Bone is living tissue. Your body replaces old bone tissue with new bone tissue in a process known as bone remodeling.
Osteoporosis happens when your body loses bone tissue faster than it can replace it.
“Bone resorption or bone breakdown can occur at a rate that’s faster than the body can make and mineralize new bone,” says Mara Horwitz, MD, associate professor of medicine, University of Pittsburgh, and a metabolic bone specialist at UPMC. “This results in bone loss and a change to the structural form of the bone, which increases your risk of fracture.
“Bone is sort of like scaffolding. If suddenly you lose some of those connections from one side of the scaffold to the other, it’s more likely to collapse.”
Several factors can put you at a higher risk of osteoporosis, including:
- Gender. Women are more at risk than men.
- Age. Osteoporosis is more likely as we age, such as in post-menopausal women or men over 70.
- Body type. Men and women who have small body frames or who are thin are at higher risk.
- Family history.
- The use of certain medicines.
- Other medical conditions, including arthritis, hormonal diseases, eating disorders, and some cancers.
- Low levels of calcium and vitamin D in your diet.
- Smoking and alcohol use.
- Sedentary lifestyle.
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Osteoporosis Diagnosis: Symptoms and Testing
It can be difficult to diagnose osteoporosis because people often have no symptoms.
“It is really a diagnosis of exclusion, and it is an asymptomatic disease until fractures occur,” Dr. Horwitz says.
A bone density test can help with the diagnosis before a fracture happens. The Bone Health & Osteoporosis Foundation (BHOF) recommends bone density tests for women age 65 and older, men age 70 and older, and others who are at increased risk for osteoporosis.
Treating and Managing Osteoporosis
Fractures from osteoporosis can become disabling and even deadly.
According to the BHOF, 20% of seniors who suffer a hip fracture die within a year due to complications from the injury or surgery. Fractures in the spine can cause a stooped posture and loss of height. Fractures also can affect your breathing, your mobility, and your ability to perform routine daily tasks.
“Especially with our aging population, the number of people with osteoporosis is growing exponentially,” Dr. Horwitz says.
You can manage your osteoporosis through lifestyle modifications and medicine.
Managing osteoporosis through lifestyle
A healthy lifestyle can help prevent osteoporosis. For people who have osteoporosis, a healthy lifestyle, in combination with calcium and vitamin D and medicines to treat the disease, can help prevent future fractures.
These steps can help prevent osteoporosis and/or osteoporosis fractures:
- Follow a diet high in calcium and vitamin D or take supplements.
- Do weight-bearing exercises regularly.
- Take prescribed medicines that promote good bone health and avoid medicines that increase bone loss.
- Stop smoking.
- Drink alcohol in moderation.
Doctors can prescribe medicine to help reduce bone loss and promote bone growth. This can help to reduce the risk of fracture in people with osteoporosis. When you take these medicines, be sure to get enough calcium and vitamin D in your diet and with supplements.
Medicines for osteoporosis include:
- Bisphosphonates. These decrease the rate of bone loss and make it easier for your body to mineralize new bone. These drugs can be taken orally or intravenously (IV), depending on the specific medicine. Frequency can range from a weekly medicine to a yearly IV infusion, depending on the drug.
- Denosumab. This is a twice-a-year subcutaneous injection. Like bisphosphonates, denosumab works to reduce bone loss. It blocks a protein that activates the cells most responsible for bone breakdown. Denosumab carries a slightly higher risk of side effects than bisphosphonates and cannot be stopped without switching to an alternate medicine.
- Teriparatide and abaloparatide. These anabolic medicines stimulate new bone formation. Often, patients who receive this type of treatment either have not had a good response to other medicines, have very low bone density, or have had a high number of fractures. These treatments are daily injections that can only be taken for up to two years and are usually followed by treatment with a bisphosphonate.
- Estrogen therapies. Estrogen can improve bone density and reduce fractures. However, it also carries potential harmful side effects and complications, so it is not generally the first-line treatment for osteoporosis. If you are receiving estrogen for another reason — such as treating menopause symptoms — the estrogen can also help to prevent bone loss.
- Selective estrogen receptor modulators (SERMs). These are designed to carry the benefits of estrogen therapies without some of the potential risks. Doctors may prescribe SERMs for milder cases of osteoporosis that affect the spine.
- Romosozumab. This medicine is the newest anabolic or bone-building medicine to be approved for patients with very severe osteoporosis who cannot take another osteoporosis medicine. It works by blocking a protein important in the regulation of bone metabolism. It is given as a monthly injection for up to one year in a very select group of patients with severe osteoporosis who are not at risk for heart disease or a stroke.
Although medicines can reduce the risk of fractures, they cannot completely prevent them.
“The ultimate goal in patients is to reduce fractures,” Dr. Horwitz says. “Nothing is 100% effective in preventing all fractures but the available treatments are excellent at reducing them.”
With an aging population, it’s important to raise awareness about screening for osteoporosis and treating the condition.
Dr. Horwitz says to talk to your doctor about bone density screening if you are a woman over age 65, a man over age 70, have other risk factors for osteoporosis, or have had a bone fracture with little or no trauma.
“Increased awareness and increased screening are a great benefit to everybody,” Dr. Horwitz says.
The UPMC Department of Endocrinology provides diagnosis and treatment for a variety of conditions, including osteoporosis. For more information or to schedule an appointment, call 412-586-9700 and select option 2.
American College of Rheumatology, Osteoporosis. Link
Bone Health and Osteoporosis Foundation, What is Osteoporosis and What Causes It? Link
Bone Health and Osteoporosis Foundation, Bone Density Exam/Testing. Link
National Institute of Arthritis and Musculoskeletal and Skin Diseases, Osteoporosis Overview. Link
Spine Health, Osteoporosis Medications. Link
U.S. National Library of Medicine, Osteoporosis. Link
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The UPMC Department of Endocrinology stands as a national leader in research of diabetes and endocrine conditions. We partner with the University of Pittsburgh Division of Endocrinology and Metabolism for research and clinical trials. We treat diabetes, obesity, osteoporosis, hormonal disorders, and thyroid disorders at several locations across western Pennsylvania. We also have specialized Diabetes Centers to help you manage your disease. U.S. News & World Report ranks UPMC Presbyterian among the top hospitals in the country for endocrinology and diabetes care.