Osteoporosis

Introduction

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.

Bone is living tissue, which is constantly being absorbed and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the removal of old bone.

Osteoporosis affects men and women of all races. But white and Asian women — especially those who are past menopause — are at highest risk. Medications, dietary supplements and weight-bearing exercise can help strengthen your bones.
 

When is Osteoporosis Surgery recommended?

Signs and Symptoms:

In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have been weakened by osteoporosis, you may have osteoporosis signs and symptoms that include:

  • Back pain, caused by a fractured or collapsed vertebra

  • Loss of height over time

  • A stooped posture

  • A bone fracture that occurs much more easily than expected

You may want to talk to your doctor about osteoporosis if you've:

  • Gone through early menopause

  • Experienced a loss of height

  • Had a bone break much more easily than expected

  • Taken corticosteroids for a lengthy period of time

  • Got a family history of osteoporosis

What are the causes?

Your bones are in a constant state of renewal — new bone is made and old bone is broken down. When you're young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Most people reach their peak bone mass by their early 20s. As people age, bone mass is lost faster than it's created.

How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age.

How is Osteoporosis diagnosed?

The most common test to measure bone density is dual energy X-ray absorptiometry (DXA). This procedure is quick, simple and gives accurate results. It painlessly measures the density of bones in your spine, hip and wrist — the areas most likely to be affected by osteoporosis.

What are the treatment options for Osteoporosis?

Bisphosphonates
For both men and women, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

  • Alendronate (Fosamax)

  • Risedronate (Actonel, Atelvia)

  • Ibandronate (Boniva)

  • Zoledronic acid (Reclast, Zometa)

Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed esophagus or esophageal ulcers. Injected forms of bisphosphonates don't cause stomach upset. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill.

Long-term bisphosphonate therapy has been linked to a rare problem in which the upper thighbone cracks, but doesn't usually break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition occurring after a tooth extraction in which a section of jawbone dies and deteriorates.

Hormone-related Therapy

Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman's risk of blood clots, endometrial cancer, breast cancer and possibly heart disease.

Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may also reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.

In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help increase bone density.

Less common osteoporosis medications

If you can't tolerate the more common treatments for osteoporosis — or if they don't work well enough — your doctor might suggest trying:

  • Teriparatide (Forteo). This powerful drug uses parathyroid hormone to stimulate new bone growth. It's given by injection under the skin. Long-term effects are still being studied, so therapy is recommended for two years or less.

  • Denosumab (Prolia, Xgeva). Compared to bisphosphonates, denosumab produces similar or better results while targeting a different step in the bone remodeling process. Denosumab is delivered via a shot under the skin every six months. The most common side effects are back and muscle pain.

  • Calcitonin, salmon (Fortical, Miacalcin). A substance produced by the thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It's usually administered as a nasal spray and may cause nasal irritation in some people. It is the least effective of the available therapies.

What are the risk factors for Osteoporosis?

A number of factors can increase the likelihood that you'll develop osteoporosis — including your age, race, lifestyle choices, and medical conditions and treatments.

Unchangeable risks

Some risk factors for osteoporosis are out of your control, including:

  • Your sex. Women are much more likely to develop osteoporosis than are men.

  • Age. The older you get, the greater your risk of osteoporosis.

  • Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.

  • Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.

  • Frame size. Men and women who have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age.

Hormone levels

Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

  • Sex hormones. The reduction of estrogen levels at menopause is one of the strongest risk factors for developing osteoporosis. Women may also experience a drop in estrogen during certain cancer treatments. Men experience a gradual reduction in testosterone levels as they age. And some treatments for prostate cancer reduce testosterone levels in men. Lowered sex hormone levels tend to weaken bone.

  • Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medication to treat an underactive thyroid.

  • Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.

Dietary factors

Osteoporosis is more likely to occur in people who have:

  • Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.

  • Eating disorders. People who have anorexia are at higher risk of osteoporosis. Low food intake can reduce the amount of calcium ingested. In women, anorexia can stop menstruation, which also weakens bone.

  • Weight-loss surgery. A reduction in the size of your stomach or a bypass of part of the intestine limits the amount of surface area available to absorb nutrients, including calcium.

Steroids and other medications

Long-term use of corticosteroid medications, such as prednisone and cortisone, interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:

  • Seizures

  • Depression

  • Gastric reflux

  • Cancer

  • Transplant rejection

Lifestyle choices

Some bad habits can increase your risk of osteoporosis. Examples include:

  • Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than do their more-active counterparts. Any weight-bearing exercise is beneficial for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful for creating healthy bones.

  • Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis, possibly because alcohol can interfere with the body's ability to absorb calcium.

  • Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.

Can Osteoporosis be prevented?

