Defining Osteoporosis

Osteoporosis, often referred to as the “silent disease,” is a condition characterized by a reduction in bone density, resulting in fragile and brittle bones. It’s like having bones that resemble a sponge in their porousness, making them susceptible to fractures. This skeletal disorder not only weakens bones but also leads to frequent and sometimes unnoticed fractures. Osteopenia, a condition with slightly less dense bones than normal, lies between healthy bones and full-blown osteoporosis.

The Scope of the Problem

Osteoporosis isn’t just a health concern; it’s a significant public health issue. In the United States, a staggering 44 million people have low bone density, with 10 million diagnosed with osteoporosis and another 34 million with osteopenia. This affects 55% of the U.S. population aged 50 and older. The consequences are severe, with one in two Caucasian women expected to experience an osteoporosis-related fracture in their lifetime. The direct healthcare costs associated with osteoporosis fractures in the U.S. reach a billion dollars, not including indirect costs like lost workdays and reduced productivity. Even more concerning, approximately 20% of those who suffer a hip fracture will pass away within a year, and one-third will be admitted to a nursing home. Only one-third of hip fracture patients regain their pre-fracture level of function. With an aging population, these numbers will only grow, leading to considerable suffering and economic burden.

Consequences of Osteoporosis

Osteoporotic bone fractures cause not only pain but also a substantial decrease in the quality of life. Up to 30% of hip fracture patients need long-term nursing home care. Pneumonia and blood clots due to prolonged bed rest can further complicate recovery. What’s even more alarming is that osteoporosis has been linked to an increased risk of death, with 20% of women experiencing a hip fracture passing away within a year due to fracture-related complications. Once a spine fracture occurs due to osteoporosis, the risk of another such fracture in the near future skyrockets. Around 20% of postmenopausal women who experience a vertebral fracture will suffer another within a year.

Causes and Risk Factors

Numerous factors increase the risk of developing osteoporosis. These include gender (with women being more vulnerable), race (Caucasian and Asian individuals are at higher risk), body frame, family history, lifestyle choices like smoking and excessive alcohol consumption, sedentary behavior, poor nutrition, chronic inflammation or bowel diseases, hormone imbalances, and certain medications. Additionally, some inherited disorders can lead to secondary osteoporosis, and these conditions require specialized treatment approaches.

Symptoms and Diagnosis

Osteoporosis typically goes unnoticed for years as it doesn’t manifest symptoms until a bone fractures. Spinal fractures cause radiating pain while repeated fractures can result in chronic lower back pain. Physical changes like loss of height and spinal curving can also occur, along with breathing difficulties, receding gums, sloping shoulders, and curvature of the lower spine. Notably, fractures caused by minor trauma or even daily activities, known as minimal trauma fractures, are often the first indicators of the condition. Early diagnosis is crucial to prevent further bone loss and future fractures.

Determining Bone Strength

Bone mass, or bone density, significantly affects bone strength. Bone density is influenced by a combination of genetic and environmental factors. It accumulates during childhood and peaks around age 25. After the age of 35, both men and women lose bone density due to the natural aging process. This loss accelerates in postmenopausal women due to a drop in estrogen levels. Maintaining bone density is critical, especially during menopausal years when the rate of loss can be as high as 2%-4% annually. Monitoring bone density can help predict the risk of fractures and guide treatment decisions.

Who Needs Bone Density Testing

Bone density testing, often performed using dual-energy X-ray absorptiometry (DXA) scans, is essential for postmenopausal women below age 65 with risk factors for osteoporosis, women aged 65 and older, and those with fractures. It’s also valuable for people with specific medical conditions associated with osteoporosis. However, it’s crucial to discuss the need for testing with a healthcare provider, and testing should only be pursued if the results will influence treatment decisions.

Treatment and Prevention

Osteoporosis treatment focuses on preventing bone fractures through a combination of lifestyle changes and medications. Lifestyle changes include quitting smoking, moderating alcohol consumption, regular exercise, and a balanced diet rich in calcium and vitamin D. Medications to prevent bone loss and strengthen bones are also vital. Bisphosphonates like alendronate, risedronate, and ibandronate are commonly prescribed, and hormone replacement therapy (HRT) can be considered in certain cases.

