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Osteoporosis



Related terms
Background
Treatment
Author information
Bibliography

Related Terms
  • Alcoholism, ankylosing spondylitis, anorexia nervosa, anticonvulsant-induced osteomalacia, BMD, bone mineral density, bulimia, cartilage, corticosteroid, Crohn's disease, Cushing's disease, cystic fibrosis, dal photon absorptiometry, DEXA, diuretics, DPA, dual-energy X-ray absorptiometry, eating disorders, estrogen, fracture, gastrectomy, hepatic osteodystrophy, hormonal replacement therapy, HRT, hyperparathyroidism, hyperthyroidism, hysterectomy, I.U., International unit, juvenile osteoporosis, Kashin-Beck disease, kyphoplasty, kyphosis, menopause, oophrectomy, osteochondrosis, osteomalacia, osteopenia, osteopenic, osteoporotic, parathyroidectomy, P-DEXA, peak bone loss, peripheral dual-energy X-ray absorptiometry, postmenopausal, progestin, QCT, quantitative computer tomography, renal osteodystrophy, selective estrogen receptor modulators, SERMS, skeletal fluorosis, single-energy X-ray absorptiometry, smoking, smoking cessation, SXA, testosterone, ultrasound, vertebroplasty.

Background
  • Osteoporosis is a disease of the bones that makes them weak and prone to fracture.
  • Osteoporosis is considered a silent disease, because bone loss itself is gradual and painless. There are usually no symptoms to indicate that a person is developing osteoporosis early in the condition. Bone is living tissue that is in a constant state of formation and resorption. Bone resorption is the gradual loss of bone. As individuals age, formation lessens and after a peak bone mass is achieved, bone mass remains stable (resorption and formation are equal). Osteoclasts are the principal cells responsible for bone resorption.
  • By their mid-30s, most individuals begin to gradually lose bone strength as the balance between bone resorption and bone formation shifts, so that more bone is lost than can be replaced. As a result, bones become less dense and structurally weaker, called osteopenia. Osteopenia refers to mild bone loss that is not severe enough to be called osteoporosis, but that increases the risk of developing osteoporosis. As this occurs, bones lose calcium, phosphorus, boron, and other minerals and become lighter, less dense, and more porous. This makes the bones weaker and increases the chance that they might break. If not prevented or if left untreated, osteopenia can progress painlessly into osteoporosis until a bone breaks or fractures.
  • Although any bone is susceptible to fracture, the most common fractures in osteoporosis occur at the spine, wrist, and hip. Spine and hip fractures in particular may lead to chronic pain, long-term disability, and even death.
  • Osteoporosis is more common in older individuals and non-Hispanic white women, but can occur at any age, in men as well as in women, and in all ethnic groups.
  • According to the National Osteoporosis Foundation, about eight million women and two million men in the United States have osteoporosis. Those over the age of 50 are at greatest risk of developing osteoporosis and suffering related fractures. In this age group, one in two women and one in six men will suffer an osteoporosis-related fracture at some point in their life.
  • Significant risk has been reported in people of all ethnic backgrounds. While osteoporosis is often thought of as an condition found in older individuals, it can strike at any age.
  • Osteoporosis may also affect children, although it is rare. This is called juvenile osteoporosis. Juvenile osteoporosis is usually due to a medical condition, such as a thyroid condition or Cushing's disease (a rare condition involving insufficient adrenal hormone output), or medications, including corticosteroids. It's a significant problem because it occurs during the child's prime bone-building years.
  • Conditions that may cause bone loss include osteomalacia, osteochondrosis, Kashin-Beck disease, and skeletal fluorosis. Osteomalacia is a softening of the bones, resulting from defective bone mineralization. Osteomalacia may cause pain, weakness, and fragility of the bones. Osteomalacia is caused by insufficient nutritional quantities or faulty metabolism of vitamin D or calcium, following a parathyroidectomy (removal of the parathyroid gland), or in other conditions such as cystic fibrosis, renal osteodystrophy (failure of kidneys to maintain adequate blood nutrients for bone), and hepatic osteodystrophy (failure of the liver to produce adequate vitamin D).
  • Kashin-Beck disease is a disorder of the bones and joints of the hands, fingers, elbows, knees, and ankles of children and adolescents who slowly develop stiff deformed joints, shortened limb length, and short stature due to necrosis (death) of the growth plates of bones and of joint cartilage.
