What is Osteoporosis?
- Osteoporosis is a systemic disease characterized by loss of bone which weakens bone structure and increases the risk of fractures.
What is Osteopenia?
- Osteopenia is low bone density but not low enough to be classified as osteoporosis.
Does Osteopenia cause problems?
- Many people with osteopenia are susceptible to fractures. It is advised that people who have osteopenia and other risk factors for fracture be treated with medications to increase bone density and prevent fractures.
Who is affected by Osteoporosis?
- Osteoporosis is most common in women after menopause. Men are also affected by osteoporosis. It is estimated that over 40 million people are living with or are at risk for developing osteoporosis.
What causes Osteoporosis?
- Bone is living tissue. Bone growth is very active from birth until about the mid 20s. After that, bone is constantly remodeling and repairing. This occurs when cells called osteoclasts carve out cavities in the bone and subsequently, building cells called osteoblasts come in behind them to fill in the cavity. As we age, the building cells are less active while the breakdown cells remain active. This leads to a net loss of bone.
Risk factors for loss of bone (osteoporosis) include age and menopause, (loss of estrogen) as bone is stimulated by estrogen. Men with low levels of testosterone are also at high risk. Individuals with small skeletal frames are at increased risk. There is a hereditary risk – people who have relatives with osteoporosis are at increased risk. Smoking increases the risk for osteoporosis. Excess alcohol increases risk. Certain medications increase bone loss: most commonly this includes steroids like prednisone, and anti-seizure medications. Poor intake of calcium and vitamin D increase risk of osteoporosis. Inflammatory disease such as rheumatoid arthritis and inflammatory bowel disease increase the risk for bone loss. Poor intake or absorption of nutrients increase risk of bone loss. Sedentary lifestyles increase risk for bone loss, as activity is a stimulant to maintain healthy bones. Weight bearing activity and strength training activities help to keep bones strong.
How dose Osteoporosis differ from Osteoarthritis?
- Osteoarthritis is a degenerative condition where cartilage that normally protects the surface of the bone at the joint wears down. Cartilage cannot repair or replace worn down tissue. Subsequently, there is pain and sometimes creaking and cracking with use of the joint. Pain and stiffness of the involved joints are a hallmark of osteoarthritis. We can also see deformity or enlargement of the joints involved. Osteoporosis, on the other hand, has no symptoms. People know they have osteoporosis by DXA testing or after fracture.
What are the symptoms of Osteoporosis?
- Unfortunately, there are no symptoms of osteoporosis until there is a fracture. Short of fracture, there is no pain when the bones are weak. Osteoporosis is a SILENT disease.
What types of fractures are caused by Osteoporosis?
- Fractures related to osteoporosis are generally low trauma fractures. These are fractures which occur after falling from standing height. Fractures can occur with coughing, twisting or turning over in bed.
The most common fractures are vertebral fractures affecting the spine – 550,000/year. While they can cause a great deal of back pain and even deformity of posture, up to 2/3 of these fractures occur without symptoms.
Hip fractures are the second most common fractures occurring at approximately 1.6 million per year worldwide. Most people with hip fractures will require surgery. There is an increased risk of dying within the year of a hip fracture. Twenty percent of hip fracture patients require nursing home placement after the fracture and do not regain their independence.
Wrist fractures tend to be the earliest fracture and may occur in younger women.
Can Osteoporosis be prevented?
- Bone strength is a product of achieving your best peak bone density in your 20s by healthy eating, fitness, and achieving optimal intake of calcium and vitamin D. Avoidance of high risk behavior is important (no smoking, fitness activities, avoid excessive alcohol). While you cannot change your genetics or your skeletal frame, you can limit risk by making better lifestyle and dietary choices.
How is osteoporosis diagnosed?
- Bone density is measured by DXA (dexa). This is a type of X-ray which measures the bone strength in the area most affected by osteoporosis. This includes the lumbar spine, hip, neck of the hip, and sometimes the forearm/wrist area.
Who should have a DXA?
- All women over 65 years old should have a DXA. Women over 50 who are past menopause and have had fractures or risk factors for osteoporosis should have a DXA. Men over 65 who have fractured, have low testosterone, are on steroid medications or other high risk medication should be evaluated by DXA.
Can Osteoporosis be treated?
- Yes, there are many different treatment options for Osteoporosis. These treatments have been demonstrated to reduce the risk of fractures. Medications used to treat osteoporosis come in pill form, intravenous, and subcutaneous forms (injected like a vaccine). The choice of treatment is based upon the characteristics of each individual including their other health conditions. Optimal intake of calcium and vitamin D is very important even when other osteoporosis medications are prescribed.
How long do you treat with medication for Osteoporosis?
- The length of treatment for osteoporosis is individualized to the severity of disease and response to treatment. In patients that have great increases in bone density after treatment, it may be appropriate to stop the medication for a period of 1-2 years and then recheck bone density to determine if more treatment is needed.
How do you monitor Osteoporosis?
- DXA scanning is generally repeated every 2 years in patients on treatment. In high risk patients, it may be repeated yearly.