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A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.

Thin bones
Last review ed: November 8, 2010.

Osteoporosis is the thinning of bone tissue and loss of bone density over time.

Causes, incidence, and risk factors
Osteoporosis is the most common type of bone disease. Researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine). Osteoporosis occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both. Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer. As you age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury. Usually, the loss occurs gradually over years. Many times, a person will have a fracture before becoming aware that the disease is present. By the time a fracture occurs, the disease is in its advanced stages and damage is severe. The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women over age 50 and men over age 70 have a higher risk for osteoporosis. Other causes include: Being confined to a bed Chronic rheumatoid arthritis, chronic kidney disease, eating disorders Taking corticosteroid medications (prednisone, methylprednisolone) every day for more than 3 months, or taking some antiseizure drugs Hyperparathyroidism Vitamin D deficiency White women, especially those with a family history of osteoporosis, have a greater than average risk of developing osteoporosis. Other risk factors include: Absence of menstrual periods (amenorrhea) for long periods of time Drinking a large amount of alcohol Family history of osteoporosis History of hormone treatment for prostate cancer or breast cancer Low body weight Smoking Too little calcium in the diet

There are no symptoms in the early stages of the disease. Symptoms occurring late in the disease include: Bone pain or tenderness Fractures with little or no trauma Loss of height (as much as 6 inches) over time Low back pain due to fractures of the spinal bones Neck pain due to fractures of the spinal bones Stooped posture or kyphosis, also called a "dowager's hump"

The medicine is given through daily shots underneath the skin. if estrogen has helped a woman. usually once a week or once a month. it does not appear to prevent other fractures. Treatment The goals of osteoporosis treatment are to: Control pain from the disease Slow down or stop bone loss Prevent bone fractures with medicines that strengthen bone Minimize the risk of falls that might cause fractures There are several different treatments for osteoporosis. including those in the hip. rather than simply the usual bone loss seen with older age. Raloxifene is similar to the breast cancer drug tamoxifen. though more studies are needed. Calcitonin appears to be less effective than bisphosphonates. Medications are used to strengthen bones when: Osteoporosis has been diagnosed by a bone density study. may be used in rare cases. However. and risedronate (Actonel). However. PARATHYROID HORMONE Teriparatide (Forteo) is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. see bone density test. but not osteoporosis) has been diagnosed by a bone density study. Sometimes. If you are considering taking hormone therapy to prevent osteoporosis. including lifestyle changes and a variety of medications. EXERCISE Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. The main side effects are nasal irritation from the spray form and nausea from the injectable form.Stooped posture or kyphosis. ibandronate (Boniva). Osteopenia (thin bones. and she cannot take other options for preventing or treating osteoporosis. It may have protective effects against heart disease and breast cancer. Bisphosphonates given through a vein (intravenously) are taken less often. The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus). Your health care provider uses this test to predict your risk for bone fractures in the future. You can give yourself the shots at home. Some of the recommended exercises include: . RALOXIFENE Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. Raloxifene can reduce the risk of spinal fractures by almost 50%. a spine or hip x-ray may show fracture or collapse of the spinal bones. discuss the risks with your doctor. Most are taken by mouth. In severe cases. It comes as a nasal spray or injection. simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis. the doctor may recommend that she continue using hormone therapy. CALCITONIN Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. HORMONE REPLACEMENT THERAPY Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis and are not approved to treat a woman who has already been diagnosed with the condition. Bisphosphonates taken by mouth include alendronate (Fosamax). For information about when testing should be done. A special type of spine CT that can show loss of bone mineral density. You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition. BISPHOSPHONATES Bisphosphonates are the primary drugs used to both prevent and treat osteoporosis in postmenopausal women. quantitative computed tomography (QCT). also called a "dowager's hump" Signs and tests Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. if a bone fracture has occurred.

