Osteoporosis

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Osteoporosis

Topic Overview

Picture of the skeletal system

What is osteoporosis?

Osteoporosis is a disease that affects your bones. It means 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.

See a picture of healthy bone versus bone weakened by osteoporosis.

Osteoporosis affects millions of older adults in Canada and the United States. It usually strikes after age 60. It’s most common in women, but men can get it too.

What causes osteoporosis?

Osteoporosis is 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. Some risk factors you can change. Others you can't change.

Risk factors you can't change include:

  • Your age. Your risk for osteoporosis goes up as you get older.
  • Being a woman who has gone through menopause. After menopause, the body makes less estrogen. Estrogen protects the body from bone loss.
  • Your family background. Osteoporosis tends to run in families.
  • Having a slender body frame.
  • Your race. People of European and Asian background are most likely to get osteoporosis.

Risk factors you can change include:

  • Smoking.
  • Not getting enough weight-bearing exercise.
  • Drinking too much alcohol.
  • Not getting enough calcium and vitamin D.

To check your risk for osteoporosis, use this Interactive Tool: Are You At Risk for Osteoporosis?

What are the symptoms?

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.

How is osteoporosis diagnosed?

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, 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 women and men age 65 and older. If you have a higher risk for fractures, it’s best to start getting the test at an earlier age. Talk with your doctor about your risk factors and whether you should be tested for osteoporosis before age 65.

How is it treated?

Treatment for osteoporosis includes medicine to reduce bone loss and to 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 dark green vegetables, yogurt, and milk (for calcium). Eat eggs, fatty fish, and fortified cereal (for vitamin D).

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.

Frequently Asked Questions

Learning about osteoporosis:

Being diagnosed:

Getting treatment:

Living with osteoporosis:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Osteoporosis: Should I Have a Dual X-Ray Absorptiometry (DEXA) Test?
  Osteoporosis: Should I Take Bisphosphonate Medicines?

Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Aging Well: Making Your Home Fall-Proof
  Osteoporosis: Taking Calcium and Vitamin D

Interactive tools help people determine health risks, ideal weight, target heart rate, and more. Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
  Interactive Tool: Are You at Risk for Osteoporosis?

Cause

During childhood and teen years, new bone grows faster than existing bone is absorbed by the body. After age 30, this process begins to reverse. As a natural part of aging, bone dissolves and 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 mineral 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. Likewise, testosterone protects men from bone loss. Osteoporosis is typically seen in men older than 65, when production of this hormone declines. In both men and women: The older you get, the more likely you are to have osteoporosis. See a picture of healthy bone versus bone weakened by osteoporosis.

Not getting enough calcium and vitamin D contributes to bone thinning. Also, a tendency for lower bone mass may pass from parent to child.

Symptoms

In the early stages of osteoporosis, you probably will not have symptoms. As the disease progresses, you may have symptoms related to weakened bones, including:

  • Back pain.
  • Loss of height and stooped posture.
  • A curved upper back (dowager's hump).
  • Broken bones (fractures) that might occur with a minor injury, especially in the hip, spine, and wrist.
  • Compression fractures in the spine that may cause severe back pain. But sometimes these fractures cause only minor symptoms or no symptoms at all.

What Happens

In a normal, healthy adult, bone is continually absorbed into the body and then rebuilt. During childhood and the teen 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 develop osteoporosis.

After age 30, both men and women lose a small amount of bone each year. Because most men build greater bone mass than women do, they tend to get osteoporosis later in life.

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:

  • The spine. About half of broken bones caused by osteoporosis are bones in the spine.1 Men and women who have a spinal fracture have a higher risk of future spinal fractures.2 Vertebrae that are weak because of osteoporosis may break and collapse on top of each other (compression fracture). Compression fractures of the spine can result in back pain, stooped posture, loss of height, and a curved upper back (dowager's hump).
  • The hip. Hip fractures are most common in older women. Hip fractures are often caused by a fall. They can make it very hard for you to move around and they usually require major surgery. After a hip fracture, many older people have medical complications such as blood clots, pressure sores, or pneumonia. For more information, see the topic Hip Fracture.
  • The wrist and forearm. Wrist fractures can lead to a reduced ability to be active and independent.3

In women, bone loss increases when the ovaries reduce production of estrogen, a hormone that protects against bone loss.

In men, the hormone testosterone protects against bone loss. Osteoporosis develops most often in men older than 65.

