Osteoporosis: Are You at Risk?

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It is estimated that 10 million people over age 50 in the United States have osteoporosis, 80 percent of them women. Another 34 million people have osteopenia (low bone mass), which predisposes them to developing osteoporosis as they age. One in two women and about one in four men over age 50 will suffer an osteoporosis-related fracture during their lifetime. 

The term "osteoporosis" actually means “porous bones” – a condition in which the bones lose their mass and mineral content, and eventually become fragile and prone to fracture. The condition develops when the pace of new bone formation cannot keep up with the loss of bone. The term is also referred to as “brittle bone disease,” and the problem with this condition is that it increases your chance of sustaining a fracture. Unfortunately, the gradual loss of bone due to osteoporosis is painless and virtually free of symptoms until it reaches late stages. By the time symptoms appear – such as back pain, loss of height, spinal deformity or an unexpected fracture – osteoporosis is already present.

Some of the more commonly fractured bones in the body as a result of osteoporosis include spine compression fractures, shoulder fractures, wrist fractures, pelvis fractures, hip fractures, tibial plateau fractures and ankle fractures. A major cause of these fractures is poor bone growth due to inadequate nutrition during childhood and adolescence, resulting in a low peak bone mass and thus less bone to lose when natural bone loss begins. People who start out with greater peak bone mass are less likely to develop osteoporosis. Bone growth reaches its peak when men and women are in their early 20s. Peak bone mass is determined by genetic factors – such as genes for slender or thicker bones – and external or lifestyle factors, such as diet and exercise.

Experts believe genetic factors may contribute 50 to 90 percent of bone mass, while external factors account for 10 to 50 percent. But while genetics is the more important factor, diet can be the deciding factor in causing or preventing osteoporosis. After achieving its peak, bone mass may remain stable in the 20s, 30s and into the 40s or may begin to decrease gradually because of lifestyle factors, such as a poor diet or inactivity.

There are several risk factors for developing the condition. Osteoporosis risk increases if you are female, if you are older (especially for women after menopause), if you had an early natural menopause or menopause caused by surgical removal of the ovaries in a premenopausal stage, if you have a petite, thin-boned body type, have a parent with the condition, are Caucasian or Asian, have low estrogen or testosterone levels, have anorexia nervosa, eat a diet low in calcium and vitamin D, have used certain medications, such as corticosteroids, over a long period of time, have smoked cigarettes for a long time, if you drink alcohol excessively and if you lead an inactive lifestyle. If not treated, osteoporosis can result in an increased risk of fractures, loss of height due to fractures in the vertebrae which causes them to compress, curving of the spine in a stooping posture (kyphosis), loss of mobility and severe back pain.

The treatment for osteoporosis is usually a combination of exercise and medications. The kind and/or amount of exercise suitable for someone with established osteoporosis depends on the condition of the bones. For people whose osteoporosis is advanced, some strength training, aerobic and flexibility exercises may be unsuitable.Your physician or physical therapist can recommend the right exercises for a patient’s particular condition.  They may include:

  • Strength training: This can be done with free weights, weight machines, resistance bands or exercises in a pool.  Such training builds muscle strength so the muscles can more effectively support the bones, and it can also slow bone mineral loss.
  • Weight-bearing aerobic exercise: Exercises in which you support your own body weight, such as walking, dancing, low-impact aerobics and gardening can strengthen bones while improving fitness and reduce your risk of cardiovascular disease.
  • Flexibility exercises: Stretching, bending and rotating your joints can increase joint mobility and overall flexibility and improve your posture.

Current medications today include estrogen, thyroid and parathyroid hormones and Bisphosphonates, such as Fosamax and Boniva. These medications slow bone loss, reduce fracture risk and may increase bone density.  They work by slowing the activity of osteoclasts, the bone-removing cells.   

The best way to address osteoporosis is to prevent bone loss. To do this, you can change some of your risk factors, especially lifestyle choices such as diet, exercise, smoking, alcohol consumption and by getting bone mineral density scans when your doctor recommends them to find out how much, if any, bone loss you’ve experienced. 

If you learn that you are at risk for osteoporosis and your bone mineral density scan indicates bone loss, you should talk to your doctor about medications that can slow the progression of osteoporosis and help strengthen and protect your bones. You should also make changes in your environment that will reduce the risk of slipping, tripping or falling, since fractures due to osteoporosis cause the greatest loss of mobility and death.  

Understanding osteoporosis will allow you and your doctor to plan a comprehensive approach to preventing or reducing bone loss so you can live healthfully and safely.  Further information on this condition can be found through The National Osteoporosis Foundation (NOF), considered the leading non-profit organization devoted to promoting lifelong bone health.