What is Osteoporosis
Osteoporosis is a bone disease that most commonly occurs in the hips and spine. It leads to loss of bone strength and increases your risk of fractures. Many people don’t even realize that they have osteoporosis until they suffer a fracture.
Diagnosis of Osteoporosis
As mentioned above, many people don’t even realize that they have osteoporosis until they have a fracture. The most common locations for fragility fractures are the wrist, spine and hip.
If you or your physician suspect that you have osteoporosis, you may need a bone mineral density test (BMD). This is a special x-ray that measures the density of your bone. The lower your bone density, the higher your chances of suffering a fracture.
It’s recommended that all women over the age of 65have a bone mineral density test, and so should all adults between the ages of 50 and 65 with other risk factors for osteoporosis.
If you are at risk of developing osteoporosis, your doctor will take a complete medical history, perform a physical examination and recommend blood tests and x-rays.
Your physician may order blood tests to identify secondary causes of osteoporosis, including:
- Serum calcium and phosphate levels
- Parathyroid hormone levels to look for hypoparathyroidism
- Creatinine test to determine renal function
- Liver enzymes
- Testosterone levels (men)
- Thyroid-stimulating hormone
The tests your physician orders will depend on your age, sex, medical history and symptoms of the disease.
Treatment for Osteoporosis
If your physician diagnoses you with osteoporosis, it’s important to ensure you’re getting enough calcium and vitamin D. The recommended intake is:
- 1,000 to 1,200 mg of elemental calcium per day, especially for post-menopausal women
- 1,000-2,000 IU of vitamin D per day
You may require supplements to ensure you’re getting enough calcium and vitamin D each day.
Medication can play an important role in managing osteoporosis. Before prescribing medication, your doctor will use the FRAX assessment tool to predict your risk of fracture over the next 10 years, and will assign you one of three risk categories: mild, moderate and severe.
Weight-bearing exercise is really important for people who have osteoporosis. By following a healthy exercise program, you can increase bone density, improve muscle strength and improve balance to reduce the risk of falls. Work with your physician or physiotherapist to determine which exercise program is best for you.
Mild Fracture Risk (<10% chance of fracture in 10 years)
If your physician determines that your risk of fracture is low, you won’t require medications. However, lifestyle changes such as quitting smoking and getting enough exercise are key in reducing bone loss and improving balance.
Moderate Fracture Risk (10-20% chance of fracture in 10 years)
In this risk group, quitting smoking and increasing exercise is also essential. Your physician may prescribe prescription medication, so discuss options with your doctor.
Severe Fracture Risk (>20% chance of fracture in 10 years)
While quitting smoking and increasing exercise are integral components in this risk category, you will probably require medication. There are several medications availabe for the treatment of osteoporosis, including:
- Oral bisphosphonates such as alendronate (Fosamax, Fosavance) or risedronate (Actonel) to prevent further thinning of the bones. There is also an intravenous infusion available once per year: a bisphosphonate called zoledronic acid (Aclasta).
- A biologic called denosumab (Prolia) that prevents loss of bone, given twice per year by injection under.
- Hormone therapy. When women are going through menopause, the body produces less estrogen and progesterone, leading to bone loss. For women with menopausal symptoms and osteoporosis, hormone therapy (estrogen/progesterone) may be a good option.
Fractures of the vertebrae (spine) are most common in people who have osteoporosis. People who have a vertebral fracture may experience back pain but no other symptoms.
Other symptoms include loss of height, which results in a hump-back appearance.
Causes of Osteoporosis
There is no one cause of osteoporosis. Your risk for developing osteoporosis starts with how much bone mass your body makes early in life. After age 30, most people’s bodies begin to make less bone tissue. Other factors can influence how quickly you lose bone mass, including low physical activity, smoking, high alcohol intake and vitamin D deficiency.
Other high-risk groups include people with chronic diseases such as rheumatoid arthritis or lupus and patients with cancer, celiac disease or anorexia.
One of the reasons that women suffer from osteoporosis more often is that they experience more bone loss after menopause because of declining estrogen.