See a picture of healthy bone versus bone weakened by osteoporosis.

What Increases Your Risk

The risk of osteoporosis increases with age as bones naturally become thinner. After age 30, the rate at which your bone dissolves and is absorbed by the body slowly increases, while the rate of bone building decreases. So overall you lose a small amount of bone each year after age 30.

Bone loss speeds up after about age 45, when women produce less of the hormone estrogen and men produce less of the hormone testosterone. But it usually does not affect people until they are 60 or older.

Whether a person develops osteoporosis depends on the thickness of the bones (bone density) in early life as well as health, diet, and physical activity later in life. Factors that increase the risk of osteoporosis in both men and women include:

  • Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed with osteoporosis or has experienced broken bones from a minor injury, you are more likely to develop osteoporosis.
  • Lifestyle factors. These include:
    • Smoking. People who smoke lose bone thickness faster than non-smokers.
    • Alcohol use. Heavy alcohol use can decrease bone formation, and it increases the risk of falling. According to some experts, 3 or more drinks a day increases your risk of osteoporosis.4 See pictures of standard alcoholic drinks.
    • Getting little or no exercise. Weight-bearing exercises—such as walking, jogging, stair climbing, dancing, or lifting weights—keep bones strong and healthy by working the muscles and bones against gravity. Exercise may improve your balance and decrease your risk of falling.
    • A diet low in foods containing calcium and vitamin D.

Other risk factors for osteoporosis may include:

  • Being inactive or bedridden for long periods of time.
  • Dieting excessively or having an eating disorder, such as anorexia nervosa.
  • Being a female athlete, if you have few or irregular menstrual cycles due to low body fat.

Women who have completed menopause have the greatest risk of osteoporosis because their levels of the estrogen hormone drop. Estrogen protects women from bone loss. Likewise, women who no longer have menstrual periods—either because their ovaries are not working properly or because their ovaries have been surgically removed—also can have decreased estrogen levels.

To check your risk for osteoporosis, use the Interactive Tool: Are You at Risk for Osteoporosis? or use this osteoporosis risk questionnaire.

The World Health Organization (WHO) has created a tool called FRAX. 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.sheffield.ac.uk/FRAX and click on Calculation Tool. If you have had a bone mineral density test (BMD) on your hip, there is a place to enter your score. If you have not 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. For more information, see the Other Places to Get Help section of this topic.

When To Call a Doctor

Call your doctor immediately if you:

  • Think you have a broken bone, notice a deformity after a fall, or cannot move a part of your body.
  • Have sudden, severe pain when bearing weight.

Call your doctor for an appointment if you:

  • Want to discuss your risk of developing osteoporosis.
  • Have symptoms of menopause or have completed menopause and want to discuss whether you should take medicine to prevent osteoporosis.
  • Have been treated for a fracture caused by a minor injury, such as a simple fall, and want to discuss your risk of osteoporosis.

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.

Watchful Waiting

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.

Who To See

Ask your family doctor or general practitioner about checking your symptoms and risk of osteoporosis. You may be referred to a specialist, such as:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

A diagnosis of osteoporosis is based on your medical history, a physical examination, and a test to measure your bone thickness (density). During a physical examination, your doctor will:

  • Measure your height and compare the results with past measurements.
  • Examine your body for evidence of previous broken bones, such as changes in the shape of your long bones and spine. See a picture of a compression fracture of the spine.

A bone mineral density test measures the mineral density (such as calcium) in your bones using a special X-ray or computed tomography (CT) scan. From this information, your doctor can estimate the strength of your bones. See a picture of a bone mineral density test.

Routine urine and blood tests can rule out other medical conditions, such as hyperparathyroidism, hyperthyroidism, or Cushing's syndrome, that can cause bone loss. In men, blood tests to measure testosterone levels can see whether low levels are causing bone loss.

If you have been diagnosed with osteoporosis, you may need to follow up regularly with your doctor to monitor your condition.

Early Detection

If you or your doctor thinks you may be at risk for osteoporosis, you may have a screening test to check your bone thickness. A screening test may be advisable if you have:

  • A fracture in a minor injury that may have been caused by osteoporosis.
  • Another medical condition that is known to cause bone thinning.
  • Risk factors for or symptoms that suggest osteoporosis.

Osteoporosis Canada recommends that all women and men age 65 and older routinely have a bone mineral density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should begin earlier.4 Talk with your doctor about your risk factors and whether you should be tested for osteoporosis before age 65.

