All of us have heard of osteoporosis. It means “porous bone.” The disease often develops without any symptoms or pain, and it is usually not discovered until the weakened bones cause fractures.
Up until about the age of 30, you normally build more bone than you lose. After age 35, bone breakdown occurs faster than bone buildup, which causes a gradual loss of bone mass.
The area inside of our bones looks like a sponge. An outer shell of dense bone wraps around the spongy bone. When osteoporosis occurs, the little holes in the sponge grown larger and more numerous, weakening the inside of the bone.
Our bones store calcium and other minerals. When your body needs calcium, it breaks down and rebuilds the bone. This helps your body obtain needed calcium and also helps to rebuild it to maintain strong bones.
There are usually no symptoms but you should watch for the following changes:
- loss of height
- change in posture such as stooping or bending forward
- bone fractures
- pain in the lower back
There are many risk factors that can increase your chance of developing osteoporosis.
- women over the age of 50 or postmenopausal women are at greatest risk
- Caucasian or Asian women
- petite and thin women
- family history
- medical conditions such as overactive thyroid, hormone treatment for breast or prostate cancer, celiac disease, inflammatory bowel disease, history of bariatric surgery with rapid weight loss, organ transplant, or blood diseases like multiple myeloma
Not all risk factors are out of our control in development of osteoporosis. You do have some control over:
- eating habits: make sure you consume enough calcium and Vitamin D
- treatment of eating disorders
- inactive lifestyle
- smoking
- alcohol intake of greater than 2 drinks a day
Diagnosis is obtained after a thorough medical history on predisposing factors and lifestyle as well as a Bone Mineral Density Test (BMD) which is also known as a DEXA scan. These X-rays use a small amount of radiation to determine how solid the bones of the spine, hip, or wrist are. All women over the age of 65 should have a bone density test; earlier with certain risk factors. Men over age 70 or younger men with risk factors should also consider getting a bone density test.
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Management and Treatment
Diet and Supplements
- Your recommended daily calcium intake should be between 1000 mg and 1200 mg and be obtained through diet and/or supplements. Besides dairy products, other good sources of calcium are salmon with bones, sardines, kale, brocolli, calcium-fortified juices and breads, and dried figs. It is best to try to get recommended daily calcium through food and drink. Vitamin D is recommended because it enables your body to better absorb calcium. Vitamin D can also be obtained from sunlight exposure as well as drinking fortified milk. Recommended daily intake for adults is at least 600mg.
Medications
- Hormone Therapy such as estrogen for women to treat menopausal symptoms, testosterone for men to increase bone density, or the use of synthetic hormones
- Bisphosphonates are drugs that stop your body from re-absorbing bone tissue. There are several formulations that can be taken daily, weekly, and even yearly. Some of the names you may recognize are Alendronate (Fosamax), Ibandronate (Boniva), Risedronate (Actonel), and Zoledronic Acid (Reclast)
- Biologics can be used when other treatments have failed. One such drug is Denosumab (prolia), which can also be used in some cases with kidney disease.
- Anabolic Agents build bone in people with osteoporosis. Some of their names are: Evenity, Forteo, and Tymlos.
Activity and Exercise
By maintaining a healthy lifestyle, you can reduce the degree of bone loss. Using your muscles can actually help protect your bones. Regular physical activity can increase your muscle strength, improve your balance, decrease your risk of bone fracture, and maintain or improve your posture. Best types of exercises include:
- strength training exercises, especially those of the upper back – use free weights, resistance bands, or your own body weight.
- weight-bearing aerobic activities such as walking, dancing, aerobics, elliptical training exercises, stair climbing, and gardening
- flexibility exercises such as stretching and moving your joint through full range of motion
- stability and balance exercises such as standing on one leg and tai chi which can help improve your strength and prevent falls.
We should all continue with lifestyle measures such as eating well, getting enough exercise, avoiding excess alcohol, and not smoking so that we can be healthy and safe from falls and fractures. Work with your healthcare provider for the best management program for you.