Monitoring Treatment

The role of repeat bone density testing during osteoporosis treatment is controversial. Bone density changes slowly during treatment, and the changes may not be discernible from machine measurement variations. The primary aim of treatment is to reduce the risk of future fractures, and bone density changes do not correlate well with fracture risk reduction. Therefore, routine bone density testing is not recommended for monitoring treatment. Ongoing research may change this approach as new technologies and therapies emerge.

Monitoring osteoporosis therapy

The controversy of bone density testing in patients already taking osteoporosis medication

The American Medical Association and other reputable medical organizations recommend that repeat bone density testing (DXA scans) not be done for monitoring osteoporosis treatment or prevention on a routine basis. It is sometimes difficult to know just how to use repeated bone density measurements during therapy. Here are a few of the most important reasons:

1. Bone density changes so slowly with treatment that the changes are smaller than the measurement error of the machine. In other words, repeat DXA scans cannot distinguish between a real increase in bone density due to treatment and a mere variation in measurement from the machine itself.
2. The real purpose of osteoporosis treatment is to decrease future bone fractures. There is no good correlation between increases in bone density with decreases in fracture risks with treatment. For example, alendronate has been shown to decrease fracture risk by 50% but only to increase bone density by a few percent. In fact, most of the fracture reduction with raloxifene is not explained by raloxifene’s effects on bone mineral density.
3. One density measurement taken during treatment will not help the doctor plan or modify treatment. For example, even if the DXA scan shows continued deterioration in bone density during treatment, there is not yet research data demonstrating that changing a medication, combining medications, or doubling medication doses will be safe and helpful in decreasing the future risk of fractures.
4. Even if bone density deteriorates during treatment, it is quite likely that the patient would have lost even more bone density without treatment.
5. Recent research has shown that women who lose bone density after the first year of HRT will gain bone density in the next 2 years of therapy, whereas women who gain in the first year will tend to lose density in the next 2 years of therapy. Therefore, bone density during treatment fluctuates naturally, and these fluctuations may not correlate with the prevention of fractures due to the medication.

For all of these reasons, as surprising as it may sound to many people (and even some doctors!), rechecking bone density is not at all like checking blood pressure during treatment of high blood pressure (hypertension). Routine bone density testing during treatment may not be helpful. In the future, however, if ongoing research brings new technology or new therapies, testing decisions may change.

Medications that prevent bone loss and breakdown

Currently, the most effective medications for osteoporosis that are approved by the FDA are antiresorptive agents, which decrease the removal of calcium from bones. The bone is a living dynamic structure; it is constantly being built and removed (resorbed). This process is an essential part of maintaining the normal calcium level in the blood and serves to repair tiny cracks in the bones that occur with normal daily activity and remodel bone based on the physical stresses placed on the bone. Osteoporosis results when the rate of bone resorption exceeds the rate of bone rebuilding. Antiresorptive medications inhibit the removal of bone (resorption), thus tipping the balance in favor of bone rebuilding and increasing bone density. HRT is one example of an antiresorptive agent. Others include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), zoledronate (Reclast), and denosumab (Prolia).

Bisphosphonates

Bisphosphonates decrease the risk of hip fracture, wrist fracture, and spine fracture in people with osteoporosis and can improve the T-score. Alendronate (Fosamax), risedronate (Actonel, Atelvia), ibandronate (Boniva), and zoledronate (Reclast) are bisphosphonates.

To reduce side effects and to enhance absorption of the medicine, all bisphosphonates taken by mouth (orally) should be taken in the morning, on an empty stomach, 30 minutes before breakfast, and with at least 8 ounces (240 ml) of water (not juice). This improves the absorption of the bisphosphonate. Taking the pill sitting or standing (as well as drinking adequate amounts of liquids) minimizes the chances of the pill being lodged in the esophagus, where it can cause ulceration and scarring. Patients should also remain upright for at least 30 minutes after taking the pill to avoid reflux of the pill into the esophagus. Newer intravenous bisphosphonates, such as ibandronate (Boniva) and zoledronate (Reclast), bypass the potential esophagus and stomach problems.

Food, calcium, iron supplements, vitamins with minerals, or antacids containing calcium, magnesium, or aluminum can reduce the absorption of oral bisphosphonates, thereby resulting in loss of effectiveness. Therefore, oral bisphosphonates should be taken with plain water only in the morning before breakfast. Also, no food or drink should be taken for at least 30 minutes afterward.

