Osteoporosis, which means "porous bone," is a disease in which the bones gradually become weak and brittle. The condition often results in broken bones, or fractures, especially of the hip, wrist, and spine, even from simple activities like lifting a chair or bending over. According to the National Institutes of Health (NIH), about 34 million Americans have osteoporosis. Another 18 million have low bone mass and are at an increased risk for the disease. Osteoporosis is common among the elderly, but the disease can strike at any age. Although it is more common in older women, men can also develop osteoporosis. One of every 2 women and 1 in every 4 men older than 50 years of age will have an osteoporosis-related fracture in their lifetime.
Osteoporosis is a potentially crippling disease. Fortunately, most Americans can avoid osteoporosis altogether by eating a well-balanced diet, exercising regularly, and living a healthy lifestyle. Such lifestyle strategies are important for young people, too, because you accumulate about 85 to 90% of your bone mass by age 18 or 20. In fact, some experts call osteoporosis a pediatric disorder with consequences for the elderly.
Osteoporosis is sometimes considered a "silent disease" because bone loss occurs without symptoms. In fact, many people do not know they have the disease until they break a bone. Osteoporosis can also cause a vertebra (one of the 33 bony segments that form the spine) to collapse. Signs of a collapsed vertebra include:
Your bone strength and density is partly due to how much calcium and other minerals they contain. Your body is constantly making new bone and breaking down (reabsorbing) old bone. When you are young, this process happens quickly. You make more bone than you lose, so you build bone mass. After your mid 30s, your body continues to make new bone, but more slowly, causing you to lose more bone than you make. The amount of bone you have in your 30s helps determine your risk of developing osteoporosis later. For women, bone loss increases significantly at menopause, when estrogen levels drop. Although there are multiple causes of bone loss, genetic factors are responsible for 60 to 80% of peak bone mass.
Other than age and menopause, causes of osteoporosis can include:
Risk factors may include:
Osteoporosis can be prevented. Because your body builds bone mass until you are in your 30s, prevention should start early. Making sure you get enough calcium and vitamin D (required for your body to use calcium) is essential.
Weight bearing exercise, such as walking or lifting weights, as well as other exercises, including tai chi, can also help stave off the disease. Research shows that exercise early in life boosts bone mass, while exercise later in life helps maintain it. Exercise also increases strength, coordination, and balance. Experts recommend 1/2 hour of weight-bearing exercise daily. These are important tools to help prevent falls that cause fractures, especially in the elderly.
Other techniques for prevention include:
If your doctor believes you are at risk for osteoporosis, they will order a bone mineral density test (BMD) to determine your bone mass. Several tests can measure bone density, and they are all painless, noninvasive, and safe. Some tests measure bone density in the spine, wrist, and hip (the most common sites of fractures due to osteoporosis), while others measure bone in the heel or hand.
The National Osteoporosis Foundation recommends a BMD for women who are not taking estrogen and:
For those who are at risk for osteoporosis or already have the disease, treatment may help boost bone mass and prevent (further) bone loss. While calcium by itself does not cure or prevent osteoporosis, getting enough calcium is an essential part of any prevention or treatment program. Making lifestyle choices, such as eating a diet rich in fruits and vegetables and doing weight-bearing exercises can also enhance bone strength.
Studies suggest that diets rich in the following foods and nutrients may help prevent bone loss in both men and women:
Exercise can help prevent bone loss. Although it is best to begin exercising when you are young (to help build bone), it is never too late to get the benefit. Weight-bearing exercise (walking, weight lifting) stimulates bones to produce more cells, slowing bone loss. Exercise also improves balance, flexibility, strength, and coordination, thereby reducing falls and broken bones associated with osteoporosis.
The standard treatment for osteoporosis for postmenopausal women used to be estrogen, but there are new options for men and for women who are wary of estrogen's risks. Most medications slow down the rate at which bone is reabsorbed (antiresorptive). One drug can help the body make new bone (bone forming).
A procedure called kyphoplasty can treat kyphosis, the humplike deformity sometimes caused by osteoporosis. A catheter inserts a balloon into the middle of a collapsed vertebra and then expands so the height of the vertebra is restored. The surgeon then injects bone cement into the vertebra to hold its shape. Vertebroplasty is another procedure in which cement is injected into the vertebra to reinforce it.
Eating fruits and vegetables and consuming adequate amounts of calcium and vitamin D are crucial in the prevention and treatment of osteoporosis. Keeping bones healthy throughout life depends on getting enough of specific vitamins and minerals, including phosphorous, magnesium, boron, manganese, copper, zinc, folate, and vitamins B12, B6, C, and K. Avoiding sodium, alcohol, and caffeine will also enhance bone health.
