What is osteoporosis?

The word “osteoporosis” means “porous bone.” It is a bone-weakening disease, and if you have it, you are at increased risk of sudden and unexpected bone fractures. Osteoporosis means you have less bone mass and strength. The disease often develops without symptoms or pain and is usually not discovered until weakened bones cause painful fractures. Most of these are fractures of the hip, wrist, and spine.

Who gets osteoporosis?

It is estimated that around 200 million people have osteoporosis worldwide. In the US, the figure is about 54 million people. Although osteoporosis occurs in both men and women, women are four times more likely to develop the disease than men. Currently, there are about two million men in the US who have osteoporosis and about 12 million more who are at risk of developing the condition.

After age 50, one in two women and one in four men will have an osteoporosis-related fracture at some point in their lives. Another 30% have low bone density that puts them at risk of developing osteoporosis. This condition is called osteopenia. Osteoporosis is responsible for more than two million fractures each year, and this number continues to grow. There are steps you can take to prevent osteoporosis from occurring. Treatments can also slow the rate of bone loss if you have osteoporosis.

What causes osteoporosis?

Researchers understand how osteoporosis develops even without knowing the exact cause of why it develops. Your bones are made of living, growing tissue. The inside of a healthy bone looks like a sponge. This area is called trabecular bone. An outer layer of dense bone surrounds the cancellous bone. This hard layer is called cortical bone.

When osteoporosis occurs, the “holes” in the “sponge” get larger and more numerous, weakening the inside of the bone. Bones support the body and protect vital organs. Bones also store calcium and other minerals. When the body needs calcium, it breaks down and rebuilds bones. This process, called bone remodelling, provides the body with needed calcium while keeping bones strong.

Until about age 30, you typically build more bone than you lose. After age 35, bone breakdown occurs faster than bone buildup, leading to a gradual loss of bone mass. If you have osteoporosis, you lose bone mass at a higher rate. After menopause, the rate of bone breakdown occurs even more rapidly.

What are the symptoms of osteoporosis?

There are usually no symptoms of osteoporosis. That is why it is sometimes called a silent disease. However, you should be careful about the following things:

  • Height loss (shortening of an inch or more).
  • Change of posture (bend over or lean forward).
  • Difficulty breathing (decreased lung capacity due to compressed discs).
  • bone fractures
  • Lower back pain.

Who is at risk of developing osteoporosis?

There are many risk factors that increase the possibility of developing osteoporosis, two of the most important being gender and age.

1. Everyone’s risk of osteoporotic fractures increases with age. However, women over the age of 50 or postmenopausal are at the highest risk of developing osteoporosis. Women experience rapid bone loss in the first 10 years after entering menopause, because menopause slows the production of estrogen, a hormone that protects against excessive bone loss.

Age and osteoporosis also affect men. You may be surprised to learn that men over the age of 50 are more likely to have an osteoporosis-induced bone fracture than to develop prostate cancer. About 80,000 men a year are expected to break their hip, and men are more likely than women to die in the year after a hip fracture.

2. Your risk of developing osteoporosis is also related to ethnicity. Caucasian and Asian women are more likely to develop osteoporosis. However, African American and Hispanic women are still at risk. In fact, African-American women are more likely than white women to die after a hip fracture.

3. Another factor is bone structure and body weight. Small, thin people are at higher risk of developing osteoporosis because they have less bone to lose than people with more body weight and larger frames.

4. Family history also plays a role in the risk of osteoporosis. If your parents or grandparents have had signs of osteoporosis, such as a hip fracture after a minor fall, you may be at higher risk of developing the disease.

5. Finally, some medical conditions and medications increase your risk. If you have or have had any of the following conditions, some of which are related to irregular hormone levels, you and your health care provider might consider early detection of osteoporosis.

  • An overactive thyroid, parathyroid, or adrenal glands.
  • History of bariatric surgery (weight loss) or organ transplant.
  • Hormonal treatment for breast or prostate cancer or a history of missed periods.
  • Celiac disease or inflammatory bowel disease.
  • Blood diseases such as multiple myeloma.

Some medications cause side effects that can damage bones and lead to osteoporosis. These include steroids, breast cancer treatments, and medications to treat seizures. You should talk to your health care provider or pharmacist about the effect of your medications on your bones.