Most experts recommend that the decision to screen people age 60 and younger be made on an individual basis, depending on the risk for osteoporosis and whether the test results will help with treatment decisions. For help to decide whether you should be tested for osteoporosis, see:

Click here to view a Decision Point. Osteoporosis: Should I Have a Dual X-Ray Absorptiometry (DEXA) Test?

Ultrasound 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 mineral density test.

Treatment Overview

The process of bone thinning (osteoporosis) is a natural part of aging. But if you receive treatment early, you may be able to stop or slow the progress of bone loss. Treatment is important to:

  • Prevent broken bones.
  • Maintain or increase your bone thickness.
  • Relieve pain caused by fractures and changes to bones.
  • Keep your ability to function physically.

Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular weight-bearing exercise, and taking medicine to reduce bone loss and increase bone thickness. It's important to take calcium and vitamin D supplements along with any medicines you take for osteoporosis. Even small changes in diet, exercise, and medicine can help prevent spine and hip fractures. Adults who adopt healthy habits can slow the progress of osteoporosis.

See a picture of healthy bone versus bone weakened by osteoporosis.

Initial treatment

If you have been diagnosed with osteoporosis, your doctor likely will recommend lifestyle and diet changes. Eat foods rich in calcium and vitamin D, which are needed for keeping 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.5 And some studies show that taking vitamin D may reduce the chances of breaking a bone.6 Talk to your doctor about measuring your vitamin D to be sure you are getting enough. The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.

For more information on taking calcium, see:

Click here to view an Actionset. Osteoporosis: Taking Calcium and Vitamin D.

Exercises, including weight-bearing exercise (walking, jogging, stair climbing, dancing, or lifting weights), aerobics, and resistance exercises are all effective in increasing bone mineral density and strength of the spine. Walking also increases bone mineral density of the hip. And exercise increases strength and balance so you are less likely to fall. Start out at an exercise level that you are comfortable with and work up gradually. To be most effective, weight-bearing exercises should be done at least 2 times per week.7 If you stop exercising, your bones weaken and may be more likely to break.

Along with exercise and diet, your doctor will recommend that you not smoke and limit how much alcohol you drink. For more information on quitting smoking, see the topic Quitting Smoking.

In some cases, medicines are prescribed to protect against bone loss. These medicines include raloxifene (Evista), bisphosphonates such as risedronate (Actonel) and alendronate (Fosamax), and parathyroid hormone (Forteo).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. For more information on taking bisphosphonates, see:

Click here to view a Decision Point. Osteoporosis: Should I Take Bisphosphonate Medicines?

If you take corticosteroids longer than 6 months for asthma or other conditions, you may be at greater risk for steroid-induced osteoporosis. If you begin to have bone loss, you may need to take osteoporosis medicines, such as bisphosphonates, while you are taking steroids.

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

Ongoing treatment

After you have been diagnosed with bone loss, whether it is mild or severe, you will need to have regular follow-up tests to monitor the disease. Osteoporosis is a progressive disease: both men and women lose a little bit of bone each year after age 30.8 It is never too late to build and then maintain healthy habits that can slow the progression of the disease.

  • Eat a nutritious diet and be sure to get adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones.
Click here to view an Actionset. Osteoporosis: Taking Calcium and Vitamin D
  • Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, keep bones healthy by working the muscles and bones against gravity.

When you have osteoporosis, it is especially important to protect yourself from falling. When bones lose mass and become more brittle, they lose strength and break more easily. Women of European and Asian ancestry are more likely to have osteoporosis than those with African ancestry. To reduce your chances of breaking bones, take steps to prevent falls, such as having your vision and hearing checked regularly and wearing slippers or shoes with a non-skid sole. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling.

If your tests show continuing bone loss, your doctor likely will recommend that you take medicine to increase bone density and decrease your risk of spine and hip fractures. These medicines include bisphosphonates, such as risedronate (Actonel) or alendronate (Fosamax). It's important to get enough calcium and vitamin D and take prescribed medicines for osteoporosis. For more information about taking bisphosphonates, see:

Click here to view a Decision Point. Osteoporosis: Should I Take Bisphosphonate Medicines?

Calcitonin may be prescribed for women who are more than 5 years beyond menopause and who cannot take bisphosphonate medicines, or for men who are not receiving testosterone treatment.

