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Handout on Health: Osteoporosis

Handout on Health: Osteoporosis

• Defining Osteoporosis


• The Occurrence and Impact of Osteoporosis


• Bone Basics


• Causes of Osteoporosis


• Risk Factors for Osteoporosis


• ? Fractures">Risk Factors for Osteoporosis-Related? Fractures



• Diagnosing Osteoporosis


• Treating Osteoporosis


• Preventing Osteoporosis


• Osteoporosis and Quality of Life


• Current Research


• Hope for the Future



• For More Information

Information Boxes

• Medications Associated With Osteoporosis
• Risk Factors for Fractures
• When to Talk to Your Doctor About Osteoporosis
• Idiopathic Juvenile Osteoporosis
• Preventing Falls Among Seniors
• Recommended Calcium and Vitamin D Intakes

This booklet is for people who have osteoporosis, their families, and others interested in learning more about the disease. The booklet describes osteoporosis and its impact, and contains information about the causes, diagnosis, and treatment of this disease as well as current research efforts supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other components of the Department of Health and Human Services’National? Institutes of Health (NIH). It also discusses risk factors for osteoporotic fractures, ways to prevent the disease and its progression, and how people with the disease can reduce their risk of future fractures. If you have further questions after reading this booklet, you may wish to discuss them with your doctor, or seek additional information from the sources listed at the end of this booklet.

Defining Osteoporosis

Osteoporosis is a disease marked by reduced bone strength leading to an increased risk of fractures, or broken bones. Bone strength has two main features: bone mass (amount of bone) and bone quality. Osteoporosis is the major underlying cause of fractures in postmenopausal women and the elderly. Fractures occur most often in bones of the hip, spine, and wrist, but any bone can be affected. Some fractures can be permanently disabling, especially when they occur in the hip.

Osteoporosis is often called a “silent disease”because it usually progresses without any symptoms until a fracture occurs or one or more vertebrae (bones in the spine) collapse. Collapsed vertebrae may first be felt or seen when a person develops severe back pain, loss of height, or spine malformations such as a stooped or hunched posture. Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of minor bumps, falls, or normal stresses and strains such as bending, lifting, or even coughing.

Many people think that osteoporosis is a natural and unavoidable part of aging. However, medical experts now believe that osteoporosis is largely preventable. Furthermore, people who already have osteoporosis can take steps to prevent or slow further progress of the disease and reduce their risk of future fractures. Although osteoporosis was once viewed primarily as a disease of old age, it is now recognized as a disease that can stem from less-than-optimal bone growth during childhood and adolescence, as well as from bone loss later in life.

The Occurrence and Impact of Osteoporosis

In the United States today, an estimated 10 million people over age 50 have osteoporosis and almost 34 million have low bone mass that puts them at increased risk for developing the disease. Four out of five people who have osteoporosis are women, but about 2 million men in the U.S. also have the disease and 14 million more have low bone mass that puts them at risk for it. One in two women and as many as one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. Osteoporosis can strike at any age, although the risk of developing the disease increases as you get older. In the future, more people will be at risk of developing osteoporosis because people are living longer and the number of elderly people in the population is increasing.

Osteoporosis affects women and men of all races and ethnic groups. It is most common in non-Hispanic white women and Asian women. African American women have a lower risk of developing osteoporosis, but they are still at significant risk. For Hispanic and Native American women the data aren’t clear. Among men, osteoporosis is more common in non-Hispanic whites and Asians than in men of other ethnic or racial groups.

The cost of osteoporosis to society is high. In 2002 dollars, between $12.2 billion and $17.9 billion was spent in the U.S. on hospitals and nursing homes for people with osteoporosis-related and associated fractures, and the costs are rising. The indirect costs of the disease, such as those resulting from reduced productivity and lost wages, are unknown. In addition to the financial costs, osteoporosis takes a toll in terms of reduced quality of life for many people who suffer fractures. It can also affect the lives of family members and friends who serve as caregivers.

