This topic talks about osteoporosis, including how to help prevent it and also how it is diagnosed and treated. For more information about how osteoporosis affects men see the topic Osteoporosis in Men.
Osteoporosis is a disease that affects your bones. It means that you have bones that are thin and brittle with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These fractures can be disabling and may make it hard for you to live on your own.
Osteoporosis affects millions of older adults. It usually strikes after age 60. It's most common in women, but men can get it too.
It's caused by a lack of bone strength or bone density. As you age, your bones get thinner naturally. But some things can make you more likely to have the severe bone thinning of osteoporosis. These things are called risk factors.
Age, gender, and body type risks
Family history risks
Osteoporosis can be very far along before you notice it. Sometimes the first sign is a broken bone in your hip, spine, or wrist after a bump or fall.
As the disease gets worse, you may have other signs, such as pain in your back. You might notice that you are not as tall as you used to be and that you have a curved backbone.
Your doctor will ask about your symptoms and do a physical examination. You may also have a test that measures your bone thickness (bone density test) and your risk for a fracture.
If the test finds that your bone thickness is less than normal but is not osteoporosis, you may have osteopenia. It's a less severe type of bone thinning.
It's important to find and treat osteoporosis early to prevent bone fractures. Osteoporosis Canada advises routine bone density testing for all women and men who are age 65 or older. If you have a higher risk for fractures, it's best to start getting the test sooner.
Treatment for osteoporosis includes medicine to reduce bone loss and build bone thickness. Medicine can also give you relief from pain caused by fractures or other changes to your bones.
It's important to get enough calcium and vitamin D and take prescribed medicine for the disease. You need calcium and vitamin D to build strong, healthy bones.
You can slow osteoporosis with new, healthy habits. If you smoke, quit. Get plenty of exercise. Walking, jogging, dancing, and lifting weights can make your bones stronger. Eat a healthy mix of foods that include calcium and vitamin D. Try yogurt, cheese, and milk (for calcium). Eat eggs, fatty fish, and soft margarine (for vitamin D). In Canada, most people don't get enough vitamin D from food only. Osteoporosis Canada recommends that all Canadian adults take daily vitamin D supplements. Talk to your doctor about how much you need.
Making even small changes in how you eat and exercise, along with taking medicine, can help prevent a broken bone.
When you have osteoporosis, it's important to protect yourself from falling. Reduce your risk of breaking a bone by making your home safer. Make sure there's enough light in your home. Remove throw rugs and clutter that you may trip over. Put sturdy handrails on stairs. Try exercises to increase your strength and balance.
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As a natural part of aging, bone tissue breaks down. It is absorbed faster than new bone is made, and bones become thinner. You are more likely to have osteoporosis if you did not reach your ideal bone thickness (bone density) during your childhood and teenage years.
In women, bone loss increases around menopause, when ovaries decrease production of estrogen, a hormone that protects against bone loss. So the older you get, the more likely you are to have osteoporosis.
Not getting enough calcium and vitamin D contributes to bone thinning. Also, thin bones may run in families.
In the early stages of osteoporosis, you probably won't have symptoms. As the disease progresses, you may have symptoms related to weakened bones, including:
In a normal, healthy adult, bone is constantly absorbed into the body and then rebuilt. During childhood and the teenage years, new bone tissue is added faster than existing bone is absorbed. As a result, your bones become larger and heavier until about age 30 when you reach peak bone mass (density). The more bone mass you developed early in life, the less likely you are to get osteoporosis.
After age 30, people lose a small amount of bone each year.
A person with thinning bones may be diagnosed with lower-than-normal bone mass (osteopenia). Osteopenia sometimes progresses to osteoporosis.
When bones thin, they lose strength and break more easily. The bones that break most often due to osteoporosis are:
In women, bone loss increases when the ovaries reduce production of estrogen, a hormone that protects against bone loss.
The risk of osteoporosis increases with age as bones naturally become thinner. But it usually doesn't affect people until they are 60 or older.
Things that increase the risk of osteoporosis include:
Other risk factors include:
Your doctors might use the FRAX tool to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool too. Go to the website at www.shef.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can enter your score. If you haven't had that test, you can leave the score blank.
The Canadian Association of Radiologists and Osteoporosis Canada also have a tool to help predict your risk of having a fracture in the next 10 years. This tool is online at www.osteoporosis.ca.
Call your doctor right away if you:
Call your doctor for an appointment if you:
If you are nearing age 65, have osteopenia, or think that you are at high risk for osteoporosis, talk with your doctor about your concerns.
