Osteoporosis Facts
What is Osteoporosis?
Fast Facts
A Serious Public Health Problem
Risk Factors
Prevention
Symptoms and Diagnosis
Frequently Asked Questions
What is Osteoporosis?
Normal bone/Osteoporotic bone
In many affected people, bone loss is gradual and without warning signs until the disease is advanced. Osteoporosis is also known as "the silent crippler" because a person usually doesn't know they have it until it's too late. Unfortunately, in many cases, the first real "symptom" is a broken bone. Loss of height — with gradual curvature of the back (caused by vertebral compression fractures) may be the only physical sign of osteoporosis.
Osteoporosis is a global problem which is increasing in significance as the population of the world both grows and ages. For these reasons, osteoporosis is often referred to as the "silent epidemic".
There are many misconceptions about osteoporosis, for example that it is "an old woman's disease". In fact, bone loss in women can begin as early as age 25. Worldwide, the lifetime risk for a woman to have an osteoporotic fracture is 30-40%. Furthermore, new studies have shown the prevalence of osteoporosis in men is higher than previously thought — with approximately one in five men affected.
(Source: International Osteoporosis Foundation)
Figure right: Osteoporosis can result in gradual loss of height and curvature of the spine (kyphosis).
Osteoporosis: Fast Facts
Osteoporosis is preventable and treatable, therefore early diagnosis and treatment is important.
Osteoporosis affects an estimated 75 million people in Europe, USA and Japan.
A 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures, and similarly, a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture.
In women over 45 years of age, osteoporosis accounts for more days spent in hospital than may other diseases, including diabetes, myocardial infarction and breast cancer.
An IOF survey, conducted in 11 countries, showed denial of personal risk by postmenopausal women, lack of dialogue about osteoporosis with their doctor, and restricted access to diagnosis and treatment before the first fracture result in underdiagnosis and undertreatment of the disease.
Calcium supplementation has been shown to reduce bone loss and the risk of spine fractures.
9 out of 10 American women and 7 out of 10 men do not consume their daily recommended daily allowance for Calcium.
Fractures:
One-third of women over 50 will experience osteoporotic fractures, as will one-fifth of men. In white women, the lifetime risk of hip fracture is1 in 6, compared with a 1 in 9 risk of a diagnosis of breast cancer.
The combined lifetime risk for hip, forearm and vertebral fractures coming to clinical attention is around 40%, equivalent to the risk for cardiovascular disease.
A woman 65 years of age with one vertebral fracture has a one in four chance of another fracture over 5 years, which can be reduced to one in eight by treatment.
Vertebral fractures can lead to back pain, loss of height, deformity, immobility, increased number of bed days, and even reduced pulmonary function. Their impact on quality of life can be profound as a result of loss of self-esteem, distorted body image and depression. Vertebral fractures also significantly impact on activities of daily living.
It is estimated that only one-third of vertebral fractures come to clinical attention and under diagnosis of vertebral fracture is a worldwide problem.
(Source: International Osteoporosis Foundation)
Osteoporosis is a serious or deadly condition.
The consequences of osteoporosis are devastating and painful. Hip fractures, which occur about twice as often in women as in men, are more serious than people realize: approximately 20 percent of hip fracture patients will die in the year after fracture, usually from complications such as pneumonia or blood clots in the lung, which are related to the fracture or to the surgery to repair the fracture.
More than half of those who survive a hip fracture will not be able to walk or move about easily, and a quarter will need long-term nursing home care.
Frail, elderly women and men who have suffered multiple fractures in the upper spine may develop stooped posture, or "kyphosis". They often have chronic lower back and side pain and difficulty walking. In extreme cases, people have trouble breathing and eating.
(Source: National Osteoporosis Foundation)
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Osteoporosis: A Serious Public Health Problem
United States
- Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older. In the U.S.,10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.
- By 2020 half of all Americans over age 50 will be at risk of Osteoporatic fractures.
- The cost to treat Osteoporosis by 2020 will exceed the cost to treat all diseases except heart disease.
- One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime.
- The estimated national direct expenditures (hospitals and nursing homes) for osteoporotic hip fractures was $18 billion in 2002, and the cost is rising.
Women
- 80 percent of those affected by osteoporosis are women.
- 20 percent of non-Hispanic white and Asian women aged 50 and older are estimated to have osteoporosis, and 52 percent are estimated to have low bone mass.
