What Is Osteoporosis?
What is Osteoporosis?
Osteoporosis is characterized by low bone mass or density that results in decreased bone strength and increased risk of fracture. Healthy bones are sturdy and have small pockets of space in the bone tissue. But for those with osteoporosis, the weakening of the bones decreases the inner network of the bone itself, making the bones fragile and more prone to breaking.
Osteoporosis translates to “porous bone”. When viewed under a microscope, a bone on an individual with osteoporosis will look porous and have large pockets of empty space scattered throughout. A stronger bone, or bone with appropriate density has a tightly packed matrix of minerals and can withstand higher amounts of force or pressure.
The bones most affected by osteoporosis are the wrists, hips, and the spine. These are the main load-bearing bones that can easily become weaker over time. However, any bones in the body may be affected and this would affect how likely that bone is to withstand impact over time. Typically, individuals with osteoporosis won’t experience symptoms or signs until they experience a bone fracture or break.
Osteoporosis is not caused by an autoimmune condition. The reason most people develop osteoporosis is genetic (meaning a parent also had osteoporosis), or a side effect of certain medications that can increase bone loss over time. Many rheumatologists treat osteoporosis because they specialize in chronic conditions affecting tissues, joints, and bones.
Symptoms of Osteoporosis
Osteoporosis is not something that a person feels in the form of symptoms, and more often than not, you do not even realize it is happening until osteoporosis is diagnosed from a bone density test or x-ray. The pain that is felt after fractures or breaks is a result of the broken bone and not specifically from a bone that is weak.
Osteoporosis can be difficult to detect before experiencing a fracture or break. That’s because there are not particular osteoporosis symptoms that a person would feel from bones thinning gradually over time.
Some symptoms of osteoporosis may include:
- Back pain related to a compression fracture in the spine
- Stooped posture (dowager’s hump)
- Loss of height caused by bone loss in the spine
- Shortness of breath caused by a compressed spine
- Broken bones or fractures, even from minor falls or minimal impact
Why Aren’t There Many Symptoms of Osteoporosis?
The reason there are so few symptoms of osteoporosis is that the bones themselves are intact (unless the bone breaks) and we cannot feel that the bones are becoming weak. Bone reabsorption does not produce a feeling that we would notice. Weaker bones don’t typically affect the body’s functioning until they are fractured or broken. Think of the structure like a bridge. Over time, heavy traffic weakens the beams, but the weakness may not be visible until parts of the bridge eventually crack or bend.
What Causes Osteoporosis?
The primary cause of osteoporosis is the dysfunction of your bones to continue to repair and rebuild at a faster rate than they reabsorb. Healthy bones continuously grow new tissue and matrix to replace the older tissue that is reabsorbed. This regeneration is what keeps your bones strong and healthy. This also accounts for why our bones change shape over time, from when we are children to when we are older adults.
When regeneration of bone tissue slows down and can’t keep up with replacing the old matrix or structure, those bones will become brittle and weak. This is most evident in the bones of the spine (vertebrae), hips and femur (long bone of the thigh), and hands and wrist bones.
The most common reasons for slower bone regeneration are decreases in dietary calcium as we age, and chronic low levels of vitamin D. Post-menopausal women experience a decrease in estrogen levels that can dramatically slow bone regeneration, which then favors bone resorption. This is why osteoporosis is most common in women over the age of 50.
Certain medications like prolonged use of prednisone, having history of chronic kidney disease, history of an organ transplant, certain cancers, and chemotherapy can also lead to faster thinning of the bones. This is mostly due to altered regulation of calcium in the body with medications or other chronic diagnoses.
Osteoporosis Risk Factors
Osteoporosis typically occurs in post-menopausal women, but anyone may develop osteoporosis, including men and individuals younger than 50.
Some osteoporosis risk factors include:
- Family history
- Certain medication usage (including certain cancer drugs, birth control, prednisone, diuretics amongst others)
- Certain pre-existing conditions (including rheumatoid arthritis, lupus, thyroid disorders, IBD, HIV/AIDs, and kidney disease amongst others)
- History of smoking
- History of eating disorders or poor nutrition
- Chronically low vitamin D
While some osteoporosis risk factors are uncontrollable (like gender, race, and family history), it is important to manage the factors you do have control of. This includes a balanced diet including different sources of calcium and minerals, weight-bearing exercise (even using ankle or wrist weights is enough), and making healthy lifestyle choices that include limiting alcohol consumption and abstaining from smoking.
Your rheumatologist is a great resource for discussing your osteoporosis risk factors and to help you develop a plan to prevent the effects of osteoporosis.
When it comes to diagnosing osteoporosis, a healthcare provider would first review the results of a bone mineral density test. Bone mineral density tests for osteoporosis (known as a DEXA scan) are a noninvasive screening method that uses X-rays to visualize areas of the bone with low mineral density. The most common bones that are tested include the hips and spine.
