Osteoporosis is a disease in which bones become fragile and are more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine and wrist.

Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture usually requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain and deformity.

Women are four times more likely than men to develop the disease, men also suffer from osteoporosis.

Figure 1: Normal bone, bone density in medium level osteoporosis and bone density in severe osteoporosis.

 

There are many factors that determine who will develop osteoporosis. The first step in prevention is to determine whether you are at risk. Known risk factors include the following:

• Age. The older you are, the greater your risk of osteoporosis. Your bones become less dense and weaker as you age.
• Gender. Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause.
• Race. Caucasian and Asian women are more likely to develop osteoporosis. However, African American and Hispanic women are still at significant risk for developing the disease.
• Bone Structure and Body Weight. Women with small frames are at greater risk.
• Menopause/Menstrual History. Normal or early menopause (caused naturally or because of surgery) increases your risk of developing osteoporosis. In addition, women who stop menstruating before menopause because of conditions such as anorexia or bulimia, or because of excessive physical exercise, may also lose bone tissue and develop osteoporosis.
• Lifestyle. Smoking, drinking too much alcohol, consuming an inadequate amount of calcium or participating in little or no weight-bearing exercise, increases your chances of developing osteoporosis.
• Medications and Disease. Osteoporosis is associated with certain medications (such as cortisone-like drugs) and is a recognized complication of several medical conditions, including such endocrine disorders as having an overactive thyroid, rheumatoid arthritis and immobilization.
• Family History. Susceptibility to fracture may be hereditary. Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass.

It is important to understand that bone is not a hard and lifeless structure, but rather a complex, living tissue. Our bones provide structural support for muscles, protect vital organs and store the calcium essential for bone density and strength.

Because bones are constantly changing, they can heal and may be affected by diet and exercise. Until about age 35, you build and store bone efficiently. Then, as part of the natural aging process, your bones begin to break down faster than new bone can be formed. In women, bone loss accelerates after menopause, when the ovaries stop producing estrogen--the hormone that protects against bone loss.

You can think of your bone as a savings account. There is only as much bone mass in your account as you deposit. The critical years for building bone mass are from prior to adolescence to about age 30. Some experts believe that young women can increase their bone mass by as much as 20 percent--a critical factor in protecting against osteoporosis.

To determine if you have osteoporosis or may be at risk for the disease, your doctor will ask you a variety of questions about your lifestyle and medical history. Your doctor will want to know if anyone in your family has been diagnosed with osteoporosis or if they have had fractured bones.

Based on a comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. A bone mass measurement is the only way to tell if you have osteoporosis. Specialized tests for bone density can measure bone density in various sites of the body. If the test is conducted at intervals of a year or more, it can detect osteoporosis before a fracture occurs, predict your chances of having a fracture in the future, determine your rate of bone loss and monitor the effects of treatment.

Building strong bones, especially before age 30, can be the best defense against developing osteoporosis, and a healthy lifestyle can be critically important for keeping bones strong.

Hormone replacement therapy (estrogen), alendronate and raloxifene are approved by the Food and Drug Administration (FDA) for the prevention of osteoporosis.

1. Exercise

Regular activity EVERY DAY
Weight - bearing activity needed to slow the rate of bone loss
Walking / jogging
Aerobic dancing
Cycling

2. Stop / Limit use of nicotine, alcohol, caffeine. They increase bone loss.

3. Eat food that will provide you with an adequate amount of calcium.

4. Consult your primary physician regarding your risks of developing Osteoporosis and possible medical intervention.

5. Other Terms:

Osteopenia - general term for decreased bone density.
Osteomalacia - weakening of bones due to Vitamin D deficiency.

The aim of treatment of osteoporosis is to reduce the frequency of vertebral and non-vertebral fractures (especially at the hip), which are responsible for morbidity associated with the disease. Results of large placebo controlled trials have shown that alendronate, raloxifene risedronate, the 1-34 fragment of parathyroid hormone, and nasal calcltonln, greatly reduce the risk of vertebral fractures. Furthermore, a large reduction of non-vertebral fractures has been shown for alendronate risedronate, and the 1-34 fragment of parathyroid hormone. Calcium and vitamin D supplementation is not sufficient to treat indlvlduals with osteoporosis but is useful, especially in elderly women in care homes. Hormone replacement therapy remains a valuable option for the prevention of osteoporosis in early postmenopausal women. Choice of treatment depends on age, the presence or prevalent fractures, especially at the spine, and degree of bone mineral density measured at the spine and hip. Non-pharmacological interventions include adequate calcium intake and diet, selected exercise programmes, reduction of other risk factors for osteoporotic fractures, and reduction of the risk of falls in elderly individuals.

Antifracture efflcacy of the most frequently used treatments of postmenopausal osteoporosis. In addition to the effects of calclum or vitamin D supplementation, or both, as derived from placebo controlled randomised trials.

Drug	Vertebral fractures	Non-vertebral fractures (hip)
Alendronate	+++	++
Calcitonin (nasal)	+	0
Etidronate	+	0
Fluoride		-
Hormone replacement therapy	+	0
Parathyroid hormone	+++	++
Raloxifene	+++	0
Risedronate	+++	++
Vltamin D derivatives		0

+++=strong evidence ++=good evidence +=some evidence =equivocal 0=no effects - =negative effects.

*Evidence derived mainly from observational studies.
+Effect on hip fractures not documented.