- 5 percent of non-Hispanic black women over age 50 are estimated to have osteoporosis; an estimated additional 35 percent have low bone mass that puts them at risk of developing osteoporosis.
- 49 percent of Hispanic women aged 50 and older are estimated to have low bone mass.
- Osteoporosis is under-recognized and under-treated not only in Caucasian women, but in African-American women as well.
Men
- 20 percent of those affected by osteoporosis are men.
- 7 percent of non-Hispanic white and Asian men aged 50 and older are estimated to have osteoporosis, and 35 percent are estimated to have low bone mass.
- 4 percent of non-Hispanic black men aged 50 and older are estimated to have osteoporosis, and 19 percent are estimated to have low bone mass.
- 3 percent of Hispanic men aged 50 and older are estimated to have osteoporosis, and 23 percent are estimated to have low bone mass.
Asia
- It is projected that more about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050.
- Vertebral fractures are as frequent in Asian as white women, whereas hip fractures are less prevalent in Asians.
China
- From 1988 to 1992, the incidence of hip fractures in Beijing increased by 34% in women and 33% in men.
- There is a higher incidence of hip fractures in men than women in China.
Hong Kong
- In 1996, the acute hospital care cost of hip fracture per year amounted to $17 million US.
- The incidence of hip fracture has increased by 200% in the last 3 decades.
- In Hong Kong Chinese, the prevalence of vertebral fracture was 17% in men and 30% in women.
Japan
- New hip fractures increased a dramatic 1.7-fold in the 10 years from 1987 to 1997 in Japan.
- The prevalence of osteporosis in the Japanese female population aged 50-79 years has been estimated to be about 35% at the spine and 9.5% at the hip.
Korea
- The occurrence of hip fractures increased about 4-fold over 10 years (1991-2001).
- The number of hip fractures after 75 years of age was 4.3 per 1000 in women and 2.97 per thousand in men.
Singapore
- Compared to the 1960's, hip fractures in women have gone up 5 times in women and 1.5 times in men.
(Source: National Osteoporosis Foundation and International Osteoporosis Foundation)
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Risk Factors
Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis and fractures are called "risk factors." These risk factors include:
- Personal history of fracture after age 50
- Current low bone mass
- History of fracture in a 1st° relative
- Being female
- Being thin and/or having a small frame
- Advanced age
- A family history of osteoporosis
- Estrogen deficiency as a result of menopause, especially early or surgically induced
- Abnormal absence of menstrual periods (amenorrhea)
- Anorexia nervosa
- Low lifetime calcium intake
- Vitamin D deficiency
- Use of certain medications (corticosteroids, chemotherapy, anticonvulsants and others)
- Presence of certain chronic medical conditions
- Low testosterone levels in men
- An inactive lifestyle
- Current cigarette smoking
- Excessive use of alcohol
- Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well
Women can lose up to 20 percent of their bone mass in the five to seven years following menopause, making them more susceptible to osteoporosis.
(Source: National Osteoporosis Foundation)
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Prevention
By about age 20, the average woman has acquired 98 percent of her skeletal mass. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later.
Bone basics
It is important to understand that bone is not a hard and lifeless structure; it is, in fact, complex, living tissue. Our bones provide structural support for muscles, protect vital organs, and store the calcium essential for bone density and strength.
Because bones are constantly changing, they can heal and may be affected by diet and exercise. Until the age of about 30, you build and store bone efficiently. Then, as part of the natural aging process, your bones begin to break down faster than new bone can be formed. In women, bone loss accelerates after menopause, when your ovaries stop producing estrogen - the hormone that protects against bone loss.
Think of your bones as a savings account. There is only as much bone mass in your account as you deposit. The critical years for building bone mass are from prior to adolescence to about age 30. Some experts believe that young women can increase their bone mass by as much as 20 percent - a critical factor in protecting against osteoporosis.
Continuing or starting preventive measures even after fractures have occurred is important; this will minimize further bone loss and help prevent additional fractures and more severe disability.
