Illness & Conditions - Health Conditions
Covers causes and symptoms of osteoporosis in women. Looks at treatment with medicine. Includes steps to slow bone loss with exercise, eating healthy foods, and quitting smoking. Covers protecting yourself from falling to prevent broken bones.
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This topic talks about osteoporosis, including how to help prevent it and also how it is diagnosed and treated. For more information about how osteoporosis affects men see the topic Osteoporosis in Men.
What is osteoporosis?
Osteoporosis is a disease that affects your bones. It means that you have bones that are thin and brittle with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These fractures can be disabling and may make it hard for you to live on your own.
Osteoporosis affects millions of older adults. It usually strikes after age 60. It's most common in women, but men can get it too.
What causes osteoporosis?
It's caused by a lack of bone strength or bone density . As you age, your bones get thinner naturally. But some things can make you more likely to have the severe bone thinning of osteoporosis. These things are called risk factors.
Age, gender, and body type risks
Family history risks
What are the symptoms?
Osteoporosis can be very far along before you notice it. Sometimes the first sign is a broken bone in your hip, spine, or wrist after a bump or fall.
As the disease gets worse, you may have other signs, such as pain in your back. You might notice that you are not as tall as you used to be and that you have a curved backbone .
How is osteoporosis diagnosed?
Your doctor will ask about your symptoms and do a physical exam. You may also have a test that measures your bone thickness (bone density test) and your risk for a fracture.
If the test finds that your bone thickness is less than normal but is not osteoporosis, you may have osteopenia. It's a less severe type of bone thinning.
It's important to find and treat osteoporosis early to prevent bone fractures. Experts advise bone density testing for women age 65 and older. If you have a higher risk for fractures, it's best to start getting the test sooner.
How is it treated?
Treatment for osteoporosis includes medicine to reduce bone loss and to build bone thickness. Medicine can also give you relief from pain caused by fractures or other changes to your bones.
It's important to get enough calcium and vitamin D and take prescribed medicine for the disease. You need calcium and vitamin D to build strong, healthy bones.
You can slow osteoporosis with new, healthy habits. If you smoke, quit. Get plenty of exercise. Walking, jogging, dancing, and lifting weights can make your bones stronger. Eat a healthy mix of foods that include calcium and vitamin D. Try yogurt, cheese, and milk (for calcium). Eat eggs, fatty fish, and fortified cereal (for vitamin D).
Making even small changes in how you eat and exercise, along with taking medicine, can help prevent a broken bone.
When you have osteoporosis, it's important to protect yourself from falling. Reduce your risk of breaking a bone by making your home safer. Make sure there's enough light in your home. Remove throw rugs and clutter that you may trip over. Put sturdy handrails on stairs. Try exercises to increase your strength and balance.
Frequently Asked Questions
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As a natural part of aging, bone tissue breaks down. It is absorbed faster than new bone is made, and bones become thinner . You are more likely to have osteoporosis if you did not reach your ideal bone thickness ( bone density ) during your childhood and teenage years.
In women, bone loss increases around menopause, when ovaries decrease production of estrogen, a hormone that protects against bone loss. So the older you get, the more likely you are to have osteoporosis.
Not getting enough calcium and vitamin D contributes to bone thinning. Also, thin bones may run in families.
In the early stages of osteoporosis, you probably won't have symptoms. As the disease progresses, you may have symptoms related to weakened bones, including:
In a normal, healthy adult, bone is constantly absorbed into the body and then rebuilt. During childhood and the teen years, new bone tissue is added faster than existing bone is absorbed. As a result, your bones become larger and heavier until about age 30 when you reach peak bone mass (density). The more bone mass you developed early in life, the less likely you are to get osteoporosis.
After age 30, people lose a small amount of bone each year.
A person with thinning bones may be diagnosed with lower-than-normal bone mass ( osteopenia ). Osteopenia sometimes progresses to osteoporosis.
