Comprehensive Guide to Osteoporosis: Patient Education and Prevention

Osteoporosis is a widespread and serious health issue characterized by decreased bone mineral density and bone mass, leading to weakened bones and an increased risk of fractures. It's often called a "silent disease" because bone loss occurs without any symptoms. This article aims to provide comprehensive information about osteoporosis, its risk factors, prevention, and available resources to empower patients, caregivers, and the general public.

Understanding Osteoporosis

Osteoporosis develops when the creation of new bone doesn't keep up with the removal of old bone. Bones are living tissue that are constantly being replaced throughout your life. Up until about age 30, your body naturally builds more bone than it loses. After about age 35, bone breakdown happens faster than your body can replace it, causing a gradual loss of bone mass. If you have osteoporosis, you lose bone mass faster than usual.

Risk Factors for Osteoporosis

Anyone can develop osteoporosis, but some factors increase the risk. In women, osteoporosis is often caused by bone loss that occurs with the hormonal changes (low levels of estrogen) that come with menopause. Estrogen plays an important role in building and maintaining your bones. The risk of developing osteoporosis is higher if you did not develop strong bones when you were young.

Osteoporosis affects people of all races and ethnic groups but is most common in non-Hispanic white women and Asian women. Osteoporosis is a common cause of fractures in postmenopausal women and in older men. Of the estimated 10 million Americans with osteoporosis, more than 8 million (80%) are women.

Other risk factors include:

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Age: The risk of osteoporosis increases with age.
Gender: Women are more likely to develop osteoporosis than men.
Race: Caucasian and Asian women are at higher risk.
Family history: Having a parent or sibling with osteoporosis increases your risk.
Body size: Small-boned women are at higher risk.
Hormone levels: Low estrogen levels in women and low testosterone levels in men increase the risk.
Dietary factors: Low calcium and vitamin D intake increase the risk.
Lifestyle factors: Sedentary lifestyle, excessive alcohol consumption, and smoking increase the risk.
Certain medical conditions: Some medical conditions, such as hyperthyroidism, celiac disease, and inflammatory bowel disease, increase the risk.
Medications: Long-term use of certain medications, such as corticosteroids, can increase the risk.
People with HIV: As people with HIV live longer than they have in previous decades, their fracture risk increases, as it does for all people.

Recognizing the Silent Signs: Symptoms of Osteoporosis

Osteoporosis doesn’t have symptoms the way that lots of other conditions do. That’s why healthcare providers sometimes call it a silent disease. You won’t feel or notice anything that signals you might have it. You won’t have a headache, fever or stomachache that lets you know something in your body is wrong. The most common “symptom” is suddenly breaking a bone, especially after a small fall or minor accident that usually wouldn’t hurt you.

Even though osteoporosis doesn’t directly cause symptoms, you might notice a few changes in your body that can mean your bones are losing strength or density. These warning signs of osteoporosis can include:

Losing an inch or more of your height
Changes in your natural posture, like stooping or bending forward more
Shortness of breath (if disks in your spine are compressed enough to reduce your lung capacity)
Lower back pain

It might be hard to notice changes in your own physical appearance. A loved one may be more likely to see them, especially your height or posture. People sometimes joke about friends or family members “shrinking” as they age. But this can be a sign that you should visit a healthcare provider for a bone density test.

Around 1 in 3 adults over 50 who don’t have osteoporosis have osteopenia. This means your bone density is lower than it should be for your age. It’s an early sign of osteoporosis. Osteopenia can progress to become osteoporosis if it’s not treated.

Diagnosis and Screening

Osteoporosis is a “silent” disease because you typically do not have symptoms. You may not even know you have the disease until you break a bone. A fracture can happen in any bone of the body, but fractures from osteoporosis are most common in the hip, wrist, and spine.

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There are tests that use either X-rays or ultrasound (sound waves) to measure bone density and can help determine if you have osteoporosis. X-ray tests, called DXA scans, examine your spine, hip, and/or wrist. DXA scans use a very small amount of radiation. Ultrasound tests the condition of the bone but is not used alone for diagnosis of osteoporosis.

The U.S. Preventive Services Task Force recommends osteoporosis screening for women over the age of 65 and for women of any age who have factors that increase the chance of developing osteoporosis.

Prevention Strategies for Strong Bones

While there is no way to cure osteoporosis, there are things you can do to prevent more bone loss or build new bone mass and strengthen bones. To help prevent osteoporosis, focus on maintaining a healthy lifestyle. Building strong bones during childhood and the teen years is important to help prevent osteoporosis later in life.

Here are some key strategies for preventing osteoporosis:

Stay physically active: Weight-bearing exercises, such as walking, jogging, and dancing, help strengthen bones.
Get enough calcium and vitamin D in your diet: Dietary supplements are products that people add to their diets. Getting enough vitamins, like vitamin D, and minerals, such as calcium, is important for bone health. Talk with your health care provider before you take any dietary supplements.
Limit caffeine: Limit caffeine to < 300 mg (4 cups) daily.
Maintain a healthy weight: Being underweight increases the risk of bone loss.
Avoid smoking: Smoking weakens bones.
Limit alcohol consumption: Excessive alcohol consumption can interfere with bone formation.
Fall Prevention: Our Safe Movement Brochure has information on preventing fragility fractures. It contains helpful information on anti-fracture medicine, safe movement recommendations, and fall prevention.

Calcium and Vitamin D Recommendations

Calcium: High doses of calcium supplements may increase risk for fractures, and calcium levels may be tied to risk of myocardial infarction. Guide patients to get recommended daily allowance through combination of food and supplements until further research is available.
Vitamin D: Add Vitamin D when taking calcium to mitigate cardiac risk. Vitamin D - dosing recommendations vary. Some recommend 1000 IU for people > age 65. Some recommend 2000 IU of D3 daily for all adults. Those living farther from the equator may require more Vitamin D due to less time in the sun.

Treatment Options for Osteoporosis

There are prescription medicines that you can take. The following types of medicines can help treat osteoporosis. Most, but not all, of these medicines have been shown to reduce the risk of bone fracture. All medicines have potential side effects.

There are different types of medications available. The Understanding Osteoporosis Medications: Biologics & Biosimilars infographic, developed with support from Sandoz, explains the differences between biologics, biosimilars, and generics. There is no best medication for everyone. The one that works for you depends on many factors. Your health history and preferences are considerations.

Available Resources and Support

The Bone Health & Osteoporosis Foundation (BHOF) offers several educational programs to help you, whether you are living with HIV or helping clients or patients living with HIV. This booklet will help you learn about the role food plays in your bone health.

The educational resources below are BHOF’s most up-to-date publications and videos geared towards patients, caregivers, and the general public. These materials provide general information about osteoporosis and low bone density. They are not intended to replace the services of trained and qualified health professionals or to be a substitute for medical advice of physicians.

Boning Up on Osteoporosis: This updated edition contains information about prevention, risk factors, diagnosis, and treatment of osteoporosis.
Healthy Bones for Life Patient Guide: This guide is meant to serve as a training guide. It will help you understand what osteoporosis is doing to your body, understand treatments, build your confidence in treating this disease, and identify sources of support throughout the course of treatment.
Bone Basics Series: This series provides concise information about a variety of topics related to osteoporosis and bone loss. This video series is from our Bone Basics Course for patients and providers at the Interdisciplinary Symposium on Osteoporosis.
NWHW Social Media Partner Toolkit: DOWNLOAD - NWHW Social Media Partner Toolkit which focuses on bone health and osteoporosis.

Clinical Trials

Clinical trials can help health care providers learn more about treatments for osteoporosis.

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