Of all fractures, hip fractures have the most serious impact. Most hip fractures require hospitalization and surgery; some hip fracture patients require nursing home placement. Fifty percent of people who fracture a hip will be unable to walk without assistance. About one in five hip fracture patients over age 50 die in the year following their fracture as a result of associated medical complications. Vertebral fractures also can have serious consequences, including chronic back pain and disability. They have also been linked to increased mortality in older people.

Bone Basics

Bone is a living tissue that supports our muscles, protects vital internal organs, and stores most of the body’s calcium. It consists mainly of a framework of tough, elastic fibers of a protein called collagen and crystals of calcium phosphate mineral that harden and strengthen the framework. The combination of collagen and calcium phosphate makes bones strong yet flexible to hold up under stress.

Bone also contains living cells, including some that nourish the tissue and others that control the process known as bone remodeling. Throughout life, our bones are constantly being renewed by means of this remodeling process, in which old bone is removed (bone resorption) and replaced by new bone (bone formation). Bone remodeling is carried out through the coordinated actions of bone-removing cells called osteoclasts and bone-forming cells called osteoblasts.

During childhood and the teenage years, new bone is added to the skeleton faster than old bone is removed, or resorbed. As a result, bones grow in both size and strength. After you stop growing taller, bone formation continues at a faster pace than resorption until around the early 20s, when women and men reach their peak bone mass, or maximum amount of bone. Peak bone mass is influenced by various genetic and external, or environmental, factors, including whether you are male or female (your sex), hormones, nutrition, and physical activity. Genetic factors may determine as much as 50 to 90 percent of bone mass, while environmental factors account for the remaining 10 to 50 percent. This means you have some control over your peak bone mass.

After your early 20s, your bone mass may remain stable or decrease very gradually for a period of years, depending on a variety of lifestyle factors such as diet and physical activity. Starting in midlife, both men and women experience an age-related decline in bone mass. Women lose bone rapidly in the first 4 to 8 years after menopause (the completion of a full year without a menstrual period), which usually occurs between ages 45 and 55. By age 65, men and women tend to be losing bone tissue at the same rate, and this more gradual bone loss continues throughout life.

Causes of Osteoporosis

Amajor cause of osteoporosis is less-than-optimal bone growth during childhood and adolescence, resulting in failure to reach optimal peak bone mass. Thus, peak bone mass attained early in life is one of the most important factors affecting your risk of osteoporosis in later years. People who start out with greater reserves of bone (higher peak bone mass) are less likely to develop osteoporosis when bone loss occurs as a result of aging, menopause, or other factors. Other causes of osteoporosis are bone loss due to a greater-than-expected rate of bone resorption, a decreased rate of bone formation, or both.

Deterioration of bone quality, which reflects the internal structure, or “architecture,”of bone as well as other factors, is also thought to contribute to decreased bone strength and increased fracture risk. Scientists do not yet clearly understand all the factors that affect bone quality and the relationship between these factors and the risk of osteoporosis and fractures. However, this is an active area of research.

A major contributor to bone loss in women during later life is the reduction in estrogen production that occurs with menopause. Estrogen is a sex hormone that plays a critical role in building and maintaining bone. Decreased estrogen, whether due to natural menopause, surgical removal of the ovaries, or chemotherapy or radiation treatments for cancer, can lead to bone loss and eventually osteoporosis. After menopause, the rate of bone loss speeds up as the amount of estrogen produced by a woman’s ovaries drops dramatically. Bone loss is most rapid in the first few years after menopause but continues into the postmenopausal years.

In men, sex hormone levels also decline after middle age, but the decline is more gradual. These declines probably also contribute to bone loss in men after around age 50.

Osteoporosis can also result from bone loss that may accompany a wide range of disease conditions, eating disorders, and certain medications and medical treatments. For instance, osteoporosis may be caused by long-term use of some antiseizure medications (anticonvulsants) and glucocorticoid medications such as prednisone and cortisone. Glucocorticoids are anti-inflammatory drugs used to treat many diseases, including rheumatoid arthritis, lupus, asthma, and Crohn’s disease. Other causes of osteoporosis include alcoholism, anorexia nervosa, abnormally low levels of sex hormones, hyperthyroidism, kidney disease, and certain gastrointestinal disorders. Sometimes osteoporosis results from a combination of causes.