When bones thin, they lose strength and break more easily. The bones that break most often due to osteoporosis are:
In women, bone loss increases when the ovaries reduce production of estrogen, a hormone that protects against bone loss.
What Increases Your Risk
The risk of osteoporosis increases with age as bones naturally become thinner. But it usually doesn't affect people until they are 60 or older.
Family and personal history
Other things that increase risk
Other risk factors include:
Find out your fracture risk
The World Health Organization (WHO) has created a tool called FRAX. Your doctors might use the FRAX tool to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool too. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can enter your score. If you haven't had that test, you can leave the score blank.
When To Call a Doctor
Call your doctor right away if you:
Call your doctor for an appointment if you:
If you are nearing age 65, have osteopenia , or think that you are at high risk for osteoporosis, talk with your doctor about your concerns.
If you do not have any risk factors for osteoporosis and you are already taking preventive measures, such as taking adequate calcium and vitamin D, you may only need routine screening.
Who to see
Health professionals who can evaluate your symptoms and risk of osteoporosis include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
A diagnosis of osteoporosis is based on your medical history, a physical exam, and a test to measure your bone thickness (density).
Medical history and physical exam
Your doctor will:
You will have a bone density test. It helps your doctor estimate the strength of your bones.
Routine urine and blood tests can rule out other medical conditions, such as hyperparathyroidism, hyperthyroidism, and Cushing's syndrome. These conditions can cause bone loss.
If you or your doctor thinks that you may be at risk for osteoporosis, you may have a screening test to check your bone thickness. A screening test may be a good idea if you have:
Experts recommend that all women age 65 and older routinely have a bone density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner. 3 The U.S. Preventive Services Task Force (USPSTF) recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.
Using the FRAX tool
The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. The tool is meant for people who are not already being treated with medicine for osteoporosis. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.
Screening in younger women
Most experts recommend that the decision to screen younger women be made on an individual basis. The need for testing will depend on the risk for osteoporosis and whether the test results will help with treatment decisions.
Ultrasound is sometimes offered at events such as health fairs as a quick screening for osteoporosis. Ultrasound by itself is not a reliable test for diagnosing osteoporosis. But if results of an ultrasound screening find low bone density, your doctor can help you decide whether you should have a bone density test.
Treatment for osteoporosis is important to prevent fractures and help you get around and function well. It usually includes lifestyle changes and medicine. It is never too late to build and then keep healthy habits that can slow bone thinning.
Take calcium and vitamin D
Your doctor likely will recommend that you eat foods rich in calcium and vitamin D. These nutrients keep bones healthy and strong.
Your bones need vitamin D to absorb calcium. Getting more vitamin D may help prevent falls in older people who are low in vitamin D. 4 And some studies show that taking vitamin D may reduce the chances of breaking a bone. 5 Talk to your doctor about measuring your vitamin D to be sure you are getting enough.
Get weight-bearing exercise
Get regular weight-bearing exercise, such as walking, jogging, stair climbing, dancing, lifting weights, aerobics, and resistance exercises. These activities keep bones healthy by working the muscles and bones against gravity. To be most effective, weight-bearing exercises should be done for 30 minutes most days of the week. Resistance exercises should be done 2 or 3 days a week.
Limit alcohol, and don't smoke
Along with exercise and diet, your doctor will recommend that you not smoke. And it's best to limit alcohol to no more than 2 drinks a day for men and no more than 1 drink a day for women. For help with quitting smoking, see the topic Quitting Smoking.
In some cases, your doctor will prescribe medicines such as bisphosphonates or hormones to protect against bone loss.
After you have been diagnosed with bone loss, you will need to have regular follow-up tests to monitor the disease.
Treatment for compression fractures
Compression fractures from osteoporosis can cause significant back pain that lasts for several months. Treatments to relieve your pain include over-the-counter medicines such as acetaminophen and nonsteroidal anti-inflammatory drugs as well as stronger prescription medicine.
Your doctor may also suggest a back brace or corset to support your spine.
