Definition: Defining the Meaning of Osteoporosis
Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density which can lead to an increased risk of fracture as bones become weak and brittle. Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry; the term "established osteoporosis" includes the presence of a fragility fracture. The disease may be classified as primary type 1, primary type 2, or secondary.
Osteoporosis is a disease marked by loss of bone tissue and low bone mass. Osteoporosis can lead to bone weakness and fragile bones. Persons who have osteoporosis have a greater risk for fractures - most notably in the wrist, hip and spine. Osteoporosis was once thought to be something experienced by older women; however, damage from the condition starts earlier in life. Peak bone density is achieved around the age of twenty-five, so it is important to build strong bones by this age, ensuring that they will stay strong later in life. The intake of calcium in adequate amounts is an important part of building strong bones.
- Approximately ten million people in America have osteoporosis.
- Around eighteen million others have low bone mass, which places them at greater risk for development of the condition.
- Approximately eighty-percent of persons affected by osteoporosis are women.
- In persons who are age fifty and older, half of all women and one in every eight men are predicted to experience an osteoporosis related fracture during their life.
The World Health Organization states that the prevalence of osteoporosis among American white women who are past menopause is estimated to be fourteen-percent in women between the ages of fifty and fifty-nine years. Twenty-two percent of these women who are between the ages of sixty and sixty-nine years of age experience osteoporosis, thirty-nine percent of these women between the ages of seventy and seventy-nine years of age do, and seventy-percent of these women older than eighty years of age experience osteoporosis. There is a significant risk reported for persons of all ethnic backgrounds, although persons from white and Asian racial groups are at greater risk of osteoporosis.
Causes of Osteoporosis
Osteoporosis occurs when an imbalance takes place between new bone formation and old bone resorption. The person's body could fail to form new bone, too much old bone can be reabsorbed, or both things may happen. There are two essential minerals needed for bone formation; phosphate and calcium. While a person is younger, their body uses these minerals in order to produce bones. If their calcium intake is insufficient, or their body fails to absorb sufficient amounts of calcium, their level of bone production and bone tissue can suffer. Calcium is also essential for the proper function of other parts of the body, such as the brain, heart and additional organs. In order to keep these critical organs functioning, the person's body can reabsorb calcium from their bones for their use, potentially making their bones weaker, resulting in fragile and brittle bones which can break easily.
The process of bone loss usually happens over many years. Many times an individual will experience a fracture prior to becoming aware that osteoporosis is present. Unfortunately, by this point the disease could be in an advanced state and the damage can be serious. The main cause of osteoporosis is a lack of specific hormones; in particular, estrogen in women and androgen in men. Women, notably those older than sixty years of age, are often diagnosed with osteoporosis. Menopause presents lower estrogen levels and an increased risk in women for osteoporosis. Additional factors which may contribute to bone loss in this age group can include a lack of weight-bearing exercise, an inadequate intake of vitamin D and calcium, as well as other age-related changes in their endocrine functions.
There are some conditions which may lead to osteoporosis. Conditions such as Cushing Syndrome, Bone Cancer, Thyroid issues, some specific genetic disorders, lack of muscle use, low calcium in the person's diet, and the use of specific medications may lead to osteoporosis. Women are at greater risk of osteoporosis than men, particularly women who have a small frame or are thin, or of advanced age. Women who are Asian or white, particularly women who have a family member with osteoporosis, have a greater risk of developing the disease than other women.
Women who are past menopause, to include women who have experienced either early, or surgically-induced menopause, or either absence of or abnormal menstrual periods are at greater risk of osteoporosis. Eating disorders such as Bulimia, Anorexia Nervosa; or low amounts of calcium in a person's diet can increase the risk for osteoporosis. An inactive lifestyle, heavy alcohol consumption, the use of specific medications such as anticonvulsants or corticosteroids, and cigarette smoking, all increase the risk of the disease.
Symptoms of Osteoporosis
While a person is in the early part of the disease they may not experience any symptoms. Later on in the course of the disease, they may experience dull pain in their muscles or bones, notably in their lower back or neck. As time continues, sharp pains may occur suddenly; the pain may not radiate, and can worsen through activities which put weight on the area as well as being tender. The pain usually subsides within a week, although it may linger for more than three months.
Persons with osteoporosis might not remember a fall or additional trauma they have experienced which has caused a broken bone. Spinal compression fractures can result in a loss of height accompanied by a stooped posture referred to as a, 'Dowager's Hump.' Other common places persons with osteoporosis experience fractures include the hips or wrists, commonly from a fall.
If you are past menopause and are experiencing consistent pain in your neck or lower back you should consult a doctor for further evaluation. If you are at risk for osteoporosis, you should consult a doctor for both medical assessment and bone density screening. You should go to a hospital if you are experiencing severe pain in your bones or muscles which limits your ability to function. You should go to a hospital emergency room if you have sustained trauma or a fracture of your hip, spine or wrist.
A diagnosis of osteoporosis commonly starts with an examination of the person's history in order to determine if they have the disease, or if they are at risk for it. A doctor will ask the person a number of questions regarding their lifestyle and any additional conditions they may experience. The doctor will also ask of there is a family history of the disease, or if the person has a history of broken bones.