Calcium: Calcium helps the body build bone. Recommended intakes of calcium are as follows (note that you generally get from 500 to 700 mg of calcium in your diet):
The recommended intake for older women is 1,500 mg/day, except for those on estrogen, who need only 1,000 mg/day.
Good dietary sources of calcium include:
If you do not get enough calcium from food alone, you may want to take a calcium supplement. There are several varieties available. Ask your doctor which one is right for you:
Calcium supplements should be taken in divided doses during the day, because your body can only absorb 500 mg of calcium at a time. Work with your doctor to make sure you get enough, but not too much, calcium, especially if you are taking any medications.
Vitamin D: In order to absorb enough calcium, your body also needs vitamin D. The National Osteoporosis Foundation recommends the following:
Vitamin K (150 to 500 mcg): Vitamin K, which the body makes in the intestine, helps bind calcium into bone. A recent study suggests that at menopause, vitamin K may start to lose its ability to bind calcium, so even women with normal levels of vitamin K may not have enough to maintain bone health. Eating 3 servings of low-fat dairy or dark, leafy greens per day can help. Talk to your doctor about whether you need a supplement. However, be especially careful about taking a supplement if you also take blood-thinning medications (diuretics), such as warfarin (Coumadin), aspirin, and others, because vitamin K may interact with these medications.
Soy isoflavones: Isoflavones are phytoestrogens, plant chemicals that have some of the same effects as estrogen. Because estrogen helps protect against osteoporosis, researchers theorize that isoflavones may also help stop bone loss. Studies are conflicting, however. The best source of soy isoflavones is through diet (tofu, soy milk, and soybeans). When isoflavones are eaten in foods, they do not appear to have the same negative effects that supplemental estrogen does. If you have a history of hormone-related cancer, talk to your doctor before taking soy. Soy contains phytic acid, which may block the aborption of calcium and other critical minerals.
Ipriflavone (600 mg per day): Ipriflavone, a synthetic isoflavone derived from natural isoflavones found in soy, red clover, and other food sources, may also help prevent and treat osteoporosis. Most studies, though not all, indicate that ipriflavone, when combined with calcium, can slow bone loss and help prevent fractures of the vertebrae (spine) in postmenopausal women. Talk to your doctor before taking ipriflavone.
Omega-3 fatty acids, such as those found in fish oil (4 g per day): A few studies have shown that supplements containing essential fatty acids, such as those found in fish oil, can help maintain or possibly increase bone mass. Essential fatty acids appear to increase the amount of calcium your body absorbs, diminish the amount of calcium lost in urine, improve bone strength, and enhance bone growth. Foods rich in essential fatty acids (including cold-water fish, such as salmon) can help raise the amount of essential fatty acids in your diet. People who are taking blood-thinning medication (anticoagulants) should not take fish oil supplements without talking to their doctor first.
Preliminary studies also suggest that the following nutrients may help prevent or treat osteoporosis:
(See the "Warnings and Precautions" section for a list of supplements that people with osteoporosis should avoid.)
Although most herbs have not been studied extensively for the treatment of osteoporosis, some have estrogen-like effects that might offer protection against bone loss. However, they may also carry some of the same risks as supplemental estrogen. They may also interact with blood-thinning medications, such as warfarin (Coumadin) and others. Talk to your doctor before taking any of these herbs.
Other herbs that may help prevent or treat osteoporosis (evidence is lacking so far) include:
Some studies suggest that too much vitamin A may increase the risk for osteoporosis. People with osteoporosis, or those at risk for the disease, should not exceed the daily recommended intake of vitamin A (900 mcg/day for men and 700 mcg/day for women).
Certain medications may contribute to the development of osteoporosis when used for long periods of time:
Talk to your doctor if you take any of these medications.
Bone fractures are the most common complications of osteoporosis and are a significant cause of disability and death. After age 60, 25% of women have a spinal fracture. That percentage doubles after age 75. By age 90, 33% of women and 17% of men have had a hip fracture, usually from a minor fall or accident. Many elderly people who suffer a hip fracture lose the ability to walk and, most significantly, up to 36% die within one year.
Although about 2 million bone fractures in the U.S. each year result from osteoporosis, most are preventable. Several medications are currently being researched that may expand the treatment options available to people with osteoporosis. In the meantime, a combination of medications, diet, exercise, and calcium and vitamin D supplements can help slow the progression of the disease.
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