If you have a fractured bone related to osteoporosis, treatment to slow your bone thinning becomes very important. If you have had a spinal fracture, you are at risk of having another.
You can build strong bones and help prevent osteoporosis with weight-bearing exercise and a diet rich in calcium and vitamin D. Young women in particular need to be aware of their risk for osteoporosis. They can take steps early to slow its progress and prevent complications.
A lot of physical activity during the preteen and teen years increases bone mass and greatly reduces the risk of osteoporosis in adulthood.
Along with diet and exercise, prevention includes not smoking and limiting alcohol. For more information, see Home Treatment.
You can do a lot to slow bone loss and prevent broken bones.
Get enough calcium and vitamin D
Getting enough calcium and vitamin D is one of the first steps toward preventing or reducing the effects of osteoporosis. Vitamin D helps your body absorb calcium. Calcium is found in many foods, including dairy products such as milk and yogurt.
If you think you may not be getting enough calcium in your diet, check with your doctor about taking calcium supplements .
Experts recommend that you choose supplements that are known brand names with proven reliability. Most brand-name calcium products are absorbed easily by the body. The U.S. Food and Drug Administration (FDA) has taken action against companies that praise the benefits of coral calcium as a superior source of calcium and a cure for disease. There is no scientific proof to support these claims.
Weight-bearing exercises (walking, jogging, stair climbing, dancing, or weight lifting), aerobics, and resistance exercises (using weights or elastic bands to help improve muscle strength) are all effective in increasing bone density and strength. These kinds of exercise may also help reduce the risk of falling or of breaking a bone. For more information, see the topic Fitness.
Limit alcohol use
Smoking reduces your bone density and speeds up the rate of bone loss. For information on how to stop, see the topic Quitting Smoking.
Learn ways to prevent falls that might result in broken bones. Have your vision and hearing checked regularly. Wear slippers or shoes that have nonskid soles. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling. You can also make changes in your home to prevent falls.
Medicines are used to both prevent and treat osteoporosis. Some medicines slow the rate of bone loss or increase bone thickness. Even small amounts of new bone growth can reduce your risk of broken bones.
Medicine for treatment and prevention
Hormone therapy is typically not recommended for most women who have osteoporosis. But if you are at high risk and cannot take other medicines, your doctor may recommend it under certain circumstances. If you continue to have bone loss while taking a bisphosphonate, such as alendronate (Fosamax) or risedronate (Actonel), you may need to take both bisphosphonate medicine and hormone therapy.
Hormone therapy for osteoporosis in women includes:
Medicine for pain from fractures
Compression fractures and other broken bones resulting from osteoporosis can cause significant pain that lasts for several months. Medicines to relieve this pain include:
If spinal compression fractures are causing nerve roots to be compressed, your doctor may talk with you about having surgery to stabilize the crushed spinal bones (vertebrae).
If you get a hip fracture because of osteoporosis, you may need surgery to repair your hip. For more information, see the topic Hip Fracture.
Soy products have been tried to help reduce the chance of broken bones due to osteoporosis, but there is not strong evidence that these products help. But soy is a good source of nondairy protein, so many people still choose to include it in their diets. (For example, 1 cup of soy milk contains 7 to 11 grams of soy protein.)
There is not enough evidence to show if other natural products, such as black cohosh, work to reduce bone loss.
Other Places To Get Help
Last Revised: July 30, 2013
Chapman-Novakofski K (2012). Nutrition and bone health. In LK Mahan, S Escott-Stump, eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 531–546. St. Louis: Saunders.
Edwards BJ, et al. (2010). Functional decline after incident wrist fractures—Study of Osteoporotic Fractures: Prospective cohort study. BMJ. Published July 8, 2010 (doi:10.1136/bmj.c3324).
U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
Gillespie LD, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (11).
Bischoff-Ferrari HA, et al. (2009). Prevention of nonvertebral fractures with oral vitamin D and dose dependency. Archives of Internal Medicine, 169(6): 551–561.
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