Osteoporosis

What is osteoporosis?

Bone is living tissue. Your body breaks down old bone and builds new bone all the time. After about age 30, you slowly start to lose bone faster than you build it. When bone loss goes far enough, bones become porous and fragile. That’s osteoporosis.

Low bone mass, sometimes called osteopenia, means your bones are thinner than normal but not yet in the osteoporosis range.

The most common breaks from osteoporosis are in the hip, spine, and wrist. About 1 in 2 women and up to 1 in 4 men over 50 will break a bone because of osteoporosis.

What are the symptoms?

Osteoporosis usually has no symptoms until a bone breaks. Signs that you may have it include:

• Breaking a bone from a minor fall, such as falling from standing height
• Losing height
• A stooped or curved upper back
• Sudden back pain, which can come from a small break in the spine

What causes osteoporosis, and who is at risk?

Many things affect bone strength. Your chance of osteoporosis is higher if you:

• Are a woman, especially after menopause, when estrogen levels drop
• Are older
• Have a parent who broke a hip
• Have a small, thin frame
• Smoke or drink a lot of alcohol
• Get little calcium or vitamin D, or are rarely active

Some health conditions raise the risk, including rheumatoid arthritis, celiac disease, an overactive thyroid, an overactive parathyroid gland, early menopause, and eating disorders. Some medicines do too, including steroid pills such as prednisone taken for 3 months or more, some breast and prostate cancer treatments, some seizure medicines, and too much thyroid hormone.

How is osteoporosis diagnosed?

Osteoporosis is diagnosed with a bone density test:

• DEXA scan (also called DXA): a low-dose X-ray that measures bone density, usually at the hip and spine. You lie on a padded table for about 10 to 20 minutes. It doesn’t hurt.
• T-score: compares your bone density to a healthy young adult’s. A T-score of -1 or higher is normal. Between -1 and -2.5 is low bone mass. -2.5 or lower is osteoporosis.
• Fracture risk score: a tool such as FRAX combines your bone density with other risk factors to estimate your chance of a break in the next 10 years.

A break from a minor fall can also lead to a diagnosis of osteoporosis, whatever the T-score. Your clinician may order blood and urine tests, such as calcium, vitamin D, kidney function, thyroid, and parathyroid hormone, to look for other causes of bone loss.

Experts recommend screening for women 65 and older and for younger women after menopause who have a higher risk of a break.

How is osteoporosis treated?

Treatment aims to lower your chance of breaking a bone. Plans often include:

• Calcium and vitamin D: from food first, with supplements if you need them
• Exercise: weight-bearing activity like walking, strength training, and balance exercises
• Preventing falls: good lighting, clear floors, sturdy shoes, and a review of medicines that cause dizziness
• Medicines that slow bone loss: these include bisphosphonates (pills or yearly infusions) and other medicines given as shots
• Medicines that build new bone: often used for people at very high risk of a break

All medicines have possible side effects. Rare ones with some bone medicines include jaw bone problems and unusual thigh fractures. Your clinician can go over the benefits and risks with you. Some bone medicines need a planned next step when they’re stopped, so don’t stop one without talking to your clinician.

Living with osteoporosis and when to get care

You’ll likely have a repeat bone density test every 1 to 2 years at first. Talk with your clinician if:

• You break a bone from a minor fall
• You notice height loss or new back pain
• You start a steroid medicine or a cancer treatment that can affect bones
• You’re having side effects from a bone medicine

If you fall and can’t get up, or can’t put weight on your leg, call 911.