Osteoporosis

Osteoporosis is a condition that causes bones to become weak and brittle, so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine.

Osteoporosis is often called a "silent disease" because bone loss occurs without symptoms. You may not know you have osteoporosis until you break a bone. However, osteoporosis can be prevented and treated. Early detection and treatment are important to prevent fractures.

Osteoporosis often has no symptoms until a fracture occurs. When symptoms do appear, they may include:

Early Stage (usually no symptoms):

• Bone loss occurs silently
• No pain or other symptoms
• May only be detected on bone density test

Later Stage (after fractures):

• Back pain: Caused by fractured or collapsed vertebrae
• Loss of height: Over time, may lose inches
• Stooped posture: Forward curvature of spine (dowager's hump)
• Bone fractures: Occur more easily than expected
• Fractures from minor trauma: Breaks from falls or even minor bumps

Common Fracture Sites:

• Hip
• Wrist
• Spine (vertebrae)
• Ribs
• Other bones

Seek emergency care if:

• Severe back pain after fall or injury
• Inability to move after fall
• Suspected hip fracture (can't bear weight)
• Severe pain after injury
• Signs of fracture

Managing osteoporosis involves:

1. Take Medications as Prescribed:

   • Bone-building medications
   • Calcium and vitamin D supplements
   • Don't skip doses
   • Report side effects

2. Adequate Calcium:

   • Food sources:
     • Dairy products
     • Dark leafy greens
     • Fortified foods
     • Sardines with bones
   • Supplements: If not getting enough from food
   • Goal: 1,000-1,200 mg daily (varies by age/sex)

3. Adequate Vitamin D:

   • Helps body absorb calcium
   • Sources: Sunlight, fatty fish, fortified foods
   • Supplements: Often needed
   • Goal: 600-800 IU daily (varies)

4. Regular Exercise:

   • Weight-bearing exercise: Walking, jogging, dancing
   • Strength training: Builds bone and muscle
   • Balance exercises: Prevents falls
   • Don't overdo it: Avoid high-impact if severe

5. Fall Prevention:

   • Remove hazards at home
   • Improve lighting
   • Use handrails
   • Wear proper footwear
   • Use assistive devices if needed
   • Review medications (some cause dizziness)

6. Healthy Lifestyle:

   • Don't smoke (smoking weakens bones)
   • Limit alcohol (excessive alcohol weakens bones)
   • Maintain healthy weight
   • Eat balanced diet

7. Regular Monitoring:

   • Bone density tests
   • Follow-up appointments
   • Monitor for fractures
   • Adjust treatment as needed

• Severe pain after fall or injury
• Inability to move or bear weight
• Suspected fracture
• Severe back pain

• Risk factors for osteoporosis
• Need for bone density test
• History of fractures
• Back pain or height loss
• Questions about prevention
• Need to adjust treatment
• Concerns about medications

• Following treatment plan
• Taking supplements
• Regular exercise
• Fall prevention measures
• Regular monitoring scheduled

Diagnosing osteoporosis involves:

1. Bone Density Test (DEXA scan):

   • Most common test
   • Measures bone density
   • Painless, low radiation
   • Usually hip and spine
   • Results as T-score

2. T-Score Interpretation:

   • Normal: -1.0 or higher
   • Osteopenia (low bone mass): -1.0 to -2.5
   • Osteoporosis: -2.5 or lower

3. Other Tests (if needed):

   • X-rays (may show fractures)
   • Blood tests (calcium, vitamin D, etc.)
   • Other specialized tests

4. Fracture Risk Assessment:

   • Age
   • Previous fractures
   • Family history
   • Other risk factors
   • Combined with bone density

Treatment aims to slow bone loss and prevent fractures:

1. Medications:

   • Bisphosphonates: Most common (alendronate, etc.)
   • Hormone-related therapy: For some women
   • Other medications: Various options
   • Calcium and vitamin D: Supplements

2. Lifestyle Modifications:

   • Adequate calcium and vitamin D
   • Regular exercise
   • Fall prevention
   • Don't smoke
   • Limit alcohol

3. Exercise Program:

   • Weight-bearing activities
   • Strength training
   • Balance exercises
   • As approved by doctor

4. Fall Prevention:

   • Home safety
   • Assistive devices
   • Balance training
   • Medication review

5. Treatment of Fractures:

   • If fractures occur
   • Pain management
   • Rehabilitation
   • Prevention of more fractures

Prevent osteoporosis by:

• Adequate Calcium: Throughout life, especially in youth
• Adequate Vitamin D: Helps absorb calcium
• Regular Exercise: Weight-bearing and strength training
• Don't Smoke: Smoking weakens bones
• Limit Alcohol: Excessive alcohol weakens bones
• Maintain Healthy Weight: Being underweight increases risk
• Eat Balanced Diet: Supports bone health
• Get Regular Check-ups: Early detection
• Prevent Falls: Especially as you age

Build Strong Bones in Youth:

• Peak bone mass reached in 20s
• Important to build strong bones early
• Adequate calcium and exercise crucial
• Sets foundation for later life

In osteoporosis:

1. Bone Remodeling Imbalance: More bone broken down than built
2. Bone Loss: Bones become less dense
3. Weakened Structure: Bones become fragile
4. Increased Fracture Risk: Bones break easily

Risk Factors:

• Age: Risk increases with age
• Sex: Women at higher risk (especially after menopause)
• Family history: Genetic component
• Body size: Small, thin people at higher risk
• Hormones: Low estrogen (women), low testosterone (men)
• Diet: Low calcium, vitamin D deficiency
• Lifestyle: Sedentary, smoking, excessive alcohol
• Medications: Some medications increase risk
• Medical conditions: Various conditions increase risk

• Higher risk, especially after menopause
• Estrogen loss accelerates bone loss
• May need hormone therapy discussion
• Regular screening important

• Risk increases with age
• Higher risk of falls
• May have multiple risk factors
• Prevention and treatment important

• Lower risk than women
• But still at risk
• Often underdiagnosed
• Should be screened if risk factors

While you can't completely reverse osteoporosis, treatment can slow or stop bone loss and may increase bone density. Early treatment is most effective.

If you have osteoporosis, usually every 1-2 years to monitor treatment. For screening, it depends on risk factors. Your doctor will recommend based on your situation.

Not everyone needs medication. It depends on your bone density, fracture risk, and other factors. Lifestyle changes are important for everyone.

Yes. Appropriate exercise can help maintain bone density, improve balance (preventing falls), and strengthen muscles. However, avoid high-impact activities if you have severe osteoporosis.

No. While women are at higher risk, men can also develop osteoporosis. Men are often underdiagnosed. Both men and women should be aware of risk factors.