  • Osteochondrosis is a disease that affects the progress of bone growth by killing bone tissue. Osteochondrosis is seen only in children and teens whose bones are still growing. Osteochondrosis is an inherited condition. Individuals with osteochondrosis nearly all have pain in the location of the bone damage. Some may involve considerable swelling, limping, bending, or kyphosis (exaggerated curve) of the upper spine.
  • Skeletal fluorosis is the chronic intake of excessive fluoride. Skeletal fluorosis can lead to severe and permanent bone and joint deformations. This can lead to softening of the bone and increases in fractures. Skeletal fluorosis should not occur with fluorinated water or toothpaste use.

Treatment
  • Nutrition and lifestyle:
  • Dietary factors: It is important to that there is enough calcium in the diet for proper bone health. Healthcare professionals recommend calcium intakes of at least 1,000mg daily for everyone over eight years of age. Higher calcium intakes of 1,200mg daily are recommended for adults over 50 years and 1,300mg daily for teens nine to 18 years. Adequate vitamin D intake is also important for calcium absorption and to maintain muscle strength. Healthcare professionals recommend 400 international units of vitamin D daily until age 60, then 600-800 international units per day after age 60. Doses can be adjusted by a doctor according to blood levels of vitamin D.
  • Milk and milk products are calcium-dense foods providing about 300 milligrams calcium per serving. These foods also contain other nutrients important to bone health such as vitamin D (if fortified), phosphorus, and magnesium. Approximately 73% of calcium in the food supply comes from dairy products, 9% from fruits and vegetables, 5% from grain products, and 12% from all other sources such as dietary supplements.
  • Weight-bearing exercises: Exercise is an important treatment for osteoporosis to maintain healthy bones. Weight-bearing aerobic activities, involving the bones supporting body weight, have been shown to have a positive effect in maintaining and increasing bone mass and preventing osteoporosis. These activities include weight-lifting, jogging, hiking, stair-climbing, step aerobics, dancing, racquet sports, and other activities that require muscles to work against gravity. Swimming and simply walking, although good for cardiovascular fitness, are not the best exercises for building bone. Individuals who live a sedentary lifestyle have weaker bones and are subjected to a higher risk of sustaining fractures.
  • Medications:
  • Bisphosphonates: Alendronate (Fosamax®), risedronate (Actonel®), ibandronate (Boniva®), and zoledronate (Zometa®) are approved by the U.S. Food and Drug Administration (FDA) for the prevention and treatment of osteoporosis in postmenopausal women. Alendronate is a drug currently approved for management of osteoporosis in men. Both alendronate and risedronate are approved for the prevention and treatment of steroid-induced osteoporosis in men and women. Bisphosphonates help slow down bone loss and have been shown to decrease the risk of fractures. All are taken on an empty stomach with water. Because bisphosphonates have the potential for irritating the esophagus, remaining upright for at least an hour after taking these medications is recommended by healthcare professionals. Alendronate and risedronate can be taken once a week, while ibandronate can be taken once a month. An IV form of ibandronate, given through the vein every three months, also has been FDA-approved for the management of osteoporosis. Another IV bisphosphonate being studied for osteoporosis is zoledronic acid or zoledronate (Zometa®). This form is injected once yearly.
  • Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if the individual has had acid reflux or ulcers in the past. If individuals cannot tolerate oral bisphosphonates, the doctor may recommend the periodic intravenous infusions of a bisphosphonate.
  • Use of bisphosphonates in women who are pregnant or breastfeeding is not well studied. Blood calcium levels in women who take bisphosphonates during pregnancy are usually monitored. Individuals using Boniva® injection will have blood levels of creatinine measured prior to each dose to determine kidney function. Creatinine is measured using blood tests.
  • Calcitonin (Miacalcin®): Calcitonin is a naturally occurring hormone produced by the thyroid gland that can be given as an injection or taken as a nasal spray. Calcitonin also inhibits the function of the cells that breakdown bone, the osteoclasts. Calcitonin has long been known to be beneficial in individuals with osteoporosis, but the injections were difficult to administer and had unpleasant side-effects. The nasal spray has greatly improved the use of calcitonin, and it is much more commonly used today. Calcitonin has been reported to slow bone loss, and also decrease pain associated with osteoporosis fractures.
  • Hormone replacement therapy (HRT): Estrogen therapy alone or in combination with another hormone, progestin, has been reported to decrease the risk of osteoporosis and osteoporotic fractures in women. However, the combination of estrogen with a progestin has been shown to increase the risk for breast and ovarian cancer, strokes, heart attacks, and blood clots. Estrogens alone may increase the risk of strokes. Healthcare professionals recommend weighing all options before choosing HRT as part of osteoporosis prevention.
