Osteoporosis is a disease that causes bones to become fragile and more likely to break. Without treatment, osteoporosis can progress—without pain or other symptoms—until fractures occur. These fractures typically occur in the hip, spine, and wrist.
Osteopenia is a term that refers to loss of bone density that might eventually become osteoporosis if left untreated.
Risk Factors for Osteoporosis
The risk factors you cannot change include:
- Gender—Women are at greater risk than men because of their smaller bone structure and the bone loss associated with the changes of menopause.
- Age—Women and men are both at risk of bone loss as they age.
- Body size—Small, thin people are at greater risk.
- Ethnicity—Non-Hispanic white or Asian women are at greatest risk but African-American and Hispanic women are at risk as well.
- Family history—The risk of fractures is due, at least in part, to heredity.
The risk factors you can change include:
- Sex hormones—Abnormal absence of menstrual periods or low estrogen levels caused by menopause in women, or low testosterone levels in men
- Diet—A lifetime diet that is low in calcium and vitamin D
- Cigarette smoking
- Alcohol abuse
Special Considerations for People with Multiple Sclerosis
In addition, any person who has experienced decreased mobility—particularly a loss of weight-bearing activity (as would be true of a person using a wheelchair or staying in bed most of the time)—must be concerned about osteoporosis. The prolonged or excessive use of corticosteroids (to treat MS relapses) also can lead to loss of bone density. Talk to your physician about your risk for osteoporosis and the advisability of a baseline and periodic follow-up evaluations to determine the health of your bones.
Screening for Osteoporosis
Dual energy X-ray absorptiometry (DXA) is the test most commonly used to evaluate bone density. The diagnosis of osteoporosis is made when the bone mineral density is less than or equal to 2.5 standard deviations below that of a comparison group of healthy young adults. The DXA score is provided as a T-score. The World Health Organization has established the following diagnostic guidelines using these scores:
- T-score equal to or greater than -1.0—NORMAL
- T-score between -1.0 and -2.5—OSTEOPENIA (low bone mass)
- T-score equal to or below -2.5—OSTEOPOROSIS
You might be able to decrease your risk of developing osteoporosis by limiting your alcohol intake, quitting smoking, doing weight-bearing exercises (walking, dancing, stair climbing, weight training), and getting an adequate amount of calcium and vitamin D in your diet or with dietary supplements.
The Revised Daily Elemental Calcium Requirements published by the National Institutes of Health include:
- 1,000 mg per day for adults 25 to 65 years old
- 1,500 mg per day for postmenopausal women
For the best absorption of calcium, it is important to obtain 400-800 IU of vitamin D from the foods you eat or from a dietary supplement. Dairy products (especially milk) often include vitamin D. Spending a brief time in the sun each day can also help.
Your doctor also might refer you to a physical therapist for a regimen of weight-bearing exercises to enhance bone strength. Do not begin any exercise program or medication regimen without first consulting your physician.
Medications to Improve Bone Density
Alendronate (Fosamax®), risedronate (Actonel®), and ibandronate (Boniva®)—from the class of drugs called bisphosphonates—are the medications most commonly used to increase bone density.
All three medications are approved for both prevention and treatment of postmenopausal osteoporosis. Alendronate is also approved to treat bone loss that results from glucocorticoid medications like prednisone or cortisone and for treating osteoporosis in men. Risedronate is also approved to prevent and treat glucocorticoid-induced osteoporosis.