Osteoporosis

Osteoporosis is a bone disease in which the mesh-like structure inside the bone becomes damaged. It literally means “porous bones.” The bone structure may be thin if either too much bone tissue has been lost or if not enough bone tissue has been made. When the internal strands of the bone become too thin (lose density), the bones become weak and can fracture or break easily.

When a bone with osteoporosis is broken, it is called a “fragility fracture.” Though fragility fractures can occur anywhere in the body, the most common occurrences are:

• Wrist fractures
• Hip fractures
• Spine fractures

Your body needs calcium and phosphate to make and keep healthy bones.

During your life, your body continues to both reabsorb old bone and create new bone.

As long as your body has a good balance of both new and old bone, your bones stay healthy and strong.

Bone loss occurs when more old bone is reabsorbed than new bone is created but can also happy without any known cause.

Brittle, fragile bones can be caused by anything that makes your body destroy too much bone, or keeps your body from making enough new bone. As you age, your body may reabsorb calcium and phosphate from your bones instead of keeping these minerals in your bones. This makes your bones weaker.

Other causes of bone loss include:

• A decrease in estrogen in women at the time of menopause and a decrease in testosterone in men as they age
• Being confined to a bed due to a prolonged illness (mostly affects bone in children)
• Having certain medical conditions that cause increased inflammation in the body
• Taking certain medicines, such as certain seizure medicines, hormone treatments for prostate or breast cancer, and steroid medicines taken for more than 3 months

Other risk factors include:

• Absence of menstrual periods for long periods of time
• A family history of osteoporosis
• Drinking a large amount of alcohol
• Low body weight
• Smoking
• Having an eating disorder, such as anorexia nervosa

Osteoporosis Symptoms

There are no symptoms in the early stages of osteoporosis. Many times, people will have a fracture before learning they have the disease.

Fractures of the bones of the spine can cause pain almost anywhere in the spine. These are called compression fractures. They often occur without an injury. The pain occurs suddenly or slowly over time.

There can be a loss of height (as much as 6 inches or 15 centimeters) over time. A stooped posture or a condition called a dowager's hump may develop.

Osteoporosis Diagnosis

A DEXA scan is a low-radiation x-ray that measures the density of the minerals in your bones. Usually, it measures density in the spine and hip bones. Your health care provider uses this test to:

• Diagnose bone loss and osteoporosis
• Predict your risk of future bone fractures
• See how well osteoporosis medicine is working

A simple spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of other bones are not very accurate in predicting whether you are likely to have osteoporosis. A new low-radiation spine x-ray called a vertebral fracture assessment (VFA) is now often done with a DEXA to better identify fractures that do not have any symptoms.

You may need blood and urine tests if your provider thinks the cause of your osteoporosis is a medical condition, rather than the slow bone loss that occurs with aging.

DEXA scan results compare your bone mineral density with both a young adult who has no bone loss and with people your age and gender. This means that at age 80, almost one third of women with normal age-related bone loss would have osteoporosis, based on their DEXA scan results.

Osteoporosis Treatment

Treatment for osteoporosis may involve:

• Making lifestyle changes, such as changing your diet and exercise routine
• Taking calcium and vitamin D supplements
• Using medicines

Medicines are used to strengthen bones when:

• Osteoporosis has been diagnosed by a bone density study, whether or not you have a fracture and your fracture risk is high.
• You have had a bone fracture and a bone density test shows that you have thin bones, but not osteoporosis.

Medicines used to treat osteoporosis include:

• Bisphosphonates (the main drugs used to prevent and treat osteoporosis in postmenopausal women)
• Estrogen and estrogen receptor modulators
• Teriparatide (a man-made form of a hormone your body makes that increases bone density)
• Calcitonin (a man-made form of a hormone your body makes that increases bone density, used mainly to treat the sudden pain from a spine fracture)
• Denusomab (lessens bone loss and increases bone density)

Surgery to treat severe, disabling pain from spinal fractures due to osteoporosis includes:

• Kyphoplasty (a material is placed into a bone of your spine to restore the height of the vertebrae)
• Spinal fusion (bones of your spine are joined together so they do not move against each other)

Osteoporosis Prevention

Be sure you get enough calcium and vitamin D to build and maintain healthy bone. Following a healthy, well-balanced diet can help you get these and other important nutrients.

Other tips for prevention:

• Do not drink large amounts of alcohol.
• Do not smoke.
• Get regular exercise.

Dental Care

It is imperative that you let your dentist know if you are on any osteoporosis medications. Some medications that prevent bone loss may negatively affect healing after certain dental procedures. You and your dentist will want to discuss options based on your medications.

Fracture Liaison Service - Osteoporosis and Bone Health

The Fracture Liaison Service at Wake Forest Baptist Health continually strives to assist you in reaching and maintaining bone health to help prevent future fractures. If you are 50 years old or older and have had a fracture, or if your provider feels you would benefit from a bone health evaluation, our Fracture Liaison Service could be a resource to help you.