With age, there often comes a loss of height and weight, as well as the development of stooped posture. A progressive disease that thins the bones, also known as osteoporosis (os-tee-oh-pour-osis), often causes these body changes. Osteoporosis slowly destroys bone tissue, which then leads to loss of bone mass. As a result, bones become brittle and the risk of fracture of the spine, hip, and wrist increases. Spinal fractures are the most common type of fractures due to osteoporosis. In fact, forty percent of all women will have at least one spinal fracture by the time they are 80 years old. These vertebral fractures can permanently alter the shape and strength of the spine.
Most women are likely to feel some effects of osteoporosis in their lifetime, but the good news is that much can be done to reduce and even prevent the loss of bone mass and fractures. New treatments for osteoporosis are being discovered each year, and you can also actively work to decrease your chances of suffering from the effects of osteoporosis. The key is prevention and intervention, and at The Spine Care Center in Manassas, we’re here to provide you with the information you need to prevent osteoporosis from compromising your quality of life.
Below you can learn about:
In general, bone mass loss begins around age 30. Although men can be affected by osteoporosis, older women are usually affected, particularly those who have already experienced menopause. Bone loss becomes worse in women after menopause because of the body’s lack of estrogen. When bones lose mass, they tend to weaken and become fragile. This increases the risk of fracture, particularly in the spine and hips.
Falls in elderly women are often actually the result, rather than the cause, of hip fractures. In other words, a fragile hip bone may simply fracture, causing the person to fall. In severe cases of osteoporosis, the bones can fracture with any kind of slight movement, leaving some people bedridden.
Doctors have identified two types of osteoporosis, primary and secondary. Primary osteoporosis is further divided into Primary Type I and Primary Type II osteoporosis.
Type I osteoporosis mainly affects postmenopausal women, and it is six times more common in women than men. In general, Type I osteoporosis occurs in women 15 to 20 years after menopause. The loss of bone is linked to an estrogen deficiency in women and a testosterone deficiency in men. The body’s production of these hormones tends to decrease with age.
Primary Type I osteoporosis is sometimes called “high-turnover osteoporosis” because it causes a rapid loss of the spongy inner part of the bones. Normally, there is a large amount of trabecular bone in the vertebral bodies of the spine and at the end of the long bones, such as the wrists. People who lose trabecular bone have a higher risk of spine and wrist fractures.
Compared to Type I, Type II osteoporosis is only two times more common in women than men. It typically occurs when people reach their 70s or 80s. It is also thought to be the result of too little calcium in the diet, low vitamin D levels, or increased activity of the parathyroid (para-thigh-roid) glands.
Type II osteoporosis causes a loss of both hard outer bone and spongy inner bone. Because the rate of bone turnover is much lower, Primary Type II osteoporosis is also called “low-turnover osteoporosis.” Hip fractures are the most common result of this type of osteoporosis.
In healthy people, bone is constantly regenerating; new bone is formed while old bone is resorbed by the body. Your body’s bone mass depends on the balance between bone formation and bone resorption. This balance is your bone turnover rate. If bone production is less than the amount of bone being resorbed, then your risk of developing osteoporosis increases. In secondary osteoporosis, the rate of bone resorption increases, leading to a loss of bone mass. Secondary osteoporosis can also occur from an imbalance in hormones due to the following diseases:
Secondary osteoporosis can also occur from disorders in which the bone marrow cavity expands at the expense of the trabecular or spongy bone, which causes the bones to lose some of their strength.
Other causes of secondary osteoporosis include:
Fractures are the most common symptom of osteoporosis, and vertebral compression fractures and hip fractures are the most prominent fractures experienced by those with osteoporosis. Compression fractures in the spine are caused by weakened vertebrae and can lead to pain in the mid back. These fractures often stabilize by themselves and the pain will eventually subside. However, the pain may persist if the crushed bone continues to move and break.
In severe cases of osteoporosis, actions as simple as bending forward can be enough to cause a crush fracture in a vertebra. This type of vertebral fracture causes loss of body height and a humped back, especially in elderly women. This disorder (called kyphosis [kye-fo-sis]) is an exaggeration in the curve of the mid back. It causes the shoulders to slump forward and the top of the back to look enlarged and humped.
