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OVERVIEW

What is osteoporosis?

Osteoporosis is a disease of the bones. It causes you to lose bone mass. Osteoporosis occurs most often in older adults. Women are more likely to have it than men. This is due to several factors. Women have less bone mass than men to begin with. They also tend to live longer and absorb less calcium. In women, the rate of bone loss speeds up after menopause, when estrogen levels fall. Since the ovaries make estrogen, faster bone loss may also occur if both ovaries are removed by surgery.

SYMPTOMS

What are the signs of osteoporosis?

You may not know you have osteoporosis until your symptoms are severe. Signs include frequent broken bones or fractures, low back pain, or a hunched back. You may also get shorter over time due to osteoporosis. The condition can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.

CAUSES & RISK FACTORS

What causes osteoporosis?

There are two ways osteoporosis can occur. You can lose too much bone, or your body cannot produce enough bone. Some people have both issues. When you’re young, your bones are dense and strong. Osteoporosis makes your bones brittle and breakable.

It is natural to lose some bone mass as you age. For most adults, this begins in their mid 20s. Other factors can increase your risk of osteoporosis. Some of these risk factors are out of your control. For others, you can take steps to reduce your risk.

Uncontrollable Risk Factors:

• Sex: Osteoporosis is more common in women than men
• Age: The older you are, the greater your chance of having osteoporosis.
• Race: Caucasians and Asians are more likely to have osteoporosis.
• Genetics: Your risk of osteoporosis is higher if it runs in your family.
• Menopause: This period in a woman’s life causes physical and hormonal effects. For example, it lowers your estrogen. These changes can increase your risk of osteoporosis. Your risk is even higher if you have early menopause (before age 45).
• Body frame: People who have small, thin bone frames are more likely to develop osteoporosis.
• Health: Certain conditions, such as cancer or stroke, can lead to osteoporosis.

Controllable Risk Factors:

• Lack of calcium and/or vitamin D
• Inactive lifestyle or lack of exercise
• Smoking or tobacco use
• Alcohol abuse
• Eating disorders such as anorexia nervosa
• Hormone imbalances, such as low estrogen or testosterone, or too much thyroid hormone
• Long-term use of certain medicines, such as corticosteroids and proton pump inhibitors (PPIs). Corticosteroids treat inflammation, pain, and chronic conditions such as asthma and rheumatoid arthritis. PPIs help reduce stomach acid. These medicines can make it hard for your body to absorb calcium and cause osteoporosis.

DIAGNOSIS & TESTS

How is osteoporosis diagnosed?

Contact your healthcare provider if you have signs of osteoporosis or if it runs in your family. If your healthcare provider suspects osteoporosis or you are aged 65 or older or have a greater fracture risk, they may suggest you have a bone density scan. A common test that measures bone density is called a dual energy X-ray absorptiometry (DXA). This test measures the density of the bones in your hips, spine and wrist, which are all places likely to be affected by osteoporosis.

PREVENTION

Can osteoporosis be prevented or avoided?

You cannot always avoid osteoporosis. However, there are some changes you can make to prevent or reduce your risk. These include regular exercise and getting enough calcium and vitamin D. They help keep your bones healthy as you age.

Calcium

People 19-50 years of age and males 51-70 years of age should get 1,000 mg of calcium per day. Females 51-70 years of age and all people 71 and older should get 1,200 mg of calcium per day. It’s usually best to try to get calcium from food. Non-fat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, salmon, spinach and broccoli. If you don’t get enough calcium from the food you eat, your healthcare provider may suggest taking a calcium supplement.

Vitamin D

Vitamin D helps your body absorb calcium. You can get vitamin D from sunlight, food, or supplements. Your skin makes vitamin D when it’s exposed to sunlight. However, you should be careful of sun exposure. Too much can cause skin cancer. Your healthcare provider can test your blood to measure your vitamin D level. If your vitamin D level is low, your healthcare provider may recommend that you take a vitamin D supplement.

Exercise

Exercise helps you build and keep strong bones. This is why it’s important to begin an active lifestyle at a young age. However, it’s never too late to start exercising. Contact your healthcare provider for tips on how to start exercising safely.

Try to do a mix of strength training and weight-bearing exercise.

TREATMENT

How is osteoporosis treated?

Treatment for osteoporosis starts with changes to your diet and lifestyle. You want to take in more calcium and Vitamin D. Your healthcare provider will want you to increase your physical activity. This helps to strengthen your bones and increase your bone mass. Examples of weight-bearing exercise include walking, jogging and climbing steps. You should also stop smoking and limit alcohol.

If you’re at risk for falls, reduce the likelihood of falls by getting rid of tripping hazards in your home. For example, remove rugs, avoid slippery surfaces, and move electrical cords. You can install grab bars in certain places, such as your bathroom or shower.  The bars can help you move around more easily and safely.

Your healthcare provider may prescribe medicine(s) to help treat osteoporosis. There are several types and forms.

Bisphosphonates. These medicines help reduce the risk of breaks and fractures, as well as increase bone density. It comes in oral (pill) form or intravenous (with an injection). Side effects can include nausea or stomach pain.  You may have irritation of the esophagus (the tube that connects the mouth to the stomach). Some people cannot take bisphosphonates.  This includes people who have kidney disease, low levels of calcium in their blood and women who are pregnant or nursing. Examples of bisphosphonates include:

• Alendronate, etidronate, and risedronate. These medicines are used to help prevent and treat osteoporosis. They help reduce the risk of fractures by decreasing the rate of bone loss. They are taken orally in pill form. Their most common side effect is an upset stomach.
• Zoledronic acid. A bisphosphonate medication that is given intravenously every 12 months.

Raloxifene. This medicine helps prevent and treat osteoporosis in women. It increases your bone density. It is not a hormone, but it mimics some of the effects of estrogen. Side effects may include hot flashes and a risk of blood clots.

Teriparatide. This medicine helps to grow new bones. It is a synthetic form of parathyroid hormone. Both women and men can use it. It is available as an injection. You inject it in your thigh or stomach once a day. Common side effects are nausea, stomach pain, headache, muscle weakness, fatigue, and loss of appetite.

Denosumab.  This drug is used when other drugs don’t work or if you can’t tolerate other treatment options. Denosumab increases your bone density. It can be used by both women and men. It is given as an injection by a healthcare provider. Side effects can include lower calcium levels, skin rash, or pain in the arms and legs.

If your healthcare provider prescribes medicine to treat osteoporosis, it is important that you take it.

When your healthcare provider prescribes a medicine, be sure to discuss:

• Side effects
• Any fears you have about taking medicines (especially if this may cause you to stop)
• The higher likelihood of fractures if you stop taking your medicine
• How you will let your doctor know if you fall
• When your next follow-up visit will be. (Schedule this for 3-6 months after your appointment.)

Living with osteoporosis

There is no complete cure for osteoporosis. You should work with your healthcare provider to treat the condition. You also can make diet and lifestyle changes to reduce the effects and prevent falls.

FOR MORE INFORMATION

Osteoporosis Canada

https://osteoporosis.ca/