Alendronate (Fosamax)

Alendronate (Fosamax) is a bisphosphonate antiresorptive medication. Alendronate is approved for the prevention and treatment of postmenopausal osteoporosis as well as for osteoporosis that is caused by cortisone-related medications (glucocorticoid-induced osteoporosis). Alendronate has been shown to increase bone density and reduce fractures in the spine, hips, and arms. Fosamax is taken by mouth once a week to prevent and treat postmenopausal osteoporosis. Alendronate is the first osteoporosis medication also approved for increasing bone density in men with osteoporosis, either in a daily or a weekly dosing schedule.

Fosamax generally is well tolerated with few side effects. One side effect of alendronate is irritation of the esophagus (the food pipe connecting the mouth to the stomach). Inflammation of the esophagus (esophagitis) and ulcers of the esophagus have been reported infrequently with alendronate use.

Risedronate (Actonel)

Risedronate (Actonel, Atelvia) is another bisphosphonate antiresorptive medication. Like alendronate, this drug is approved for the prevention and treatment of postmenopausal osteoporosis as well as for osteoporosis that is caused by cortisone-related medications (glucocorticoid-induced osteoporosis). Risedronate is chemically different from alendronate and has less likelihood of causing esophageal irritation. Risedronate also is more potent in preventing the resorption of bone than alendronate.

Ibandronate (Boniva)

Ibandronate (Boniva) is a bisphosphonate for the prevention and treatment of postmenopausal osteoporosis. It is available in formulations for both daily and monthly oral use as well as for intravenous use every three months.

Zoledronate (Reclast)

Zoledronate (Reclast) is a unique intravenous bisphosphonate antiresorptive medication that is given once every year. This formulation seems to have a very good ability to strengthen bones and prevent fractures of both spinal and nonspinal bones. The convenience of once-a-year dosing is obvious. As with all bisphosphonates, patients taking Reclast must be taking adequate calcium and vitamin D prior to and after infusion of the medication for optimal results. Generally, patients are given acetaminophen (Tylenol) the day of the infusion and for several days afterward to prevent occasional minor muscle and joint aches. The infusion lasts approximately 20-30 minutes. Reclast is used to treat and prevent osteoporosis in postmenopausal women and increases bone mass in men with osteoporosis. Reclast is also used to treat and prevent steroid-induced osteoporosis (glucocorticoid-induced osteoporosis). Reclast reduces the risk of fractures after a low-trauma hip fracture. Reclast should not be used in patients who have had avascular necrosis or during/prior to pregnancy.

Selective estrogen receptor modulators (SERMs)

Raloxifene (Evista)

Raloxifene (Evista) belongs to a class of drugs called selective estrogen receptor modulators (SERMs). SERMs work like estrogen in some tissues but as an antiestrogen in other tissues. The SERMs were developed to reap the benefits of estrogen while avoiding the potential side effects of estrogen. Thus, raloxifene can act like estrogen on the bone but as an antiestrogen on the lining of the uterus where the effects of estrogen can promote cancer.

The first SERM to reach the market was tamoxifen (Nolvadex), which blocks the stimulative effect of estrogen on breast tissue. Tamoxifen has proven valuable in women who have had cancer in one breast for preventing cancer in the second breast. Raloxifene is the second SERM to be approved by the FDA. Evista has been approved for the prevention and treatment of osteoporosis in postmenopausal women. In a 3-year study involving some 600 postmenopausal women, raloxifene was found to increase bone density (and lower LDL cholesterol) while having no detrimental effect on the uterine lining (which means that it is unlikely to cause uterine cancer).

Because of its antiestrogen effects, the most common side effects with Evista are hot flashes. Conversely, because of its estrogenic effects, Evista increases the risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (blood clots in the lung). The greatest increase in risk occurs during the first four months of use. Patients taking raloxifene should avoid prolonged periods of immobility during travel when blood clots are more prone to occur. The risk of deep vein thrombosis with raloxifene is probably comparable to that of estrogen, about two to three times higher than the usual low rate of occurrence. Evista decreases the risk of spinal fractures in postmenopausal women with osteoporosis, but it is not known if there is a similar benefit in decreasing the risk of hip fracture. (The only agents that are definitely proven to decrease the risk of hip fracture are bisphosphonates and denosumab.)

