What is Osteoporosis and Osteopenia?

OsteoOsteoporosis, which literally means porous bone, is a disease in which the density and quality of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs silently and progressively. Osteoporosis leads to abnormally porous bone and occurs when the creation of new bone doesn’t keep up with the removal of old bone. Osteopenia is a condition where bone mineral density (BMD) is below normal levels but not low enough to be classified as osteoporosis.

The National Osteoporosis Foundation (NOF) recommends a bone density test of the hip and spine using a central dual energy x-ray absorptiometry (DEXA) machine to diagnose osteoporosis (see DIAGNOSIS & BONE DENSITY TESTING).  A bone density test tells you if you have normal bone density, low bone density (osteopenia) or osteoporosis. It is the only test that can diagnose osteoporosis.

Bone Basics

Your bones are made of living, growing tissue. An outer shell of cortical or dense bone encases trabecular bone, a sponge-like bone. When a bone is weakened by osteoporosis, the “holes” in the “sponge” grow larger and more numerous, weakening the internal structure of the bone. As your bones become less dense, they also become weaker and more likely to break even from simple actions, like sneezing or bumping into furniture.

Some people think of bones as hard and lifeless, but they are actually living, growing tissue. Your bones are made up of three major components that make them flexible and strong:

Collagen, a protein that gives bones a flexible framework.

Calcium-phosphate mineral complexes that make bones hard and strong.

Living bone cells that remove and replace weakened sections of bone.

When you’re young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Children and teenagers form bone faster than they lose bone. Even after children and teens stop growing taller, they continue to make more bone than they lose. This means their bones continue getting denser until they reach what experts call peak bone mass, the point when you have the greatest amount of bone you will ever have. Peak bone mass usually happens between the ages of 18 and 25. The more bone you have at the time of peak bone mass, the less likely you are to break a bone or get osteoporosis later in life. After your mid-thirties, bone breakdown outpaces bone buildup, resulting in a gradual loss of bone mass.

How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.

Osteoporosis Is Common

About 54 million Americans have osteoporosis and low bone mass, placing them at increased risk for osteoporosis. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to 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 is Serious

Breaking a bone is a serious complication of osteoporosis, especially when you’re older. Broken bones due to osteoporosis are most likely to occur in the hip, spine and wrist, but other bones can break too. Bone fractures particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often result from a fall and can result in disability and even death from postoperative complications, especially in older adults. In some cases, spinal fractures can occur even if you haven’t fallen. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). Broken bones can cause severe pain that may not go away.

Osteoporosis also causes some people to lose height. When osteoporosis causes the bones of the spine, called vertebrae, to break or collapse, it affects your posture and causes you to become stooped or hunched.

Osteoporosis is Costly

Osteoporosis is responsible for two million broken bones and $19 billion in related costs every year. By 2025, experts predict that osteoporosis will be responsible for approximately three million fractures and $25.3 billion in costs each year.

Osteoporosis Is A Silent Disease

Osteoporosis is often called a silent disease because you can’t feel your bones getting weaker. Breaking a bone is often the first sign that you have osteoporosis or you may notice that you are getting shorter or your upper back is curving forward. If you are experiencing height loss or your spine is curving, be sure to talk to your doctor or another healthcare professional right away as you may be experiencing early signs of osteoporosis.

What Women Need to Know

Being female puts you at risk of developing osteoporosis and broken bones. Consider these facts:

  • Of the estimated 10 million Americans with osteoporosis, about eight million or 80% are women. Women tend to have smaller, thinner bones than men.
  • Approximately one in two women over age 50 will break a bone because of osteoporosis.
  • A woman’s risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.
  • In the five to seven years following menopause, a woman can lose up to 20% of her bone density. Estrogen, a hormone in women that protects bones, decreases sharply when women reach menopause, which can cause bone loss.

Symptoms

There typically are no symptoms in the early stages of bone loss. But once bones have been weakened by osteoporosis, you may have signs and symptoms that include:

  • Back pain, caused by a fractured or collapsed vertebra.
  • Loss of height over time.
  • A stooped posture.
  • A bone fracture that occurs much more easily than expected.

Risk Factors

Risk factors for osteoporosis include:

  • Your sex. Women are much more likely to develop osteoporosis than are men.
  • Age. The older you get, the greater your risk of osteoporosis.
  • Race. You’re at greatest risk of osteoporosis if you’re white or of Asian descent.
  • Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father experienced a hip fracture.
  • Body frame size. Men and women who have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age.

Hormone levels

Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

  • Sex hormones. Lowered sex hormone levels tend to weaken bone. The reduction of estrogen levels at menopause is one of the strongest risk factors for developing osteoporosis. Women may also experience a drop in estrogen during certain cancer treatments.
  • Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medication to treat an underactive thyroid.
  • Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.

Dietary factors

Osteoporosis is more likely to occur in people who have:

  • Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.
  • Eating disorders. People who have anorexia are at higher risk of osteoporosis. Low food intake can reduce the number of calories and amount of protein and calcium ingested. In women, anorexia can stop menstruation, leading to weaker bones.
  • Gastrointestinal surgery. A reduction in the size of your stomach or a bypass or removal of part of the intestine limits the amount of surface area available to absorb nutrients, including calcium.

Steroids and other medications

Long-term use of oral or injected corticosteroid medications, such as prednisone and cortisone, interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:

  • Seizures
  • Gastric reflux
  • Cancer
  • Transplant rejection

Lifestyle

Some bad habits can increase your risk of osteoporosis. Examples include:

  • Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful.
  • Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis.
  • Tobacco use. The exact role tobacco plays in osteoporosis isn’t clearly understood, but it has been shown that tobacco use contributes to weak bones.

Good News

People used to think that osteoporosis was an inevitable part of aging. Today we know a lot more about how to prevent, detect, and treat the disease. You are never too young or old to take care of your bones. Good lifestyle habits can help you protect your bones and decrease your chance of getting osteoporosis. And, if your healthcare provider hasn’t talked to you about your bone health, it’s time for you to bring it up!

Prevention and Healthy Living

Osteoporosis and the broken bones it can cause are not part of normal aging. There is a lot you can do to protect your bones throughout your life. You’re never too young or too old to improve the health of your bones. Osteoporosis prevention should begin in childhood. But it shouldn’t stop there. Whatever your age, the habits you adopt now can affect your bone health for the rest of your life. Now is the time to take action.

What can you do to protect your bones?

  • Get enough calcium and Vitamin D and eat a well-balanced diet.
  • Engage in regular exercise.
  • Eat foods that are good for bone health, such as dairy products and dark green, leafy vegetables. Avoid smoking and limit alcohol to 2-3 drinks per day.