It may seem like every risk factor is related to something out of your control, but that’s not true. You have control over some of the risk factors for osteoporosis. You can discuss medication problems with your health care provider. AND—you are in charge of your:

  • Eating habits: You are more likely to develop osteoporosis if your body does not have enough calcium and vitamin D. Although eating disorders such as bulimia or anorexia are risk factors, they can be treated.
  • Lifestyle: People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis.
  • Tobacco use: Smoking increases the risk of fractures.
  • Alcohol consumption: Drinking two drinks a day (or more) increases the risk of osteoporosis.

How is osteoporosis diagnosed?

Your health care provider may order a test to give you information about your bone health before problems start. Bone mineral density (BMD) tests are also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans. These x-rays use very small amounts of radiation to determine how strong the bones of the spine, hip, or wrist are.

Regular X-rays will only show osteoporosis when the disease is very advanced. All women over the age of 65 should have a bone density test. DEXA scanning may be done earlier in women who have risk factors for osteoporosis. Men over the age of 70 or younger men with risk factors should also consider having a bone density test.

How is osteoporosis treated?

Treatments for established osteoporosis may include exercise, vitamin and mineral supplements, and medications. Exercise and supplementation are often suggested to help prevent osteoporosis. Loading, resistance and balance exercises are all important.

What medications are used to treat osteoporosis?

There are several classes of drugs used to treat osteoporosis. Your health care provider will work with you to find the best option. It is really not possible to say that there is a better medicine to treat osteoporosis. The “best” treatment is the one that is best for you.

  • Hormonal and hormone-related therapy

This class includes estrogen, testosterone, and the selective estrogen receptor modulator raloxifene (Evista®). Due to the potential for blood clots, certain cancers, and heart disease, estrogen therapy is likely to be used in women who need to treat menopausal symptoms and in younger women. Testosterone may be prescribed to increase bone density if you are a man with low levels of this hormone.

Raloxifene acts like estrogen in the bones. The drug is available in tablet form and is taken every day. In addition to treating osteoporosis, raloxifene might be used to reduce the risk of breast cancer in some women. For osteoporosis, raloxifene is usually used for five years.

Salmon-calcitonin (Fortical® and Miacalcin®) is a synthetic hormone. It reduces the chance of spinal fractures, but not necessarily hip fractures or other types of fractures. It can be injected or inhaled through the nose. Side effects include runny or nosebleeds and headaches for the inhaled form. Side effects include rashes and redness from the injected form. It is not recommended as a first option. More serious side effects are possible, including a weak link to cancer.

  • Bisphosphonates

Treatments for osteoporosis with bisphosphonates are considered antiresorptive drugs. They prevent the body from reabsorbing bone tissue. There are several formulations with various dosage schedules (monthly, daily, weekly and even yearly) and different brands:

Alendronate: Fosamax®, Fosamax Plus D®, Binosto®.
Ibandronate: Boniva®.
Risedronate: Actonel®, Atelvia®.
Zoledronic acid: Reclast®.

You may be able to stop taking bisphosphonates after three to five years and still get benefits after you stop taking them. Also, these drugs are available as generic drugs. Of these products, Boniva and Atelvia are recommended only for women, while the others can be used by both women and men.

Possible side effects of bisphosphonates include flu-like symptoms (fever, headache), heartburn, and impaired kidney function. There are also potentially serious side effects, such as the rare occurrence of jaw bone damage (osteonecrosis of the jaw) or atypical femur fractures (mild trauma thigh fractures). The risk of these rare events increases with prolonged use of the drug (>5 years).

  • Biological products

Denosumab (Prolia®) is a product that is available as an injection given every six months to women and men. It is often used when other treatments have failed. Denosumab can even be used in some cases of reduced kidney function. Its long-term effects are not yet known, but there are potentially serious side effects. These include possible problems with the thigh or jawbones and serious infections.

  • Anabolic agents

These products strengthen bones in people who have osteoporosis. There are three of these products currently approved:

1. Romososumab-aqua (Evenity®) has been approved for postmenopausal women who are at high risk of fracture.

2. The product allows the formation of new bone and decreases the breakdown of bone. You will receive two injections, one after the other, once a month. The time limit is one year for these injections.

3. Teriparatide (Forteo®) and Abaloparatide (Tymlos®) are injectable medications that are given daily for 2 years. They are parathyroid hormones, or products similar in many ways to hormones.