Calcitonin (Calcimar, Miacalcin)

Calcitonin (Calcimar, Miacalcin) is a hormone that has been approved by the FDA in the U.S. for treating osteoporosis. Calcitonins come from several animal species, but salmon calcitonin is the one most widely used. Calcitonin can be administered as a shot under the skin (subcutaneously), into the muscle (intramuscularly), or inhaled nasally (intranasally). Intranasal calcitonin is the most convenient of the three methods of administration.

Calcitonin has been shown to prevent bone loss in postmenopausal women. In women with established osteoporosis, calcitonin has been shown to increase bone density and strength in the spine only.

Calcitonin is a weaker antiresorptive medication than bisphosphonates. Calcitonin is not as effective in increasing bone density and strengthening bone as estrogen and other antiresorptive agents, particularly bisphosphonates. In addition, it is not as effective as bisphosphonates in reducing the risk of spinal fractures and has not been proven effective in reducing hip fracture risk. Therefore, calcitonin is not the first choice of treatment in women with established osteoporosis. Nevertheless, calcitonin is a helpful alternative treatment for patients who cannot tolerate other medications.

Common side effects of either injected or nasal spray calcitonin are nausea and flushing. Patients using Miacalcin Nasal Spray can develop nasal irritation, a runny nose, or nosebleeds. Injectable calcitonin can cause local skin redness at the site of injection, skin rash, and flushing.

Teriparatide (Forteo)

Teriparatide (Forteo) is a synthetic version of the human hormone, parathyroid hormone, which helps to regulate calcium metabolism. Unlike other medications for osteoporosis that reduce the resorption of bone, teriparatide very effectively promotes the growth of new bone. Forteo is self-injected into the skin. Because long-term safety is not yet established, it is only FDA-approved for 24 months of use. It reduces spinal fractures in women with known osteoporosis, but it is not known if there is a similar reduction in the risk for hip fracture. Generally, after a 2-year course of teriparatide, the patient is switched to bisphosphonate therapy to maintain bone density.

Denosumab (Prolia)

The latest treatment approved for osteoporosis is denosumab (Prolia), an injectable antibody that blocks a chemical messenger that plays a role in promoting bone thinning by the bone cells that are responsible for bone resorption. Prolia strengthens bone by increasing its density and reducing fractures. Prolia is administered by twice yearly injections under the skin. Denosumab is used for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or patients who have failed or are intolerant to other available osteoporosis therapy. Denosumab can cause an increased risk of infections and low blood calcium levels (hypocalcemia).

Prevention of osteoporosis due to long-term corticosteroids

The long-term use of corticosteroids (such as prednisone, cortisone, and prednisolone) can lead to osteoporosis. Corticosteroids cause decreased calcium absorption from the intestines, increased loss of calcium through the kidneys in urine, and increased calcium loss from the bones. To prevent bone loss while on long-term corticosteroids, patients should

1. have adequate calcium (1,000 mg daily if premenopausal, 1,500 mg daily if postmenopausal) and vitamin D intake (the actual level of Vitamin D can be measured with a simple blood test); however, calcium alone or combined with vitamin D cannot be relied upon to prevent bone loss from corticosteroids unless other prescription medications are added;
2. discuss with their doctor the use of either alendronate, risedronate, and zoledronate, which have been approved for the prevention and treatment of corticosteroid-induced osteoporosis;
3. discuss with their doctor about having a DXA bone density scan as well as blood testing for calcium, kidney function, and vitamin D prior to beginning therapy and monitoring for osteoporosis during therapy.

Calcium supplements for osteoporosis

Building strong and healthy bones requires an adequate dietary intake of calcium beginning in childhood and adolescence for both sexes. Most importantly, however, a high dietary calcium intake or taking calcium supplements alone is not sufficient in treating osteoporosis and should not be viewed as an alternative to or substituted for more potent prescription medications for osteoporosis. In the first several years after menopause, rapid bone loss may occur even if calcium supplements are taken.

The following calcium intake has been recommended by the National Institutes of Health Consensus Conference on Osteoporosis for all people, with or without osteoporosis:

• 800 mg/day for children 1-10 years of age
• 1,000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen
• 1,200 mg/day for teenagers and young adults 11-24 years of age
• 1,500 mg/day for postmenopausal women not taking estrogen
• 1,200 mg-1,500 mg/day for pregnant and nursing mothers
• The total daily intake of calcium should not exceed 2,000 mg.

