Osteoporosis is a condition where, due to loss of calcium, bones become porous. This condition, also called losing bone mass, causes bone weakness, brittleness, and may lead to bone fractures over time. Osteoporosis usually occurs more often in women, especially post-menopause, due to several reasons. First, women tend to have less bone mass than men. Secondly, women tend to take in less calcium and live longer than men. Finally, after menopause or in the case of the surgical removal of ovaries, the estrogen levels in women fall drastically, which speeds up bone loss. Osteoporosis can affect men as well, especially in the case of men with low estrogen and testosterone levels. However, osteoporosis is much more common in women.

In the human body, the bones change constantly. There is continuous remodeling of the bone, involving new bone being made and old bone being broken down. Bone mass increases when a person is young because the amount of new bone being produced is greater than the amount of old bone being lost. Peak bone mass is usually reached during a person’s mid-thirties. After that, an individual starts losing old bone at a greater rate than they are making new bone.

The likelihood of developing osteoporosis also greatly depends on how much bone mass is attained when a person is in their twenties and early 30s, and how rapidly bone mass is lost after that critical period. The higher the peak bone mass, the more calcium “deposits” there are in the body and, in this case, developing osteoporosis as a person ages becomes less likely.

A bone’s size and density determines its strength and bone density is determined by how much calcium, phosphorus, and other minerals exist within the bones. Fewer minerals within the bones eventually contribute to the loss of their internal supporting structure. Hormone levels also affect bone density.

Causes and risk factors of osteoporosis include one or more of the following:

• Early menopause, occurring in women before age 45

• Surgical removal of a woman’s ovaries before menopause

• Low calcium intake

• Family history of osteoporosis

• Fair skin, usually a person of Asian or Caucasian race

• Sedentary lifestyle, not getting sufficient exercise

• Thin body and small bone frame

• Alcohol abuse

• Smoking or tobacco use

• Eating disorders, not getting enough nourishment to the bones

• Hyperthyroidism, either a thyroid being overactive or occasionally taking too much medicine to treat hyperthyroidism weakens the bones

• Long-term use of corticosteroids (medications used to treat inflammation, pain, and chronic conditions such as rheumatoid arthritis and asthma) or proton pump inhibitors (medications used for chronic gastroesophageal reflux disease (GERD) or ulcers)

Osteoporosis may manifest as severe back pain or stooped posture with a loss of height over time. The loss of height is the result of compression fractures – osteoporosis can cause vertebrae, or the bones in the spine, to collapse over time. Frequent broken bones or fractures, often in the hip or wrist, are also possible sign of osteoporosis. These symptoms indicate a significant loss of bone calcium.

If a person is experiencing any of these symptoms, they should go see their doctor. The doctor will likely test their bone density. The most effective screening is a dual X-ray absorptiometry, or DEXA, performed to check the density of bones in the wrist, spine, and hip (those areas most likely to be affected by osteoporosis). Other tests used to measure bone density are a single photon absorptiometry, a quantitative computerized tomography (CT) scan, and an ultrasound. Regular X-rays may also be ordered to determine if a fracture has already occurred.

Medications are the preferred way to treat osteoporosis, including:

• Biphosphonates – increase bone density and help reduce the risk of bone fractures by slowing bone loss. They may be administered through intravenous injection or orally in form of pills. However, biphosphonates cannot be taken by people with low calcium levels, pregnant women, and people with kidney or peptic ulcer disease/GERD. Side effects include esophageal irritation, vision problems, irregular heartbeats, abdominal pain, and nausea. There have been some reports of osteonecrosis (bone loss in jaw) in some patients using these medications for several years.

• Calcitonin – slows bone loss; this hormone is produced by the thyroid gland and it is available as an injection or nasal spray. Some people experience nasal irritation due to the use of nasal spray. Calcitonin is generally used by people who cannot take biphosphonates.

• Raloxifene – gives the same beneficial effects to improving bone density as the body’s estrogen hormone. Raloxifene helps to increase bone density in post-menopausal women without causing risks like uterine or breast cancer. One side effect of raloxifene is the possibility of blood clots, so the medication should not be used by people with a history of blood clots. Another common side effect of this drug is hot flashes.

• Terparatide – is a synthetic parathyroid hormone that helps promotes new bone growth. It is given via injection into the abdomen or thigh in both men and women and is usually prescribed in combination with other medications that simultaneously prevent further bone loss. The immediate side effects of terparatide include loss of appetite, muscle weakness, abdominal pain, headache and nausea. Long-term side effects are still being researched so, currently, treatment is not a recommended for more than two years.

There are a few methods that help to keep bones strong and prevent osteoporosis.

The first is to get the daily recommended amount of calcium. The daily amount of calcium recommended for women before menopause is 1000mg of calcium per day. After menopause, if a woman is not taking estrogen, then 1500mg of calcium is recommended each day. For women after menopause who are taking estrogen, the recommended calcium intake is 1000mg per day.

The best way to get calcium is through the diet. Food sources rich in calcium include low-fat or nonfat milk, yogurt, cheese, and other dairy products. Spinach, broccoli, pink salmon, and dried beans also contain high levels of calcium. Vitamin D also helps in absorption of calcium into the body and the recommendation for vitamin D is 200-600 IU (international units) daily. So, food sources rich in vitamin D such as fish oil, saltwater fish, egg yolks, liver, and fortified milk should also be incorporated into the diet. If the person is unable to get the recommended amounts through food sources, their doctor may recommend supplements. Because calcium is not well absorbed by the body, patients should take no more than 400 to 500 mg of calcium (combined with vitamin D) at a time with meals.

Exercise regularly. Strength training exercises help strengthen the muscles and bones of the upper spine and arms, whereas weight-bearing exercises like jogging, stair climbing, skipping rope, walking, and sports activities strengthen the bones in the legs, hips and lower spine.

Smoking should be strictly avoided as it decreases estrogen production in women, leading to bone loss. Alcohol should also be avoided because taking more than two alcoholic beverages per day decreases bone formation considerably.

Support

Everyone, especially women who are past menopausal, should be aware of osteoporosis and its debilitating effects. By taking the necessary precautionary steps, one can strengthen the bones considerably and keep their bones strong as they grow older.