Osteoporosis is a disease that affects your bones. It means 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?
Osteoporosis is 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. Some risk
factors you can change. Others you can't change.
Risk factors
you can't change include:
Your age. Your risk for osteoporosis goes up
as you get older.
Being a woman who has gone through
menopause. After menopause, the body makes less
estrogen. Estrogen protects the body from bone loss.
Your family
background. Osteoporosis tends to run in families.
Having a
slender body frame.
Your race. People of European and Asian
background are most likely to get osteoporosis.
Risk factors you can change
include:
Smoking.
Not getting enough
weight-bearing exercise.
Drinking too much alcohol.
Not getting enough calcium and vitamin D in the things you eat or
from supplements.
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, a less severe type of bone thinning.
It's important to find and treat osteoporosis early to prevent
bone fractures. The
United States Preventive Services Task Force advises
routine 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 at age 60.
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 take
both calcium and vitamin D supplements along with any medicine you take for the
disease. You need both of these supplements 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 dark green vegetables, yogurt, 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.
During childhood and teen years,
new bone grows faster than existing bone is absorbed by the body. After age 30,
this process begins to reverse. As a natural part of aging, bone dissolves and
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 mineral 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.
Likewise,
testosterone protects men from bone loss. Osteoporosis
is typically seen in men older than 65, when production of this hormone
declines. In both men and women: The older you get, the more likely you are to
have osteoporosis. See a picture of
healthy bone versus bone weakened by osteoporosis.
Not getting
enough
calcium and
vitamin D contributes to bone thinning. Also, a
tendency for lower bone mass may pass from parent to child.
Symptoms
In the early stages of
osteoporosis, you probably will not have symptoms. As
the disease progresses, you may have symptoms related to weakened bones,
including:
Broken
bones (fractures) that might occur with a minor injury,
especially in the hip,
spine, and wrist.
Compression fractures in the spine that may cause severe back pain. But sometimes
these fractures cause only minor symptoms or no symptoms at all.
What Happens
In a normal, healthy adult,
bone is continually 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 develop
osteoporosis.
After age 30, both men and
women lose a small amount of bone each year. Because most men build greater
bone mass than women do, they tend to get osteoporosis later in life.
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:
The spine. About half of broken bones caused by
osteoporosis are bones in the spine.1 Men and women
who have a spinal fracture have a higher risk of future spinal
fractures.2 Vertebrae that are weak because of
osteoporosis may break and collapse on top of each other (compression
fracture). Compression fractures of the
spine can result in back pain, stooped posture, loss
of height, and a curved upper back (dowager's hump).
The hip. Hip fractures are most common in older
women. Hip fractures are often caused by a fall. They can make it very hard for
you to move around and they usually require major surgery. After a hip
fracture, many older people have medical complications such as blood clots,
pressure sores, or pneumonia.
The wrist and forearm.
In women, bone loss increases when the ovaries reduce
production of
estrogen, a hormone that protects against bone loss.
Studies show that on average, women lose 1% to 3% of their bone mass every year
for about 3 to 5 years after
menopause.3
In
men, the hormone
testosterone protects against bone loss. Osteoporosis
develops most often in men older than 65.
The risk of
osteoporosis increases with age as bones naturally
become thinner. After age 30, the rate at which your bone dissolves and is
absorbed by the body slowly increases, while the rate of bone building
decreases. Both men and women lose a small amount (approximately 0.4%) of bone
each year after age 30.4
In women, more
rapid bone loss 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 starts to develop gradually when 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 an 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 of 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:
Smoking. People who smoke lose bone
thickness faster than nonsmokers.
Alcohol use.
Heavy alcohol use can decrease bone growth and
increase the risk of falling. But moderate alcohol use (no more than 2 drinks a
day for men and 1 drink a day for women) is linked to higher bone thickness.
Most doctors recommend limiting, but not eliminating, alcohol use.5
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
a woman at risk for other serious medical conditions, including
type 2 diabetes,
high blood pressure, and coronary artery disease
(CAD).
Thyroid replacement
medicine, if the dose is more than the body needs. This should be monitored by
checking the level of thyroid-stimulating hormone (TSH) every year.
Depo-Provera, a birth
control medicine given by injection. Longtime use may thin
bones.
Antacids that contain aluminum, if they are overused.
Aluminum-containing antacids remove calcium from your
body.
Medicines called SSRIs
(selective serotonin reuptake inhibitors). SSRIs are used to treat many
conditions, including
depression,
fibromyalgia, and
premenstrual syndrome. Studies have found that daily
use of SSRIs may increase the risk of bone fracture in adults over age 50.
Before you take an SSRI, talk to your doctor about this risk.
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. People of African ancestry are least
likely.
Being inactive or bedridden for long periods of
time.
Dieting excessively or having an eating disorder, such as
anorexia nervosa.
Being a female athlete,
if you have few or irregular
menstrual cycles due to low body fat.
Women who have completed menopause have the greatest risk
of osteoporosis because their levels of the estrogen hormone drop. Estrogen
protects women from bone loss. Likewise, women who no longer have menstrual
periods-either because their ovaries are not working properly or because their
ovaries have been surgically removed-also can have decreased estrogen
levels.