Raloxifene (Evista) may be prescribed for women, especially if you are 55 to 65 years old. Raloxifene can cause hot flashes. So it is not often used in early menopause (45 to 55 years) when hot flashes are frequent.

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

Treatment if the condition gets worse

It is never too late to build and then keep healthy habits that can slow bone thinning.

  • Eat a nutritious diet and be sure you are getting adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones.
Click here to view an Actionset. Osteoporosis: Taking Calcium and Vitamin D
  • Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, keep bones healthy by working the muscles and bones against gravity.

Medicines called bisphosphonates, such as alendronate (Fosamax) or zoledronic acid (Aclasta), may be used to slow the rate of bone loss and increase bone thickness and strength. This will reduce the risk of broken bones. For more information on bisphosphonates, see:

Click here to view a Decision Point. Osteoporosis: Should I Take Bisphosphonate Medicines?

In some cases, hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is given to women to slow bone loss from osteoporosis. But hormone therapy can also increase the risk of other conditions, including stroke and breast cancer. Many experts recommend that long-term hormone replacement therapy only be considered for women with a significant risk of osteoporosis that outweighs the risks of taking HRT or ERT.

If your osteoporosis is severe or you continue to have bone loss while taking a bisphosphonate:

  • You may need to take both a bisphosphonate medicine and hormone therapy. Studies show that taking both medicines results in increased bone mass when compared to taking either alone.9
  • Your doctor may prescribe teriparatide (Forteo) or denosumab (Prolia).

It's important to get enough calcium and vitamin D and take prescribed medicines for osteoporosis.

Compression fractures resulting from osteoporosis can cause significant back pain that lasts for several months. Treatments available to relieve your pain include:

  • Non-prescription acetaminophen (such as Tylenol).
  • Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and ASA. If you take NSAIDs regularly, your doctor may recommend that you also take a medicine such as a proton pump inhibitor (PPI) to protect your digestive system. But there is also a chance that PPIs can help cause osteoporosis. Talk to your doctor about taking NSAIDs and PPIs for long periods of time.
  • A pain reliever such as a narcotic, which may be prescribed on a short-term basis.
  • Other medicines such as calcitonin (Calcimar or Miacalcin) to help reduce pain from spinal fractures.
  • A back brace or corset to support the spine.

One of two surgical treatments, vertebroplasty or kyphoplasty, may relieve pain from spinal compression fractures. In these procedures, a surgeon injects bone cement through a needle into the crushed spinal bones (vertebrae).

If you experience 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.2

What to think about

It's important to get enough calcium and vitamin D and take prescribed medicines for osteoporosis. For more information on taking calcium, see:

Click here to view an Actionset. Osteoporosis: Taking Calcium and Vitamin D.

Prevention

After the age of about 30, bone thinning is a natural process and cannot be stopped completely. Whether you develop osteoporosis depends not only on the thickness of your bones early in life but also on your health, diet, and physical activity later in life. The thicker your bones, the less likely the bones are to become thin enough to break. Young women in particular need to be aware of their risk for osteoporosis and take steps early to slow its progress and prevent complications.

A lot of physical activity during the preteen and teen years increases bone mass and greatly reduces the risk of osteoporosis in adulthood. If you eat a diet adequate in calcium and vitamin D and exercise regularly early in life and then continue with these healthy habits, you may be able to delay or avoid osteoporosis.

  • Eat a nutritious diet that includes adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones. Vitamin D is vital for calcium absorption in bones and to improve muscle strength. Getting more vitamin D may help prevent falls in older people who are low in vitamin D.5 And some studies show that taking vitamin D may reduce the chances of breaking a bone.6 Talk to your doctor about measuring your vitamin D to be sure you are getting enough. The best source of vitamin D is exposure to sunlight. Vitamin D is also added to milk, some calcium supplements, and many multivitamin supplements.
  • Get regular exercise. Weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or weight lifting, keep bones healthy by working the muscles and bones against gravity.
  • Limit how much alcohol you drink. According to some experts, 3 or more drinks a day increases your risk of osteoporosis.4 See pictures of standard alcoholic drinks.
  • Don't smoke. Smoking puts you at a higher risk for osteoporosis and increases the rate of bone thinning after it starts.