Your provider will use the images to assign you a score (T-score or Z-score) to determine the likelihood that your bones are at a normal density or thinning. The T-score measures your bone density against that of a healthy adult, while the Z-score measures your bone density comparing individuals in your age group. These scores let your rheumatologist diagnose the fragility of those bones and estimate your risk of fracturing a bone.
In addition to a DEXA scan for diagnosing osteoporosis, your provider may also conduct a physical examination to look for signs of spinal compression, including reduced height or hunching.
How Long Does it Take to Diagnose Osteoporosis?
If you are being tested for osteoporosis with a DEXA scan, the scan only takes around 10 minutes to complete. Your results will then need to be examined by a radiologist and your provider, so it may take a week to receive the results.
If you have not had a recent DEXA scan, there is not an effective way to diagnose osteoporosis. Sometimes x-rays may give clues that you have osteopenia or thinning of the bone, but then you will still need a DEXA to confirm that suspicion. In some cases, individuals are not diagnosed with osteoporosis until they experience a fracture. It is therefore important to talk with your healthcare providers about regularly having bone density tests monitored if you are over the age of 65, have a history of a hip fracture or fragility fracture, or other major risk factors that are mentioned above.
Osteoporosis treatment will most often include a combination of medications and lifestyle changes to prevent further bone loss and minimize the risk of fractures or breaks. Depending on your age and the severity of your disease, treatments may vary.
Medications for Osteoporosis
A variety of medications for osteoporosis have been shown to both prevent further bone density loss and even rebuild bone density.
Estrogen hormone therapy mimics the natural hormones progesterone and oestrogen. Women who are experiencing early menopause and are at a higher risk of osteoporosis, or have been diagnosed with osteoporosis, are often great candidates for this osteoporosis treatment. Many primary care or gynecologists prescribe hormone replacement therapy. You may discuss with your provider if you are a candidate to be on one of these medications.
Bisphosphonates are a class of medication that are often the first line of treatment for osteoporosis and fracture prevention. These medications work by slowing down the process of bone tissue resorption. This allows bone tissue creation to keep up and ultimately strengthens the bones faster than the matrix is resorbed.
There are a range of bisphosphonates available, including both oral and infusible (IV) options. Common ones include:
- Zoledronic Acid (Reclast)
- Ibandronate (Boniva)
- Risedronate (Actonel)
- Alendronate (Fosamax)
Monoclonal Antibody Therapy
Monoclonal antibodies are administered via IV or injection to treat patients with osteoporosis, while also working to slow the process of bone resorption. Medications like Evenity (romosozumab) and Prolia (denosumab) are typically prescribed for cases of more advanced osteoporosis or those who do not tolerate bisphosphonates due to side effects.
Supplements for Osteoporosis
In addition to osteoporosis medications, your provider may suggest the use of specific supplements for osteoporosis to encourage healthy bone regeneration. If your provider has not recommended supplements for osteoporosis, it is important to discuss their use and most appropriate dose with your provider before taking any supplements.
Vitamin D is essential to healthy bones. Your provider may recommend daily vitamin D to encourage calcium and phosphorous absorption. There are different doses that are recommended, often based on the level of vitamin D measured from a blood test. While you are being treated for osteoporosis, your healthcare provider may want your vitamin D level to be slightly higher because osteoporosis medications require vitamin D to be effective. Vitamin D is also essential for immune system function, muscle health, and nerve function, so having low vitamin D levels makes it difficult for your body to allocate enough to rebuild your bones.
Calcium is well known to help build healthier, stronger bones. To encourage bone rebuilding, your rheumatologist may recommend additional calcium supplementation. Ideally, individuals should meet their calcium requirements in their diet by consuming calcium-rich foods. These can be vegetables, fortified foods, dairy, and non-dairy alternatives. However, it is still sometimes necessary to supplement with calcium in pill or chewable supplement form.
Diet for Osteoporosis
Foods rich in calcium and vitamin D are essential for bone health. Also, a balanced diet that contains these ingredients spread over the course of the day will help your body absorb more nutrients at each meal. When we consume more than our body is able to store, the excess nutrition is wasted. So if you eat a breakfast high in calcium, you can add other ingredients to your other meals to increase calcium intake later in the day as well.
Foods high in vitamin D:
- Salmon and other oily fish
- Fortified orange juice
- Egg yolks
Foods high in calcium:
- Dairy (milk, cheese, and yogurt)
- Non-dairy milks (almond milk, coconut milk, oat milk)
- Green, leafy vegetables (broccoli, kale, collard greens, cabbage)
- Soy (soy milk and tofu)
If you are looking for a rheumatologist to manage osteoporosis treatment, Summit Rheumatology is currently accepting new patients. We will be sure to discuss your options and the best ways to help you rebuild stronger bones, no matter if you have mild, moderate, or severe osteoporosis.
Summit manages osteoporosis prevention as well as treatment options for all stages of osteopenia and osteoporosis.
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