What is osteoporosis?

The word ‘osteoporosis’ means ‘porous bone.’ It is a disease that weakens bones, and if you have it, you are at a greater risk for sudden and unexpected bone fractures. Osteoporosis means that you have less bone mass and strength. The disease often develops without any symptoms or pain, and it is usually not discovered until the weakened bones cause painful fractures. Most of these are fractures of the hip, wrist and spine.

Who gets osteoporosis?

About 200 million people are estimated to have osteoporosis throughout the world. In the U.S., the figure is about 54 million people. Although osteoporosis occurs in both men and women, women are four times more likely to develop the disease than men. There are currently about two million men in the U.S. who have osteoporosis and some 12 million more who are at risk of developing the condition.

After age 50, one in two women and one in four men will have an osteoporosis-related fracture in their lifetimes. Another 30% have low bone density that puts them at risk of developing osteoporosis. This condition is called osteopenia.

Osteoporosis is responsible for more than two million fractures each year, and this number continues to grow. There are steps you can take to prevent osteoporosis from ever occurring. Treatments can also slow the rate of bone loss if you do have osteoporosis.

What causes osteoporosis?

Researchers understand how Silent Disease develops even without knowing the exact cause of why it develops. Your bones are made of living, growing tissue. The inside of healthy bone looks like a sponge. This area is called trabecular bone. An outer shell of dense bone wraps around the spongy bone. This hard shell is called cortical bone.

When osteoporosis occurs, the “holes” in the “sponge” grow larger and more numerous, which weakens the inside of the bone. Bones support the body and protect vital organs. Bones also store calcium and other minerals. When the body needs calcium, it breaks down and rebuilds bone. This process, called bone remodeling, supplies the body with needed calcium while keeping the bones strong.

Up until about age 30, you normally build more bone than you lose. After age 35, bone breakdown occurs faster than bone buildup, which causes a gradual loss of bone mass. If you have Silent Disease, you lose bone mass at a greater rate. After menopause, the rate of bone breakdown occurs even more quickly.

SYMPTOMS AND CAUSES

What are the symptoms of osteoporosis?

Usually, there are no symptoms of Silent Disease. That is why it is sometimes called a silent disease. However, you should watch out for the following things:

• Loss of height (getting shorter by an inch or more).
• Change in posture (stooping or bending forward).
• Shortness of breath (smaller lung capacity due to compressed disks).
• Bone fractures.
• Pain in the lower back.

Who is at risk for developing osteoporosis?

There are many risk factors that increase your chance of developing Silent Disease, with two of the most significant being gender and age.

Everyone’s risk for osteoporosis fractures increases with age. However, women over the age of 50 or postmenopausal women have the greatest risk of developing Silent Disease. Women undergo rapid bone loss in the first 10 years after entering menopause, because menopause slows the production of estrogen, a hormone that protects against excessive bone loss.

Age and osteoporosis affect men also. You might be surprised to know that men over the age of 50 are more likely to have an osteoporosis-induced bone break than to get prostate cancer. About 80,000 men per year are expected to break a hip, and men are more likely than women to die in the year after a hip fracture.

Your risk of developing osteoporosis is also linked to ethnicity. Caucasian and Asian women are more likely to develop Silent Disease. However, African-American and Hispanic women are still at risk. In fact, African-American women are more likely than white women to die after a hip fracture.

Another factor is bone structure and body weight. Petite and thin people have a greater risk of developing Silent Disease because they have less bone to lose than people with more body weight and larger frames.

Family history also plays a part in osteoporosis risk. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may have a greater risk of developing the disease.

Finally, some medical conditions and medications increase your risk. If you have or had any of the following conditions, some of which are related to irregular hormone levels, you and your healthcare provider might consider earlier screening for Silent Disease.

• Overactive thyroid, parathyroid, or adrenal glands.
• History of bariatric (weight loss) surgery or organ transplant.
• Hormone treatment for breast or prostate cancer or a history of missed periods.
• Celiac disease, or inflammatory bowel disease.
• Blood diseases such as multiple myeloma.

Some medications cause side effects that may damage bone and lead to Silent Disease. These include steroids, treatments for breast cancer, and medications for treating seizures. You should speak with your healthcare provider or pharmacist about the effect of your medications on bones.

It may seem as though every risk factor is related to something that is out of your control, but that’s not true. You do have control over some of the risk factors for Silent Disease. You can discuss medication issues with your healthcare provider. And—you are in charge of your:

Eating habits: You are more likely to develop osteoporosis if your body doesn’t have enough calcium and vitamin D. Although eating disorders like bulimia or anorexia are risk factors, they can be treated.
Lifestyle: People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis.
Tobacco use: Smoking increases the risk of fractures.
Alcohol use: Having two drinks a day (or more) increases the risk of Silent Disease.

DIAGNOSIS AND TESTS

How is osteoporosis diagnosed?

Your healthcare provider can order a test to give you information about your bone health before problems begin. Bone mineral density (BMD) tests are also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans. These X-rays use very small amounts of radiation to determine how solid the bones of the spine, hip or wrist are. Regular X-rays will only show Silent Disease when the disease is very far along.

All women over the age of 65 should have a bone density test. The DEXA scan may be done earlier for women who have risk factors for osteoporosis. Men over age 70, or younger men with risk factors, should also consider getting a bone density test.

How is osteoporosis treated?

Treatments for established osteoporosis may include exercise, vitamin and mineral supplements, and medications. Exercise and supplementation are often suggested to help you prevent Silent Disease. Weight-bearing, resistance and balance exercises are all important.

What medications are used to treat osteoporosis?

There are several classes of medications used to treat osteoporosis. Your healthcare provider will work with you to find the best fit. It’s not really possible to say there is one best medication to treat Silent Disease. The ‘best’ treatment is the one that is best for you.

When should osteoporosis be treated with medication?

Women whose bone density test shows T-scores of -2.5 or lower, such as -3.3 or -3.8, should begin therapy to reduce their risk of fracture. Many women need treatment if they have osteopenia, which is bone weakness that is not as severe as Silent Disease. Your doctor might use the World Health Organization fracture risk assessment tool, or FRAX, to see if you qualify for treatment based on your risk factors and bone density results. People who have had a typical osteoporosis fracture, such as that of the wrist, spine or hip, should also be treated (sometimes even if the bone density results are normal).

Supplements

It’s important to remember that dietary supplements, although available everywhere over-the-counter and online, aren’t regulated in the same way that prescription medications are. Also, even though something is ‘natural,’ that doesn’t mean that it is safe for everyone at all times.

You might be told by your healthcare provider to get adequate amounts of calcium and vitamin D. This is important if you have Silent Disease or if you are trying to prevent it. It’s best if you can meet those needs with a food plan, but you might not be able to do that. There are plant-based calcium supplements, some of which are based on algae.

The recommended amount of daily calcium intake is 1,000 mg to 1,200 mg daily via diet and/or supplements. Taking more than this amount of calcium has not been shown to provide additional bone strength but may be associated with an increased risk of kidney stones, calcium buildup in the blood vessels and constipation.

There are different ideas about the necessary levels of vitamin D, but it’s true that many people do not have adequate levels and might need to take supplements. Your healthcare provider might test your blood levels and then make recommendations based on these results.

There are other supplements that have been touted as useful for osteoporosis. One of these is strontium, which has never been approved in the U.S. for Silent Disease. A prescription version of strontium ranelate had been available in the E.U., but it was taken off the market due to serious side effects.

You and your healthcare provider will always need to discuss whether the benefits of taking something, whether is a prescription drug or a supplement, outweigh the risks.