What is osteoporosis?

The word ‘osteoporosis’ means ‘porous bone.’ It is a disease that makes the bones weak and increases your risk for sudden and unexpected bone fractures. The mass and the strength of the bones reduce considerably due to the loss of mineral density and bone mass.

In Osteoporosis, the bone mass becomes low, and there is structural deterioration of bone tissue, leading to an increased risk of bone fractures.

The World Health Organization (WHO) defines osteoporosis as a spinal or hip bone mineral density (BMD) of 2.5 standard deviations or more below the mean for healthy, young women (T-score of −2.5 or below) as measured by dual energy x-ray absorptiometry (DEXA).

Osteopenia is defined as a spinal or hip BMD between 1 and 2.5 standard deviations below the mean.

The disease often presents no symptoms and is therefore called a “silent” disease. It is discovered when your weakened bones develop a painful fracture rather easily.

Osteoporosis is typically seen in postmenopausal women and in older men. Fractures can occur in any bone but they mostly occur in the bones of the hip, wrist, and the vertebrae of the spine.

The International Osteoporosis Foundation (IOF) estimates that over 44 million people in the United States are currently living with osteoporosis.

Bones are essentially living tissues that are constantly being broken down and replaced with new tissues. The bone structure is constantly undergoing a process called remodeling. It gets broken down and rebuilt. The bone reabsorbing cells are called osteoclasts, the bone-forming cells are called osteoblasts, and the process is called coupling.

Coupling links bone resorption to formation in a synchronized manner within the remodeling cycle. In order to maintain skeletal strength, it is essential that the amount of bone that is reabsorbed match the amount of newly formed bone.

As you age, more bone is reabsorbed than is deposited. This tends to result in a negative balance in the remodeling cycle, which leads to osteopenia and osteoporosis, and weakened bones. This predisposes to bone fracture even with minimal trauma.

Osteopenia is a condition where your bone density is lower than usual for your age. Osteoporosis is a more severe form of bone loss that makes your bones weak and more likely to fracture.

Who is more likely to get osteoporosis?

It is estimated that about 200 million people have osteoporosis throughout the world. In the U.S., the figure stands at about 54 million people. Women are four times more liable to developing this condition than men. There are currently about two million men in the U.S. who have osteoporosis and some 12 million more who are at risk of developing the condition.

After age 50, fifty percent of women and twenty-five percent of men will suffer from an osteoporosis-related fracture during their lifetimes.

Another 30% suffer from osteopenia, which puts them at risk of developing osteoporosis. Two million people suffer from fractures each year due to this bone disease.

Causes and risk factors

When you suffer from too much bone loss causing a weakened bone structure, you are prone to suffer from osteoporosis. There are certain risk factors that increase your likelihood of developing this condition.

You have control over some while some you may not be able to influence. However, some people who develop this condition may not have any specific risk factors.

Factors that may increase your risk for osteoporosis include:

  • Sex. Women are at a greater risk because they have lower peak bone mass and smaller bones than men. However, men’s risk increases after the age of 70 years.
  • Age. As you age, you lose bone mass at a quicker rate and its replacement with new bone happens more slowly. Your bones, therefore, weaken during these advanced years, and your risk for osteoporosis increases.
  • Body size. Slender, thin-boned women and men have less bone to lose compared to larger-boned women and men. They are, therefore, at greater risk to develop osteoporosis.
  • Race. More White and Asian women are seen to suffer from osteoporosis than African  American and Mexican American women who have a lower risk. Similarly, more White men suffer from this condition than African American and Mexican American men, indicating they are at a higher risk.
  • Family history. Researchers have found that the risk for easy fractures may increase if you have a family history. If one of your parents has suffered from osteoporosis or a bone fracture, your risk increases.
  • Hormonal changes.
    • High levels of thyroid hormone can cause loss of bone mass. This can occur if you suffer from untreated hyperthyroidism or if you have taken higher doses of thyroid medication to treat your hypothyroidism.
    • Low levels of the sex hormone, estrogen, tend to weaken your bones. Such low levels of estrogen seen in women at menopause are one of the strongest risk factors for developing osteoporosis.
    • Similarly, hormonal treatments for prostate cancer that cause testosterone levels in men to fall and treatments for breast cancer that reduce estrogen levels in women can induce rapid loss of bone mass and increase osteoporosis risk.
  • Diet. Osteoporosis is more likely to develop in people who have:
    • A poor diet that you have been eating since childhood, which is low in calcium, vitamin D, and protein increases your risk. Excessive dieting too can cause low levels of these nutrients in your body and increase your risk of having weak bones.
    • Severe restrictions on eating food to stay underweight for whatever the reason resulting malnourishment and weak bones in men and women.
    • Undergone gastrointestinal surgery as part of weight loss treatment or removal of part of the intestine. This limits the amount of surface area available and absorption of nutrients, including calcium, suffers.
  • Other medical conditions. Some medical conditions increase your risk of secondary osteoporosis. They include
    • certain endocrine and hormonal diseases such as hypogonadism, growth hormone deficiency, Cushing’s syndrome, and anorexia nervosa
    • gastrointestinal diseases,
    • rheumatoid arthritis,
    • certain types of cancer,
    • HIV/AIDS
  • Medications. Long-term use of certain medications increases your risk of bone loss and osteoporosis:
    • Glucocorticoids and adrenocorticotropic hormones are used in the treatment of some conditions such as asthma and rheumatoid arthritis
    • Antiepileptic medicines, which are used to treat seizures
    • Cancer medications, which use hormones to treat breast and prostate cancer
    • Proton pump inhibitors are used in the treatment of gastritis to reduce gastric acid secretion
    • Selective serotonin reuptake inhibitors treat depression and anxiety
    • Thiazolidinediones are used to treat type II diabetes
  • Lifestyle. A healthy lifestyle can be a very important part of your life for good health and strong bones. Unhealthy lifestyle factors that contribute to bone loss include:
    • A sedentary lifestyle and low levels of physical activity predispose to an increased rate of bone loss.
    • Regular heavy drinking of alcohol or alcohol abuse significantly increases your risk of osteoporosis.
    • Smoking, too, makes you more prone to developing this condition and fracture.

