Osteoporosis is a disease of low bone mass that increases the risk of fractures, particularly of the hip, spine, and wrist. These fractures can occur with even minimal trauma and are referred to as “fragility fractures.” Fractures of the hip can lead to serious disability and loss of mobility. Fractures of the spine can lead to pain, height loss and curvature of the spine.
Osteoporosis is most commonly diagnosed in women post-menopause; one in five women will sustain a fragility fracture during their lifetime. However, men may also develop osteoporosis. Certain conditions can also result in osteoporosis in young individuals as well.
Causes and Risk Factors
Osteoporosis is caused when bone resorption outpaces bone formation, causing a net loss of bone. Bone loss naturally increases around menopause.
Common factors increasing the risk of osteoporosis include:
- Inadequate calcium in the diet
- Low vitamin D
- Excess alcohol consumption
- Use of steroid medications, such as prednisone
- Presence of other diseases, including:
- High parathyroid or thyroid hormone
- Celiac disease
- Inflammatory bowel disease
- Inflammatory diseases of the joints, such as rheumatoid arthritis
- The treatment for inflammatory diseases like rheumatoid arthritis, such as steroid medications like prednisone, is also a major contributor to the development of osteoporosis.
Like hypertension or high cholesterol, osteoporosis has no symptoms until a complication occurs. In patients with osteoporosis, a fracture may be the first indication of a problem with bone health.
Osteoporosis is diagnosed by an imaging test called a Dual Energy X-ray Absorptiometry (commonly referred to as a DXA scan). A DXA scan takes only a few minutes and involves very little radiation exposure. Osteoporosis can also be diagnosed by the occurrence of a fragility fracture of the hip. DXA are recommended for women 65 and older, men 70 and older, and younger individuals at risk for osteoporosis (for example, younger patients on chronic prednisone).
Osteoporosis treatment involves:
- A diet that includes adequate amounts of calcium and vitamin D
- Regularly performed weight-bearing exercises
- Smoking cessation
- Moderation of alcohol consumption
- Use of certain medications that limit bone loss:
- bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), and zoledronate (Reclast)
- raloxifene (Evista)
- denosumab (Prolia).
- Use of medications that increase bone formation:
- abaloparatide (Tymlos).
To learn more about our services or to make an appointment with a Brigham and Women’s Hospital rheumatologist, contact one of our trained coordinators at 1-800-294-9999 to get connected with the best doctor for your needs.