Women taking estrogen should have routine mammograms. High-calcium foods include: Cheese Ice cream Leafy green vegetables. a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. Other ways to prevent falling include: Avoiding walking alone on icy days Using bars in the bathtub. PREVENT FALLS It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. This is one of the major reasons people are admitted to nursing homes. it does not affect life expectancy. However. uses balloons to widen the spaces that need the glue. Too much alcohol can damage your bones.200 milligrams per day of calcium and 800 . as well as put you at risk for falling and breaking a bone.walking. pelvic exams. (The balloons are removed during the procedure. yoga Riding a stationary bicycle Using rowing machines Avoid any exercise that presents a risk of falling. weight machines. called kyphoplasty. such as spinach and collard greens Low-fat milk Salmon Sardines (with the bones) Tofu Yogurt STOP UNHEALTHY HABITS Quit smoking.000 international units of vitamin D3.2 weights. and protein. Vitamin D helps your body absorb calcium.) Expectations (prognosis) Medications to treat osteoporosis can help prevent fractures. if you smoke. playing tennis. Although osteoporosis is debilitating. . when needed Wearing well-fitting shoes MONITORING Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1 . A similar procedure.tai chi. vitamin D. and Pap smears. it will guarantee that a supply of the materials the body uses to form and maintain bones is available. stretch bands Balance exercises -. While this will not completely stop bone loss.recommended exercises include: Weight-bearing exercises -. but vertebrae that have already collapsed cannot be reversed. or high-impact exercises that may cause fractures. Also limit alcohol intake.1. Follow a diet that provides the proper amount of calcium. jogging. Make sure your vision is good. Some persons with osteoporosis become severely disabled as a result of weakened bones. It can also help prevent weak vertebrae from becoming fractured by strengthening the bones in your spinal column. dancing Resistance exercises -. DIET Get at least 1.Your doctor may recommend a supplement to give you the calcium and vitamin D you need. Hip fractures leave about half of patients unable to walk independently. The procedure involves injecting a fast-hardening glue into the areas that are fractured or weak. RELATED SURGERIES There are no surgeries for treating osteoporosis itself.

2006. Menopause. Review provided by VeriMed Healthcare Netw ork. References 1. [PubMed: 16563939] 3. well-balanced diet can help you get these and other important nutrients throughout life. Review ed by: Ari S.D.175(1):52-59. MD. Papaioannou A. Clinical Guidelines Committee of Osteoporosis Canada. Eckman. Am J Med. Parathyroid hormone for the treatment of osteoporosis: a systematic review. et al. Cranney A. it does not affect life expectancy. 2006 4. NJ. Prevention Calcium is essential for building and maintaining healthy bone. Medical Director. Figures . [PubMed: 12544671] Review Date: 11/8/2010. Division of Endocrinology. Other tips for prevention: Avoid drinking excess alcohol Don't smoke Get regular exercise A number of medications are approved for the prevention of osteoporosis. CMAJ. MHA.M.Although osteoporosis is debilitating. Also review ed by David Zieve. Zytaruk N. 2010 Jan-Feb.. Dawson-Hughes B. Chief.119:S3-S11. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Preventing osteoporosis-related fractures: an overview. A. Vitamin D is also needed because it helps your body absorb calcium. Following a healthy. Elizabeth. Complications Compression fractures of the spine Disability caused by severely weakened bones Hip and wrist fractures Loss of ability to walk due to hip fractures Calling your health care provider Call your health care provider if you have symptoms of osteoporosis or if you wish to be screened for the condition. [PubMed: 16818910] 2. Diabetes and Metabolism. MD.17(1):25-54.. Gass M. Trinitas Regional Medical Center. Inc.A.

A bone density scan has the advantage of being painless and exposing the patient to only a small amount of radiation. Washington.D. University of Washington School of Medicine. Bellevue. FACOG. Inc. .Figures Bone density scan A bone density scan measures the density of bone in a person.M. Reviewed by: Susan Storck. Medical Director. Group Health Cooperative of Puget Sound. Eastside Department of Obstetrics and Gynecology. is a useful aid in evaluating the probability of a fracture and whether any preventative treatment is needed. The lower the density of a bone the higher the risk of fractures.. along with a patient's medical history. Review Date: 12/22/2010. Clinical Teaching Faculty. MD. Chief. Also reviewed by David Zieve. A bone scan. MD. MHA. A.A. Department of Obstetrics and Gynecology.

Inc. A.Osteoporosis Osteoporosis is a condition characterized by progressive loss of bone density.A. Bellevue. Department of Obstetrics and Gynecology. Also reviewed by David Zieve. Chief. MD.D. . MHA. Eastside Department of Obstetrics and Gynecology. Washington. MD. Osteoporosis may result from disease.M. dietary or hormonal deficiency or advanced age. Group Health Cooperative of Puget Sound. Review Date: 12/22/2010. Clinical Teaching Faculty. Reviewed by: Susan Storck. Medical Director. FACOG. University of Washington School of Medicine.. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density. thinning of bone tissue and increased vulnerability to fractures.

