Understanding the Basics of Osteoporosis
Now that you can see some of the dramatic, as well as subtle, symptoms of osteoporosis, it’s time to learn a little bit more about the disease itself, including the stages of the disease and the different forms the condition can take.
Before you get osteoporosis, you experience osteopenia. The sad thing is, many people don’t know what osteopenia is, although we all know what osteoporosis is!
Much like prediabetes is the precursor to type 2 diabetes, osteopenia is the precursor to osteoporosis. In fact, WebMD defines osteopenia as “a midpoint between having healthy bones and having osteoporosis. Osteopenia is when your bones are weaker than normal but not so far gone that they break easily.”
Essentially, it is the weakening of your bones before you get osteoporosis. However, you can prevent it from occurring. You can also develop osteopenia, and through self-care and nutrition you may never go on to get osteoporosis!
Most people who get osteopenia get it around the age of 50, but it can happen earlier if your bones aren’t naturally dense. It can also occur later (or again, not at all).
Primary vs. Secondary Osteoporosis
If your osteopenia progresses to osteoporosis, you may experience one of two types of osteoporosis – primary osteoporosis or secondary osteoporosis.
Primary is a systemic condition and is usually age-related, but can also have a genetic component. When it occurs in young people, it is often due to a poor bone formation or an alteration in the natural bone development and resorption cycle.
While primary osteoporosis develops independently of other conditions, secondary osteoporosis occurs as a direct result of poor nutrition, illness or other factors. Medication can sometimes cause secondary osteoporosis to develop.
Secondary osteoporosis may occur independently from primary osteoporosis, or it may be present in addition to primary osteoporosis.
Who Is at Risk for Developing Osteoporosis?
The risk of developing osteoporosis varies greatly and depends upon many controllable and uncontrollable factors.
There are a variety of risk factors that can increase your chances of developing both osteopenia and osteoporosis. Some of these are unchangeable, such as your gender. Others are modifiable, such as your diet. Let’s take a look.
Unchangeable Risk Factors
- Gender – Women are more likely than men to develop osteoporosis. In fact, according to the IOF, “Worldwide, 1 in 3 women over age 50 will experience osteoporotic fractures, as will 1 in 5 men aged over 50.”
- Age – as you age, your chances of developing osteoporosis increases. According to the IOF, “Osteoporosis is estimated to affect 200 million women worldwide [with] approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90.”
- Race – if you’re white or Asian descent, you have the highest chance of developing osteoporosis.
- Family history – having a family history of osteoporosis increases your risk, especially if your mother or father sustained a hip fracture.
Medical Conditions That May Cause Osteoporosis
People with certain medical conditions and who have too much or too little of certain hormones are at increased risk for developing osteoporosis.
- Sex hormones – having decreased sex hormones can be detrimental to bone strength. In women, the reduction of estrogen during menopause is a risk factor. In men, a decrease in testosterone during aging can increase the risk. Also, treatments for prostate cancer and breast cancer can accelerate bone loss.
- Hyperthyroidism – having a thyroid gland which produces too much thyroid hormone can speed up bone loss. Also, having an underactive hormone and taking too much thyroid medication can have the same effect.
- Having certain illnesses seems to be associated with an increase in bone loss, perhaps because of the medications that are prescribed to treat the illnesses. They are often treated with corticosteroids (such as prednisone) which can increase the risk of a hip fracture in women twofold in women and 2.6-fold in men if used long-term. These illnesses include:
- Rheumatoid arthritis
- Celiac disease
- Inflammatory bowel disease
- Multiple myelomas
- Kidney or liver disease
- Diet and Lifestyle
- Low calcium intake – if you have had a low calcium intake for a long time, this can this can play a part in the development of osteoporosis.
- Eating disorders – having an eating disorder with severely restricted food intake is known to weaken bones in both men and women. According to the IOF, women with eating disorders and women who are elite athletes may “experience amenorrhea which makes them at risk for low bone mass and fractures.”
- Gastrointestinal surgery – having had a GI surgery to reduce the size of the stomach or to remove a portion of the intestine reduces the surface area that is available to absorb nutrients – namely calcium, which is important for bones.
- Sedentary lifestyle – being sedentary (meaning that you spend more time sitting than being active) have an increased risk for osteoporosis. Why? Because people who are active are typically doing weight-bearing activities that are known to build bone, as well as promoting posture and balance.
- Smoking – smoking is known to increase the risk of osteoporosis, although the exact mechanism isn’t exactly understood. It is known that the risk is even more pronounced with increasing age.
- Alcoholism – excessive alcohol intake increases the risk for osteoporosis. In fact, drinking four alcoholic beverages per day doubles the risk of hip fractures.
How Your Doctor May Diagnose Osteoporosis
The National Osteoporosis Foundation recommends that anyone who meets the following criteria is screened for osteoporosis, using bone mineral density testing:
- All women over 65
- Postmenopausal women under 65 with specific risk factors
- At menopause, if undecided about hormone replacement therapy
- Abnormal spinal X-rays
- Long-term use of steroids
Dual-energy X-ray absorption scan (DEXA scan) is often considered the “gold standard” when it comes to screening for osteoporosis; it is simple, noninvasive, and has limited radiation exposure. The test entails a low-energy X-ray be passed through a bone (often the spine, hip, or wrist).
Values are then generated and are compared to:
- Young adult population: This is called the “T score” and measures the variance between the patient and the young adult baseline. A score above -1 is considered normal, while a score between -1 and -2.5 is osteopenia and below -2.5 is osteoporosis.
- Age and gender-matched population: This is called the “Z score” and measures the variance between the patient and control groups of similar age and gender. Very high or very low scores indicate further testing.
Early stage osteoporosis does not cause noticeable osteoporosis symptoms, so diagnostic testing is relied on to identify the condition. At least 25 percent of bone mass must be lost before osteoporosis is detectable by regular X-rays.
The painless tests only take a few minutes, yet they can detect early changes so effective interventions may be promptly initiated to preserve bone mass. A wide array of osteoporosis treatments are able to prevent and sometimes reverse osteoporosis effectively, so this testing is critical to salvaging bone mass.
Keep Your Bones Healthy
Screening for osteoporosis is quick and easy. Follow your healthcare practitioner’s recommendations for screening and other measures you can take so osteoporosis will not affect your quality of life now or in the years to come.
If you want to keep your bones strong and healthy for years to come, consider the following tips:
Take Your Calcium Through Your Food
Calcium supplements are not as effective as researchers once thought regarding preventing bone fractures and improving bone strength. However, eating whole foods that are rich in bone-building nutrients like calcium has been shown to be effective at strengthening and protecting your bones.
Some of the best calcium-rich foods if you have osteoporosis include:
- Fatty fish
- Dark green leafy vegetables
Weight-bearing exercise increases bone strength. It also can help you develop a healthier posture and better balance, thereby reducing your risk of falls (and the injury risks related to falls).
If you smoke, this is a good reminder to talk to your doctor about ways to quit the habit. Smokers lose bone mineral much faster than non-smokers. The World Health Organization warns that hip fractures among smokers are 71 percent higher at age 80 compared to non-smokers.
You can talk to your doctor about medication-based options for defeating osteoporosis. Examples include hormone-based drugs, bisphosphonates, denosumab, and teriparatide. There are many effective medications on the market, so it’s important to work closely with your doctor to get your bone health tested and treated through a wide range of options.