The doctor will perform a physical examination, and could perform a test referred to as a, 'Bone Mineral Density Test,' which can measure bone density in a number of sites in the person's body. The test is able to detect osteoporosis prior to the occurrence of a fracture, as well as detecting fractures before they happen. The Bone Mineral Density Test is also something that can be used to monitor the effects of treatment, if the test is done annually or so, and could assist in determining the rate of bone loss the person is experiencing.
Results of the Bone Mineral Density Test are compared to two standards known as, 'Age-Matched,' and, 'Young-Normal.' The Age-Matched reading compares a person's bone mineral density to the expected standard for someone of the person's gender, age and size. The Young-Normal reading compares the person's density to the optimal peak bone density of a healthy young adult of the same gender. Information from the Bone Mineral Density Test helps the person's doctor to identify where they are in relation to others in their age group, as well as in relation to young adults who are considered to have a maximum bone density. A score that is notably lower than Young-Normal indicates that the person has osteoporosis and is at risk for bone fractures.
There are a number of different machines that are able to measure bone density; all of them are noninvasive, safe and painless. These machines are becoming more available in testing centers, and you may not even have to change into an examination robe. Central machines can measure bone density in a person's spine, hips, and total body. Peripheral machines have the ability to measure bone density in a person's wrists, fingers, shins, kneecaps, and heels.
The Dual Energy X-ray Absorptiometry can measure bone density in a person's hips, spine, or total body. With their clothes on, the person merely lies on their back with their legs on a large block; the X-ray moves rapidly over their hips and lower spine. The Single Energy X-ray Absorptiomety is done with a smaller X-ray machine which measures bone density in a person's shins, heels, and kneecaps. Some of these machines use ultrasound waves through water in order to measure the bone density in a person's heels. The person places their bare foot in a water bath, fitted into a footrest as sound waves pass through their ankle. The presence of bone loss in a person's heel may indicate bone loss elsewhere in their body.
Treatment of Osteoporosis
Treatment of osteoporosis involves a focus on slowing down or ceasing mineral loss while increasing bone density, as well as the prevention of fractures and control of pain. Around forty-percent of women will experience a fracture related to osteoporosis during their lifetime. Among persons who experience a fracture of the spine, one in five will experience another one within a year. Osteoporosis potentially leads to additional fractures, something referred to as a, 'Fracture Cascade.' One of the goals of treatment is to prevent fractures.
Young adults are encouraged to achieved their peak bone mass through getting enough calcium, about 1000 milligrams each day, in their diet through drinking milk or calcium-fortified orange juice, and eating foods that are high in calcium. Young adults should perform weight-bearing exercises like aerobics or walking, as well as maintaining a normal body weight.
Persons who have hip, spinal or wrist fractures should see an Orthopedic Surgeon for management. Additionally, they should be referred to a Physical and Occupational Therapist in order to learn safe exercise methods. Persons with spinal fractures, for example, would avoid things such as doing sit-ups, lifting heavy objects, or touching their toes. Lifestyle modifications should be incorporated into the person's treatment plan.
Studies have shown that exercises which require muscles to pull on bones cause the person's bones to retain and maybe even gain density. Researchers have found that women who walk a mile each day have four to seven additional years of bone reserve than women who do not. Recommended exercises include riding a stationary bicycle, walking, jogging, weight-bearing exercises, and using a rowing machine. Prior to starting an exercise program be sure to review the program with a doctor.
Prevention of Osteoporosis
The best defense against osteoporosis may be development of strong bones during childhood and adolescence. The average woman has already acquired ninety-eight percent of her skeletal mass by the time she is thirty years of age.
Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. The average woman has acquired 98% of her skeletal mass by age 30 years. Four steps which may prevent osteoporosis, although one step alone is not enough, include:
1.) A balanced diet that is rich in calcium and vitamin D
2.) Pursuit of weight-bearing exercise
3.) Living a healthy lifestyle, avoiding excessive alcohol intake and smoking
4.) Taking medication in order to improve bone density when it is appropriate
The progression of osteoporosis can be slowed, stopped or reversed with adequate treatment. Despite this, some people experience severe disability due to weakened bones. Hip fractures are common in persons with osteoporosis, leaving approximately half of persons who break a hip without the ability to walk independently. Fifteen-percent of women and five-percent of men have experienced a hip fracture by the age of eighty.
Quick Facts: Osteoporosis
Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are past menopause, are at highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.
Osteoporosis itself has no symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.
People with rheumatologic disorders such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and polyarticular juvenile idiopathic arthritis are at increased risk of osteoporosis, either as part of their disease or because of other risk factors (notably corticosteroid therapy). Systemic diseases such as amyloidosis and sarcoidosis can also lead to osteoporosis.
Statistics: U.S. Osteoporosis
- Percent of men 50 years of age and over with osteoporosis of the hip: 2%
- Percent of women 50 years of age and over with osteoporosis of the hip: 10%
- Number of men 50 years of age and over with osteoporosis of the hip: 0.8 million
- Number of women 50 years of age and over with osteoporosis of the hip: 4.5 million