What is Osteoporosis, and What Causes It?

Osteoporosis

Osteoporosis is a condition that causes bones to become weak and brittle over time. From the outside, osteoporotic bone appears like normal bone. However, the interior becomes increasingly more porous during aging, leading first to low bone density due to the loss of calcium and phosphate. In people with osteoporosis, the bones weaken as they become more porous, leading to a greater risk of fractures in the hips, spine, and peripheral joints, like the wrist.

It is the world's most common bone condition. The International Osteoporosis Foundation (IOF) estimates that more than 44 million people in the United States have osteoporosis.

What Causes Osteoporosis?

Bone is living tissue that constantly breaks down and regenerates. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone, leading to low bone mass. Bone density peaks in your late 20s and starts to weaken at around age 35 when the body begins to absorb the minerals inside the bone. Osteoporosis may develop when bone mass breaks down excessively.

Both men and women can have poor bone density, but postmenopausal women have the most significant risk of osteoporosis because of the sudden decrease in estrogen, which protects against excessive bone loss.

The IOF indicates that once people reach age 50, one in three women and one in five men will experience fractures due to osteoporosis, with spine fractures being the most common.

Common Osteoporosis Symptoms

Osteoporosis is a silent disease, as many people have no symptoms until they suffer from broken bones. Loss of height of more than an inch is another strong indicator. Look for these other symptoms:

• Back pain caused by a spine fracture or collapsed vertebrae
• Stooped or hunched posture
• Breaking a bone more easily than expected

What are the Risk Factors for Osteoporosis?

Osteoporosis has several avoidable and unavoidable risk factors that increase the risk of developing porous bone. Genetic factors, such as having a family history of hip fractures, increase the risk of weakened bones.

Other unavoidable risk factors for osteoporosis, according to the American College of Rheumatology, include:

• Age - Increases significantly after age 50
• Hormones - Less estrogen makes it more difficult for the bone to regenerate
• Gender - Women are four times more likely to experience rapid bone loss
• Ethnicity - White and Asian people have higher risk factors than other ethnic groups
• Body frame - Those who have small body frames, are over 5 feet 7 inches tall or weigh less than 125 pounds may have less bone mass to draw from as they age
• Personal history of fractures - People over age 50 with previous fractures after low-level injuries have a higher risk factor

Other hormonal problems can also increase the risk of developing osteoporosis. Too much thyroid hormone can cause bone loss. An overactive thyroid or too much thyroid hormone medication can affect bone tissue. Overactive parathyroid and adrenal glands can also put you at risk for osteoporosis.

Dietary Factors

A diet lacking essential nutrients can put you at an increased risk, so it's vital that you have a well-balanced, healthy diet to keep bones strong. A lifelong lack of calcium and vitamin intake can play a role. Not getting enough calcium contributes to poor bone mineral density, early bone loss and an increased risk of fractures. Eating disorders where one is severely underweight and restrict food intake also weakens healthy bone. Surgery to reduce your stomach size and remove part of the intestine can limit nutrients that affect bone health.

Other considerations include:

• Poor vitamin D intake
• Not consuming enough fruits and vegetables containing magnesium, potassium, and vitamins C and K.
• Lack of protein
• Consuming too much sodium or caffeine

Lifestyle Factors

Consuming too much alcohol straddles the line between dietary and lifestyle factors that increase the risk of developing osteoporosis, as alcohol affects the absorption of vitamin D and other nutrients. Cigarette smoking also inhibits nutrient absorption. However, having an inactive lifestyle may play an even more significant role as exercise induces controlled stress, helping to promote bone formation.

Diseases and Conditions That May Cause Bone Loss

Long-term use of corticosteroid medications, like prednisone and cortisone, interferes with the bone-rebuilding process. Other medicines used to prevent or control the following diseases or conditions also may make you develop osteoporosis:

• Cancer
• Transplant rejection
• Gastric reflux
• Seizures

The incidence of osteoporosis is more common in people with these medical conditions:

• Inflammatory bowel disease
• Kidney or liver disease
• Celiac disease
• Rheumatoid arthritis
• Multiple myeloma

How Do You Diagnose Osteoporosis?

The most definitive way to diagnose osteoporosis is through a bone density test called a DEXA scan that uses low levels of X-rays to determine the proportion of minerals in your bones.  DEXA scan results compare your bone mineral density with those of young adults with peak bone mass and people of your same age and sex. Patients lie on a padded table while the scanner passes over the body during this painless test. You may need to repeat these scans every two to five years to determine how well treatments are working and whether you have lost more bone. Simple X-rays can show a bone or hip fracture but are not accurate in predicting whether you have osteoporosis.

We may order other tests to rule out other medical conditions.

What are the Options for Treatment?

Treatment includes medications, healthy diet, and weight-bearing exercise to help prevent bone loss or strengthen already weak bones. There are several classes of medications used to treat osteoporosis. The “best” treatment is the one that works best for you.

Hormone and Hormone-Related Therapy

This class includes estrogen, testosterone and the selective estrogen receptor modular raloxifene (Evista®), Calcitonin-salmon (Fortical® and Miacalcin®).

Bisphosphonates

These medications stop the body from reabsorbing bone tissue. There are several formulations with various dosing schemes:

• Weekly – Alendronate
• Monthly – Ibandronate
• Yearly – Zoledronic acid

Biologics

Denosumab (Prolia®) is given as an injection every six months to women and men.

Anabolic Agents

These products build bone in people with osteoporosis. Three are currently FDA-approved: Romososumab-aqqg (Evenity), Teriparatide (Forteo), and Abaloparatide (Tymlos).

Preventing Osteoporosis

Although you cannot avoid some factors, you can minimize your risk and keep bones healthy by eating a healthy diet and remaining active. Weight-bearing exercises are essential for older adults because these activities help slow mineral loss by helping to build muscles that support and protect your joints while increasing overall balance.

If you are concerned about your chances of developing osteoporosis, contact us to make an appointment to see Dr. Kaur at VIVAA. We will happily schedule tests to determine your bone mass and help you maintain healthy bones.