Eastside Department of Obstetrics and Gynecology. MD. FACOG. University of Washington School of Medicine. Department of Obstetrics and Gynecology. thinning of bone tissue and increased vulnerability to fractures.. A. Washington.A.Osteoporosis Osteoporosis is a condition characterized by progressive loss of bone density.M. Chief. Osteoporosis may result from disease. Reviewed by: Susan Storck. Also reviewed by David Zieve. Group Health Cooperative of Puget Sound. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density. Inc. Bellevue. . Medical Director. Review Date: 12/22/2010.D. Clinical Teaching Faculty. MHA. MD. dietary or hormonal deficiency or advanced age.

MD. Reviewed by: Linda J. In elderly patients with bones weakened by osteoporosis. MEDEX Northwest Division of Physician Assistant Studies.Hip fracture Hip fractures occur as a result of major or minor trauma. . even walking. Sports Medicine and Shoulder Service. Review Date: 6/4/2011. MHA. Medical Director. MD. of Orthopaedic Surgery. relatively little trauma. Also reviewed by David Zieve..M. Medical Director. MD.D. School of Medicine. and C. Assistant Professor. Inc. UCSF Dept.A. may result in a hip fracture. Benjamin Ma. University of Washington. Vorvick. Chief. A.

Reviewed by: Alison Evert. MD. vitamin D may be obtained in the recommended amount with a well-balanced diet. Inc. In addition. . University of Washington Medical Center Diabetes Care Center. Seattle. the body manufactures vitamin D when exposed to sunshine. Washington. A.A. including some enriched or fortified foods. Review Date: 2/8/2011.M. MHA.Vitamin D source Like most vitamins.. Nutritionist.D. Also reviewed by David Zieve. RD. MS. Medical Director. CDE. and it is recommended people get 10 to 15 minutes of sunshine 3 times a week.

Nutritionist.A.Calcium benefit Calcium requires adequate vitamin D in order to be absorbed by the body. many food sources of calcium such as milk are fortified with vitamin D. Medical Director. Seattle. Washington. In the United States. Inc. Review Date: 2/14/2011. MD. CDE..D. MHA. A. Reviewed by: Alison Evert.M. Also reviewed by David Zieve. MS. . University of Washington Medical Center Diabetes Care Center. RD.

There are many ways to supplement calcium. Review Date: 2/14/2011. Calcium deficiency also effects the heart and circulatory system. Reviewed by: Alison Evert. Medical Director. such as a tendency toward kidney stones.D. as well as the secretion of essential hormones. A.M. MD. Inc. for avoiding calcium-rich food sources. CDE. University of Washington Medical Center Diabetes Care Center.. RD. MS. Washington. including a growing number of fortified foods.A.Calcium source Getting enough calcium to keep bones from thinning throughout a person's life may be made more difficult if that person has lactose intolerance or another reason. Nutritionist. Seattle. MHA. Also reviewed by David Zieve. .

NJ. Chief.A. Reviewed by: Ari S. Trinitas Regional Medical Center. MHA. Studies show that exercises requiring muscles to pull on bones cause the bones to retain and possibly gain density. MD.Bone-building exercise Exercise plays an important role in the retention of bone density in the aging person.M. Elizabeth. Eckman. Division of Endocrinology. A. Medical Director. Review Date: 11/8/2010. Also reviewed by David Zieve. Inc. MD.. Review provided by VeriMed Healthcare Network. .D. Diabetes and Metabolism.

becoming more curved and more fragile. A. Disclaimer Copyright © 2011. Review Date: 11/8/2010. Review provided by VeriMed Healthcare Network.. MD. Medical Director. A. Trinitas Regional Medical Center. Also reviewed by David Zieve.M.D.M. MD. Reviewed by: Ari S. Eckman.M. Chief. .D. Elizabeth.A.D.. Diabetes and Metabolism. A.Changes in spine with age The spine weakens with age.A.. MHA. Inc.A. NJ. Division of Endocrinology. Inc.