Daily calcium intake can be calculated by the following method:

1. Excluding dairy products, the average American diet contains approximately 250 mg of calcium.
2. There is approximately 300 mg of calcium in an 8-ounce glass of milk.
3. There is approximately 450 mg of calcium in 8 ounces of plain yogurt.
4. There is approximately 130 mg of calcium in 1 cup of cottage cheese.
5. There is approximately 200 mg of calcium in 1 ounce of cheddar cheese.
6. There is approximately 90 mg of calcium in ½ cup of vanilla ice cream.
7. There is approximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice.

Unfortunately, surveys have shown that the average woman in the U.S. is consuming less than 500 mg of calcium per day in their diet, less than the recommended amounts. Additional calcium can be obtained by drinking more milk and eating more yogurt or cottage cheese or by taking calcium supplement tablets as well from calcium-fortified foods, such as orange juice.

The various calcium supplements contain different amounts of elemental calcium (the actual amount of calcium in the supplement). For example, Caltrate, Os-Cal, and Tums are calcium carbonate salts. Each 1,250 mg of calcium carbonate salt tablet (such as Caltrate 600 mg, Os-Cal 500 mg, or Tums 500 mg extra strength) contains 500 mg of elemental calcium. A person who needs 1,000 mg/day of calcium supplement can take one tablet of Tums 500 mg extra strength (containing 500 mg of elemental calcium) twice daily with meals.

The calcium carbonate supplements are best taken in small divided doses with meals since the intestines may not be able to reliably absorb more than 500 mg of calcium all at once. Therefore, the best way to take 1,000 mg of a calcium supplement is to divide it into two doses. Likewise, a dosage of 1,500 mg should be split into three doses.

Calcium supplements are safe and generally well tolerated. Side effects are indigestion and constipation. If constipation and indigestion occur with calcium carbonate supplements, calcium citrate (Citracal) can be used. Some patients have difficulty swallowing calcium tablets. In this situation, chewable candy-like calcium in the form of Viactiv is available. Certain medications can interfere with the absorption of calcium carbonate. Examples of such medications include proton-pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), lansoprazole (Protonix), and rabeprazole (Aciphex), which are used in treating gastroesophageal reflux disease (GERD) or peptic ulcers. When these medications are being taken, calcium citrate is preferred.

Many “natural” calcium carbonate preparations, such as oyster shells or bone meal, may contain high levels of lead or other harmful elements and should be avoided.

Vitamin D for osteoporosis

An adequate intake of calcium and vitamin D are important foundations for maintaining bone density and strength. However, calcium and vitamin D alone are not sufficient to treat osteoporosis and should be given in conjunction with other treatments. Vitamin D is important in several respects:

• Vitamin D helps the absorption of dietary calcium from the intestines.
• The lack of vitamin D alone can cause calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.
• Vitamin D, along with adequate calcium (1,200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in postmenopausal women but not in premenopausal or perimenopausal women.

Vitamin D comes from the diet and the skin. Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions (Southern California, Hawaii, countries around the equator, etc.) can produce most of the vitamin D they need in their skin. Conversely, lack of exposure to sunlight, due to residence in northern latitudes or physical incapacitation, causes vitamin D deficiency. In less temperate regions such as Minnesota, Michigan, and New York, production of vitamin D by the skin is markedly diminished in the winter months, especially among the elderly. In that population, dietary vitamin D becomes more important.

Unfortunately, vitamin D deficiency is quite common in the U.S. In a study in a general medical ward of one hospital, vitamin D deficiency was detected in 57% of the patients. An estimated 50% of elderly women consume far less vitamin D in their diet than is recommended. The vitamin D status is easily evaluated with a simple blood test.

The Food and Nutrition Board of the Institute of Medicine has recommended the following as an adequate vitamin D intake:

• 800 IU/day for men and women over the age of 71
• 600 IU/day for women in other age groups, men, and children
• 400 IU/day for infants under 12 months

But if a person already has osteoporosis, it is advisable to ensure 400 IU twice per day as the usual daily intake, most commonly as a supplement alongside prescribed medications for osteoporosis.

An average multivitamin tablet contains 400 IU of vitamin D. Therefore, one to two multivitamins a day should provide the recommended amount of vitamin D. Alternatively, vitamin D can be obtained in combination with calcium in tablet forms, such as Caltrate 600 + D (600 mg of calcium and 200 IU of vitamin D) and others.

