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Osteoporosis literally means porous bone and is a skeletal disorder characterized by compromised bone strength, predisposing an increased risk of fracture.
(See Figure 1).
Osteoporosis is a general term for a skeletal condition characterized by a reduction in the mass of the bone affected and an increase in the risk of fractures. There are several forms of the disease, and osteoporosis should be differentiated from osteopenia.
Osteopenia is a bone condition in which the concentration of mineral is diminished and the total bone mass is reduced. In osteoporosis, whatever bone is left is normally mineralized. In osteopenia bone is demineralized.
In normal bone development, old bone is removed and new bone is generated in a balanced system of coupled actions. For unknown reasons, as people age, the coupled actions get out of balance; old bone is removed at a faster rate than it is replaced. This leads to osteoporosis. In osteoporosis, the bone composition remains normal, but both bone mineral and bone matrix are reduced. Figure 1 shows a cross-section of a normal and an osteoporotic bone. If bone strength is compromised, but not yet severe, a diagnosis of osteopenia is made. Patients with osteopenia are at risk of developing osteoporosis.
Osteoporosis is the most common type of bone disease impacting 44 million Americans and leads to approximately 1.5 million fractures in the US each year. The disease is typically asymptomatic until a fracture occurs. Preventing these fractures means recognizing who is at risk and identifying an appropriate screening protocol for them.
Osteoporosis is classified as either primary or secondary. Primary osteoporosis is the deterioration of bone mass that is not associated with a chronic illness. Secondary osteoporosis results from chronic conditions or their treatment that contribute significantly to accelerated bone loss.
Patient history and physical examination are not sensitive enough to diagnose primary osteoporosis. Nonetheless, the physical examination is important for the diagnosis of secondary osteoporosis as well as the direction of further evaluation. The medical history provides valuable information regarding the presence of chronic conditions, behaviors, and level of physical fitness, all of which can increase or decrease the risk of osteoporosis.
It is currently not possible to reverse established osteoporosis. The goal of therapy is to prevent osteoporosis or possibly to halt its progression. Ultimately, one third of all women and one sixth of all men will have a hip fracture. Vertebral compression fractures are even more problematic, with osteoporosis causing approximately 700,000 to 750,000 vertebral fractures a year. These fractures result in increased hospitalization, increased economic burden and decreased quality of life. Typical osteoporotic fractures include fractures of the vertebra, distal forearm and hip. Of the approximately 25 million American women who have osteoporosis, one third will have a documented fracture. Vertebral compression fractures account for 150,000 hospital admissions each year in the US with an average length of stay of 9 days.
Osteoporosis is a public health problem. There are 125 million people at risk for osteoporosis-related fractures worldwide including 35 million people in the US. Moreover, the fracture rate is increasing faster than the population is aging. During the course of their lifetime, 30% of all postmenopausal white women will develop osteoporotic fractures.
While osteoporosis is more common in women than in men, both sexes become vulnerable as they age. Additional risk factors for osteoporosis can be classified as genetic, nutritional and behavioral. These risk factors include:
• Thin and/or small frame
• Family history of osteoporosis
• Race (white or Asian)
• Certain medications
• Inactive lifestyle
• Cigarette smoking
• Excessive use of alcohol
• High caffeine intake
• Low body weight
• Low calcium diet
• Postmenopausal state
• Advanced age
• Certain diseases
• Low testosterone levels in men
Patients suffering from osteoporosis may experience loss of height, changes in the way their clothing fits, and /or spinal deformity. However, osteoporosis is typically asymptomatic until a fracture occurs and therefore it is critical to recognize individuals who are at risk and identify an appropriate screening protocol for them.
Links to additional information about Osteoporosis (and sources for data on this page):
Web MD: Osteoporosis Guide – www.webmd.com/osteoporosis
MedicineNet: Osteoporosis – www.medicinenet.com/osteoporosis
National Osteoporosis Foundation – www.nof.org
Society of Interventional Radiology – www.sirweb.org
Spine Universe – www.spineuniverse.com
Foundation for Osteoporosis Research & Education – www.fore.org
Spine-health – www.spine-health.com
International Osteoporosis Foundation – www.iofbonehealth.org
Frequently Asked Questions
What causes osteoporosis?
There are several risk factors that can lead to osteoporosis.
The leading risk factors are:
• Ethnic group – Caucasian and Asian women have the highest risk
• The risk rises in women over 50 and increases with age
• Women are at higher risk
• Men and women who smoke lose bone mass much faster than non-smokers
• Post-menopausal women
What are the symptoms of osteoporosis?
A person may not be aware they have osteoporosis until a fracture occurs. There are symptoms such as backache, loss of height, a stooped posture, and fractures of the spine, wrist or hip.
How is osteoporosis diagnosed?
Osteoporosis has no obvious symptoms until a fracture occurs after the bone is already significantly weakened, it is important to go to the doctor if any of the risk factors apply to you. The doctor will take a thorough medical history that includes information on any recent fractures and may determine that the next step is to have a bone mineral density (BMD) test.
When should I get a Bone Density Test?
• If you are over the age of 65
• If you are under 65 and have risk factors for osteoporosis consult your doctor or nurse- your doctor will consider factors such as:
– Your age and whether you have reached menopause
– Your height and weight
– Whether you smoke
– Your daily use of alcohol
– Whether your parents have broken a hip
– Medicines you use
– Whether you have a disorder that increases your risk
What are the treatments for osteoporosis?
It is important to talk to your doctor about what is the best treatment for you.
There are a number of treatment options that have been shown to act quickly (within one year), to maintain bone density and to reduce the risk of having fractures. It is important that the choice of treatment be tailored to a patient’s specific medical needs and lifestyle. Common treatments that are currently available (although not in all countries) are: bisphosphonates (alendronate, ibandronate, risedronate), calcitonin, raloxifene, strontium ranelate, teriparatide and tibolone.
Hormone replacement therapy (HRT), although not specifically for the treatment of osteoporosis, has also been shown to have a beneficial effect on bone.
Calcium and vitamin D supplements are also usually prescribed, to ensure adequate intake, and to ensure maximum effectiveness of the drug therapy. Sufficient calcium, vitamin D and protein intake not only helps to prevent osteoporosis, it is also important in helping to maintain bone density and muscle function in patients diagnosed with osteoporosis. www.iof.org
What are the symptoms of vertebral compressions fractures (VCF)?
Pain associated with a compression fracture can vary from patient to patient. For some people the pain may subside as the bone heals, which can take up to two or three months. In other people the pain may continue even after the fracture has healed.
Sudden severe back pain, especially in older women, may signal a vertebral compression fracture.
One or more symptoms can be:
• Sudden severe back pain
• Worsening back pain when walking or standing
• Some pain relief when lying down
• Difficulty and pain when bending or twisting
• Curved or stooped posture
How can I prevent vertebral compression fractures?
It is important to treat the osteoporosis that caused your fracture to prevent future fractures. You doctor may recommend taking a calcium supplement, getting more vitamin D, and doing weight-bearing and strength-building exercises. Your doctor may also recommend medications to halt or slow osteoporosis.
For more information:
Patient Information Brochure (PDF)