Think you have a broken bone, notice a
deformity after a fall, or cannot move a part of your body.
Have
sudden, severe pain when bearing weight.
Call your doctor for an appointment if you:
Want to discuss your risk of developing
osteoporosis.
Have symptoms of
menopause or have completed menopause and want to
discuss whether you should take medicine to prevent osteoporosis.
Have been treated for a fracture caused by a minor injury, such as
a simple fall, and want to discuss your risk of osteoporosis.
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.
Watchful Waiting
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:
A diagnosis of
osteoporosis is based on your
medical history, a physical exam, and a test to
measure your bone thickness (density). During a physical exam, your
doctor will:
Measure your height and compare the results
with past measurements.
Examine your body for evidence of previous
broken bones, such as changes in the shape of your long bones and
spine. See a picture of a
compression fracture of the spine.
A
bone mineral density test measures the mineral density
(such as calcium) in your bones using a special X-ray, computed tomography (CT)
scan, or ultrasound. From this information, your doctor can estimate the
strength of your bones. See a picture of a
bone mineral density test.
If you have been diagnosed with osteoporosis,
you may need to follow up regularly with your doctor to monitor your
condition.
Early Detection
If you or your doctor thinks you may be at risk
for developing osteoporosis, you may have a screening test to check your bone
thickness. A screening test may be advisable if you have:
A
fracture in a minor injury that may have been caused
by osteoporosis.
Another medical condition that is known to cause
bone thinning.
Risk factors for or symptoms that
suggest osteoporosis.
Most
experts recommend that the decision to screen women age 60 and younger be made
on an individual basis, depending on the risk of developing osteoporosis and
whether the test results will help with treatment decisions. To help you decide
whether you should be tested for osteoporosis, see:
The process of bone thinning
(osteoporosis) is a natural part of aging. But if you
receive treatment early, you may be able to stop or slow the progress of bone
loss. Treatment is important to:
Prevent broken bones.
Maintain or
increase your bone thickness.
Relieve pain caused by
fractures and changes to bones.
Maintain
your ability to function physically.
Treatment for osteoporosis includes eating a diet rich in
calcium and vitamin D, getting regular exercise, and taking medicine to reduce
bone loss and increase bone thickness. It's important to take calcium and
vitamin D supplements along with any medicines you take for osteoporosis. Even
small changes in diet, exercise, and medicine can help prevent
spine and hip fractures. Adults who adopt healthy
habits can slow the progress of osteoporosis.
If you have been diagnosed with
osteoporosis, your doctor likely will recommend
lifestyle and diet changes. Eat foods rich in
calcium and
vitamin D, which are necessary for keeping bones
healthy and strong. Take supplements if you think you are not getting enough of
these nutrients in your diet. Recommendations vary, but the National
Osteoporosis Foundation suggests that adults up to age 50 get 1,000 mg of
calcium and 400 to 800 IU of vitamin D a day. If you are age 50 or older, the
recommended amounts are 1,200 mg of calcium and 800 to 1,000 IU a day of
vitamin D.
Your bones need vitamin D to absorb calcium. One study
showed that vitamin D may reduce an older person's risk of falling by
22%.9 The best source of vitamin D is exposure to
sunlight. Vitamin D is also added to milk, some calcium supplements, and many
multivitamin supplements.
Research studies do not agree about
whether calcium plus vitamin D supplements can prevent fractures. Some studies
show that calcium and vitamin D supplements reduce the risk of
fracture.10 But other studies show little effect of
supplements on fracture risk.11 The greatest benefit of
supplements appears to be for people who have osteoporosis. Calcium and vitamin
D supplements are recommended if you have been diagnosed with
osteoporosis.
Exercises, including weight-bearing exercise (walking,
jogging, stair climbing, dancing, or lifting weights), aerobics, and resistance
exercises are all effective in increasing bone mineral density and strength of
the spine. Walking also increases bone mineral density of the hip.12 And exercise increases strength and balance so you are less
likely to fall. Start out at an exercise level that you are comfortable with
and work up gradually. To be most effective, weight-bearing exercises should be
done for 30 minutes most days of the week, and resistance exercises 2 to 3 days
a week.13 If you stop exercising, your bones weaken and
may be more likely to break.
Along with exercise and diet, your
doctor will recommend that you not smoke and limit alcohol to no more than 2
drinks a day for men and 1 drink a day for women. For more information on
quitting smoking, see the topic
Quitting Smoking.
In some cases,
medicines are prescribed to protect against bone loss. These medicines include
raloxifene (Evista),
bisphosphonates such as risedronate (Actonel) and
alendronate (Fosamax), and parathyroid hormone (Forteo). It's important to take
calcium and vitamin D supplements along with any medicines you take for
osteoporosis. For more information on taking bisphosphonates, see:
If you take
corticosteroids longer than 6 months for asthma or
other conditions, you may be at greater risk for developing
steroid-induced osteoporosis. If you begin to have
bone loss, you may need to take osteoporosis medicines, such as
bisphosphonates, while you are taking steroids.