Home Treatment

Most adults with osteoporosis need to take medicine to slow bone loss. In addition to medicine, there is much you can do to help slow the process and prevent broken bones:

  • Get enough calcium and vitamin D. Getting enough vitamin D, along with sufficient calcium, 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 or yogurt. If you think you may not be getting enough calcium in your diet, check with your doctor about taking calcium supplements. For more information, see:
    Click here to view an Actionset. Osteoporosis: Taking Calcium and Vitamin D.
  • Exercise. Recent studies show that 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 the bone mineral density and strength of the spine in post-menopausal women. Walking also increases bone mineral density of the hip. Regular exercise throughout life cuts in half the number of hip fractures in older people.10 Create an exercise program that fits your lifestyle and is easy to follow. For more information, see the topic Fitness.
  • Eat nutritious foods to keep your body healthy. For more information, see the topic Healthy Eating.
  • Take steps to prevent falls that might result in broken bones. Have your vision and hearing checked regularly. And 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. For more information, see:
    Click here to view an Actionset. Aging Well: Making Your Home Fall-Proof.
  • Limit alcohol use. Heavy alcohol use can decrease bone formation, and it clearly increases the risk of falling. According to some experts, 3 or more drinks a day increases your risk of osteoporosis.4 See pictures of standard alcoholic drinks.
  • Stop smoking. Smoking reduces your bone density and speeds up the rate of bone loss. For information on how to stop, see the topic Quitting Smoking.

If you need calcium supplements, experts recommend that you choose calcium supplements that are known brand names with proven reliability. Most brand-name calcium products are absorbed easily by the body. There is no scientific evidence to support the benefits of coral calcium as a superior source of calcium and a cure for disease.

Medications

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.

If you take medicine for osteoporosis, you will also need to take calcium and vitamin D supplements, eat a healthy diet, and exercise regularly. A large part of treating or reducing the effects of osteoporosis is getting enough calcium and vitamin D.

Medication Choices

Medicines for treatment and prevention

Medicines used to prevent or treat osteoporosis include:

  • Bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Aclasta), which slow the rate of bone thinning and can lead to increased bone density. These medicines may be used in men and women.
    Click here to view a Decision Point. Osteoporosis: Should I Take Bisphosphonate Medicines?
  • Raloxifene (Evista), a selective estrogen receptor modulator (SERM), which is used only in women. Raloxifene slows bone thinning and causes some increase in bone thickness.11
  • Calcitonin (Calcimar or Miacalcin), a naturally occurring hormone that helps regulate calcium levels in your body and is part of the bone-building process. When taken by shot or nasal spray, it slows the rate of bone thinning. Calcitonin also relieves pain caused by spinal compression fractures. Calcitonin is used in men and women.
  • Parathyroid hormone (teriparatide [Forteo]), used for the treatment of men and post-menopausal women with severe osteoporosis who are at high risk for bone fracture. It is given by injection.
  • Denosumab (Prolia), which is used to treat women who are past menopause and who are at high risk for bone fracture. It works by slowing bone thinning, so bone is able to become stronger. It is given by injection, usually every 6 months.

Hormone therapy

Hormone therapy for osteoporosis in women includes:

  • Estrogen. Estrogen without progestin (estrogen replacement therapy, or ERT) may be used to treat osteoporosis in women who have gone through menopause and do not have a uterus. Because taking estrogen alone increases the risk for cancer of the lining of the uterus (endometrial cancer), ERT is only used if a woman has had her uterus removed (hysterectomy).
  • Estrogen and progestin. In rare cases, the combination of estrogen and progestin (hormone replacement therapy, or HRT) is recommended for women who have osteoporosis.

For men, testosterone (shots, gel, or patches) sometimes is given to prevent osteoporosis caused by low testosterone levels. Use of testosterone to treat osteoporosis has not been approved by Health Canada's Therapeutic Product Directorate (TPD).

A woman's level of the hormone estrogen, which affects the growth and loss of bone, decreases naturally during and after menopause. Estrogen replacement therapy (ERT) or combination estrogen/progesterone replacement therapy (HRT) can help to reduce bone loss.

But the long-term risks of taking low-dose estrogen (and progesterone in one-third of the cases) were not studied and are unclear.12 Experts recommend that HRT or ERT be used at the lowest dose for the shortest length of time to reach your treatment goals.

