Fractures of in osteoporosis occur most commonly in the spine.

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Osteoporosis is a condition of very low bone density that is commonly seen in women over the age of 50. It also can occur in men, typically after age 65. When bones lose density, either from having low bone mass or excessive bone loss, they become fragile and more likely to break. According to the International Osteoporosis Foundation, a whopping 44 million Americans over the age of 50 are estimated to have osteoporosis, and the vast majority are not yet aware of it. Worldwide, two out of three women and four out of five men over 50 will experience osteoporotic fractures.

Risk Factors for Osteoporosis

Females over the age of 50 are four times more likely to have osteoporosis than males. Post-menopausal white and Asian females are particularly susceptible. Other risk factors include:

• Low estrogen in women
• Low testosterone in men
• Sedentary lifestyle
• Cigarette smoking
• Use of oral steroids
• Use of antiepileptic drugs
• Diet low in calcium and vitamin D over lifetime
• History of fractures

Women in particular are encouraged to maintain recommended intake of calcium and vitamin D, as well as perform weight-bearing exercises to maintain bone density. Note that osteoporosis and osteoporotic fractures are still common in men.

Symptoms of Osteoporosis

Osteoporosis can be silent for many years with no symptoms or discomfort until a fracture occurs. Spinal vertebrae can become weakened to the point where they break spontaneously or with minor trauma. These fractures are called pathological fractures since they result from an inherent weakness of the person’s bones when subjected to less-than-expected force, rather than a true injury.

Fractures in osteoporosis occur most commonly in the spine (twice as commonly as fractured hips or wrists) and are called vertebral compression fractures. People with osteoporosis can gradually lose height and develop skeletal deformities due to vertebral compression fractures over decades.

Assessment of Osteoporosis

If a man or woman presents with a pathological fracture due to osteoporosis, he or she would be investigated with a medical history, physical examination, laboratory tests, and imaging. X-rays are crucial to the diagnosis of bone thinning and fractures. Advanced imaging (a bone density scan, for example) may be performed to check for bone density. An MRI also may be performed to check for any soft tissue or nerve damage around the fracture. Pain from spinal osteoporosis (without fracture) can be treated conservatively with heat, ice, exercise, massage, and relaxation. Treatment for vertebral compression fracture from osteoporosis is discussed on page 22. People with an osteoporotic vertebral compression fracture have a five-fold increased risk of getting a second one.

Osteoporosis is the most common bone disease in humans, representing a major public health problem,” according to the American College of Rheumatology in its 2014 report on osteoporosis. “Osteoporosis can be prevented, diagnosed, and treated before fractures occur.”

In addition to calcium and vitamin D, prescription drugs are effective in improving bone health and lowering risk of fracture. These include bisphosphonates like alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast).

Poor compliance to recommended medications is one of the most preventable treatment problems related to osteoporosis. The International Osteoporosis Foundation estimates that less than half of patients take their recommended medication.

The U.S. Preventive Services Task Force recommends that women over the age of 65 should be regularly screened with a bone density scan due to the prevalence of osteoporosis in women. Brigham and Women’s Hospital also recommends that men and women diagnosed with osteoporosis further reduce their risk of future fractures with the following:

• Take daily recommended calcium (1,000 to 1,200 mg/day) and vitamin D (800 to 1,000 mg/day).
•  Get daily sunlight exposure.
• Quit smoking or limit smoking consumption.
• Stay active as much as you can.
• Strengthen your back muscles.Be aware of your risks for fractures.
• Follow-up regularly with your doctor and stick to treatment.

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