If you do not have any risk factors for osteoporosis and you are already taking preventive measures, such as taking adequate calcium and vitamin D, you may only need routine screening.
Ask your family doctor or general practitioner about checking your symptoms and risk of osteoporosis. You may be referred to a specialist, such as:
A diagnosis of osteoporosis is based on your medical history, a physical examination, and a test to measure your bone thickness (density).
Your doctor will:
You may have a bone density test. It helps your doctor estimate the strength of your bones.
Routine urine and blood tests can rule out other medical conditions, such as hyperparathyroidism, hyperthyroidism, and Cushing's syndrome. These conditions can cause bone loss.
If you or your doctor thinks that you may be at risk for osteoporosis, you may have a screening test to check your bone thickness. A screening test may be a good idea if you have:
Osteoporosis Canada recommends that all women and men age 65 and older routinely have a bone density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner. Osteoporosis Canada recommends that you and your doctor check your fracture risk using a tool such as FRAX or CAROC to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.
The FRAX tool can help predict your risk of having a fracture related to osteoporosis in the next 10 years. The tool is meant for people who are not already being treated with medicine for osteoporosis. You can use this tool. Go to the website at www.shef.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.
Most experts recommend that the decision to screen younger women be made on an individual basis. The need for testing will depend on the risk for osteoporosis and whether the test results will help with treatment decisions.
is sometimes offered at events such as health fairs as a quick screening for osteoporosis. Ultrasound by itself is not a reliable test for diagnosing osteoporosis. But if results of an ultrasound screening find low bone density, your doctor can help you decide whether you should have a bone density test.
Treatment for osteoporosis is important to prevent fractures and help you get around and function well. It usually includes lifestyle changes and medicine. It is never too late to build and then keep healthy habits that can slow bone thinning.
Take calcium and vitamin D
Your doctor likely will recommend that you eat foods rich in calcium and vitamin D and take daily vitamin D supplements. These nutrients keep bones healthy and strong.
Your bones need vitamin D to absorb calcium. Getting more vitamin D may help prevent falls in older people who are low in vitamin D.footnote 3 And some studies show that taking vitamin D may reduce the chances of breaking a bone.footnote 4 Talk to your doctor about how much vitamin D you should take to be sure you are getting enough.
Get weight-bearing exercise
Get regular weight-bearing exercise, such as walking, jogging, stair climbing, dancing, lifting weights, aerobics, and resistance exercises. These activities keep bones healthy by working the muscles and bones against gravity. To be most effective, weight-bearing exercises should be done for at least 150 minutes each week. Resistance exercises should be done 2 or 3 days a week.
Limit alcohol, and don't smoke
Along with exercise and diet, your doctor will recommend that you not smoke. And it's best to limit alcohol to no more than 3 drinks a day. For help with quitting smoking, see the topic Quitting Smoking.
In some cases, your doctor will prescribe medicines such as bisphosphonates to protect against bone loss.
After you have been diagnosed with bone loss, you will need to have regular follow-up tests to monitor the disease.
If you've had a fracture, your doctor may suggest that you see a fracture liaison service. In this program, health professionals will work with you to help prevent future fractures.
from osteoporosis can cause significant back pain that lasts for several months. Treatments to relieve your pain include over-the-counter medicines such as acetaminophen and non-steroidal anti-inflammatory drugs as well as stronger prescription medicine.
If you have a fractured bone related to osteoporosis, treatment to slow your bone thinning becomes very important. If you have had a spinal fracture, you are at risk of having another.
You can build strong bones and help prevent osteoporosis with weight-bearing exercise and a diet rich in calcium and vitamin D. Young women in particular need to be aware of their risk for osteoporosis. They can take steps early to slow its progress and prevent complications.
A lot of physical activity during the preteen and teenage years increases bone mass and greatly reduces the risk of osteoporosis in adulthood.
Along with diet and exercise, prevention includes not smoking and limiting alcohol. For more information, see Home Treatment.
You can do a lot to slow bone loss and prevent broken bones.
Getting enough calcium and vitamin D is one of the first steps toward preventing or reducing the effects of osteoporosis. Vitamin D helps your body absorb calcium. Calcium is found in many foods, including dairy products such as milk and yogurt.
If you think you may not be getting enough calcium in your diet, check with your doctor about taking calcium supplements.
Many Canadians do not get enough vitamin D from food only, and may need to take supplements. Osteoporosis Canada recommends that all Canadian adults take daily vitamin D supplements. Talk to your doctor about how you can get the right amount through supplements and what you eat.