Hormone therapy is typically not recommended for most women with osteoporosis. But if you are at high risk and cannot take other medicines, your doctor may recommend it under certain circumstances. If you continue to have bone loss while taking bisphosphonate medicine, such as risedronate (Actonel) or alendronate (Fosamax), you may need to take both bisphosphonate medicine and hormone therapy. Studies show that taking a bisphosphonate with hormone therapy results in increased bone mass compared to taking either medicine alone.9

What to Think About

Calcium, vitamin D, bisphosphonates, calcitonin, and teriparatide may be used by men or women. HRT, ERT, and raloxifene are prescribed only for women. Testosterone is prescribed only for men.

Compression fractures and other broken bones resulting from osteoporosis can cause significant pain that lasts for several months. Medicines to relieve this pain include:

  • Non-prescription acetaminophen, such as Tylenol.
  • Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. If you take NSAIDs regularly, your doctor may recommend that you also take a medicine such as a proton pump inhibitor (PPI) to protect your digestive system. But there is also a chance that PPIs can help cause osteoporosis. Talk to your doctor about taking NSAIDs and PPIs for long periods of time.
  • A narcotic pain reliever, such as codeine or morphine.
  • Calcitonin, such as Calcimar or Miacalcin.

If you are taking medicine but still have pain or have side effects from the medicine, such as an upset stomach, talk with your doctor.

Statins are medicines used to treat high cholesterol, which increases the risk for life-threatening diseases, such as coronary artery disease, heart attack, and stroke. Recent studies have reported conflicting results on statins' potential for lowering a woman's risk of bone fractures. Evidence does not yet support the use of statins to prevent or treat osteoporosis.13, 14

Surgery

Two surgical treatments, vertebroplasty and kyphoplasty, may relieve pain from spinal compression fractures resulting from osteoporosis. In these procedures, a surgeon injects bone cement through a needle into the crushed spinal bones (vertebrae).

If you experience a hip fracture because of osteoporosis, you may need surgery to repair your hip. For more information, see the topic Hip Fracture.

Other Treatment

Exercise is an important part of managing osteoporosis. Your doctor may recommend physiotherapy. Your physiotherapist may teach you how to safely do weight-bearing exercises, which can slow bone loss. Exercising will help you keep your muscle strength, which is needed to avoid falls. You may also learn exercises to help you stay flexible and improve your balance.

Hip protectors have been recommended to help prevent hip fractures from osteoporosis. They look like a girdle or underwear with pads on both hips. The pads may help reduce the force of a fall. But a summary of several studies concluded that hip protectors do not prevent hip fractures in people who live at home. And they may not be helpful for people in nursing homes or other institutions.15 One problem with studying hip protectors is that people do not like wearing them even if they might help protect the hips. Hip protectors are bulky under clothing. They can irritate the skin and are hard to fit properly.

Some people use alternative treatments to try to reduce their risk of osteoporosis. Soy products may help reduce the chance of broken bones due to osteoporosis. One large study showed that post-menopausal women who ate an average of 11 grams of soy protein a day had a lower risk of fracture.16 (As an example, 1 cup of soy milk 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.

Other Places To Get Help

Organizations

Society of Obstetricians and Gynaecologists of Canada (SOGC)
780 Echo Drive
Ottawa, ON  K1S 5R7
Phone: 1-800-561-2416
(613) 730-4192
Fax: (613) 730-4314
Email: helpdesk@sogc.com
Web Address: www.sogc.org
 

The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.


North American Menopause Society (NAMS)
5900 Landerbrook Drive
Suite 390
Mayfield Heights, OH 44124
Phone: (440) 442-7550
Fax: (440) 442-2660
Email: info@menopause.org
Web Address: www.menopause.org
 

The North American Menopause Society (NAMS) is a nonprofit organization that promotes the understanding of menopause and thereby improves the health of women as they approach menopause and beyond. NAMS members include experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education. The NAMS website has information on perimenopause, early menopause, menopause symptoms and long-term health effects of estrogen loss, and a variety of therapies.


Osteoporosis Canada
1090 Don Mills Road
Suite 301
Toronto, ON  M3C 3R6
Phone: 1-800-463-6842
(416) 696-2663
Fax: (416) 696-2673
Email: info@osteoporosis.ca
Web Address: www.osteoporosis.ca
 

Osteoporosis Canada works to educate and support individuals and communities in the prevention and treatment of osteoporosis. Services to individuals with osteoporosis and the public include free publications, a bilingual toll-free information line, educational programs, and referrals to self-help groups and community resources.


U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
Phone: 1-877-22-NIAMS (1-877-226-4267) toll-free
(301) 495-4484
Fax: (301) 718-6366
TDD: (301) 565-2966
Email: niamsinfo@mail.nih.gov
Web Address: www.niams.nih.gov
 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research.

