Symptoms and treatment of Osteoporosis

Description

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a break. Osteoporosis-related, tears most commonly occur in the hip, wrist or spine.

Bone is a living tissue that is constantly broken down and replaced. Osteoporosis occurs when the creation of new bone does not keep up with the loss of old bone.

Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are past menopause are at high risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.

Symptoms

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

Back pain, caused by a fractured or collapsed bone in the spine.
The loss of height over time.
A stooped posture.
A bone that breaks much more easily than expected.

When to see a doctor

You may want to talk with your health care provider about osteoporosis if you went through early menopause or took steroids for several months at a time, or if either of your parents had hip fractures.

Causes

Their bones are in a constant state of renewal — new bone, and the old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. After the first 20 years of this process slows down, and most people reach their peak bone mass by the age of 30 years. As people age, bone mass is lost faster than you think.

The likelihood of developing osteoporosis depends in part on how much bone mass is reached in their youth. Peak bone mass is partly inherited, and varies also according to the ethnic group. The higher your peak bone mass, the more bone you have "in the bank" and are less likely to develop osteoporosis as you age.

Risk factors

A number of factors that can increase the likelihood that you'll develop osteoporosis, including age, race, lifestyle, and medical conditions and treatments.

Immutable risks

Some risk factors for osteoporosis are out of your control, including:

Your sex. Women are much more likely to develop osteoporosis than men.
Age. The older you get, the greater your risk of osteoporosis.
Of the race. You are at increased risk of osteoporosis if you're white or of Asian origin.
The history of the family. Have a parent or sibling with osteoporosis puts you at greater risk, especially if the mother or the father fractured his hip.
Body frame size. The 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 you age.

The levels of the hormone

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

The sex hormones. Lower levels of sex hormones, tend to weaken the bone. The fall in the levels of estrogen in women at the menopause is one of the major risk factors for the development of osteoporosis. The treatments for prostate cancer that reduce the levels of testosterone in men, and treatments for breast cancer to reduce levels of estrogen in women are likely to accelerate the loss of bone.
Problems of the thyroid. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive, or if you take too much thyroid hormone medicine to treat an underactive thyroid.
Other glands. Osteoporosis has also been associated with hyperactivity of the 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 role in the development of osteoporosis. Low calcium intake contributes to the reduction of bone density, early bone loss and an increased risk of fractures.
Eating disorders. Restricting the food intake and weight deficits weakens the bone in men and women.
Gastrointestinal surgery. The surgery to reduce the size of your stomach, or to remove part of the intestine limits the amount of surface area available for the absorption of nutrients, including calcium. These surgeries are those that can help you lose weight and for other gastrointestinal disorders.

Steroids and other medications

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

Seizures.
Gastric reflux.
Cancer.
The rejection of the transplant.

Medical problems

The risk of osteoporosis is higher in people who have certain medical problems, including:

The celiac disease.
The inflammatory bowel disease.
Kidney or liver disease.
Cancer.
Multiple myeloma.
Rheumatoid arthritis.

Lifestyle options

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

Sedentary life style. People who spend a lot of time sitting have a higher risk of osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture is good for your bones, but walking, running, jumping, dancing, and lifting weights seems to be particularly useful.
The excessive consumption of alcohol. The Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.
The consumption of tobacco. The exact role tobacco plays in osteoporosis is not clear, but it has been shown that tobacco use contributes to weak bones.

Complications

The bone is broken, especially in the spine or hip, are the most serious complications of osteoporosis. Hip fractures are often caused by a fall and can result in disability and even an increase in the risk of death within the first year after the injury.

In some cases, fracture of bones in the spine can occur even if you have not fallen. The bones that make up the spine, called vertebrae, can weaken to the point of collapse, which can result in back pain, lost height and a hunched-forward posture.

Prevention

Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.

Calcium

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams of women by the age of 50 years, and men turn 70.

Good sources of calcium include:

Low-fat dairy products.
Dark green leafy vegetables.
Canned salmon or sardines with bones.
Soy products, like tofu.
Calcium-fortified cereals and orange juice.

If you find it difficult to get enough calcium in your diet, consider taking calcium supplements. However, an excess of calcium has been linked to kidney stones. Although it is still not clear, some experts suggest that an excess of calcium, especially in supplements, can increase the risk of heart disease.

The Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine recommended that the total intake of calcium from supplements and diet combined, should be no more than 2,000 milligrams per day for people over the age of 50 years.

Vitamin D

Vitamin D improves the body's ability to absorb calcium and enhances bone health in other ways. The people can get some of their vitamin D from sunlight, but this might not be a good source if you live in a high latitude, whether you're at home, or if you regularly use a sunscreen or avoid the sun because of the risk of skin cancer.

Dietary sources of vitamin D include cod liver oil, trout and salmon. Many types of milk and cereals have been fortified with vitamin D.

Most people need at least 600 international units (IU) of vitamin D a day. That recommendation increases to 800 IU a day after 70 years of age.

People without other sources of vitamin D, and, especially, with limited exposure to the sun may be that you need a supplement. The majority of multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

Exercise

Exercise can help strengthen bones and reduce bone loss. Exercise will be of benefit to your bones no matter when you start, but you'll get more benefits if you start to do exercise regularly when you are young and continue to exercise throughout your life.

Combine strength training exercises with weight and balance exercises. Strength training helps to strengthen the muscles and bones of the arms and the upper part of the spine. Weight-bearing exercises, such as walking, jogging, running, stair climbing, jumping rope, the skiing and the impact of producing sports — mainly affect the bones of the legs, the hips and the lumbar spine. Balance exercises such as tai chi can reduce the risk of falls, especially as you get older.

