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Frequently Asked Questions

1. What Causes Osteoporosis?

Bones may seem like hard and lifeless structures, but they are in fact living tissue. Old bone is constantly broken down (through a process called bony resorption) by our bodies, and new bone is deposited. Any time bone is broken down faster than it is deposited, low bone mass (osteopenia) and osteoporosis can occur.

2. What are the Symptoms of Osteoporosis?

In many people, low bone mass (osteopenia) and osteoporosis occur without any symptoms. In people with osteoporosis, a simple everyday movement, such as picking up a grocery bag, can cause a sudden onset of back pain, and that can be the first symptom. As osteoporosis progresses over a period of time, the bones in the spine (vertebrae) can begin to collapse. Collapsed vertebrae may be felt as severe back pain or seen as loss of height or spine deformities such as a hunchback (dowager's hump). The most common bones broken in osteoporosis are the hip, spine, wrist, and ribs, although any bone in the body can be affected by osteoporosis and can break.

3. When Does Osteoporosis Occur?

Osteoporosis can occur at any age. However, it is more common in people older than 50 years, and the older a person is, the greater the risk is of osteoporosis. This is because during childhood and teenage years, new bone is generally added faster than old bone is removed. This is the time when a diet rich in calcium, phosphate, and vitamin D is important. As a result, bones become larger, heavier, and denser. Maximum bone density and strength is reached at age 20-25 years. The density and strength of the bones is fairly stable from age 25-45. A slight loss of bone density begins to occur after age 30 because bone slowly begins to break down (a process called resorption) faster than new bone is formed. For women, bone loss is fastest in the first few years after menopause, but it continues gradually into the postmenopausal years. As bone density loss occurs, osteoporosis can develop. This process is slower by 10 years in men.

4. Who is at Risk for Osteoporosis?

Certain risk factors are associated with developing osteoporosis. Many people with osteoporosis have several risk factors, but some people with osteoporosis have none. Some risk factors cannot be changed. These include the following:

  • Sex: Women are more likely to develop osteoporosis than men.
  • Age: The older a person is, the greater the risk of osteoporosis.
  • Physical build: People who are small and have thin bones are at greater risk.
  • Race: White and Asian women are at the highest risk.
  • Family history: If a person's parents had osteoporosis, he or she may be at risk.

Some risk factors can be modified. These include the following:

  • Levels of sex hormones: Low estrogen in women and low testosterone in men are associated with osteoporosis.
  • Anorexia, diet: Diets low in calcium, phosphate, and vitamin D are risk factors.
  • Use of medications: Glucocorticoids, which are medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn disease, lupus, and other diseases, can cause osteoporosis.
  • Inactive lifestyle
  • Cigarette smoking
  • Excessive alcohol intake

For more information, see Prevention of Osteoporosis, Bone Mineral Density Tests, and Osteoporosis in Men. You can also take the 1-minute osteoporosis risk test from the International Osteoporosis Foundation.

5. How is Osteoporosis Detected?

Unfortunately, many people do not know they have osteoporosis until they experience a broken bone. By that time, bones are already weak. However, osteoporosis can be prevented or delayed by early detection and treatment. Specialized tests called bone density tests can measure bone density (solidness) in various sites of the body, such as the hip, spine, and wrist. These tests are quick (taking less than 15 minutes), painless, and noninvasive. A bone density test can detect osteoporosis before a fracture occurs and can predict your chances of having a broken bone in the future. A dual-energy x-ray absorptiometry (DXA) scan of bone mineral density (BMD) can determine your rate of bone loss and/or monitor the effects of treatment. Talk to the doctor about these tests.

6. How Can Osteoporosis Be Prevented?

Osteoporosis is prevented by reaching the peak bone mass (maximum bone density and strength) during the childhood and teenage years and by continuing to build more bone as one gets older, particularly after the age of 30. A few things that can be done to maintain healthy bone are as follows:

  • Get enough calcium and vitamin D by drinking milk or eating milk products.
  • Exercise
  • Do not smoke
  • Avoid excessive intake of alcohol

Be aware that long-term use of some medications such as glucocorticoids (medications prescribed for a wide range of diseases, including arthritis, asthma, Crohn disease, lupus, and other diseases of the lungs, kidneys, and liver) can lead to a loss of bone density. Contact the treating doctor to discuss either prevention or treatment of osteoporosis under these circumstances.

Other drugs that can cause bone loss include certain antiseizure drugs, such as phenytoin (Dilantin) and barbiturates; gonadotropin-releasing hormone (GnRH) analogs used to treat endometriosis; excessive use of aluminum-containing antacids; certain cancer treatments in both men and women; and excessive thyroid hormone. Talk to the doctor. Also, talk to the doctor about the many medications that are available to delay or prevent osteoporosis (see Prevention of Osteoporosis and Osteoporosis and Calcium).

7. How is Osteoporosis Treated?

Osteoporosis treatment includes both lifestyle changes and medications. Treatment programs focus on nutrition, exercise, and safety issues to prevent falls that may result in broken bones (see Fall Prevention and Osteoporosis). The doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk. Available oral medications (pills) include alendronate (Fosamax), raloxifene (Evista), and risedronate (Actonel) for preventing and treating postmenopausal osteoporosis. Teriparatide (Forteo) is a self-injectable medication used to treat osteoporosis in postmenopausal women and men. Alendronate can also be used to treat osteoporosis in men. Glucocorticoid-induced osteoporosis is treated by alendronate and risedronate in men and women (see Understanding Osteoporosis Medications).

Other medications, including estrogen or hormone replacement therapy (ET/HRT), are used to prevent postmenopausal osteoporosis (see Hormone Replacement and Osteoporosis), and calcitonin is approved for treatment. Talk to the doctor about these medications.

8. How do I know I have a fracture?

There will be severe pain and swelling at the site of fracture. An x-ray will help in confirming the fracture.

9. How much calcium and vitamin D do I need each day?

To keep your bones strong, be sure to consume adequate amounts of calcium and vitamin D. Women over age 50 should consume 1,200 milligrams (mg) of calcium daily. Men between the ages of 51 and 70 should consume 1,000 mg of calcium a day, and men over 70 should consume 1,200 g per day. This can be done by eating calcium-rich foods and taking calcium supplements.

10. Which exercises are best for bone health?

Exercise can make bones and muscles stronger and help slow the rate of bone loss. It is also a way to stay active and mobile. Weight-bearing exercises, done three to four times a week, are best for preventing osteoporosis. Walking, jogging, playing tennis, and dancing are examples of weight-bearing exercises. Strengthening and balance exercises may help you avoid falls and reduce your chances of breaking a bone.