Experts recommend that you choose supplements that are known brand names with proven reliability. Most brand-name calcium products are absorbed easily by the body. The U.S. Food and Drug Administration (FDA) has taken action against companies that praise the benefits of coral calcium as a superior source of calcium and a cure for disease. There is no scientific proof to support these claims.
Weight-bearing exercises (walking, jogging, stair climbing, dancing, or weight lifting), aerobics, and resistance exercises (using weights or elastic bands to help improve muscle strength) are all effective in increasing bone density and strength. These kinds of exercise may also help reduce the risk of falling or of breaking a bone. For more information, see the topic Fitness.
Heavy alcohol use
can decrease bone formation. It also increases the risk of falling. Heavy alcohol use is 3 or more drinks a day.
Smoking reduces your bone density and speeds up the rate of bone loss. For information on how to stop, see the topic Quitting Smoking.
Learn ways to prevent falls that might result in broken bones. Have your vision and hearing checked regularly. Wear slippers or shoes that have non-skid soles. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling. You can also make changes in your home to prevent falls.
Medicines are used to both prevent and treat osteoporosis. Some medicines slow the rate of bone loss or increase bone thickness. Even small amounts of new bone growth can reduce your risk of broken bones.
Medicines that help treat and prevent bone loss include:
Hormone therapy is typically not recommended for most women who have osteoporosis. But if you are at high risk and cannot take other medicines, your doctor may recommend it under certain circumstances.
Hormone therapy for osteoporosis in women includes:
and other broken bones resulting from osteoporosis can cause significant pain that lasts for several months. Medicines to relieve this pain include:
If spinal compression fractures are causing nerve roots to be compressed, your doctor may talk with you about having surgery to stabilize the crushed spinal bones (vertebrae).
If you get a hip fracture because of osteoporosis, you may need surgery to repair your hip. For more information, see the topic Hip Fracture.
Your doctor may recommend physiotherapy. Your physiotherapist may teach you how to safely do weight-bearing exercises.
Soy products have been tried to help reduce the chance of broken bones due to osteoporosis, but there is not strong evidence that these products help. But soy is a good source of non-dairy protein, so many people still choose to include it in their diets. (For example, 1 cup of soy beverage contains 7 to 11 grams of soy protein.)
There is not enough evidence to show if other natural products, such as black cohosh, work to reduce bone loss.
Chapman-Novakofski K (2012). Nutrition and bone health. In LK Mahan, S Escott-Stump, eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 531–546. St. Louis: Saunders.
Edwards BJ, et al. (2010). Functional decline after incident wrist fractures—Study of Osteoporotic Fractures: Prospective cohort study. BMJ. Published July 8, 2010 (doi:10.1136/bmj.c3324).
Gillespie LD, et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (11).
Bischoff-Ferrari HA, et al. (2009). Prevention of nonvertebral fractures with oral vitamin D and dose dependency. Archives of Internal Medicine, 169(6): 551–561.
Other Works Consulted
Avenell A, et al. (2014). Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database of Systematic Reviews (4). DOI: 10.1002/14651858.CD000227. Accessed October 22, 2014.
Bell KJL, et al. (2009). Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: Secondary analysis of trial data. BMJ. Published online June 23, 2009 (doi:10.1136/bmj.b2266).
Heiss G, et al. (2008). Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA, 299(9): 1036–1045.
Howe TE, et al. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews (7).
National Osteoporosis Foundation (2014). Clinician's guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation. http://nof.org/hcp/clinicians-guide. Accessed October 22, 2014.
National Osteoporosis Foundation (accessed November 2012). Exercise for strong bones. Available online: http://www.nof.org/articles/238.
Nelson HD, et al. (2010). Screening for osteoporosis: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 153(2): 99–111.
Newberry SJ, et al. (2012). Treatment to Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report. Comparative Effectiveness Review No. 53 (AHRQ Publication No. 12-EHC023-EF). Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1006&pageaction=displayproduct.
North American Menopause Society (2010). Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause, 17(1): 23–54. Also available online: http://www.menopause.org/aboutmeno/consensus.aspx.
Qaseem A, et al. (2008). Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 149(6): 404–415. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.
Current as ofMarch 15, 2018
Author: Healthwise StaffMedical Review: Kathleen Romito, MD - Family MedicineBrian O'Brien, MD, FRCPC - Internal MedicineAdam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineCarla J. Herman, MD, MPH - Geriatric Medicine
Current as of: March 15, 2018
Kathleen Romito, MD - Family Medicine & Brian O'Brien, MD, FRCPC - Internal Medicine & Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine
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