Diagnosis

Your bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of minerals in the bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked — usually in the hip, and spine.

Treatment

Treatment recommendations are often based on an estimate of your risk of bone fracture in the next 10 years, the use of the information, such as the bone density test. If the risk is not high, treatment may not include medication and can focus on modifying risk factors for bone loss and falls.

Bisphosphonates

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

Alendronate (Binosto, Fosamax).
Risedronate (Actonel, Atelvia).
Ibandronate.
Zoledronic acid (Reclast, Zometa).

The side effects include nausea, abdominal pain, and heartburn-like symptoms. These are less likely to occur if the medication is taken correctly. Intravenous forms of bisphosphonates does not cause stomach discomfort, but it can cause fever, headache, and muscle aches.

A very rare complication of bisphosphonates is a break or crack in the middle of the femur. A second common complication is delayed healing of the jaw, also called osteonecrosis of the jaw. This can occur after a dental procedure invasive, such as the extraction of a tooth.

Denosumab

In comparison with bisphosphonates, denosumab (Prolia, Xgeva) produces similar or better results of bone density and reduces the risk of all types of fractures. Denosumab is delivered through an injection under the skin every six months.

Similar to bisphosphonates, denosumab has the same rare complication of cause breakage or cracks in the middle of the femur and osteonecrosis of the jaw. If you take denosumab, you might need to continue to do so indefinitely. Recent research indicates that there may be a high risk of spine fractures after stopping the drug.

Related hormone therapy

Estrogen, especially when started soon after menopause, can help to maintain bone density. However, estrogen therapy may increase the risk of breast cancer, and blood clots that can cause strokes. Therefore, estrogen is typically used for bone health in younger women or in women whose menopause 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 medication can reduce the risk of some types of breast cancer. Hot flashes are a possible side effect. Raloxifene may also increase your risk of blood clots.

In men, osteoporosis may be associated with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help to improve the symptoms of low testosterone levels, but the osteoporosis drugs that have been best studied in men to treat the osteoporosis and therefore are recommended alone or in addition to testosterone.

The construction of the bones of the medicines

If you have severe osteoporosis or if the most common treatments for osteoporosis are not working well enough, your doctor might suggest that you:

Teriparatide (Bonsity, Forteo). This potent drug is similar to parathyroid hormone and stimulates the new growth of the bones. Is given by daily injection under the skin for up to two years.
Abaloparatide (Tymlos) is another medication similar to parathyroid hormone. This medicine can be taken only two years.
Romosozumab (Evenity). This is the new bone-building medication for the treatment of osteoporosis. It is given as an injection every month in the office of his doctor and is limited to one year of treatment.

After you stop taking any of these the construction of the bones of the medications, in general, you will need to take another medication for osteoporosis to keep the new growth of the bones.

Lifestyle and home remedies

These suggestions can help reduce your risk of developing osteoporosis or fractures of the bones:

Do not smoke. Smoking increases the rate of loss of bone mass and fracture risk.
Limit the consumption of alcohol. Consuming more than two alcoholic drinks a day can reduce the formation of new bone. To be under the influence of alcohol may also increase the risk of falls.
To prevent falls. Wear low-heeled shoes with non-slip soles and check your home from electrical cables, carpets and slippery surfaces that could cause a fall. Keep the rooms are bright, install grab bars just inside and outside the shower door, and make sure that you can get in and out of bed easily.

Preparing for your appointment

Your health care team may suggest bone density testing. The detection of osteoporosis is recommended for all women over 65 years of age. Some guidelines also recommend screening men by 70 years of age, especially if they have health problems, probably because of osteoporosis. If you have a broken bone after a minor force of injury, such as a simple fall, bone density testing may be important to assess the risk of more frequent breaks.

If the test results show very low bone density or have other complex health issues, you may be referred to a provider who specializes in metabolic disorders, called an endocrinologist or a provider who specializes in diseases of the joints, muscles, or bones, called a rheumatologist.

Here's some information to help you prepare for your appointment.

What you can do

Write down any symptoms you've observed, although it is possible that you do not have any.
Write down key personal information, including major stresses or recent life changes.
Make a list of all the medicines, vitamins, and supplements you are taking or have taken, including dosage. It is especially useful if you record the type and dose of calcium and vitamin D supplements, because many different preparations are available. If you're not sure what information it is possible that your doctor, take the bottle with you or take a photo of the label with your smartphone and share it with your doctor.
Write questions to ask their health care provider.

For osteoporosis, the basic questions to ask your provider include:

What do I need to be screened for osteoporosis?
What treatments are available, and which do you recommend?
What side effects can I expect from treatment?
There are alternatives to the treatment you are suggesting?
I have other health problems. How can I best manage them together?
Do I need to limit my activities?
Do I have to change my diet?
Do I need to take supplements?
There is a program of physical therapy that benefit me?
What can I do to prevent falls?

Do not hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask you questions, such as:

You have broken bones?
Have you gotten shorter?
How is your diet, especially intake of dairy products? Do you think you get enough calcium? Vitamin D?
How often do you exercise? What type of exercise do you do?
How is your balance? You have fallen?
Do you have a family history of osteoporosis?
Has a parent, a broken hip?
Have you ever had stomach or intestinal surgery?
Have you taken medication with corticosteroids, including prednisone, cortisone, such as pills, injections or creams?