What you can do
There are five steps, which together can optimize bone health and help prevent osteoporosis. They are:
- A balanced diet rich in calcium and vitamin D
- Weight-bearing and resistance-training exercises
- A healthy lifestyle with no smoking or excessive alcohol intake
- Talking to one's healthcare professional about bone health
- Bone density testing and medication when appropriate
(Source: National Osteoporosis Foundation)
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Symptoms and Diagnosis
Osteoporosis is often called "the silent disease" because it progresses slowly over time, without symptoms, until a fracture occurs. For example, many people continue to assume height loss is a normal part of aging. However, it may be due to a collapse in the bones of the spine, called vertebrae, weakened by osteoporosis. NOF advises everyone to routinely monitor their height and talk to their healthcare provider if they notice a loss of more than an inch. Patients often don't realize they have osteoporosis or are even at risk until they suffer a fracture — most commonly of the hip, spine or wrist — after a fall or from doing ordinary activities. At this point, they have already suffered the consequences of osteoporosis.
Many people are not having appropriate testing to determine if they have osteoporosis before, or even after they fracture. As many as 95 percent of adults who break a bone are being treated without being evaluated for osteoporosis. Bone mineral density tests can measure the amount of bone in different parts of the skeleton and can predict the risk of future fractures.
Diagnosing Osteoporosis
- The only sure way to determine bone density and fracture risk for osteoporosis is to have a bone mass measurement (also called bone mineral density or BMD test).
- Your doctor can help you determine whether you should have a BMD test. NOF Guidelines indicate, BMD testing should be performed on:
- All women aged 65 and older regardless of risk factors*
- Younger postmenopausal women with one or more risk factors (other than being white, postmenopausal and female).
- Postmenopausal women who present with fractures (to confirm the diagnosis and determine disease severity).
(*Note: Medicare covers BMD testing for the following individuals aged 65 and older)
- Estrogen deficient women at clinical risk for osteoporosis
- Individuals with vertebral abnormalities
- Individuals receiving, or planning to receive, long-term glucocorticoid (steroid) therapy
- Individuals with primary hyperparathyroidism
- Individuals being monitored to assess the response or efficacy of an approved osteoporosis drug therapy.
(Medicare permits individuals to repeat BMD testing every two years.)
There are several ways to measure bone mineral density; all are painless, noninvasive and safe and are becoming more readily available. In many testing centers you don't even have to change into an examination robe.
The tests measure bone density in your spine, hip and/or wrist, the most common sites of fractures due to osteoporosis. Recently, bone density tests have been approved by the FDA that measure bone density in the middle finger and the heel or shinbone. Your bone density is compared to two standards, or norms, known as "age matched" and "young normal." The age-matched reading compares your bone density to what is expected in someone of your age, sex and size. The young normal reading compares your density to the optimal peak bone density of a healthy young adult of the same sex.
The information from a bone density test enables your doctor to identify where you stand within ranges of normal and to determine whether you are at risk for fracture. In general, the lower your bone density, the higher your risk for fracture. Test results will help you and your doctor decide the best course of action for your bone health.
(Source: National Osteoporosis Foundation)
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Frequently Asked Questions
CALCIUM
Q: I know dairy foods have calcium, but what are good food sources?
A: Calcium is necessary for bones to stay strong, and every cell in the body needs calcium to work properly. Maintaining an adequate calcium intake is an important step towards good bone health throughout life. Luckily, there are many foods that contain calcium.
Most people know dairy foods contain calcium but are unaware that low-fat and fat-free milk, yogurt and cheese actually have more calcium per serving than the regular versions. But did you know a cup of frozen broccoli has 94 mg of calcium? Or that 10 dried figs 270 mg? Dry roasted almonds pack 75 mg into each ounce. Many foods are made with added calcium. Look for calcium-fortified orange juice, cereals, breads and other foods. Check your local library for books on foods and their nutritional content, or visit the U.S. Department of Agriculture's Food and Nutrition Center's Nutrient Data Laboratory on-line at www.nal.usda.gov/fnic/foodcomp.
Q: How do I choose the calcium supplement that is right for me?
A: Many people consume all the calcium they need from their diet, but others rely on a combination of calcium-rich foods and calcium supplements or on supplements alone to meet their daily needs. There are many supplements from which to choose, allowing each person to find the one that is easiest for her/him to use. Calcium supplements are available as pills, capsules, chewable tablets, chewable candies, powders and tablets that dissolve in water.
In nature, calcium is found only in combination with another substance, such as carbonate, citrate or gluconate. These combinations, or compounds, form calcium"salts" that vary in the amount of actual (elemental) calcium they contain. For example, calcium carbonate is 40 percent elemental calcium and calcium citrate contains 20 percent elemental calcium.
If a tablet contains 1250 mg of calcium carbonate, it contains 500 mg of elemental calcium (40 percent of 1250 = 500 mg).
