Last Updated: March 29, 2013
Osteoporosis is a disease that weakens bones to the point where
they break easily-most often bones in the hip, backbone (spine),
and wrist. It's called the "silent disease"-you may not notice any
changes until a bone breaks-but your bones have been losing
strength for many years.
Bone is living tissue. To keep bones strong, your body
continually breaks down old bone and replaces it with new bone
tissue. As people enter their forties and fifties, more bone is
broken down than is replaced. A close look at the inside of bone
shows something like a honeycomb. When you have osteoporosis, the
spaces in this honeycomb grow larger and the bone that forms the
honeycomb gets smaller. The outer shell of your bones also gets
thinner. All this loss makes your bones weaker.
Who Gets Osteoporosis?
Millions of Americans have osteoporosis-mostly women, but more
than 2 million men also have this disease. White and Asian women
are most likely to have osteoporosis. Other women at great risk
include those who:
- have a family history of the disease,
- have broken a bone while an adult,
- had surgery to remove their ovaries before their periods
- had early menopause,
- have not gotten enough calcium throughout their lives,
- had extended bed rest,
- used certain medicines for a long time, or
- have a small body frame.
The risk of osteoporosis increases as you get older. At the time
of menopause women may lose bone quickly for several years, after
which the process slows down but continues. In men the loss of bone
mass is slower. But, by age 65 or 70 men and women are losing bone
at the same rate.
What is Osteopenia?
Millions more Americans have osteopenia. Whether your doctor
calls it osteopenia or just says you have low bone mass, consider
it a warning. Bone loss has started, but you can still take action
to keep your bones strong and maybe prevent osteoporosis later in
life. That way you will be less likely to break a wrist, hip, or
vertebrae (bone in your spine) when you are older.
Can My Bones Be Tested?
For some people the first sign of osteoporosis is to realize
they are getting shorter or to break a bone easily. Don't wait
until that happens to see if you or your loved one has
osteoporosis. Your doctor may suggest a type of bone density test
called a DEXA-scan (dual-energy x-ray absorptiometry) if you are
age 65 or older or if he or she thinks you are at risk for
osteoporosis. This test shows how solid your bones are and assesses
your risk for a fracture or broken bone. It could show that you
have normal bone density. Or, it could show that you have low bone
mass or even osteoporosis.
How Can I Keep My Bones Strong?
There are things you should do at any age to prevent weakened
bones and keep them strong and healthy. Eating foods that are rich
in calcium and vitamin D is important, as is including regular
weight-bearing exercise in your lifestyle.
Calcium. Getting enough calcium all through your life helps to
build and keep strong bones. People over age 50 need 1200 mg of
calcium every day. Foods that are high in calcium are the best
source, such as low-fat dairy foods, canned fish with soft bones
such as salmon, dark green leafy vegetables, and calcium-fortified
foods like orange juice, breads, and cereals.
If you think you aren't getting enough calcium in your diet,
check with your doctor first. He or she may tell you to try a
calcium supplement, the most common of which are calcium carbonate
and calcium citrate. However, too much calcium can cause problems
for some people. On most days you should not get more than 2500 mg
of total calcium from all sources, including foods, drinks, and
Vitamin D. Your body uses vitamin D to absorb calcium. Most
people's bodies are able to make enough vitamin D if they are out
in the sun for a total of 20 minutes every day. You can also get
vitamin D from eggs, fatty fish, and cereal and milk fortified with
vitamin D. If you think you are not getting enough vitamin D, check
with your doctor. Each day you should have:
- 400 IU (international unit) if you are age 51 to 70
- 600 IU if you are over age 70.
As with calcium, be careful. More than 2000 IU of vitamin D each
day may cause side effects.
Exercise. Your bones and muscles will be stronger if you are
physically active. Weight-bearing exercises, done three to four
times a week, are best for preventing osteoporosis. These include
walking, jogging, playing tennis, and dancing. Strengthening and
balance exercises can also be effective, as they may help you avoid
falls that might cause a broken bone.
Medicines. Some common medicines can make bones weaker. These
include a type of steroid drug called glucocorticoids used for
arthritis and asthma, some antiseizure drugs, certain sleeping
pills, treatments for endometriosis, and some cancer drugs. An
overactive thyroid gland or using too much thyroid hormone for an
underactive thyroid can also be a problem. If you are taking these
medicines, talk to your doctor about what you can do to help
protect your bones.
