Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected.
Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older. In the U.S. today, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. And 80 percent of them don't even know it!
Of the 10 million Americans estimated to have osteoporosis, eight million are women and 2 million are men. Thirty-four million Americans have low bone mass, which puts them at increased risk of developing osteoporosis and related fractures.
Although we said that any bone can be affected, of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis are called "risk factors." These risk factors include:
- Personal history of fracture after age 50
- Current low bone mass
- Having family history of osteoporosis
- Being female
- Advanced age
- Being physically inactive
- Estrogen deficiency as a result of menopause, especially early or surgically induced
- Abnormal absence of menstrual periods (amenorrhea)
- Taking cortico-steroids, thyroid medications, anticonvulsants, anticoagulants, Dilantin, diuretics, antacids with aluminum, and drugs that alter digestion, such as Ranitidine
- Low lifetime calcium intake
- Anorexia nervosa
- Vitamin D deficiency
- Low testosterone levels in men
- Excessive use of alcohol
- Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well
- Chronic diseases of the kidney, lung, stomach, and intestines
- Lactose intolerance, low stomach acid
Specialized tests called bone density tests can measure bone density in various sites of the body. A bone density test can:
- Detect osteoporosis before a fracture occurs
- Predict your chances of fracturing in the future
- DEXA BMD (bone mineral density test) can determine your rate of bone loss and/or monitor the effects of treatment
By about age 20, the average woman has acquired 98 percent of her skeletal mass. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. There are four steps, which together, can optimize bone health and help prevent osteoporosis. They are:
- A balanced diet rich in calcium and vitamin D
- Eat plenty of fresh vegetables and fruits
- Enjoy nuts and seeds
- Experiment with broccoli, kale, collard greens, cabbage, and turnip greens
- Try tofu, salmon, sardines, grains and low fat dairy products, such as milk and yogurt (a glass of low fat milk and a cup of yogurt adds 600 mg of calcium to the diet a day)
- Watch your animal protein intake
- Weight-bearing activity for 20 minutes three times a week is helpful
- Try walking, jogging, playing racquet sports, lifting weights, or doing aerobics
- A healthy lifestyle with no smoking or excessive alcohol intake
Although there is no cure for osteoporosis, the following medications are approved by the FDA for postmenopausal women to prevent and/or treat osteoporosis:
- Alendronate (brand name Fosamax®)
- Risedronate (brand name Actonel®)
- brand name Miacalcin®
- Estrogens (brand names, such as Climara®, Estrace®, Estraderm®, Estratab®, Ogen®, Ortho-Est®, Premarin®, Vivelle®, and others)
- Estrogens and Progestins (brand names, such as Activella™, FemHrt®, Premphase®, Prempro®, and others)
- Teriparatide (PTH (1-34) (brand name Fortéo®)
Selective Estrogen Receptor Modulators (SERMS)
- Raloxifene (brand name Evista®)
Alendronate is approved as a treatment for osteoporosis in men and is approved for treatment of glucocorticoid (steroid)-induced osteoporosis in men and women. Risedronate is approved for prevention and treatment of glucocorticoid-induced osteoporosis in men and women.
Treatments under investigation include sodium fluoride, vitamin D metabolites, and other bisphosphonates and selective estrogen receptor modulators.