An easier way to figure out how much calcium each preparation contains is to look at the label and find the heading titled, "percent daily value." If the percent daily value is 20, add a '0' to the 20. Taking the recommended number of tablets will provide 200 mg of elemental calcium.
If the percent daily value is 40, add a '0' to the 40. The recommended number of tablets will provide 400 mg of elemental calcium.
If the percent daily value is 50, add a '0' to the 50. The recommended number of tablets will provide 500 mg of elemental calcium.
Suggestions for choosing a supplement that is right for you:
- Determine your daily calcium intake from foods.
- If calcium intake is around 1200 mg a day, keep up the good work. If additional calcium is needed from a supplement, determine which supplement provides closest to the amount needed. (One that provides 200 mg, 400 mg, or 500 mg per pill)
- Decide the form of calcium that will be easiest for you to take.
- You now know how much calcium you need and the form you would prefer. Choose a recognized brand name or check with the pharmacist in a local store.
- Calcium is easier to absorb when it is consumed in small doses throughout the day. Think about dividing your calcium intake between breakfast and dinner or bedtime. Most calcium supplements, with the exception of calcium citrates, are better absorbed if taken with food.
- Remember, calcium alone does not protect your bones. Vitamin D (400-800 IU/day) is necessary for calcium absorption, but the vitamin D does not have to be included with the calcium. Many people take a daily multivitamin that provides 400 IU of vitamin D. Other sources of vitamin D include fortified foods, fatty fish and skin production with sun exposure. Exercise also plays an important role in lifelong bone health.
Q: Advertisements for coral calcium supplements appear to be everywhere. The ads claim that this calcium not only helps bones but also cures many other medical conditions. Is coral calcium better than any other kind?
A: Coral calcium supplements are made from limestone, which is a form of calcium carbonate. Another common form of calcium is calcium citrate. While all calcium supplements preserve bone health, some individuals selling coral calcium have made health claims that go beyond the current research findings.
Because those coral calcium marketers were making health claims that were not supported by scientific research, they came under investigation by the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA). Two marketers were ordered to stop their infomercials touting unsupported health claims and to return money made as a result of those ads. In addition, the FTC warned several additional coral calcium marketers to remove misleading statements from their web sites.
In another report, researchers presented results of a study on a variety of well-known calcium supplements. They looked at whether or not the calcium in the bottle measured up to the claims on the label, and their results were disappointing. In some instances the amount of calcium in the supplement did not match the amount stated on the label. In other cases the supplements contained unacceptable levels of lead contamination and some did not dissolve fully in the stomach.
NOF recommends that you read labels carefully and choose purified calcium carbonate or calcium citrate.
(Source: National Osteoporosis Foundation)
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NOTE: Do not start any exercise program without first consulting with your healthcare professional.
Q: I have been clumsy all my life, tripping and falling down a lot. Now that I have osteoporosis, I'm worried about breaking a bone when I fall. What can I do to improve my poor balance?
A: People can improve their balance and reduce their risk for falling by repeating a few simple exercises every day.
Exercise 1
While standing and facing a counter top or the back of a sturdy chair, hold on and stand on one leg at a time for one minute. Switch sides and repeat.
Exercise 2
While standing and facing a counter top or the back of a sturdy chair, hold on and rock up onto your toes for a count of ten, roll back onto your heels for a count of ten. Repeat ten times.
Start each exercise at Level 1 below and, when you can do it comfortably, progress to the next level.
Level 1: Hold on with both hands during exercise
Level 2: Hold on with one hand only
Level 3: Hold on with one fingertip only
Level 4: Keep both hands two inches above a chair or table
Level 5: Close your eyes and keep both hands two inches above a chair or table.
(Source: National Osteoporosis Foundation)
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Q: My mother is recovering from surgery to fix a broken hip. How can I help her become independent again?
A: Identifying the reason for the broken hip is a good first step. Your mother is likely to have underlying osteoporosis, which can be diagnosed by having a bone mineral density (BMD) test. If the test shows significant bone loss from osteoporosis, your mother's doctor will encourage her to consume at least 1200 mg of calcium a day and between 400-800 IU of vitamin D a day. The doctor should also consider prescribing a medication to treat her bone loss and reduce risk of future fractures.