Lifestyle. Smoking increases the loss of bone mass; for this and
many other serious health reasons, stop smoking. Limit how much
alcohol you drink, as too much alcohol can put you at risk for
falling and breaking a bone.
What Can I Do for My Osteoporosis?
Treating osteoporosis means stopping the bone loss and
rebuilding bone to prevent breaks. Diet and exercise can help make
your bones stronger, but they may not be enough if you have already
lost a lot of bone density. There are also several medicines to
think about. Some will slow your bone loss, and others can help
rebuild bone. Talk with your doctor to see if one of these might
work for you:
- Alendronate or risedronate. These medicines are
bisphosphonates, drugs that slow the breakdown of bone and increase
bone density. They can make it less likely that you will break a
bone, most of all in your spine, hip, or wrist. Side effects may
include nausea, heartburn, and stomach pain. A few people have
muscle, bone, or joint pain while using these medicines. These
drugs must be taken in a certain way-when you first get up, before
you have eaten,andwith a full glass of water. Youshould notlie
down, eat, or drink for at least one-half hour after taking the
drug. Even if you follow the directions closely, these drugs can
cause serious digestive problems, so be aware of any side effects.
These pills are available in both once-daily and once-a-week
- Raloxifene. Called a SERM (selective estrogen receptor
modulator), this drug prevents bone loss and spine fractures but
may cause hot flashes or increase the risk of blood clots in some
- Estrogen. Doctors sometimes prescribe this female hormone
around the time of menopause to treat symptoms like hot flashes or
vaginal dryness. Estrogen also slows bone loss and increases bone
mass in your spine and hip, so women can use it to prevent or treat
osteoporosis. But, estrogen use is thought to be risky for some
women, so talk to your doctor about the benefits, risks, and side
effects, as well as other possible treatments for you.
- Calcitonin. This hormone increases bone mass in your spine and
can lessen the pain of fractures already there. It comes in two
forms-a shot or nasal spray. The shot may cause an allergic
reaction and has some side effects like nausea, diarrhea, or
redness in your face, ears, hands, or feet. The only side effect of
the nasal spray is a runny nose in some people. Calcitonin is most
useful for women who are 5 years past menopause.
- Parathyroid hormone (PTH). Also called teriparatide, this shot
is given daily for up to two years to postmenopausal women and men
who are at high risk for broken bones. It improves bone density in
the spine and hip. Common side effects include nausea, dizziness,
and leg cramps.
Can I Avoid Falling?
When your bones are weak, a simple fall can cause a broken bone.
This can mean a trip to the hospital and maybe surgery. It might
also mean being laid up for a long time, especially in the case of
a hip fracture, so it's important to prevent
falls. Some things you can do are:
- Make sure you can see and hear well. Use your glasses or a
hearing aid if needed.
- Ask your doctor if any of the drugs you are taking can make you
dizzy or unsteady on your feet.
- Use a cane or walker if your walking is unsteady.
- Wear rubber-soled and low-heeled shoes.
- Make sure all the rugs and carpeting in your house are firmly
attached to the floor, or don't use them.
- Keep your rooms well lit and the floor free of clutter.
- Use nightlights.
Do Men Have Osteoporosis?
Osteoporosis is not just a woman's disease. Not as many men have
it as women do, but men need to worry about it as well. This may be
because most men start with more bone density than women and lose
it more slowly as they grow older.
Experts don't know as much about this disease in men as they do
in women. However, many of the things that put men at risk are the
same as those for women:
- family history
- not enough calcium or vitamin D
- too little exercise
- low levels of testosterone
- too much alcohol
- taking certain drugs
Older men who break a bone easily or are at risk for
osteoporosis should talk with their doctors about testing and
treatment. Men can use alendronate, risedronate, or parathyroid
hormone to increase bone density. Testosterone supplements may also
help for some men with low levels of testosterone.
National Osteoporosis Foundation
1232 22nd Street, NW
Washington, DC 20037-1292
National Institutes of Health
Osteoporosis and Related Bone Diseases~National Resource
2 AMS Circle
Bethesda, MD 20892-3676
Source: National Institute on Aging, www.nia.nih.gov (Original