The NIAMS website provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.


U.S. National Institute on Aging
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD  20892
Phone: (301) 496-1752
1-800-222-2225, Information Center
Fax: (301) 496-1072
TDD: 1-800-222-4225 (TTY)
Web Address: www.nih.gov/nia
 

The National Institute on Aging (NIA), one of the centers of the U.S. National Institutes of Health, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. The NIA funds research and provides information about health and research advances to the public and interested groups.


References

Citations

  1. Anderson JJB (2008). Nutrition and bone health. In LK Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, 12th ed., pp. 614–635. St. Louis: Saunders Elsevier.
  2. Feldstein A, et al. (2003). Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures. Archives of Internal Medicine, 163(18): 2165–2172.
  3. 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).
  4. Papaioannou A, et al. (2010). 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. Canadian Medical Association Journal, 182 (17): 1864–1873.
  5. Gillespie LD, et al. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (2).
  6. 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.
  7. Canadian Society for Exercise Physiology (2011). Canadian Physical Activity Guidelines For Adults. Available online: http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-adults-ENG.pdf.
  8. American College of Obstetricians and Gynecologists (2004, reaffirmed 2008). Osteoporosis. ACOG Practice Bulletin No. 50. Obstetrics and Gynecology, 103(1): 203–216.
  9. Greenspan SL, et al. (2003). Combination therapy with hormone replacement and alendronate for prevention of bone loss in elderly women. JAMA, 289(19): 2525–2533.
  10. Fiechtner JJ (2003). Hip fracture prevention. Postgraduate Medicine, 114(3): 22–32.
  11. Drugs for postmenopausal osteoporosis (2008). Treatment Guidelines From the Medical Letter, 6(74): 67–74.
  12. Prestwood KM, et al. (2003). Ultralow-dose micronized 17 B-estradiol and bone density and bone metabolism in older women. JAMA, 290(8): 1042–1048.
  13. LaCroix AZ, et al. (2003). Statin use, clinical fracture, and bone density in postmenopausal women: Results from the Women's Health Initiative Observational Study. Annals of Internal Medicine, 139(2): 97–104.
  14. Bauer DC, et al. (2004). Use of statins and fracture: Results of 4 prospective studies and cumulative meta-analysis of observational studies and controlled trials. Archives of Internal Medicine, 164(2): 146–152.
  15. Parker MJ, et al. (2006). Effectiveness of hip protectors for preventing hip fractures in elderly people: Systematic review. BMJ, 332(7541): 571–574.
  16. Zhang X, et al. (2005). Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Archives of Internal Medicine, 165(16): 1890–1895.

Other Works Consulted

  • American Association of Clinical Endocrinologists (2003). Medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis. Endocrine Practice, 9(6): 544–564.
  • 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).
  • Bonaiuti D, et al. (2002). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
  • Heiss G, et al. (2008). Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA, 299(9): 1036–1045.
  • Holt EH (2008). Diseases of calcium metabolism and metabolic bone disease. In DC Dale, DD Federman, eds., ACP Medicine, section 3, chap. 6. Hamilton, ON: BC Decker.
  • Liu H, et al. (2008). Screening for osteoporosis in men: A systematic review for an American College of Physicians guideline. Annals of Internal Medicine, 148(9): 685–701.
  • MacLean C, et al. (2008). Systematic review: Comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Annals of Internal Medicine, 148(3): 197–213.
  • National Osteoporosis Foundation (2008). Prevention: Exercise for healthy bones. Available online: http://www.nof.org/prevention/exercise.htm.
  • National Osteoporosis Foundation (2008). Prevention. Available online: www.nof.org/prevention/index.htm.
  • 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.
  • 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.
  • 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.
  • Reid R, et al. (2009). Menopause and osteoporosis update 2009. SOGC Clinical Practice Guideline No. 222. Journal of Obstetrics and Gynaecology Canada, 31(Supplement 1): S1–S49. Available online: http://www.sogc.org/guidelines/documents/Menopause_JOGC-Jan_09.pdf.
  • Vondracek SF, Hansen LB (2004). Current approaches to the management of osteoporosis in men. American Journal of Health-System Pharmacists, 61(17): 1801–1811.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Primary Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Carla J. Herman, MD, MD, MPH - Geriatric Medicine
Last Revised May 13, 2011

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