What is Osteoporosis

What Is Osteoporosis?

What is osteoporosis? In simple terms, osteoporosis, literally "porous bone," is a condition in which bones become more fragile and more susceptible to breakage or fracture. In most cases there are no obvious symptoms of osteoporosis, and bone degradation can continue until a person falls, experiences a break, and seeks treatment. Although any bone can be affected, the most common fractures occur in the wrist, the hip, and the spine. In serious cases, bones can deteriorate to the point where a sneeze can cause fractures.

Read our detailed overview of the disease for further insight into the question 'what is osteoporosis?'

What Is Osteoporosis? Risk Factors

Because there are very few, if any, symptoms of osteoporosis, it is important to know the disease's risk factors, and, if one is at risk, to consult with a physician and take preventive measures. Millions of Americans are at risk, and while women are far more likely to develop the disease than men, men can still suffer from a loss of bone density, especially as they grow older. Other risk factors include a family history of osteoporosis, a history of broken bones, older age, low levels of sex hormones (in women, low levels of estrogen, or menopause; in men, low levels of testosterone and estrogen), a sedentary lifestyle (lack of activity/exercise), smoking, excessive alcohol use, treatment with glucocorticoids, and a lack of calcium and vitamin D in the diet. Race may play a role as well, as people of Caucasian and Asian ancestry are more likely to develop osteoporosis than African-Americans or Latinos/Hispanics. However, as there are no symptoms of osteoporosis, the disease is likely under recognized.

What Is Osteoporosis? Prevention

Because most of our bone growth and development is acquired by age 18 to 20, developing habits that support healthy bone growth during childhood can help prevent osteoporosis as we age. It's important to exercise regularly, and weight-bearing and muscle-strengthening activity can help promote bone health. In addition, getting the recommended daily amounts of vitamin D and calcium is an important preventative measure. One should avoid smoking and excessive alcohol use and, especially as one ages, regular checkups with attention to bone health are important.

What Is Osteoporosis? The Hormonal Component

Although men can develop osteoporosis, women are twice as likely to suffer from the disease. During menopause, which happens naturally at around age 50, a woman's ovaries stop producing estrogen. One of estrogen's roles in the body is bone protection. In addition, excessive exercise and stress can lead to deficiency of estrogen. As men age, the loss of testicular function and its attendant decrease in testosterone production can lead to a loss of bone density. An overactive thyroid gland (hyperthyroidism) and type I diabetes can also result in osteoporosis. Because of the role of hormones in osteoporosis, treatment of the disease may include hormonal agents.

What Is Osteoporosis? Symptoms of Osteoporosis

Although osteoporosis is typically symptom-free, there are a number of indicators that should prompt a visit to the physician for a thorough check up. These symptoms of osteoporosis stem from fractures in the vertebrae, which, although they can result in severe back pain, can also be pain-free. Loss of height is one of these symptoms of osteoporosis, as the vertebrae may compress when they break. Other symptoms include spinal deformities, such as kyphosis or an extremely rounded upper back.

These conditions are rare, however, as often there are no symptoms of osteoporosis until the individual suffers a fracture. Visit our in-depth overview to learn more about the symptoms of osteoporosis.

What Is Osteoporosis? Treatments

Because in many cases lifestyle and dietary changes aren't enough to counteract osteoporosis on their own, osteoporosis treatments often combine medication with the adoption of a healthier lifestyle. Osteoporosis treatments begin with an exercise regimen along with ensuring the proper levels of calcium and vitamin D in the diet. Since one should not undertake too strenuous of an exercise program, and, especially in the case of vitamin D, supplementation to the diet in improper levels can be harmful, it's important that these lifestyle changes be made under a doctor's supervision. There are a number of medications that comprise part of osteoporosis treatments as well:

• Estrogen -- Estrogen is another naturally-occurring hormone used in osteoporosis treatments. Often taken in pill form, estrogen helps prevent bone loss and reduces the risk of fractures of the spine and hip.
• Teriparatide – This is a fragment of a naturally-occuring hormone that stimulates the growth of new bone, and is thus particularly useful in severe cases of this disease.
• Bisphosphonates -- Biphosphonates are often included in post-menopausal osteoporosis treatments due to their ability to slow bone loss, increase bone mass, and prevent fractures (including, in some cases, in the hip). Some of these can be used in males and females, and in treatment of steroid-induced osteoporosis. Approved bisphosphonates include alendronate, risedronate, ibandronate, and zolendronic acid.
• Raloxifene is an agent in one of a group of substances acting through estrogen-like mechanisms to slow bone loss and prevent spinal fractures. This agent may have other important positive actions in postmenopausal women.
• Calcitonin -- Calcitonin is a naturally-occurring hormone produced by the thyroid gland that helps to regulate calcium levels in the body. When taken as a medication, typically as a nasal spray, it helps reduce the risk of spinal fractures.

This is only a partial list of medications and hormones used to treat osteoporosis. To learn more, please visit our comprehensive overview of osteoporosis, symptoms of osteoporosis, and osteoporosis treatments.

Because the first of the symptoms of osteoporosis is often a fracture that can severely impact quality of life, and because osteoporosis treatments can have severe side effects, it's important, especially if you have risk factors, to consult with an endocrinologist. To find a physician in your area, please use our "Find an Endocrinologist" feature.

Further Information About the Endocrine System:

Symptoms of Thyroid Disease

Cushing's Syndrome: Endocrine System Diseases

Luteinizing Hormone & Menopause

Editors:

Michael Draper, MD, PhD

Ada Wolfsen, MD

March 2008