Osteoporosis: Causes, Symptoms, and Treatment

Bone loss and fractures often occur in aging adults, though other factors can increase osteoporosis risk. Learn what causes bone loss and available osteoporosis treatment and prevention options here.

Doctor and patient reviewing x-ray, both female

Osteoporosis is a bone condition that tends to come with age. It comes on silently, though osteoporosis can be dangerous. 

In fact, the International Osteoporosis Foundation, 1 in 3 women over age 50 will experience osteoporotic fractures. One in 5 men aged over 50 worldwide will, too. 

For women over 45 years of age, osteoporosis accounts for more days spent in hospital than many diseases. These include diabetes, heart attack, and breast cancer, which are some of the leading chronic diseases in the United States.

Fortunately, there are many effective methods to prevent and manage osteoporosis. Read on to find out how to support bone health and lower the risk of related ailments. 

What Is Osteoporosis?

Literally meaning ‘porous bones,’ the IOF defines osteoporosis as “a disease in which the density and quality of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased.” 

What’s more, bone fractures can be quite serious, especially spinal and hip fractures. These fractures can lead to loss of height and intense back pain. Surgeries can result in loss of independence or death.

Osteoporosis Causes and Risk Factors 

The cause of bone loss is rather complex and involves a delicate balance of bone formation and remodeling. There is not a single cause of osteoporosis, but rather a series of fixed and modifiable risk factors.

Fixed Risk Factors

Fixed risk factors are those we have no control over and cannot be changed. While they increase the risk of osteoporosis, knowing these factors can help one take the necessary steps to mitigate their risk. Common fixed risk factors include:

  • Gender, as women are at higher risk than men
  • Ethnicity, particularly Caucasian women who have gone through menopause 
  • Having a previous bone fracture
  • Family history of osteoporosis
  • Some medical conditions such as celiac disease and kidney disease
  • Hormones, including thyroid hormones and sex hormones
  • Body frame size, particularly a smaller frame 

Modifiable Risk Factors

Unlike fixed risk factors, these factors can namely be modified. Modifiable risk factors related to bone loss include, but are not limited to, the following:

  • Dietary factors, including low calcium and disordered eating patterns
  • A sedentary lifestyle
  • Smoking and tobacco use
  • Heavy alcohol intake

Osteoporosis Symptoms, Signs, and Diagnosis

Someone with osteoporosis may not experience any symptoms until a bone fracture. This is because bone loss occurs silently and progressively. 

Long-term bone weakening and reshaping can permanently change the shape of the bones that support the spine. This can lead to:

  • Back pain
  • An observable stooping or hunched appearance
  • Loss of height over time

Diagnosing Osteoporosis

Since the onset of osteoporosis symptoms are slow in nature, bone health can be challenging to gauge. Fortunately, there are certain tests that help objectively determine bone density.

Bone mineral density (BMD) shows up on an x-ray known as densitometry. It provides a precise measurement of BMD in the body, especially in the lower lumbar spine or neck of the femur.

A score will be given as to how much bone mineral density is registering. The score is known as a T-score:

  • T-scores between +1 to -1 are considered normal. 
  • A red flag is waved when bone mineral density levels fall below -1. 
  • Full-blown osteoporosis is present when t-scores falls below -2.5.

Osteoporosis Treatment and Protection

There are many ways to prevent osteoporosis from starting at an early age, including eating a calcium-rich diet and resistance training. 

These lifestyle factors can also protect bone health and the risk of mineral loss that comes with age. Medications may be prescribed as well. 

Dietary Factors

Diet plays a significant role in bone health, especially with a focus on adequate calcium and vitamin D intake. 

Dairy products, including milk, yogurt, and cheese, are excellent sources of calcium. However, dairy is not the only source of calcium. Knowing non-dairy foods is especially important for those with a dairy allergy or lactose intolerance. These sources include:

  • Orange juice with added calcium
  • Sesame seeds
  • Whole grain cereals
  • Oriental radishes
  • Sardines with bone
  • Unsweetened almond milk
  • Mature soybeans
  • Almonds
  • Collard greens
  • Spinach

Calcium absorption is achieved by the intake of calcium-containing products. But absorption can be enhanced by vitamin D, a vitamin produced by the skin when exposed to sunlight. Vitamin D is naturally supplied from many foods as well, including:

  • Beef liver
  • Egg yolks
  • Swiss cheese
  • Shrimp
  • Salmon
  • Mackerel
  • Tuna
  • Swordfish
  • Cod liver oil

Like calcium, vitamin D can be added to foods. For instance, cereal, milk, yogurt, and orange juice are routinely fortified with vitamin D.

When it comes to vitamin D and calcium supplements, nutrition experts may suggest if dietary intake of the nutrients is low. American Bone Health also recommends the “calcium rule of 300” to help determine if a supplement is warranted. 

Other dietary factors include:

  • Ensure adequate intake of other bone-support nutrients, including phosphorus, magnesium, and fluoride.
  • Achieve a sufficient intake of protein.
  • Consider adopting a Mediterranean diet, as research shows this sort of eating pattern can reduce bone loss in people with osteoporosis.
  • Avoid undernutrition to lower the side effects of severe weight-loss diets.

Ultimately, though, consult with a doctor to determine recommended daily nutrient requirements. A Registered Dietitian can also help create a custom dietary plan to meet individual needs.

Weight-Bearing Exercise 

If an individual does not exercise, bone is not stimulated to lay down new bone tissue. This can result in weakened bones over time. 

Including weight training at least twice per week can reduce the risk of bone weakening for both men and women. Focus on the major muscle groups, including the back, chest, shoulders, arms, and legs. 

If new to this sort of training, consider consulting with a personal trainer to learn safe and effective practices. 

Other Lifestyle Factors

Diet and exercise are key to lowering a high risk of osteoporosis and protect from bone loss. However, there are other lifestyle factors to consider such as:

  • Avoid smoking and exposure to secondhand smoke.
  • Drink alcohol in moderation. Men are encouraged to limit alcohol intake to two servings daily while women are limited to one. 

Osteoporosis Medication

While lifestyle changes can help support bone health, medication may also be prescribed to treat osteoporosis. Osteoporosis medications come in various forms, too, including pills and injections. 

The most common medications are known as bisphosphonates, which may include:

  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Ibandronate (Boniva)
  • Zoledronic acid (Reclast)

Hormones may be prescribed to manage osteoporosis and halt further bone loss as well. For instance, abaloparatide (Tymlos) is a daily injection parathyroid hormone labeled for osteoporosis treatment in postmenopausal women. 

All-in-all, consult with a doctor to determine whether or not medication can be of benefit. They can likewise suggest other methods to ensure good bone health for years to come.

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