In some cases,
hormone replacement therapy (HRT) or
estrogen replacement therapy (ERT) is given to women
to slow bone loss from osteoporosis. But hormone therapy can also increase the
risk of other conditions, including
stroke and
breast cancer. Many experts recommend that long-term
hormone replacement therapy only be considered for women with a significant
risk of osteoporosis that outweighs the risks of taking HRT or ERT.
Ongoing treatment
After you have been diagnosed
with bone loss, whether it is mild or severe, you will need to have regular
follow-up tests to monitor the disease.
Osteoporosis is a progressive disease: both men and
women lose approximately 0.4% of bone each year after age 30.4 It is never too late to develop and then maintain healthy
habits that can slow the progression of the disease.
Eat a nutritious diet that includes adequate
amounts of calcium and vitamin D. Both are necessary for building healthy,
strong bones. Take supplements if you think you are not getting enough of these
nutrients in your diet. Recommendations vary, but the National Osteoporosis
Foundation suggests that adults up to age 50 get 1,000 mg of calcium and 400 to
800 IU of vitamin D a day. If you are age 50 or older, the recommended amounts
are 1,200 mg of calcium and 800 to 1,000 IU a day of vitamin D. Your bones need
vitamin D to absorb calcium. One study showed that vitamin D may reduce an
older person's risk of falling by 22%.9 The best
source of vitamin D is exposure to sunlight. Vitamin D is also added to milk,
some calcium supplements, and many multivitamin supplements.
Get
regular exercise. Weight-bearing exercises such as walking, jogging, stair
climbing, dancing, or lifting weights keep bones healthy by working the muscles
and bones against gravity.
When you have osteoporosis, it is especially important
to protect yourself from falling. When bones lose mass and become more brittle,
they lose strength and break more easily. Women of European and Asian ancestry
are more likely to have osteoporosis than those with African ancestry. An
estimated 17% of white women will break a hip sometime after age 50, as will 6%
of white men.14 To reduce your chances of breaking
bones, take
steps to prevent falls, such as having your vision and hearing checked
regularly and wearing slippers or shoes with a nonskid sole. Exercises that
improve balance and coordination, such as
tai chi, can also reduce your risk of falling.
If your tests
indicate continuing bone loss, your doctor likely will recommend that you take
medicine to increase bone density and decrease your risk of spine and hip
fractures. These medicines include
bisphosphonates, such as risedronate (Actonel) or
alendronate (Fosamax). It's important to take calcium and vitamin D supplements
along with any medicines you take for osteoporosis. For more information about
taking bisphosphonates, see:
Calcitonin may be prescribed for women who are more
than 5 years beyond menopause and who cannot take bisphosphonate medicines, or
for men who are not receiving testosterone treatment. Calcitonin has the added
advantage of helping reduce pain from spinal fractures. But studies show that
calcitonin is less effective than bisphosphonate medicines at stopping bone
loss.15
Raloxifene (Evista)
may be prescribed for women, especially if you are 55 to 65 years old.
Raloxifene has been proved to reduce the risk of spinal fractures but not hip
fractures.16 Raloxifene may also reduce the risk of
breast cancer, although it is not approved for this purpose. Raloxifene can
cause hot flashes, so it is not often used in early menopause (45 to 55 years)
when hot flashes are frequent.
In some cases,
hormone replacement therapy (HRT) or
estrogen replacement therapy (ERT) is given to women
to slow bone loss from osteoporosis. But hormone therapy can also increase the
risk of other conditions, including
stroke and
breast cancer. Many experts recommend that long-term
hormone replacement therapy only be considered for women with a significant
risk of osteoporosis that outweighs the risks of taking HRT or ERT.
Treatment if the condition gets worse
It is never
too late to build and then keep healthy habits that can slow bone
thinning.
Eat a nutritious diet that includes adequate
amounts of calcium and vitamin D. Both are necessary for building healthy,
strong bones. Take supplements if you think you are not getting enough of these
nutrients in your diet. Recommendations vary, but the National Osteoporosis
Foundation suggests that adults up to age 50 get 1,000 mg of calcium and 400 to
800 IU of vitamin D a day. If you are age 50 or older, the recommended amounts
are 1,200 mg of calcium and 800 to 1,000 IU a day of vitamin D. Your bones need
vitamin D to absorb calcium. One study showed that vitamin D may reduce an
older person's risk of falling by 22%.9 The best
source of vitamin D is exposure to sunlight. Vitamin D is also added to milk,
some calcium supplements, and many multivitamin supplements.
Get
regular exercise. Weight-bearing exercises, such as walking, jogging, stair
climbing, dancing, or lifting weights, keep bones healthy by working the
muscles and bones against gravity.
Medicines called
bisphosphonates, such as alendronate (Fosamax) or
zoledronic acid (Reclast), may be used to slow the rate of bone loss and
increase bone thickness and strength. This will reduce the risk of broken
bones. For more information on bisphosphonates, see:
In some cases,
hormone replacement therapy (HRT) or
estrogen replacement therapy (ERT) is given to women
to slow bone loss from
osteoporosis. But hormone therapy can also increase
the risk of other conditions, including
stroke and
breast cancer. Many experts recommend that long-term
hormone replacement therapy only be considered for women with a significant
risk of osteoporosis that outweighs the risks of taking HRT or ERT.