Three factors essential for keeping your bones healthy throughout your life are:

  • Adequate amounts of calcium

  • Adequate amounts of vitamin D

  • Regular exercise

Calcium

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70. Good sources of calcium include:

  • Low-fat dairy products

  • Dark green leafy vegetables

  • Canned salmon or sardines with bones

  • Soy products, such as tofu

  • Calcium-fortified cereals and orange juice

If you find it difficult to get enough calcium from your diet, consider taking calcium supplements. The Institute of Medicine recommends taking no more than 2,000 to 2,500 milligrams of calcium daily.

Vitamin D

Vitamin D is necessary for your body to absorb calcium. Many people get adequate amounts of vitamin D from sunlight, but this may not be a good source if you live in high latitudes, if you're housebound, or if you regularly use sunscreen or you avoid the sun entirely because of the risk of skin cancer.

Scientists don't yet know the optimal daily dose of vitamin D. A good starting point for adults is 600 to 800 international units (IU) a day, through food or supplements. If your blood levels of vitamin D are low, your doctor may suggest higher doses. Teens and adults can safely take up to 4,000 international units (IU) a day.

Exercise

Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life.

Combine strength training exercises with weight-bearing exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — mainly affect the bones in your legs, hips and lower spine.

Swimming, cycling and exercising on machines such as elliptical trainers can provide a good cardiovascular workout, but because such exercises are low impact, they're not as helpful for improving bone health as weight-bearing exercises are.

How fast can you recover?

To be shared by the doctor.

After Discharge?

Calcium is important for osteoporosis because it helps build bone mass. Osteoporosis is a long-term medical condition that causes your body to break down more bone than it makes. Your bones become weak, brittle, and more likely to fracture.

Follow up with your primary healthcare provider or dietitian as directed:

Write down your questions so you remember to ask them during your visits.

Your calcium needs:

Infants:

  • - 0 to 6 months: 200 mg
  • - 6 to 12 months: 260 mg

Children:

  • - 1 to 3 years: 700 mg
  • - 4 to 8 years: 1,000 mg
  • - 9 to 18 years: 1,300 mg

Women:

  • - 19 to 50 years: 1,000 mg
  • - Over 50: 1,200 mg
  • - Pregnant or breastfeeding, 19 years to 50 years: 1,000 mg

Men:

  • - 19 to 70: 1,000 mg
  • - Over 70: 1,200 mg

Food sources of calcium:

Dairy:

  • 1 cup of low-fat plain yogurt (415 mg) or low-fat fruit yogurt (245 to 384 mg)
  • 1½ ounces of shredded cheddar cheese (306 mg) or part skim mozzarella cheese (275 mg)
  • 1 cup of skim, 2% milk, or whole milk (300 mg)
  • 1 cup of cottage cheese made with 2% milk fat (138 mg)
  • ½ cup of frozen yogurt (103 mg)

Other foods:

  • 1 cup of calcium-fortified orange juice (300 mg)
  • ½ cup of cooked collard greens (220 mg)
  • 4 canned sardines, with bones (242 mg)
  • ½ cup of tofu (with added calcium) (204 mg)

How to get extra calcium:

  • Add powdered milk to puddings, cocoa, custard, or hot cereal.

  • Sift powdered milk into flour when you make cakes, cookies, or breads.

  • Use low-fat or fat-free milk instead of water in pancake mix, mashed potatoes, pudding, and hot breakfast cereals.

  • Add low-fat or fat-free cheese to salad, soup, or pasta.

  • Add tofu (with added calcium) to vegetable stir-fry.

  • Take calcium supplements if you cannot get enough calcium from the foods you eat. Your body can absorb the most calcium from supplements when you take 500 mg or less at one time. Do not take more than 2,500 mg of calcium each day.

What are the results of the surgery?

To be provided by the doctor.

What are the complications?

Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often result from a fall and can result in disability and even death from postoperative complications, especially in older adults.

In some cases, spinal fractures can occur even if you haven't fallen. The bones that make up your spine (vertebrae) can weaken to the point that they may crumple, which can result in back pain, lost height and a hunched forward posture.

Cost of Surgery?

The cost of surgery for Osteoporosis depends on many factors. They include the cost of being in the hospital for several days. Unexpected events that result in an extended hospital stay will also increase the overall cost.

Costs also vary depending on the type of insurance coverage you have. Many insurance companies cover the cost of the surgery, the hospital stay, and the instruments to straighten the spine. You may owe a co-payment or you may be billed the balance of what your insurance does not cover.

Be sure to contact your insurance provider prior to surgery to discuss the extent of your coverage. Discuss with your surgeon, as well as the hospital billing department to make sure you understand all the costs involved.

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