Definition

Osteoporosis is a disease marked by decreasing bone mass and density, making bones weak and brittle. If left unchecked, it can lead to fracture. Any bone can be affected. Fractures of special concern are of the hip, spine, and wrist.

Causes

Osteoporosis is caused by an imbalance between bone loss and bone formation (known as bone remodeling). After age 30, bone loss occurs more quickly. Many factors over the course of a lifetime can influence bone remodeling.

Risk Factors

Osteoporosis is more common in older adults. It is more common in women than in men. People of Caucasian, Asian, or Hispanic ethnicity are more likely to get osteoporosis.

Osteoporosis is more likely to occur if full bone mass was not achieved during your bone-building years. Other factors that may increase your chance of osteoporosis include:

• Low weight
• Smoking
• Alcohol abuse
• History of falls
• Family history of osteoporosis
• Postmenopausal status
• Certain health conditions, such as:
  • Rheumatoid arthritis
  • No menstrual periods— amenorrhea
  • Hyperthyroidism
  • Type 2 diabetes
  • Asthma
  • Liver disease
  • Eating disorder
  • Depression
  • Crohn’s disease
  • Female athlete triad
• Certain medications, such as antidepressants, corticosteroids, anticonvulsants, or long-term use of heparin or proton-pump inhibitors
• Low hormone levels (low estrogen levels in women, low testosterone levels in men)
• Inactive lifestyle
• Certain restrictive diets that may result in a deficit of calcium or vitamin D
• Too little sunlight—the effect of sun on the skin is a primary source of vitamin D
• Certain cancers, including lymphoma and multiple myeloma

Symptoms

In most cases, people with osteoporosis remain symptom-free until there is a fracture. In those who do have symptoms, osteoporosis may cause:

• Severe back pain
• Loss of height with stooped posture— kyphosis
• Shortness of breath
• Constipation
• Abdominal pain
• Loss of appetite or feeling full soon after eating

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Tests may include:

• Blood tests
• Urine tests

Osteoporosis can be seen with bone mineral density (BMD) tests of the hip, spine, wrist, or other site. These may include:

• Central (preferred) or peripheral dual-energy x-ray absorptiometry (DXA)
• Quantitative ultrasound (QUS)
• Central or peripheral quantitative CT scan (QCT)

Treatment

The treatment and management of osteoporosis involves lifestyle changes and medications. Although osteoporosis is highly preventable, it cannot be cured. Treatment focuses on reducing the incidence of fractures and slowing bone loss.

Prevention

Building strong bones throughout your early years is the best defense against osteoporosis. Getting enough calcium, vitamin D, and regular exercise can keep bones strong throughout life.

To help reduce your chance of osteoporosis:

• Eat a balanced diet rich in calcium and vitamin D.
• Perform weight-bearing exercises.
• Live a healthy lifestyle—avoid smoking and drink alcohol only in moderation (2 drinks per day for men, 1 drink per day for women).
• If you are a postmenopausal woman at high risk for bone fractures, medications may be appropriate to prevent osteoporosis.

National Osteoporosis Foundation http://www.nof.org

Women’s Health Matters http://www.womenshealthmatters.ca

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Accessed June 4, 2015.

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10/6/2006 DynaMed’s Systematic Literature Surveillance
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5/16/2008 DynaMed’s Systematic Literature Surveillance
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Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148:680-684.

1/30/2009 DynaMed’s Systematic Literature Surveillance
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Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ. 2009;180:32-39. Epub 2008 Dec 10.

12/29/2009 DynaMed’s Systematic Literature Surveillance
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Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ. 2009;339:b4229.

6/4/2010 DynaMed’s Systematic Literature Surveillance
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FDA approves new injectable osteoporosis treatment for postmenopausal women. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm214150.htm. Published June 1, 2010. Accessed June 4, 2015.