Osteoporosis (meaning porous bones in Latin) is a thinning of the bones, which makes them fragile and brittle so that they fracture easily.
Bone tissue constantly "remodels" itselflays down calcium and then releases and replaces itbut for most of adult life there is an equilibrium: calcium is laid down and released without apparent change in bone density. However, at about age 35 for women and slightly later for men, bone density begins to decrease.
This doesn’t mean that the bone is diseased or abnormal. It just means there’s less of it: when new bone forms, it’s less dense. The body continues to remove calcium from the bone storehouse, but as people age some of this calcium is not replaced.
Although osteoporosis can affect men, it’s about eight times more common in women. For both men and women, the main risk factor is age: the disease usually becomes detectable in people in their 60s, 70s, and beyond. About 1.5 million older Americans suffer fractures each year owing to osteoporosis. It can also result in a decrease in height because of the compression of the vertebrae, and it causes the stooped posture known as dowager’s hump. It’s a major cause of disability among older women.
Like hypertension, osteoporosis has been called a silent disease: you may not be aware of it until you fall and fracture a bone. Today, there are medications that can halt the course of the disease, and may even reverse it to some extent. But prevention is the best line of defense.
Symptoms of Osteoporosis
- Lower-back pain
- A gradual loss of height; a stooping posture
- Sometimes no obvious symptoms until a bone breaks, typically the hip, arm, or wrist
What Causes Osteoporosis?
Gender may be the most important factor in bone maintenance. The sex hormones (testosterone in men, estrogen in women) are a major influence on calcium uptake by bone tissue and thus skeletal strength. Other hormones aid in the release of calcium and the breakdown of bone mass.
In this respect women are at a disadvantage. They begin life with less bone mass, on average, than men. Then at menopause, usually around the age of 50, a woman’s supply of the hormone estrogen decreases, and her bone loss becomes more rapid than a man’s.
Nutritional factors—the intake of calcium and vitamin D, as well as other nutrients whose function in bone building is not fully understood—also play an important role in formation and loss of bone mass.
Another factor is physical activity: a lack of it can hasten the onset of osteoporosis. Bones respond to mechanical stress by becoming denser and stronger. Without the stress that comes primarily from weight-bearing activity such as walking, in which your legs support your body, and from strength-building activity (such as weight lifting), your bones will eventually grow weaker.
Another influence on bone is genetics. Asian and white women tend to be small-boned, which makes them susceptible to osteoporosis. African and many African-American women tend to have more bone mass throughout life (which is a protective genetic trait), though that does not mean they never develop osteoporosis.
Certain lifestyle habits, such as smoking and alcohol consumption, have also been identified as risk factors. The long-term use of certain medications, including antiseizure drugs and glucocorticoids (which are used to treat a wide range of disorders), can also lead to bone loss.
What Puts You at Risk: A Checklist
Of the risks listed here, the more you have, the greater your chances of developing osteoporosis.
- Increasing age
- Lack of physical activity
- Being female. By age 65, the average man still has 91 percent of his bone mass, but the average woman only about 74 percent.
- Early menopause before the age of 45
- Being chronically underweight or having a slight frame
- Being white or Asian (usually small-boned)
- Having osteoporosis in the family
- Eating a poor diet, low in vitamins and minerals, especially calcium
- Being sedentary, and failing to get enough weight-bearing exercise
- Smoking. In women smoking cigarettes lowers the estrogen content of the blood, thus weakening the bones. Smoking is particularly dangerous for women who have other risk factors for osteoporosis.
- Heavy drinking. It’s not known why heavy drinking weakens the bones—perhaps because heavy drinkers often eat a poor diet.
- Long-term use of certain medications. Some people with asthma and rheumatoid arthritis take glucocorticoid medications for long periods, which can diminish bone strength. So can long-term use of excessive thyroid hormone.
- Health conditions such as rheumatoid arthritis, chronic liver and kidney disease, thyroid disease, celiac disease, Crohn’s disease and other inflammatory bowel conditions
What If You Do Nothing?
If you have osteoporosis and do nothing to stop the loss of bone, the condition will worsen and can have serious implications for your health.
Home Remedies for Osteoporosis
There is no cure for osteoporosis nor are there any remedies, but you can take steps to slow down and even reverse some of the bone loss. These include exercise and dietary measures as well as medication. You should discuss available options with your doctor.
Unfortunately, many women think they don’t have to start worrying about osteoporosis until menopause. This a myth. Research shows that certain lifelong habits are the best preventive for osteoporosis. You can’t do much about small frame size or hereditary factors that put you at risk—but that’s all the more reason to take preventive steps.
It’s best to begin a prevention program in childhood or early adulthood, when bone density is on the increase. The more bone you build early in life, the better you will be able to withstand bone loss later in life. But even if you’ve waited until your 40s, 50s, or 60s, there is still plenty of reason to follow a preventive program.
- Consume enough calcium. Besides building strong bones and maintaining bone density and strength, calcium also plays a role in regulating your heartbeat and other vital functions. Adults up to age 50, including pregnant or lactating women, are advised to consume at least 1,000 milligrams daily. The goal for postmenopausal women should be 1,200 to 1,500 milligrams. Similar increases in calcium consumption for men are important as well, especially for men over 65, who should also try to consume 1,200 to 1,500 milligrams of calcium daily.
