility.

Q: What are some resources for more information about osteoporosis?

A: Some of the resources for more information about osteoporosis are:

    – The National Osteoporosis Foundation (NOF):

    – The International Osteoporosis Foundation (IOF): 

    – The Osteoporosis Society of Canada (OSC): 

    – The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): 

    – The World Health Organization (WHO):