If your osteoporosis is severe or you continue to have bone loss while
taking a bisphosphonate:
You may need to take both a bisphosphonate
medicine and hormone therapy. Studies show that taking both medicines results
in increased bone mass when compared to taking either alone.17, 18
Your doctor may
prescribe
teriparatide (Forteo). Forteo has been shown to slow
bone loss and increase the rate of new bone growth.19
But Forteo is expensive and requires daily self-injections.
It's important to take calcium and vitamin D supplements
along with any medicines you take for osteoporosis.
Compression fractures resulting from osteoporosis can
cause significant back pain that lasts for several months. Treatments available
to relieve your pain include:
Nonprescription acetaminophen (such as
Tylenol or Panadol).
A pain reliever such as a
narcotic, which may be prescribed on a short-term
basis.
Other medicines such as
calcitonin (Calcimar or Miacalcin) to help decrease
pain from spinal fractures.
A back brace or corset to support the
spine.
One of two surgical treatments,
vertebroplasty or kyphoplasty, may relieve pain from
spinal compression fractures. In these procedures, a
surgeon injects bone cement through a needle into the crushed spinal bones
(vertebrae).
If you experience 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.2
What to think about
Although HRT and ERT have
been used to prevent or slow bone loss, currently they are not recommended for
women as the first choice for prevention or treatment of osteoporosis. But
hormone therapy can also increase the risk of other conditions, including
stroke and
breast cancer. Many experts recommend that long-term
hormone replacement therapy only be considered for women with a significant
risk of osteoporosis that outweighs the risks of taking HRT or ERT.
Because taking estrogen alone increases the risk of developing cancer of
the lining of the uterus (endometrial cancer), ERT is only used if a woman has
had her uterus removed.
Researchers are studying the effects of
low-dose estrogen on women 65 and older. An early small study indicates that a
low estrogen dose (one-quarter that of conventional ERT) may provide the same
benefit (increased bone density and decreased fractures) as the higher dose. In
the same study, about one-third of the women were given the low estrogen dose
and progesterone (because these women had not had hysterectomies). This group
of women also experienced increased bone density. But the long-term risks of
taking low-dose estrogen (and progesterone in one-third of the cases) were not
studied and are unclear.20
It's important
to take calcium and vitamin D supplements along with any medicines you take for
osteoporosis. For more information on taking calcium, see:
After the age of about 30,
bone thinning is a natural process and cannot be
stopped completely. Whether you develop
osteoporosis depends not only on the thickness of your
bones early in life but also on your health, diet, and physical activity later
in life. The thicker your bones, the less likely the bones are to become thin
enough to break. Young women in particular need to be aware of their risk for
developing osteoporosis and take steps early to slow its progress and prevent
complications. Plentiful physical activity during the preteen and teen years
increases bone mass and greatly reduces the risk of osteoporosis in adulthood.
If you eat a diet adequate in
calcium and
vitamin D and exercise regularly early in life and
then continue with these healthy habits, you may be able to delay or avoid
osteoporosis.
Eat a nutritious diet that includes adequate
amounts of calcium and vitamin D. Both are necessary for building healthy,
strong bones. The recommended daily calcium intake for adults up to age 50 is
1,000 mg a day. Men and women age 50 and older need 1,200 mg of calcium each
day. The recommended daily intake for vitamin D is 400 to 800 IU a day for
adults up to age 50. If you are age 50 or older, the recommended amount is 800
to 1,000 IU of vitamin D a day. The best source of vitamin D is exposure to
sunlight. Vitamin D is vital for calcium absorption in bones and to improve
muscle strength. One study showed that vitamin D may reduce an older person's
risk of falling by 22%.9
Take supplements
if you are not getting enough calcium and vitamin D in your diet. Most doctors
suggest daily vitamin D supplements for children and teens, starting by age 2
months. Talk with your doctor about how much and what sources of vitamin D are
right for you and your child.
Get regular exercise. Weight-bearing
exercises, such as walking, jogging, stair climbing, dancing, or weight
lifting, keep bones healthy by working the muscles and bones against
gravity.
Don't drink more than 2 alcohol drinks a day if you are a
man, or 1 alcohol drink a day if you are a woman. Drinking more than this puts
you at higher risk for osteoporosis.
Don't smoke. Smoking puts you
at a higher risk for developing osteoporosis and increases the rate of bone
thinning after it starts.
After osteoporosis develops,
getting enough calcium and
vitamin D, along with other healthy habits, can slow
the process and reduce the chances of bones breaking. It's common for a
person's diet to supply only half the calcium the bones need, so you probably
need to take supplements. Your bones need vitamin D to absorb calcium. One
study showed that vitamin D may reduce an older person's risk of falling by
22%.9
Research studies do not agree about
whether calcium plus vitamin D supplements can prevent fractures. Some studies
show that calcium and vitamin D supplements reduce the risk of
fracture.10 But other studies show little effect of
supplements on fracture risk.11 The greatest benefit of
supplements appears to be for people who have osteoporosis. Calcium and vitamin
D supplements are recommended if you have been diagnosed with
osteoporosis.