Symptoms and warning signs in men and women

In the early stages, osteoporosis presents no symptoms. Many times, especially elderly people will learn about their osteoporotic condition after they suffered a fracture. Fractures often occur in the bones of the hip, wrist, and vertebrae of the spine and they tend to occur rather easily even with mild injuries.

Bones of the spine develop compression fractures that can occur without any injury. They can cause pain anywhere along the vertebral column. The pain can be of sudden onset or may develop slowly over time.

A significant loss of height of more than two inches, a hunched posture, back or neck pain, and bone fractures that happen even with small injuries are often the most common symptoms of later-stage osteoporosis.

However, some early symptoms and warning signs that can indicate the presence of osteoporosis include:

1. Receding Gums

Receding gums is a common symptom of osteoporosis and is mainly due to bone loss in the jaw bone. Teeth are connected to our jaw bone. If the jaw is losing bone mass, the gums can recede back. Deterioration of the jawbones often also causes premature tooth loss and gum disease.

Periodontal (gum) disease is another fallout. The loss of jawbone density makes it easier for bacteria to infect the bone leading to gum disease.

2. Decreased Grip Strength

Due to weakened hand bones especially among older women, there is an inability to grip objects and gain support. With a loosening grip, objects may fall out of the hands and the person may fall because of the inability to grip objects for support.

3. Cramps and Bone Pain

Regular muscle cramps and pains are common symptoms that can be caused by a variety of other reasons. This is an early symptom of osteoporosis and indicates a severe deficiency of vitamin D.

Muscle cramps that occur at night often indicate very low blood levels of calcium, magnesium, and/or potassium levels. If this deficiency persists for a long time, you could suffer from excessive bone loss.

4. Fracture

Fractures that occur easily are the most common early warning sign of Osteoporosis. Fragile and brittle bones caused by osteoporosis break more easily than when you were young (as of the pre-menopausal period in women). Even a mild injury like falling or tripping lightly can cause your bone to fracture.

5. Loss of Height

It is normal to lose a little height, as we get older. However, certain physical changes such as too much height loss are the most common sign of osteoporosis. A height loss of more than two inches is not normal and simply indicates that loss of bone density is causing your bones in the spine to break and making you shorter.

6. Brittle Fingernails

Weak brittle fingernails, which often break after some manual work, can be a sign that your bone density has decreased and assumes significance as one of the signs of osteoporosis of the hand bones.

7. Widow’s Hump

Compression fractures of the vertebrae are quite common in people with Osteoporosis. This can lead to changes in the overall posture, and cause a “widow’s hump”. This is a bend that develops in the spine near the shoulders.

What are the symptoms of osteoarthritis in the knee?

  • Your knee feels stiff and looks swollen.
  • You hear grinding noise when you flex your knee.
  • Your knee feels shaky as if it could buckle under your body weight.

Symptoms of osteoporosis of neck vertebrae

  • Neck pain. The neck pain could just be mild tenderness or it could be unbearable pain.

Symptoms of osteoporosis in the lower back

  • Severe back pain of sudden onset that becomes worse when you are standing or walking. You get relief when you lie down.
  • You have pain when you twist or bend your body.
  • You lose significant height  and may develop kyphosis, which is also referred to as a “dowager’s hump.”

Symptoms of osteoporosis in hands

Osteoporosis of the bones of the hands causes your grip strength to weaken. Your fingernails become weak and brittle and break easily. This could be an early sign of osteoporosis of the hand bones.


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