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Osteoporosis

What is osteoporosis?

Osteoporosis, or porous bone, is a disease in which there is a loss of bone mass and destruction of bone tissue. This process causes weakening of the bones and makes them more likely to break. The bones most often affected are the hips, spine, and wrists.

Who is affected by osteoporosis?

Osteoporosis affects over 10 million Americans over the age of 50, with women four times more likely to develop osteoporosis than men.

Photo of older couple walking on path

Another 34 million  Americans over the age of 50 have low bone mass (osteopenia) and therefore have an increased risk for osteoporosis. Estrogen deficiency is one of the main causes of bone loss in women during and after menopause. Women may lose up to 20 percent of their bone mass in the five to seven years following menopause.

Other risk factors for osteoporosis

Although the exact medical cause for osteoporosis is unknown, a number of factors contribute to osteoporosis, including the following:

In 2006, the North American Menopause Society (NAMS) reviewed and updated its guidelines on the diagnosis, prevention, and treatment of postmenopausal osteoporosis. Among its updated recommendations, NAMS suggests that women's lifestyle practices should be reviewed regularly by their doctors, and that practices that help to reduce the risk for osteoporosis should be encouraged. Also, NAMS recommends that a woman's risk for falls should be evaluated at least once a year after menopause has occurred. An additional recommendation is that a woman's height and weight should be measured annually, and she should be assessed for kyphoses--development of a rounded humped spines--and back pain.

What are the symptoms of osteoporosis?

Osteoporosis is often called the silent disease because people with osteoporosis may not develop any symptoms. Some may have pain in their bones and muscles, particularly in their back. Occasionally, a collapsed vertebra may cause severe pain, decrease in height, or deformity in the spine.

The symptoms of osteoporosis may resemble other bone disorders or medical problems. Always consult your doctor for a diagnosis.

How osteoporosis is diagnosed

In addition to a complete personal and family medical history and physical examination, diagnostic procedures for osteoporosis may include the following:

The effects of this disease can best be managed with early diagnosis and treatment.

More about bone densitometry

Bone densitometry testing is primarily performed to identify people with osteoporosis and osteopenia (decreased bone mass that has not yet reached the level of osteoporosis) so that the appropriate medical therapy and treatment can be implemented. Early treatment helps to prevent future bone fractures. It may also be recommended for people who have already fractured a bone and are considered at risk for osteoporosis.

The bone densitometry test determines the bone mineral density (BMD). Your BMD is compared to two norms--healthy young adults (your T-score) and age-matched adults (your Z-score).

First, your BMD result is compared with the BMD results from healthy 25- to 35-year-old adults of your same sex and ethnicity. The standard deviation (SD) is the difference between your BMD and that of the healthy young adults. This result is your T-score. Positive T-scores indicate the bone is stronger than a healthy young adult; negative T-scores indicate the bone is weaker.

Illustration of T-score and what it means

According to the World Health Organization, osteoporosis is defined based on the following bone density levels:

In general, the risk for bone fracture doubles with every SD below normal. Thus, a person with a BMD of 1 SD below normal (T-score of -1) has twice the risk for bone fracture as a person with a normal BMD. A person with a T-score of -2 has four times the risk for bone fracture as a person with a normal BMD. When this information is known, people with a high risk for bone fracture can be treated with the goal of preventing future fractures.

Secondly, your BMD is compared to an age-matched norm. This is called your Z-score. Z-scores are calculated in the same way, but the comparisons are made to someone of your age, sex, race, height, and weight.

Treatment for osteoporosis

Specific treatment for osteoporosis will be determined by your doctor based on:

The goals of managing osteoporosis are to decrease pain, prevent fractures, and minimize further bone loss. Some of the methods used to treat osteoporosis are also the methods to help prevent it from developing, including the following:

For postmenopausal osteoporosis in women, the FDA has approved the following medications to maintain bone health:

Rehabilitation for osteoporosis

An osteoporosis rehabilitation program is designed to meet the needs of the individual patient, depending on the type and severity of the disease. Active involvement of the patient and family is vital to the success of the program.

The goal of rehabilitation is to help the patient to return to the highest level of function and independence possible, while improving the overall quality of life--physically, emotionally, and socially. The focus of rehabilitation is to decrease pain, help prevent fractures, and minimize further bone loss.

In order to help reach these goals, osteoporosis rehabilitation programs may include the following:

The osteoporosis rehabilitation team

Osteoporosis rehabilitation programs can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the osteoporosis rehabilitation team, including any or all of the following: