Overview

A condition in which bones become weak and brittle.
The body constantly absorbs and replaces bone tissue. With osteoporosis, new bone creation doesn’t keep up with old bone removal.
Many people have no symptoms until they have a bone fracture.
Treatment includes medication, a healthy diet and weight-bearing exercise to help prevent bone loss or strengthen already weak bones.

Symptoms

There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might 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 that breaks much more easily than expected

Causes

After the early 20s this process slows, and most people reach their peak bone mass by age 30. As people age, bone mass is lost faster than it’s created.

How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. Peak bone mass is somewhat inherited and varies also by ethnic group. 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.

Treatment

Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If your risk isn’t high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.

Biophosphonates
For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

Alendronate (Binosto, Fosamax)
Risedronate (Actonel, Atelvia)
Ibandronate (Boniva)
Zoledronic acid (Reclast, Zometa)
Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly.

Intravenous forms of bisphosphonates don’t cause stomach upset but can cause fever, headache and muscle aches for up to three days. It might be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so.

Monoclonal antibody medications
Compared with bisphosphonates, denosumab (Prolia, Xgeva) produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months.

If you take denosumab, you might have to continue to do so indefinitely. Recent research indicates there could be a high risk of spinal column fractures after stopping the drug.

A very rare complication of bisphosphonates and denosumab is a break or crack in the middle of the thighbone.

A second rare complication is delayed healing of the jawbone (osteonecrosis of the jaw). This can occur after an invasive dental procedure such as removing a tooth.

You should have a dental examination before starting these medications, and you should continue to take good care of your teeth and see your dentist regularly while on them. Make sure your dentist knows that you’re taking these medications.

Hormone-related therapy
Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment.

Raloxifene (Evista) mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug can reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.
In men, osteoporosis might be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.

Bone-building medications
If you can’t tolerate the more common treatments for osteoporosis – or if they don’t work well enough – your doctor might suggest trying:

Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It’s given by daily injection under the skin. After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth.
Abaloparatide (Tymlos) is another drug similar to parathyroid hormone. You can take it for only two years, which will be followed by another osteoporosis medication.
Romosozumab (Evenity). This is the newest bone-building medication to treat osteoporosis. It is given as an injection every month at your doctor’s office. It is limited to one year of treatment, followed by other osteoporosis medications.

Diagonsis

A machine called a dual energy X-ray absorptiometry, or DXA machine, can scan your hip and spine to determine how dense your bones are compared to other people of your gender and age.

The DXA scan is the primary diagnostic method, and it takes anywhere from 10 to 15 minutes.
Other imaging studies that doctors use to diagnose or confirm a diagnosis include:
ultrasound, usually of a person’s heel
quantitative CT scan of the lower spine
lateral radiographs, which are conventional X-rays
A doctor can interpret the results, letting you know if your bone density is normal or below normal. Sometimes a doctor will give a diagnosis for osteopenia, or low bone mass. This isn’t osteoporosis yet. It means that your bones aren’t as dense as they should be.

Risk factor

The risk of getting osteoporosis increases with age as bones naturally become thinner. After age 30, the rate at which your bone tissue dissolves and is absorbed by the body slowly increases, while the rate of bone building decreases. So overall you lose a small amount of bone each year after age 30.

In women, bone loss is more rapid and usually begins after monthly menstrual periods stop, when a woman’s production of the hormone estrogen slows down (usually between the ages of 45 and 55). A man’s bone thinning typically starts to develop gradually when his production of the hormone testosterone slows down, at about 45 to 50 years of age. Women typically have smaller and lighter bones than men. As a result, women develop osteoporosis far more often than men. Osteoporosis usually does not have a noticeable effect on people until they are 60 or older.

Whether a person develops osteoporosis depends on the thickness of the bones (bone density) in early life, as well as health, diet, and physical activity later in life. Factors that increase the risk for osteoporosis in both men and women include:

Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed with osteoporosis or has experienced broken bones from a minor injury, you are more likely to develop osteoporosis.
Lifestyle factors. These include:
Tuxedo. People who smoke lose bone density faster than nonsmokers.
Alcohol use. Heavy alcohol use can decrease bone formation, and it increases the risk of falling. Heavy alcohol use is more than 2 drinks a day for men and more than 1 drink a day for women. See pictures of standard alcoholic drinks.
Getting little or no exercise. Weight-bearing exercises — such as walking, jogging, stair climbing, dancing, or lifting weights — keep bones strong and healthy by working the muscles and bones against gravity. Exercise may improve your balance and decrease your risk of falling.
Being small-framed or thin. Thin people and those with small frames are more likely to develop osteoporosis. But being overweight puts women at risk for other serious medical conditions, including type 2 diabetes, high blood pressure, and coronary artery disease (CAD). For more information, see the topic Weight Management.
A diet low in foods containing calcium and vitamin D.
Having certain medical conditions. Some medical conditions, such as hyperthyroidism or hyperparathyroidism, put you at greater risk for osteoporosis.
Taking certain medicines. Several medicines, such as corticosteroids used for long periods, cause bone thinning.
Having certain surgeries, such as having your ovaries removed before menopause.

Other risk factors for osteoporosis may include:
Being of European and Asian ancestry, the people most likely to have osteoporosis.
Being inactive or bedridden for long periods of time.
Excessive dieting or having an eating disorder, such as anorexia nervosa.
Being a female athlete, if you have infrequent menstrual cycles due to low body fat.

When to see a doctor

Make an appointment with your doctor if you experience any signs or symptoms that worry you.

How much cost

Half of the non-fracture osteoporosis patients received drug treatment, averaging $ 500 per treated patient, or $ 2 billion nationwide. Conclusions: The annual cost of osteoporosis and fractures in the US elderly was estimated at $ 16 billion, using a national 2002 population-based sample.