Speak with your doctor if you believe that you are experiencing any of the symptoms of osteoporosis. Older women should discuss their risk factors with their doctor, even if they are not currently showing any signs of osteoporosis. All women should be aware of the many preventive steps that can lower their risk of developing osteoporosis.
Osteoporosis does not affect everyone. There are risk factors that may predict your chances of developing it. Some risk factors are genetic, meaning you inherited them from your biological parents. Some risks are due to medical conditions that you may not be able to avoid, such as the use of particular medications. Risk factors that are considered to considered to be related to your lifestyle decisions are the ones that you can change.
Whether or not you are at risk of developing osteoporosis, there are some things you can do to help keep your bones healthy:
Increasing your calcium intake is the easiest way to prevent osteoporosis. You can increase your calcium intake by eating foods that are high in calcium, or by taking a calcium supplement. It is best for people to begin adequate calcium intake at an early age, as bone mass begins to decrease around the age of 30. After age 30, calcium can help decrease bone loss, strengthen bones, and decrease the risk of fractures.
The recommended daily intake of calcium for women 25 to 50 years old and women over 50 who take hormone replacements is 1,000 milligrams per day. Women over 50 who do not take hormone replacements should take 1,500 milligrams of calcium per day. Men 25 to 65 years old should take 1,500 mg of calcium per day. Men and women over age 65 should take 1,500 mg of calcium per day.
If you take calcium supplements, make sure they contain vitamin D, as it helps the body with calcium absorption. Also, look for calcium citrate because it is more easily absorbed by the body than calcium carbonate. If you take the carbonate form, make sure you take it with food.
To help prevent bone loss and fracture, adults should take at least 800 milligrams of vitamin D per day. Many calcium supplements contain vitamin D, but you can also get vitamin D through foods such as egg yolks, fish, fortified milk, and cereals. Halibut, mackerel, sardines, shrimp, pink salmon, and cod liver oil are all excellent natural sources of vitamin D.
Exercising five days a week for at least 30 minutes can reduce your risk of bone loss. The best exercises for maintaining bone mass are weight-bearing exercises such as walking, low-impact aerobics, and safe forms of dancing. Always check with your doctor before starting an exercise program.
Currently, there are four medications that are approved by the US Food and Drug Administration (FDA) to help prevent bone loss and osteoporosis. Speak with your physician to determine if they could be right for you.
Hormone (estrogen) replacement therapy (HRT) is used to both prevent and treat osteoporosis. HRT can reduce bone loss, increase bone density in the spine and hips, and reduce the risk of hip and spinal fractures in postmenopausal women.
HRT is usually administered in pill or patch form, and it is effective even after age 70. Estrogen taken alone can increase the risk of developing endometrial cancer (cancer of the uterine lining). For this reason, a second hormone, progestin, is usually prescribed in combination with estrogen.
Side effects of HRT can include nausea, bloating, breast tenderness, and high blood pressure. Some studies indicate a link between estrogen use and breast cancer, while other studies do not. Make sure to discuss the pros and cons of hormone replacement therapy with your doctor.
Bisphosphonates inhibit bone breakdown and slow down bone resorption. They have been shown to increase bone density and decrease the risk of hip and spinal fractures. Alendronate is the bisphosphonate that has been approved by the FDA for preventing and treating osteoporosis in postmenopausal women. The strongest side effect of alendronate is gastrointestinal problems. To avoid unpleasant side effects, alendronate should be taken with a full glass of water and on an empty stomach, and you should remain in an upright position for at least thirty minutes after taking alendronate.
Calcitonin is recommended for women who cannot, or choose not to, take estrogen or receive hormone replacement therapy. For women who are at least five years past menopause, calcitonin can increase spinal bone density and slow bone loss. Calcitonin is a protein, so it cannot be taken by mouth. Instead, calcitonin is available as an injection or nasal spray.
SERMs are medications that have effects similar to estrogen in some parts of the body, such as the spine and hips. SERMs seem to prevent bone loss of the spine, hips, and throughout the body. Raloxifene is the SERM drug currently approved by the FDA for preventing osteoporosis. Its impact on the spine does not appear to be as powerful as either hormone replacement therapy or alendronate, but there are no common side effects with raloxifene. Some women have experienced hot flashes and deep vein thrombosis (DVT), which is a blood clot in the leg.