- Many dark green leafy vegetables are rich in calcium. But the favorite food source of calcium for most Americans remains low-fat or nonfat dairy products. The vitamin D added to milk and the lactose naturally in milk and dairy products are thought to aid in the absorption of calcium. Many people may also need to take calcium supplements to meet the daily recommended amounts.
- If you’re a woman on hormone replacement therapy, calcium is still important: estrogen enhances bone strength, as does an adequate calcium intake, but the beneficial effect of the two combined is greater than the sum of the effects of each alone. That was the conclusion of a review of 31 studies on the subject in the American Journal of Nutrition.
- Include other bone-building nutrients in your diet. Many vitamins and minerals—including vitamins C, K, and D, magnesium, and potassium—either contribute directly to bone formation or help bones retain and utilize calcium. You can find these nutrients in a diet rich in fruits, whole grains, and vegetables as well as in dairy products and fortified cereals. A daily multivitamin/ mineral is also recommended for most people.
- Make weight-bearing exercise part of your daily life. That means walking, running, dancing, or weight lifting—or activities such as housework or mowing. Swimming and yoga are not weight-bearing exercises and thus don’t build bones, though they have other benefits.
- If you smoke, stop. Do so not only for the strength of your bones but for your general health and well-being.
- If you drink, do so moderately. Light to moderate drinking is defined as an average of no more than one drink a day for women, two a day for men. One “drink” is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80-proof liquor (all contain about half an ounce of pure alcohol).
- If you are menopausal, consider hormone replacement therapy (HRT). This consists of low-dose estrogen and progesterone treatments that can unquestionably slow bone loss and prevent fractures as well as reduce hot flashes and other menopausal problems. The added progesterone also reduces the risk of endometrial cancer. Estrogen probably protects against heart disease, though the evidence is controversial.
- HRT, if used to prevent osteoporosis, should be started at menopause—when bone loss greatly accelerates—for maximum effect. But it can still have a beneficial effect even if started years later.
- Only you, in consultation with your doctor, can decide whether HRT is appropriate for your health. Some women do very well without HRT, which has its downside, too. If you have one or more risk factors for osteoporosis, you should consider HRT.
- Consider nonhormonal medications for osteoporosis. A number of prescription drugs that slow or stop bone loss or increase bone density have been approved by the Food and Drug Administration (FDA) for both treatment and prevention of osteoporosis. These provide alternatives to HRT, and some have been approved for use by men.
- Whether you opt for one of these medications or for HRT, don’t neglect modifying other risk factors such as exercise and calcium intake.
- Reduce or avoid caffeine intake. A large amount of caffeine may increase the risk of osteoporosis.
Men Need Strong Bones, Too
Most people think of osteoporosis as a disease affecting only women, but in fact men do suffer from bone loss as they age. In the United States, one-quarter of all hip fractures—about 80,000 per year—occur in men, usually at advanced ages.
The bone loss is linked to decreased testosterone production, which occurs gradually in men, but since they generally have denser bones to begin with, bone loss in men is not sudden or dramatic compared to the loss in women. By age 70, men will have lost, on average, one-seventh of their bone mass, but the loss does not usually produce symptoms in men until age 75 and older. About one in every eight men will suffer some kind of bone fracture caused by bone thinning, and such injuries can lead to disability or even death in the very elderly. Occasionally osteoporosis occurs early in men—those in their 50s and 60s may develop brittle bones, depending on various factors.
The men most likely to suffer bone loss include white men and those who eat a diet deficient in calcium; advancing age and a family history of osteoporosis are also significant risk factors. Those with chronic low levels of testosterone (impotence and the lack of erections during sleep may be signs of low testosterone) are also at risk.
Following the preventive steps on these pages should help ensure the preservation of strong bones in men. Some doctors are prescribing testosterone replacement therapy for men. However, virtually nothing is known about its long-term effects, including whether the therapy will actually halt bone loss.
Beyond Home Remedies: When To Call Your Doctor
Contact your doctor if you develop chronic pain in your spine, ribs, or feet after a strain or other injury. The doctor needs to rule out a bone fracture and can evaluate you for osteoporosis.
What Your Doctor Will Do
After a careful examination, your physician may recommend any of several techniques available for measuring bone density. A noninvasive 10-minute test called DEXA (for dual energy x-ray absorptiometry) can be used to measure the bone density of your hips and spine. Generally, the test—which delivers a very small radiation dose—is a good idea for women at high risk. Nobody recommends that all women be tested.
A test, called Sahara, uses high-frequency sound waves, rather than radiation, to measure bone in the heel, and from the measurements estimate fracture risk in other locations. The test is both cheaper and easier to perform than DEXA.
If test results indicate evidence of osteoporosis, your doctor will begin more aggressive steps to slow down or stop the loss of bone mass. A calcium-rich diet and/or supplements will be recommended, as will a weight-bearing exercise program, including walking, jogging, dance, or weight training.
If you are through menopause, HRT may be recommended. If you decide against, or cannot undertake, HRT, long-term daily use of a prescription medication such as raloxifene (Evista), alendronate (Fosamax), or risedronate (Actonel) may be recommended to promote bone density and rebuild bone. Alendronate and risedronate have been approved for prevention and/or treatment of osteoporosis in some men as well as in women. When used for prevention, these medications are intended only for people who are at high risk for osteoporosis. Make sure you understand the risks and benefits of any medication and that your physician monitors your progress.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media