Rehabilitation and a slow return to exercise are vital after breaking a bone, especially a hip bone. At first, walking may be difficult. For this reason, many patients are transferred from the hospital to a rehabilitation facility. A good rehabilitation center has staff specially trained to help your mother work hard so that she becomes stronger and more active every day. Initially, she may need a walker to move herself a few steps, but slowly her balance and strength will improve, and she will graduate from the walker to a cane. Before your mother returns home, you may wish to check her house to make sure it is fall-proof. A few basic home safety tips include:
- Remove all obstacles from the floor such as loose throw rugs, long electrical and phone cords and clutter.
- Install railings next to the tub and toilet.
- Do not wear backless shoes or slippers.
- Use 100 watt bulbs in place of low level lighting.
- Add light-sensitive night lights in the bedroom, hall and bathroom.
- Consider subscribing to an at-home monitoring service.
- Review all medications with the doctor as many medications can cause dizziness and increase risk of falling.
(Source: National Osteoporosis Foundation)
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Q: Can all osteoporosis medications build bone?
A: Yes. Osteoporosis occurs when the process that removes old bone and replaces it with new bone becomes imbalanced. Bone is resorbed more quickly than it is replaced so bones weaken and may break. Today, medications that prevent or treat osteoporosis act on either bone resorption (anti-resorptive) or bone formation (anabolic).
Anti-resorptive medications slow the rate of bone resorption without changing the rate of bone formation. Bone formation continues as usual, resulting in a small increase in bone. Anti-resorptive medications approved by the Food and Drug Administration for the prevention and/or treatment of osteoporosis include bisphosphonates (alendronate, ibandronate and risedronate), calcitonin, estrogen/hormone therapies and selective estrogen receptor modulators, called SERMs (raloxifene).
There is one anabolic medication that acts on the bone formation part of the cycle. Parathyroid hormone injections stimulate new bone formation, which strengthens bone and reduces fracture risk.
Remember, no matter what medication you may be prescribed, it is important to get at least 1200 mg of calcium and 400-800 International Units of vitamin D every day. Regular weight-bearing exercise also is an essential part of any osteoprosis prevention or treatment plan. People with osteoporosis should be sure to review any exercise program with a healthcare provider.
Q: Can you explain how parathyroid hormone injections make bones stronger when too much parathyroid hormone made by the body weakens bones?
A: Parathyroid hormone (PTH) is produced by four small parathyroid glands in the neck that control how much calcium is in the blood and tissues. Calcium is necessary not only for bone health but also for normal heart, muscle and nerve function and normal blood clotting. Every day, calcium lost in urine, feces and sweat, or shed in skin, hair and nails must be replaced by calcium from food and/or calcium supplements. When there is too little calcium to make up for these normal losses, the body senses the low calcium level in the blood and tissues, and responds by releasing special hormones, including PTH. PTH breaks down or resorbs bone tissue to release calcium into the blood and tissues so that the body continues to function normally. Higher PTH levels bring the calcium level back to normal in one of three ways:
- By breaking down bone, which releases calcium into the blood and tissues
- By making it easier for calcium from calcium-rich foods or supplements to be absorbed from the intestines
- By slowing the loss of calcium through the kidneys and urine so more can be absorbed
When the calcium level in the blood and tissues returns to normal, PTH levels drop again.
Hyperparathyroidism is a medical condition that results when one or more of the four parathyroid glands becomes overactive. This leads to the constant release of too much PTH, which continues to break down bone and release calcium into the blood and tissues. Over time, excess bone breakdown can lead to osteoporosis and related fractures.
While continuous exposure to PTH causes bone loss, studies have shown that once-a-day injections of PTH have the opposite effect and build new bone. The different effect on bone cells seems to be related to the rapid rise and fall of PTH in the blood when it is given as an osteoporosis treatment, as opposed to the constant high levels of PTH in the blood when someone has hyperparathyroidism.
Parathyroid hormone injections (teriparatide) form new bone, increase bone mineral density and bone strength, and reduce risk for osteoporotic fractures. This is the first bone-building treatment for osteoporosis.
(Source: National Osteoporosis Foundation)
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Q: What is osteonecrosis of the jaw?
A: Osteonecrosis refers to death of bone tissue. The condition results in chronic pain and disfigurement and is resistant to treatment. Early diagnosis may reduce morbidity. Symptoms of osteonecrosis of the jaw include:
- Toothache
- Possible altered sensation
- Jaw pain
- Loose teeth
- Recurrent soft-tissue infection.
- Exposed bone
If you experience any of these symptoms, be sure to report them to your healthcare professional.
(Source: National Osteoporosis Foundation)
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