Home Treatment
Most adults with
osteoporosis need to take medicine to slow bone loss.
In addition to medicine, there is much you can do to help slow the process and
prevent broken bones:
Get enough calcium. This is one of the
first and then ongoing steps in trying to prevent and treat osteoporosis. If
you are diagnosed with osteoporosis, your recommended daily calcium intake is
1,200 mg. Calcium is found in many foods, including dairy products such as milk
or yogurt. If you think you may not be getting enough calcium in your diet,
take
calcium supplements. Most Americans get only half the
calcium they need from their diet. Research studies do not agree about whether
calcium plus vitamin D supplements can prevent fractures.10, 11 The greatest benefit of supplements
appears to be for people who have osteoporosis. Calcium and vitamin D
supplements are recommended if you have been diagnosed with osteoporosis. For
more information, see:
Get enough vitamin D. Getting enough
vitamin D, along with sufficient calcium, is one of the first steps toward
preventing or reducing the effects of osteoporosis. Vitamin D helps your body
absorb calcium. Taking calcium without vitamin D probably is not beneficial.
Recommendations vary, but the National Osteoporosis Foundation suggests that
adults up to age 50 get 400 to 800 IU of vitamin D a day. If you are age 50 or
older, the recommended amount is 800 to 1,000 IU a day. One glass of milk
[8 fl oz (0.2 L)] has about 100
IU. Your bones need vitamin D to absorb calcium. One study showed that vitamin
D may reduce an older person's risk of falling by 22%.9 Usually 10 to 15 minutes of sun exposure a day is enough to
satisfy the body's vitamin D requirement. But as you age, you cannot make as
much vitamin D through your skin. Vitamin D supplements can help older people
who are not in the sun much.
If you are taking medicines to treat
osteoporosis, also take calcium and vitamin D supplements.
Exercise. Recent studies show that
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 the bone
mineral density and strength of the spine in postmenopausal women. Walking also
increases bone mineral density of the hip.12 Regular
exercise throughout life cuts in half the number of hip fractures in older
people.21 Develop an exercise program that fits your
lifestyle and is easy to follow. For more information, see the topic
Fitness.
Eat a nutritious diet to keep
your body healthy. For more information, see the topic
Healthy Eating.
Take
steps to prevent falls that might result in broken bones. Have your vision and
hearing checked regularly, and wear slippers or shoes with a nonskid sole.
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. For more information, see:
Limit alcohol use.
Heavy alcohol use can decrease bone formation, and it
clearly increases the risk of falling. But some studies show moderate alcohol
use (no more than 2 drinks a day for men and 1 drink a day for a women) is
linked to higher
bone density. Most doctors recommend limiting, but not
eliminating, alcohol use as part of treatment for osteoporosis.5
Stop smoking. Smoking reduces your bone density
and speeds up the rate of bone loss. For information on how to stop, see the
topic
Quitting Smoking.
Experts recommend that you choose calcium 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 tout the benefits of coral calcium as a
superior source of calcium and a cure for disease. There is no scientific
evidence to support these claims.
Medications
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.
If you take medicine for
osteoporosis, you will also need to take calcium and vitamin D supplements, eat
a healthy diet, and exercise regularly. A large part of treating or reducing
the effects of osteoporosis is
getting enough calcium and
vitamin D.
Medication Choices
Medicines for treatment and prevention
Medicines
used to prevent or treat osteoporosis include:
Bisphosphonates, such as alendronate (Fosamax),
ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast),
which slow the rate of bone thinning and can lead to increased bone
density.4 These medicines may be used in men and
women.
Raloxifene (Evista), a selective
estrogen receptor modulator (SERM), which is used only in women. Raloxifene
slows bone thinning and causes some increase in bone thickness.22
Calcitonin (Calcimar or Miacalcin), a
naturally occurring hormone that helps regulate calcium levels in your body and
is part of the bone-building process. When taken by shot or nasal spray, it
slows the rate of bone thinning. Calcitonin also relieves pain caused by
spinal compression fractures. Calcitonin is used in
men and women.
Parathyroid hormone (teriparatide
[Forteo]), used for the treatment of men and postmenopausal women with severe
osteoporosis who are at high risk for bone
fracture. It is given by injection.
Hormone therapy
Hormone therapy for osteoporosis
in women includes:
Estrogen. Estrogen without progestin
(estrogen replacement therapy, or ERT) may be used to treat osteoporosis in
women who have gone through
menopause and do not have a uterus. Because taking
estrogen alone increases the risk of developing cancer of the lining of the
uterus (endometrial cancer), ERT is only used if a woman has had her uterus
removed (hysterectomy).
Estrogen and progestin. In rare cases, the combination of estrogen and progestin
(hormone replacement therapy, or HRT) is recommended for women who have
osteoporosis.
For men,
testosterone (shots, gel, or patches) sometimes is
given to prevent osteoporosis caused by low testosterone levels, although use
of testosterone to treat osteoporosis has not been approved by the U.S. Food
and Drug Administration (FDA).
