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Osteoporosis - overview

Definition

Osteoporosis is a disease in which bones become fragile and more likely to break (fracture).

Alternative Names

Thin bones; Low bone density; Metabolic bone disease

Causes

Osteoporosis is the most common type of bone disease.

Osteoporosis increases the risk of breaking a bone. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine) during their lifetime. Spine fractures are the most common.

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

Sometimes, bone loss occurs without any known cause. Other times, bone loss and thin bones run in families. In general, white, elderly women are the most likely to have bone loss.

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.

Osteoporosis

Watch this video about:
Osteoporosis

A major risk is not having enough calcium to build new bone tissue. It is important to eat enough high-calcium foods. You also need vitamin D, since it helps your body absorb calcium. Your bones may become brittle and more likely to fracture if:

Other causes of bone loss include:

Other risk factors include:

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) over time. A stooped posture or a condition called a dowager's hump may develop.

Exams and Tests

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:

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.

Treatment

Treatment for osteoporosis may involve:

Medicines are used to strengthen bones when:

Medicines used to treat osteoporosis include:

Exercise plays a key role in preserving bone density in older adults. Some of the exercises recommended to reduce your chance of a fracture include:

Avoid any exercise that presents a risk of falling. Also, do not do high-impact exercises that can cause fractures in older adults.

Follow these guidelines for getting enough calcium and vitamin D:

[Note: Some expert groups are not sure the benefits and safety of these amounts of vitamin D and calcium outweigh their risks. Be sure to discuss with your doctor whether supplements are a good choice for you.]

Stop unhealthy habits:

It is important to prevent falls. These suggestions can help:

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

Outlook (Prognosis)

Medicines to treat osteoporosis can help prevent future fractures. But spine bones that have already collapsed cannot be made stronger.

Osteoporosis can cause a person to become disabled from weakened bones. Hip fractures are one of the main reasons people are admitted to nursing homes.

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:

Medicines can treat osteoporosis and prevent fractures. Your doctor can tell you if any are right for you.

References

Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011;155(1):ITC1-1-15;quiz ITC1-16.

Lorenzo JA, Canalis E, Raisz LG. Metabolic bone disease. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 29.

Moyer VA; U.S. Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 May 7;158(9):691-6.

The National Osteoporosis Foundation (NOF) Clinician's Guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC. 2013.

North American Menopause Society. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010 Jan-Feb;17(1):25-54.

Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305(8):783-789.

Rosen C. Osteoporosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 251.


Review Date: 10/25/2014
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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