Adequate levels of calcium and vitamin D are essential for optimal bone health, especially when used with prescribed medication for osteoporosis. Chronic excessive use of vitamin D can lead to toxic levels of vitamin D, elevated calcium levels in blood and urine, and may also cause kidney stones. Since various dietary supplements may also contain vitamin D, it is important to review vitamin D content in dietary supplements before taking additional vitamin D.

Diet helps to prevent osteoporosis

Eating a diet that has adequate calcium and vitamin D can be beneficial in preventing osteoporosis.

Are there foods to avoid when it comes to osteoporosis?

Excessive alcohol should be avoided by those with osteoporosis. For those with underlying celiac disease, it is essential to avoid foods with gluten (wheat, barley, and rye) in them.

Exercise, quitting cigarettes, and curtailing alcohol

Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased. Research has not yet determined what type of exercise is best for osteoporosis or for how long it should be continued. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily for optimal health.

A word of caution about exercise: It is important to avoid exercises that can injure already weakened bones. In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure, exercise should be prescribed and monitored by physicians. Extreme levels of exercise (such as marathon running) may not be healthy for the bones. Marathon running in young women that leads to weight loss and loss of menstrual periods can actually promote osteoporosis.

Smoking one pack of cigarettes per day throughout adult life can itself lead to a loss of 5%-10% of bone mass. Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause. Smoking cigarettes also can lead to earlier menopause. In postmenopausal women, smoking is linked with an increased risk of osteoporosis. Data on the effect of regular consumption of alcohol and caffeine on osteoporosis is not as clear as with exercise and cigarettes. In fact, research regarding alcohol and caffeine as risk factors for osteoporosis shows widely varying results and is controversial. Certainly, their effects are not as great as other factors. Nevertheless, moderation of both alcohol and caffeine is prudent.

Prevention of hip fractures in elderly people with osteoporosis

Elderly people with osteoporosis can decrease their risk for hip fracture by maintaining muscle strength, coordination, and balance with exercise programs. Throw rugs and animals in pathways of the home should be minimized or eliminated. Good lighting is essential for safe walking to the restroom both day and night.

Additionally, for those elderly people who use canes for walking, etc., it is essential that the rubber tips of the canes are regularly checked for any signs of wear. When this rubber wears through it presents a serious risk of causing the cane (and, therefore, the person) to slip, which can result in serious bodily harm — including hip fracture.

Controversy

Currently, it is not clear how long patients with osteoporosis are treated with bisphosphonates and should continue the bisphosphonate treatment. Many doctors are interrupting treatment for a “drug holiday” off of the drug as it may not be necessary after 5-7 years. Guidelines for the duration of treatment of osteoporosis with bisphosphonates are being developed.

What are complications of osteoporosis?

The primary complication of osteoporosis is a bone fracture.

• This may lead to no symptoms or be associated with severe, intractable pain.
• Recurrent fractures are common and can lead to deteriorating skeletal structure.
• Occasionally, fractures of the spinal vertebrae can push bone into adjacent nerves and/or the spinal cord.
• This can require neurosurgical intervention.
• Osteoporotic vertebral fractures can also be relieved by vertebroplasty (kyphoplasty) procedures whereby the collapsed vertebra is inflated by a balloon and a cement (methylmethacrylate) is injected to reform the structure of the vertebra.

Repeated vertebral compression fractures can lead to severe deformity of the spine of the chest (kyphosis) that can compromise breathing along with cause extreme loss of height. This can increase the risk of problems with any respiratory infections.

What is the prognosis for osteoporosis?

The outlook for patients with osteoporosis depends greatly on where fractures occur. Additionally, if treatment is begun when the bone disease is detected early, the outcome is better.

Hip fractures are a particularly dangerous consequence of osteoporosis in the elderly. Approximately 20% of those who experience a hip fracture will die in the year following the fracture. Only one-third of hip-fracture patients regain their pre-fracture level of function. One-third of hip-fracture patients are discharged to a nursing home within the year after fracture.

Newer medications, medicine with different methods of delivery, and research into the optimal management of osteoporosis will bring even better options for the healthcare of patients with osteoporosis in the future. Persons interested in more information about osteoporosis and its treatment options can get information from the National Osteoporosis Foundation.