A woman's level of the hormone
estrogen, which affects the growth and loss of bone, decreases naturally during
and after menopause. Estrogen replacement therapy (ERT) or
combination estrogen/progesterone replacement therapy (HRT) can help
to reduce bone loss. Many experts recommend that long-term hormone replacement
therapy only be considered for women with a significant risk of osteoporosis
that outweighs the risks of taking HRT or ERT.
Researchers are
studying the effects of low-dose estrogen on women age 65 and older. An early,
small study indicates that a low estrogen dose (one-quarter that of
conventional ERT) may provide the same benefit (increased bone density and
decreased fractures) as the higher dose. In the same study, about one-third of
the women were given the low estrogen dose and progesterone (because these
women had not had hysterectomies). This group of women also experienced
increased bone density. But the long-term risks of taking low-dose estrogen
(and progesterone in one-third of the cases) were not studied and are
unclear.20 Experts recommend that HRT or ERT be used at
the lowest dose for the shortest length of time to reach your treatment goals.
While hormone therapy is typically not recommended for most women
with osteoporosis, 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 bisphosphonate medicine, such as risedronate
(Actonel) or alendronate (Fosamax), you may need to take both bisphosphonate
medicine and hormone therapy. Studies show that taking a bisphosphonate with
hormone therapy results in increased bone mass when compared to taking either
medicine alone.17, 18
What To Think About
Calcium, vitamin D,
bisphosphonates, calcitonin, and teriparatide may be used by men or women. HRT,
ERT, and raloxifene are prescribed only for women. Testosterone is prescribed
only for men.
Compression fractures and other broken
bones resulting from osteoporosis can cause significant pain that lasts for
several months. Medicines available to relieve your pain include:
If you are taking medicine but still have pain or have
side effects from the medicine, such as an upset stomach, talk with your
doctor.
Statins are medicines used to treat high
cholesterol, which increases the risk of developing
life-threatening diseases, such as
coronary artery disease, heart attack, and stroke.
Recent studies have reported conflicting results on statins' potential for
lowering a woman's risk of bone fractures. Evidence does not yet support the
use of statins to prevent or treat osteoporosis.23, 24
If you experience a hip fracture due to osteoporosis,
you may need surgery to repair your hip. For more information, see the topic
Hip Fracture.
Other Treatment
Exercise is an important part
of managing
osteoporosis. Your doctor may recommend
physical therapy. Your physical therapist may teach
you how to safely do
weight-bearing exercises, which can slow bone loss.
Exercising will help maintain your muscle strength, which is necessary to avoid
falls. You may also learn exercises to help maintain flexibility and improve
balance.
Hip protectors have been recommended to help prevent hip
fractures from osteoporosis. They look like a girdle or underwear with pads on
both hips. The pads may help reduce the force of a fall. But a summary of
several studies concluded that hip protectors do not prevent hip fractures in
people who live at home. And they may not be helpful for people in nursing
homes or other institutions. 25 One problem with
studying hip protectors is that people do not like wearing them even if they
might help protect the hips. Hip protectors are bulky under clothing. They can
irritate the skin and are hard to fit properly.
Some women use
alternative treatments to try to reduce their risk of osteoporosis. Soy
products may help reduce the chance of broken bones due to osteoporosis. One
large study showed that postmenopausal women who ate an average of 11 grams of
soy protein a day had a lower risk of fracture.26 (As
an 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
Organizations
American Association of Clinical Endocrinologists
(AACE)
1000 Riverside Ave
Suite 205
Jacksonville, FL 32204
Phone:
(904) 353-7878
Fax:
(904) 353-8185
E-mail:
info@aace.com
Web Address:
http://www.aace.com
AACE is a professional community of clinical endocrinologists, who
are physicians primarily in practice and in clinical endocrine research and
academic medicine. AACE provides information on diseases that involve the
endocrine system, such as thyroid disease and osteoporosis.
National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS Web site provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
National Institute on Aging
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892
Phone:
(301) 496-1752 1-800-222-2225, Information Center
Fax:
(301) 496-1072
TDD:
1-800-222-4225 (TTY)
Web Address:
www.nih.gov/nia
The National Institute on Aging (NIA), one of the centers of the
U.S. National Institutes of Health, leads a broad scientific effort to
understand the nature of aging and to extend the healthy, active years of life.
The NIA funds research and provides information about health and research
advances to the public and interested groups.
National Osteoporosis Foundation
(NOF)
1232 22nd Street NW
Washington, DC 20037-1292
Phone:
(202) 223-2226
Web Address:
www.nof.org
The National Osteoporosis Foundation (NOF) funds research and
publishes educational material about osteoporosis for consumers and health
professionals. The NOF also provides information about bone density testing
sites, new treatment, and local groups interested in osteoporosis. The
foundation's mission is to prevent osteoporosis, to promote lifelong bone
health, to help improve the lives of those affected by osteoporosis and related
fractures, and to find a cure.
North American Menopause Society
(NAMS)
P.O. Box 94527
Cleveland, OH 44101-4527
Phone:
(440) 442-7550
Fax:
(440) 442-2660
E-mail:
info@menopause.org
Web Address:
www.menopause.org
The North American Menopause Society (NAMS) is a nonprofit
organization that promotes the understanding of menopause and thereby improves
the health of women as they approach menopause and beyond. NAMS members include
experts from medicine, nursing, sociology, psychology, nutrition, anthropology,
epidemiology, pharmacy, and education. The NAMS Web site has information on
perimenopause, early menopause, menopause symptoms and long-term health effects
of estrogen loss, and a variety of therapies.
