Osteoporosis is characterized by a loss of bone mass due to an imbalance of bone formation and bone resorption. Affected bones become porous and brittle and susceptible to fractures. The wrists and hips, and vertebrae in the spine are the most common fracture sites. The disorder is very common among people over age 70; it affects women four times more often than men, owing to hormonal changes that occur with menopause.

Symptoms of Osteoporosis

• Usually no symptoms.

• Lower back pain is usually the result of a vertebral fracture.

• Gradual loss of height and stooping posture.

• Wrist, hip, or vertebral fractures.

What Causes Osteoporosis?

• Some degree of loss of bone mass is a normal consequence of aging, but a number of factors hasten osteoporosis: reduced estrogen levels after menopause; dietary calcium deficiency; physical inactivity; smoking; excessive alcohol use; and being underweight.

• Hereditary factors may be involved. For example, white women have a higher incidence of osteoporosis than others.

• Osteoporosis may occur as a consequence of an underlying condition, such as hyperthyroidism, hyperparathyroidism, premature menopause (before age 45), hypogonadism in men (testosterone deficiency), chronic lung diseases, and Cushing’s disease (excessive production of corticosteroids by the adrenal glands). It may also arise from long-term use of corticosteroid drugs or heparin (an anticoagulant).

Prevention of Osteoporosis

• Hormone replacement therapy (HRT) is highly effective in preventing osteoporosis in postmenopausal women. (Women without a uterus can take estrogen without a progestational agent, termed estrogen replacement therapy, or ERT.) HRT can also slow the progress of osteoporosis. However, HRT has been found to increase the risk of breast cancer and cardiovascular events such as heart attack when taken for several years. Therefore, women who are concerned about bone loss should consider alternate forms of prevention or treatment in consultation with their doctor.

• A diet rich in calcium and vitamin D protects against osteoporosis. Older men and postmenopausal women should get 1,500 milligrams of calcium and 600 to 800 IU of vitamin D daily through diet and supplements.

• Regular weight-bearing exercise is important.

• For women at high risk, medications known as bisphosphonates—which include Fosamax (alendronate), Actonel (risedronate), and Boniva (ibandronate)—have been approved for the prevention of osteoporosis. These drugs act to slow bone resorption. Evista (raloxifene), a drug that provides some of the benefits of HRT without its drawbacks, is also approved for prevention.

Diagnosis of Osteoporosis

• Patient history and physical examination.

• Bone density scan.

• Blood or urine tests, and rarely, a bone biopsy to detect or rule out other causes of bone loss.

• X-rays or other imaging tests, such as CT (computed tomography) scans. Routine x-rays, however, do not detect osteoporosis until 25 percent or more bone mass has been lost.

How To Treat Osteoporosis

• Bisphosphonate therapy (see Prevention) is effective at slowing the progression of osteoporosis. Evista is also used in treatment. A newer drug approved for treatment, Forteo (teriparatide), is different from previous medications in that it stimulates bone formation rather than preventing bone resorption.

• Calcium supplements may be advised.

• High doses of calcitonin (a hormone that regulates the body’s calcium usage) can slow bone loss and possibly add bone mass.

• Exercise and physical therapy may preserve function.

When To Call A Doctor

• Consider being screened for osteoporosis if you have a family history, are a woman over 65, are considering HRT, or have experienced a nontraumatic fracture.

• See a doctor with any symptoms of osteoporosis.

• If you have osteoporosis and pain develops after any strain or injury, call a doctor immediately.

For more information on osteoporosis and related conditions, click on this link -- Johns Hopkins Health Alerts: Back Pain and Osteoporosis

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