Who Gets Osteoporosis?

Osteoporosis affects 200 million women around the world, and 44 million women and men over the age of 50 have low bone density, which represents 55% of Americans. By the time a woman reaches age 80, two-fifths of women have osteoporosis. This is considered a silent disease as most people do not know they have osteoporosis until they get a bone fracture. Only about 25% of people get the required calcium intake for healthy bones.

Primary osteoporosis is typically caused by age-related bone loss or loss that occurs due to medications. Idiopathic osteoporosis is the term used when the cause of bone loss is unknown. This term is often used for men under the are of 70 that have serious bone loss.

Men can also exhibit bone loss, as 4-6% of men older than 50 have osteoporosis. Additionally, 33 to 47% of men have osteopenia, which is the stage of bone loss just before osteoporosis.

As a comparison, at age 65 men 4-5 men per thousand have hip fractures, where as 8-10 women at age 65 have hip fractures. Men have a higher peak bone mass, which is one reason the onset of bone loss is at a more advanced age.

Osteoporosis happens when your body absorbs more bone than your body can produce. When low bone density occurs you become prone to bone fractures. Hip fractures tend to be particularly serious for the elderly, as women often die from complications.

There are other causes of osteoporosis that contribute to this condition. Diet has a specific impact on the health of your bones. Unfortunately, if children do not eat a balanced diet due to poverty or poor eating habits they may not develop strong, healthy bones. Lack of exercise, certain diseases and specific medications also have an impact on bone health.

Some risk factors that take work to overcome include:

• Family history
• Ethentricity
• Age
• Gender

Other common causes include:

• Medications, especially glucocorticoid
• Hypogonadism (low levels of testosteron
• Gastrointestinal disease
• Alcohol abuse
• Hypercalciuria
• Smoking
• Immobilization

Having low estrogen levels puts you at risk for osteoporosis, as estrogen protects bones. A quick decrease in estrogen levels occur after menopause. After menopause a 4-8% annual bone loss occurs.

If your ovaries have been removed the risk for osteoporosis increases as they produce a great deal of estrogen. A supplemental estrogen therapy is often prescribed. Young women with irregular periods may have low estrogen levels, so bone health should be a priority. However, irregular periods may also be caused “under-eating” or “over-exercising”, which also causes bone loss.

While men have some estrogen, testosterone protects the bones. Low body weight in women with petite frames and under 130 pounds tend to have less bone mass, which puts them at a greater risk.

Thyroid conditions (hypothyroid or hyperthyroid) both cause bone loss. If hyperthyroidism (Graves Disease) is undiagnosed the cycle of bone remodeling is cut in half. Hypothyroidism, which is much more common (particularly in women). It causes the bone-resorbing osteoclast and therefore, the bone-forming osteoblast process to decrease, and it may cause osteoporosis.

Lactose intolerance is a common problem, and people with this condition often do not get enough calcium in their diet. “The Institute of Medicine" recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50, increasing to 1,200 mg for women over age 50 and men over age 70.” Calcium along with vitamin D and a healthy diet may adequately support bone health.

Celiac disease (gluten intolerance) has become more common. This is often an inherited disease, but if not treated you may not absorb enough calcium, as the small intestine absorbs our important nutrients, such as calcium.

Osteogenesis imperfecta (OI) a genetic disorder that causes bones to break more easily. This disease may present as mild or severe, and bone malformations are common.

Autoimmune diseases, such as systemic lupus and rheumatoid arthritis tend to run in families, but have not been classified as an inherited disease. The glucocorticoids that are often proscribed, plus the pain, fatigue and loss of joint function can all result in osteoporosis. As 90% of patients that have this disease are women, there is concern as women are already at high risk for osteoporosis.

Inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis also experience bone loss primarily due to glucocorticoids treatment.

Anorexia nervosa is an eating disorder where the patient is obsessed with their weight, and they severely limit their food intake, which causes a number of problems.

Diabetes, particularly Type 1 causes bone loss, and there is really no explanation for this. People with Type 2 diabetes tend to have a better bone density, but they still have bone loss as they age, possibly due to inactivity.

Undiagnosed people with osteoporosis may have no symptoms. Back pain due to a fractured or collapsed vertebra is a sign. Many people are not diagnosed until they actually have a bone fracture. Loss of height is another symptom.

The primary test used to diagnose osteoporosis and low bone mass is a bone mineral density (BMD) test. The Dexa-Scan “uses a low energy X-ray to evaluate bone density in the hip and/or spine”. This is an accurate measurement of your BMD.

There are several minerals and vitamins responsible for healthy bones including:

1. Calcium, magnesium, boron, copper, silicon, nichol, selenium, strontium, phosphorus, potassium, vanadium and zinc

2. Vitamins C, D, K2, B6, B12

Obviously, a healthy diet is imperative and one that includes the minerals and vitamins listed above, although a few of the minerals are not commonly discussed. If you smoke, quit! Smoking actually results in bone loss for a variety of reasons. Excessive alcohol also causes bone loss. Limit your caffeine as well. Too much protein can also cause the loss of calcium.

A good routine for exercising will strengthen your bones. Mixing aerobic exercise with strengthening exercises is ideal.

Medications that may cause osteoporosis include: corticosteroids (Prednisone), thyroid hormones, some anticonvulsants or anti-seizure (such as, Dilantin) and antacids with aluminum. If you take any of these medications you may be prescribed a medication to help protect your bones.

The most commonly prescribed bisphosphonate medications for osteoporosis treatment include:

• Alendronate (Fosamax)

• Risedronate (Actonel)

• Ibandronate (Boniva)

• Zoledronic acid (Reclast)

These medications are not well absorbed in the stomach, so taking them with a large glass of water is recommended. They may cause heartburn or an upset stomach.

Two of them are given by an infusion. While they do not cause an upset stomach, they can give you flu-like symptoms, so taking a Tylenol is recommended.

• Ibandronate (Boniva), infused once every three months

• Zoledronic acid (Reclast), infused once a year

These biophosphids can safely be taken for ten years, but at that time physicians recommend stopping for 5 years if there have been no fractured bones, as the biophsphids stay in your bones.

Estrogen may be prescribed for prevention or treatment at a low dose due to potential side effects.

Raloxifene (Evista) is a hormonelike treatment prescribed for treatment or prevention. It is a newer medication

Denosumab (Prolia, Xgeva) has been shown to prevent the risk of bone fractures in men and women for osteoporosis treatment. This usually requires an injection every six months.

People with diagnosed very low bone density and/or bone fractures may take Teriparatide (Forteo) or Abaloparatide (Tymlos). These medications require a daily injection, but they have been shown to rebuild bones. These medications for low bone density or osteoporosis slow the breakdown of bones and also rebuilds them. Your physician will prescribe the appropriate medication for your particular condition, sometimes based on cost. For example, Forteo costs $1000 a month if you have good insurance (my personal experience).

Osteoporosis is usually preventable. Eating the right diet and getting some exercise is so important. If you are one of those people with a disease that requires Prednisone or another medication that causes bone loss, discuss treatment for bone loss with your doctor.

I have lupus and have severe osteoporosis due to the medications I received. I am taking Forteo and have not had a bone fracture for over a year, so I guess it is helping. I had 11 bone fractures in 2017, plus I have had 2 failed back surgeries. I wish I had understood the physical and mental cost of the medications I received, as there are a few things I would have done differently. However, there was no treatment for lupus until a very few years ago.