When most people think of osteoporosis, they imagine this bone-loss condition only affects older women.
While post-menopause is one of the biggest risk factors for osteoporosis, anyone can have bone loss.
The human skeleton is comprised of bones that build up and break down many times throughout life. However, as we get older, our bones can’t repair or replace themselves as well as they used to. This can result in osteoporosis, a condition characterized by weakened bones and a higher-than-normal risk of fractures.
At Yale Medicine, we are committed to diagnosing and treating osteoporosis and early as possible to minimize further damage.
What are the symptoms of osteoporosis?
The first indication of osteoporosis is often a broken bone. “If you’ve had a fracture that occurred with low trauma—meaning if you simply tripped and fell and broke your hip or your wrist—that puts you at risk for being osteoporotic,” Dr. Insogna says.
For some people, especially women, loss of height or increasing curvature of the spine can also be signs of osteoporosis.
What are the most common types of osteoporosis?
The most common type of osteoporosis is postmenopausal. This occurs when women no longer produce enough estrogen to keep their bones healthy.
“In your 20s, you get a whole new skeleton every few years,” says Dr. Insogna. “But that process begins to go awry as you get older.”
After menopause, women break down more bone than they form. In their 70s and 80s, they don’t make much new bone at all.
There is also drug-induced osteoporosis, which can affect men and women at any age. When people take medications such as steroids for an extended period of time, the drug can prevent bone formation. When new bones cannot form properly, fractures can occur.
Men and younger women can also get osteoporosis, as a result of hormone imbalances, alcohol abuse, or lack of proper nutrition.
What are the risk factors for osteoporosis?
Family history: This is also an important risk factor for both sexes. So is having an inflammatory disease such as rheumatoid arthritis, or a family history of one. (Rheumatoid arthritis can contribute to weaker bones, and so can some of the medicines used to treat it – especially Prednisone, says Dr. Insogna.
Low testosterone: For men, having low testosterone is a risk factor for osteoporosis. So is a history of heavy drinking, since alcohol lowers blood testosterone in men, damages bone-building cells and leaches nutrients such as calcium away from bones.
Osteopenia: This term is used to describe people who have low bone density but do not yet meet the criteria for osteoporosis. A person diagnosed with osteopenia should take precautions to protect her bones and keep the condition from getting worse.
Postmenopause: Being a postmenopausal woman is the biggest risk factor for osteoporosis. Younger women who have not had a normal menstrual cycle are also at increased risk. (Abnormal menstruation can be caused by an eating disorder or a very low body weight, for example.)
Smoking: This is an indirect risk factor as it lowers estrogen in women.
Weight: Older adults who are thin are also at increased risk for osteoporosis because having an extra layer of fat protects bones from injury. “This may be the one condition where being overweight is good for you,” says Dr. Insogna, MD. “The extra weight puts stress on your bones and makes them stronger.”
How is osteoporosis diagnosed?
Starting at 65 years old for women and 70 for men, adults should have a bone-density scan to measure the strength of their skeleton. The most common type of bone-density scan, and the one offered at Yale Medicine is called a dual-energy X-ray absorptiometry, also known as DEXA or DXA.
This test uses low-energy X-ray beams to measure how thick or thin bones are in the spine, wrist and hip—three sites where people frequently suffer fractures. It is safe, noninvasive, and only takes a few minutes to complete. Patients lie still on a table while an X-ray scanner moves over them.
Using this test, doctors can determine a patient’s 10-year risk of having an osteoporotic fracture. A DXA scan provides two results:
- T score, which compares a person’s bone density to that of a healthy 30-year-old
- Z score, which compares a person’s bone density to what is normal for his age and body size
Postmenopausal women and men 50 and older who have T scores of -2.5 and below are considered to have osteoporosis. (Those with scores between -1 and -2.5 have low bone mass, and those with scores of -1 to 1 are considered normal.) For younger patients, a diagnosis is often made using their Z score instead of their T score.
This test can also serve as a baseline that can be compared with later scans, to measure bone loss over time. Doctors may also order a bone-density test in younger patients who have fractured a bone or have other risk factors for osteoporosis.
What are the treatment options for osteoporosis?
Osteoporosis is treated with a combination of lifestyle changes, nutritional therapies and medications. Patients who have osteoporosis or are at risk for developing it should stop smoking, limit the amount of alcohol they drink, and make sure they are getting adequate calcium and vitamin D in their diets.
It’s also important that they protect themselves from accidental falls, which could cause fractures. This step may include making sure their home environment is safe and easy to navigate.
“One's home should be well-lit, without throw rugs or other things on the floor to trip over,” says Dr. Insogna.
Doctors should also help patients to address vision problems or modify any medicines they’re taking that could make them dizzy or unsteady on their feet.
Staying physically active—especially by doing weight-bearing exercise such as walking and running—can slow the rate of bone breakdown. Doing core-strengthening and balancing exercises are also important because they can help to prevent falls. “Exercises like tai chi and yoga are very good for people with osteoporosis,” Dr. Insogna says.
Taking medication may also reduce a person’s risk of fractures once they are diagnosed with osteoporosis. Drugs used to treat this condition include:
- Bisphosphonates: Medicines such as Fosamax, Actonel, Boniva and Reclast work by stopping the cells that break down bone tissue.
- Evista: A drug that mimics estrogen and helps women to maintain bone mass after menopause.
- Forteo: A man-made version of parathyroid hormone that stimulates new bone formation.
- Prolia: A man-made version of the human antibody that stops bone breakdown.
Those drugs can be taken by mouth or given intravenously or by injection. Some are taken once a day and others just once a year. When combined with nutrition and exercise, they can be very effective.
Proper treatment can also help people to maintain their height.
“We cannot yet return a person’s skeleton to what it looked like when he or she was 20, but we can substantially reduce their risk for fracture,” Dr. Insogna says.
What makes Yale Medicine’s approach to treating osteoporosis unique?
The doctors at Yale Medicine have a long-standing expertise in osteoporosis both in clinical practice and in the research lab.
“We have an expert group of physicians who are national leaders in understanding this disease,” says Dr. Insogna. “And we have an infrastructure that allows us to do state-of-the-art measurements and provide the best care to patients—even those with rare and unusually severe cases.”
Dr. Insogna works with Mary O’Connor, MD, director of the Center for Musculoskeletal Care, to develop a program that identifies patients who have suffered a fragility fracture (such as a broken hip, for example) and who should be evaluated for osteoporosis.
“It sounds obvious, but most people who suffer a hip fracture leave the hospital thinking that there is nothing wrong with their bones,” Dr. Insogna says. “There is a huge missed opportunity to catch this problem, and this program is aiming to address that.”