  • Selective estrogen receptor modulators (SERMs): Selective estrogen receptor modulators (SERMS) mimic the positive effects of estrogen on bones without some of the serious side effects such as breast cancer and stroke. Raloxifene (Evista®) decreases spine fractures in women, and is approved for use only in women at this time. Hot flashes are a common side effect of raloxifene, and individuals with a history of blood clots should not use this drug.
  • Teriparatide (Forteo®): Teriparatide is a form of parathyroid hormone that helps stimulate bone formation. Teriparatide is approved for use in postmenopausal women and men at high risk for osteoporotic fracture. It is given as a daily injection under the skin and can be used for up to two years. If the individual has ever had radiation treatment or if parathyroid hormone levels are already too high, they may not be able to take this medication.
  • Tamoxifen (Nolvadex®): Tamoxifen (Nolvadex®) is a synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in the body, including bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women over age 50. Possible side effects of tamoxifen include hot flashes, stomach upset, and vaginal dryness or discharge.
  • Surgery:
  • Vertebroplasty: Vertebroplasty is a minimally invasive procedure used to reinforce vertebrae with compression fractures. Compression fractures are common in individuals with osteoporosis. Vertebroplasty involves injecting an acrylic compound into the collapsed vertebra to stabilize the weakened bone. The procedure is performed in an operating room or radiology suite and treatment of each affected vertebra takes approximately one hour.
  • Local anesthesia, usually lidocaine (Xylocaine®), is injected into the vertebra. Then, a small incision is made, and a bone biopsy needle is inserted. Several small syringes of the acrylic cementing material are then injected through the needle into the vertebra. The cement hardens almost immediately.
  • Approximately 70-90% of individuals experience pain relief after vertebroplasty and most are released from the hospital the same day. Anti-inflammatory medications, such as ibuprofen (Motrin®, Advil®), may be used to relieve pain after the procedure.
  • Complications from a vertebroplasty are rare. Bone cement may enter the lung, spinal cord, or epidural space surrounding the vertebra. Other possible complications associated with vertebroplasty include nerve irritation, punctured lung (pneumothorax), and spinal cord injury.
  • Kyphoplasty: Multiple spinal compression fractures caused by osteoporosis may lead to height loss, kyphosis (extreme curvature of the spine), and pain. Kyphoplasty is a minimally invasive procedure that is used to restore the height of the vertebrae and stabilize weakened bone. Kyphoplasty cannot correct established spine deformities and is used in individuals who have experienced recent fractures, usually within two to four months. The procedure is usually performed in the hospital under local or general anesthesia and takes approximately one hour for each affected vertebra.
  • A small incision is made and a fluoroscope (device that consists of a screen and an x-ray tube) is used to guide the insertion of a balloon catheter into the vertebra. The balloon is inflated slowly to raise the compressed vertebra and is deflated. An acrylic compound (cementing material) is then injected into the vertebra through a bone biopsy needle. The material hardens almost immediately. Pain relief usually occurs within two days.
  • Most individuals are released from the hospital the day after kyphoplasty and can resume daily activities upon discharge. Strenuous activity, such as heavy lifting, should be avoided for at least six weeks.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Brown SA, Guise TA. Drug insight: the use of bisphosphonates for the prevention and treatment of osteoporosis in men. Nat Clin Pract Urol. 2007;4(6):310-20.
  2. Centers for Disease Control and Prevention. .
  3. International Osteoporosis Foundation. .
  4. Lata PF, Elliott ME. Patient assessment in the diagnosis, prevention, and treatment of osteoporosis. Nutr Clin Pract. 2007;22(3):261-75.
  5. Middleton ET, Steel SA. The effects of short-term hormone replacement therapy on long-term bone mineral density. Climacteric. 2007;10(3):257-63.
  6. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). .
  7. National Osteoporosis Foundation. .
  8. Natural Standard: The Authority on Integrative Medicine. .
  9. Shen M, Kim Y. Osteoporotic vertebral compression fractures: a review of current surgical management techniques. Am J Orthop. 2007;36(5):241-8.
  10. Straub DA. Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutr Clin Pract. 2007 Jun;22(3):286-96.
  11. Swanenburg J, de Bruin ED, Stauffacher M, et al. Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study. Clin Rehabil. 2007;21(6):523-34.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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