Osteoporosis and Related Bone Diseases-National Resource
Center (ORBD-NRC)
The Osteoporosis and Related Bone Diseases-National Resource Center
is a government resource center that helps health professionals, patients, and
the public learn about and locate current information on metabolic bone
diseases such as osteoporosis, Paget's disease, osteogenesis imperfecta, and
hyperparathyroidism.
Anderson JJB (2008). Nutrition and bone health. In LK
Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, pp. 614-635. St. Louis: Saunders Elsevier.
Feldstein A, et al. (2003). Bone mineral density
measurement and treatment for osteoporosis in older individuals with fractures.
Archives of Internal Medicine, 163(18):
2165-2172.
Cummings SR (2002). Bone biology, epidemiology, and
general principles. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 3-25.
Philadelphia: American College of Physicians-American Society of Internal
Medicine.
American College of Obstetricians and Gynecologists
(2004, reaffirmed 2008). Clinical management guidelines for
obstetrician-gynecologists. Osteoporosis. ACOG Practice Bulletin No. 50.
Obstetrics and Gynecology, 103(1): 203-216.
Nieves J (2002). Nutrition. In SR Cummings et al.,
eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 85-108. Philadelphia: American College of
Physicians-American Society of Internal Medicine.
Tucker KL, et al. (2006). Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham osteoporosis study. American Journal of Clinical Nutrition, 84(4): 936-942.
U.S. Preventive Services Task Force (2002). Screening
for osteoporosis in postmenopausal women: Recommendations and rationale.
Annals of Internal Medicine, 137(6):
526-528.
Qaseem A, et al. (2008). Screening for osteoporosis in
men: A clinical practice guideline from the American College of Physicians.
Annals of Internal Medicine, 148(9):
680-684.
Bischoff-Ferrari HA, et al. (2004). Effect of vitamin
D on falls: A meta-analysis. JAMA, 291(16):
1999-2006.
Mosekilde L, et al. (2008). Fracture prevention in
postmenopausal women, search date January 2007. Online version of
BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Jackson RD, et al. (2006). Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine, 354(7): 669-683.
Bonaiuti D, et al. (2006). Exercise for preventing and
treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
National Osteoporosis Foundation (2008).
Prevention. Available online:
www.nof.org/prevention/index.htm.
Cummings SR, Melton LJ III (2002). Epidemiology and
outcomes of osteoporotic fractures. Lancet, 359(9319):
1761-1767.
Silverman SL (2002). Calcitonin. In SR Cummings et
al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 197-208. Philadelphia: American College of
Physicians-American Society of Internal Medicine.
Cosman F (2002). Selective estrogen-receptor
modulators. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 151-167.
Philadelphia: American College of Physicians-American Society of Internal
Medicine.
Harris ST, et al. (2001). Effect of combined
risedronate and hormone replacement therapies on bone mineral density in
postmenopausal women. Journal of Clinical Endocrinology and Metabolism, 86(5): 1890-1897.
Greenspan SL, et al. (2003). Combination therapy with
hormone replacement and alendronate for prevention of bone loss in elderly
women. JAMA, 289(19): 2525-2533.
U.S. Food and Drug Administration (2002). FDA approves
teriparatide to treat osteoporosis. FDA Talk Paper T02-49. Available online:
http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01176.html.
Prestwood KM, et al. (2003). Ultralow-dose micronized
17 B-estradiol and bone density and bone metabolism in older women.
JAMA, 290(8): 1042-1048.
Fiechtner JJ (2003). Hip fracture prevention.
Postgraduate Medicine, 114(3): 22-32.
Drugs for postmenopausal osteoporosis (2008).
Treatment Guidelines From the Medical Letter, 6(74):
67-74.
LaCroix AZ, et al. (2003). Statin use, clinical
fracture, and bone density in postmenopausal women: Results from the Women's
Health Initiative Observational Study. Annals of Internal Medicine, 139(2): 97-104.
Bauer DC, et al. (2004). Use of statins and fracture:
Results of 4 prospective studies and cumulative meta-analysis of observational
studies and controlled trials. Archives of Internal Medicine, 164(2): 146-152.
Parker MJ, et al. (2006). Effectiveness of hip
protectors for preventing hip fractures in elderly people: Systematic review.
BMJ, 332(7541): 571-574.
Zhang X, et al. (2005). Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Archives of Internal Medicine, 165(16): 1890-1895.
Other Works Consulted
American Association of Clinical Endocrinologists
(2003). Medical guidelines for clinical practice for the prevention and
treatment of postmenopausal osteoporosis. Endocrine Practice, 9(6): 544-564.
Cummings SR (2002). Bone biology, epidemiology, and
general principles. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 3-25.
Philadelphia: American College of Physicians-American Society of Internal
Medicine.
Heiss G, et al. (2008). Health risks and benefits 3
years after stopping randomized treatment with estrogen and progestin.
