Osteoporosis

In this Article

• What is osteoporosis?
• What are the symptoms of osteoporosis?
• What are the consequences of osteoporosis?
• Why is osteoporosis an important public health issue?
• What factors determine bone strength?
• What are risk factors for developing and causes of osteoporosis?
• How is osteoporosis diagnosed?
• Who should have bone density testing?
• How is osteoporosis treated and prevented?
• Exercise, quitting cigarettes, and curtailing alcohol
• Calcium supplements
• Vitamin D
• Hormone therapy (hormone replacement therapy, menopausal replacement therapy)
• Medications that prevent bone loss and breakdown
• Choosing an osteoporosis medication
• Prevention of osteoporosis caused by long term corticosteroids
• Monitoring osteoporosis therapy medication
• Prevention of hip fractures in elderly persons with osteoporosis
• Osteoporosis At A Glance
• Patient Discussions: Osteoporosis - Symptoms at Onset of Disease

How is osteoporosis treated and prevented?

The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment. Osteoporosis treatment and prevention measures are:

1. Life style changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D;
   
   
2. Medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast);
   
   
3. Medications that increase bone formation such as teriparatide (Forteo).

Lifestyle changes

Exercise, quitting cigarettes, and curtailing alcohol

Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased. Research has not yet determined what type of exercise is best for osteoporosis or for how long. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily.

A word of caution about exercise: it is important to avoid exercises that can injure already weakened bones. In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure, exercise should be prescribed and monitored by their doctors. Finally, extreme levels of exercise (such as marathon running) may not be healthy for the bones. Marathon running in young women that leads to weight loss and loss of menstrual periods can actually cause osteoporosis.

Smoking one pack of cigarettes per day throughout adult life can itself lead to loss of 5% to 10% of bone mass. Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause. Smoking cigarettes can also lead to earlier menopause. In postmenopausal women, smoking is linked with increased risk of osteoporosis. Data on the effect of regular consumption of alcohol and caffeine on osteoporosis is not as clear as with exercise and cigarettes. In fact, research regarding alcohol and caffeine as risk factors for osteoporosis shows widely varying results, and is controversial. Certainly, these effects are not as powerful as other factors. Nevertheless, moderation of both alcohol and caffeine is prudent.

Osteoporosis - Symptoms at Onset of Disease

The MedicineNet physician editors ask:

The symptoms of osteoporosis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?

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