Osteoporosis is the continuing thinning and loss of density in bones (bone mass), which makes bones more brittle, fragile, and likely to break after minor trauma. Loss of height and back pain are common. Women are at special risk for osteoporosis after their menstrual periods end (menopause), because quicker bone loss occurs after reduced production of the hormone estrogen. Estrogen blocks a protein that weakens bones.
Osteoporosis is a silent disease, and it may not be evident until a bone breaks.
Normal bone formation needs the minerals calcium and phosphate. If the body does not get enough calcium from the diet, bone production and bone tissues may suffer.
The main causes of osteoporosis include aging, which leads to a drop in estrogen in women at menopause and a drop in testosterone (a male hormone) in men. Other causes are being underweight, lifestyle habits (being sedentary or inactive), alcohol use, cigarette smoking, eating disorders, taking certain drugs, some chronic diseases, and long-term bed rest or immobilization.
No symptoms may be obvious early in the disease, but in time, low back and neck pain, stooped posture, and gradual loss of height may be seen. In other cases the first sign is a fracture (ribs, wrists, or hips). Bones (vertebrae) in the spine may collapse (become flattened or compressed) and break, which is the most common fracture. Hip fractures can cause the greatest disability.
The physician will take a medical history and do a physical examination to look for age-related signs of a deformed spine. Laboratory tests can measure calcium and vitamin D levels. An x-ray examination called DEXA can measure bone density at important places, such as the spine and the hip. Screening for osteoporosis may be recommended for all women after menopause and for men with risk factors such as long-term use of corticosteroids such as prednisone, which predisposes to osteoporosis.
Lifestyle changes may help reduce fracture risk. Such changes include doing regular weight-bearing and muscle-strengthening exercises, stopping smoking, limiting alcohol intake, and getting enough calcium (at least 1,200 mg/day) and vitamin D (at least 800 IU/day) in the diet. Treatments focus on slowing down or stopping bone loss and on preventing bone fractures by minimizing the risk of falls.
Different drugs, including bisphosphonates such as alendronate, taken weekly may be prescribed in addition to adequate supplementation of calcium and vitamin D. Several other medications are also available.
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