JAMA, 299(9): 1036-1045.
Holt EH (2008). Diseases of calcium metabolism and
metabolic bone disease. In DC Dale, DD Federman, eds., ACP Medicine, section 3, chap. 6. Hamilton, ON: BC Decker.
Liu H, et al. (2008). Screening for osteoporosis in
men: A systematic review for an American College of Physicians guideline.
Annals of Internal Medicine, 148(9):
685-701.
MacLean C, et al. (2008). Systematic review:
Comparative effectiveness of treatments to prevent fractures in men and women
with low bone density or osteoporosis. Annals of Internal Medicine, 148(3): 197-213.
Qaseem A, et al. (2008). Pharmacologic treatment of
low bone density or osteoporosis to prevent fractures: A clinical practice
guideline from the American College of Physicians. Annals of Internal Medicine, 149(6): 404-415.
Vondracek SF, Hansen LB (2004). Current approaches to
the management of osteoporosis in men. American Journal of Health-System Pharmacists, 61(17): 1801-1811.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Anderson JJB (2008). Nutrition and bone health. In LK
Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, pp. 614-635. St. Louis: Saunders Elsevier.
Feldstein A, et al. (2003). Bone mineral density
measurement and treatment for osteoporosis in older individuals with fractures.
Archives of Internal Medicine, 163(18):
2165-2172.
Cummings SR (2002). Bone biology, epidemiology, and
general principles. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 3-25.
Philadelphia: American College of Physicians-American Society of Internal
Medicine.
American College of Obstetricians and Gynecologists
(2004, reaffirmed 2008). Clinical management guidelines for
obstetrician-gynecologists. Osteoporosis. ACOG Practice Bulletin No. 50.
Obstetrics and Gynecology, 103(1): 203-216.
Nieves J (2002). Nutrition. In SR Cummings et al.,
eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 85-108. Philadelphia: American College of
Physicians-American Society of Internal Medicine.
Tucker KL, et al. (2006). Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham osteoporosis study. American Journal of Clinical Nutrition, 84(4): 936-942.
U.S. Preventive Services Task Force (2002). Screening
for osteoporosis in postmenopausal women: Recommendations and rationale.
Annals of Internal Medicine, 137(6):
526-528.
Qaseem A, et al. (2008). Screening for osteoporosis in
men: A clinical practice guideline from the American College of Physicians.
Annals of Internal Medicine, 148(9):
680-684.
Bischoff-Ferrari HA, et al. (2004). Effect of vitamin
D on falls: A meta-analysis. JAMA, 291(16):
1999-2006.
Mosekilde L, et al. (2008). Fracture prevention in
postmenopausal women, search date January 2007. Online version of
BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Jackson RD, et al. (2006). Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine, 354(7): 669-683.
Bonaiuti D, et al. (2006). Exercise for preventing and
treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
National Osteoporosis Foundation (2008).
Prevention. Available online:
www.nof.org/prevention/index.htm.
Cummings SR, Melton LJ III (2002). Epidemiology and
outcomes of osteoporotic fractures. Lancet, 359(9319):
1761-1767.
Silverman SL (2002). Calcitonin. In SR Cummings et
al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 197-208. Philadelphia: American College of
Physicians-American Society of Internal Medicine.
Cosman F (2002). Selective estrogen-receptor
modulators. In SR Cummings et al., eds., Osteoporosis: An Evidence-Based Guide to Prevention and Management, pp. 151-167.
Philadelphia: American College of Physicians-American Society of Internal
Medicine.
Harris ST, et al. (2001). Effect of combined
risedronate and hormone replacement therapies on bone mineral density in
postmenopausal women. Journal of Clinical Endocrinology and Metabolism, 86(5): 1890-1897.
Greenspan SL, et al. (2003). Combination therapy with
hormone replacement and alendronate for prevention of bone loss in elderly
women. JAMA, 289(19): 2525-2533.
U.S. Food and Drug Administration (2002). FDA approves
teriparatide to treat osteoporosis. FDA Talk Paper T02-49. Available online:
http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01176.html.
Prestwood KM, et al. (2003). Ultralow-dose micronized
17 B-estradiol and bone density and bone metabolism in older women.
JAMA, 290(8): 1042-1048.
Fiechtner JJ (2003). Hip fracture prevention.
Postgraduate Medicine, 114(3): 22-32.
Drugs for postmenopausal osteoporosis (2008).
Treatment Guidelines From the Medical Letter, 6(74):
67-74.
LaCroix AZ, et al. (2003). Statin use, clinical
fracture, and bone density in postmenopausal women: Results from the Women's
Health Initiative Observational Study. Annals of Internal Medicine, 139(2): 97-104.
Bauer DC, et al. (2004). Use of statins and fracture:
Results of 4 prospective studies and cumulative meta-analysis of observational
studies and controlled trials. Archives of Internal Medicine, 164(2): 146-152.
Parker MJ, et al. (2006). Effectiveness of hip
protectors for preventing hip fractures in elderly people: Systematic review.
BMJ, 332(7541): 571-574.
Zhang X, et al. (2005). Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Archives of Internal Medicine, 165(16): 1890-1895.
