What is osteoporosis?
Osteoporosis is a problem with the bones when they become thin and lose their strength. It is typically considered a condition that affects women; however, at least one in five men will break a bone from osteoporosis, and one-quarter of the 30,000 hip fractures a year caused by osteoporosis in Canada are in men. It does not cause any pain until you break a bone.
Osteoarthritis is a problem with the joints. Osteoarthritis causes pain when the bones rub against each other in the joints, and it is not the same as osteoporosis.
What causes osteoporosis?
No single cause for osteoporosis has been identified. However, building strong bones in adolescence and childhood can help prevent osteoporosis in later years.
Are there secondary causes of osteoporosis?
There are secondary causes of osteoporosis, such as being on high doses of cortisone or prednisone, or some types of medical conditions such as Cushing’s disease or multiple myeloma. But these are relatively rare.
Very low levels of testosterone, the male sex hormone, is also a risk factor for developing osteoporosis.
Can a calcium deficiency cause osteoporosis?
No, it cannot. If you have low calcium, it can cause another bone disease such as osteomalacia, which is different from osteoporosis. But calcium deficiency generally is not a cause of osteoporosis.
Can celiac disease cause osteoporosis?
No, it cannot. But, celiac disease is associated with malabsorption and very low levels of vitamin D, which then causes a different disease called osteomalacia or rickets. Celiac disease does not cause osteoporosis, but it does make your bones susceptible to fractures.
Is osteoporosis hereditary?
Yes, osteoporosis is hereditary. There is an increased risk of fractures if your parents have broken bones.
You can’t exercise or diet your way out of osteoporosis. However, people who exercise are less likely to develop osteoporosis and less likely to become frail and break a bone.
Getting enough calcium and vitamin D from a combination of your diet/and or a supplement is necessary to provide the building blocks for your bones.
Calcium-rich foods include cheese, yogurt, and salmon. You can get vitamin D from sunshine, and from foods like egg yolks and saltwater fish.
Good sleep isn’t particularly effective in preventing osteoporosis; however, good sleep hygiene is a good idea for your overall health.
Smoking is associated with an increased risk of osteoporosis. It doesn’t mean that everybody who smokes has osteoporosis, but you’re more likely to have osteoporosis if you smoke.
Excessive alcohol can cause osteoporosis. It increases your risk of falls and fractures and low bone density. However, drinking a modest amount of alcohol is not a problem.
For men no more than 15 drinks a week, with no more than 3 drinks in one sitting, and with days off in between.
Signs & symptoms
Osteoporosis is a silent disease without any signs or symptoms until you have the first fracture. Once you’ve had the fracture, you will experience lots of pain; but before the first fracture, it’s without any symptoms whatsoever. You could have very low bone density and osteoporosis and not be aware of it.
What are the early symptoms of osteoporosis?
There are no early symptoms of osteoporosis until you have the first fracture.
Does osteoporosis make you tired?
The pain caused by fractures can make you feel tired.
Can osteoporosis cause bone loss in teeth?
Not really. The bone in the jaw and the calcium in the teeth are different from osteoporosis.
The first treatment ensures that all the secondary causes are excluded, like an overactive thyroid, too much calcium in your blood from hyperparathyroidism, rare cancers or kidney problems. All of those need to be ruled out first before treatment for osteoporosis begins.
Once that’s done, you will begin a drug treatment which is typically administered by injection to help reduce your fracture risk. You will also need to get enough calcium and vitamin D from diet and supplements. In general, 1 to 2000 international units of vitamin D a day in the form of a vitamin tablet and two to three servings of dairy a day. If you don’t get two or three servings of dairy a day, then it becomes important to take a calcium tablet (5 to 600 milligrams of elemental calcium).
The best treatment is one that prevents future fractures or prevents the first fracture. The best treatment depends on how significant the risk is, if the person’s had a fracture, what conditions are present in the patient, alongside convenience and cost.
What is the safest treatment for osteoporosis?
They are all pretty safe, and none of the treatments have severe side effects.
Are there medications or injections for osteoporosis?
There are several injections for osteoporosis. There are two antiresorptive; in other words, they prevent the bone from being broken down. These are called Denosumab (or Prolia), and the second one is zoledronic acid (or Aclasta). Prolia is given by injection under the skin every six months/ twice a year, while Aclasta is administered intravenously once a year.
There are also bone-building drugs or anabolic agents that are given by injection. The names of these medications are teriparatide (or Forteo) and romosozumab (or Evenity). Both of these drugs are substantially more expensive than the others mentioned previously.
I don’t want to take osteoporosis drugs. Are there other treatments?
Unfortunately, the answer is no. If you have a very high fracture risk (in other words, you’ve had an existing fracture, you have frailty, or you have very low bone density), then the best advice is drug treatment. You can’t exercise your way out of osteoporosis, nor can you take calcium, vitamin D or supplements of any sort to reduce your future fracture risk.
Can exercising help with osteoporosis?
Yes. When you exercise, you become stronger, you’re less likely to become frail, and you’re less likely to fall. So exercise is very important for osteoporosis.
But unfortunately, there’s very little to no evidence which shows exercise can significantly increase your bone density. If you hear someone say, “When you exercise, you don’t need treatment for osteoporosis,” that is not true.
Is osteoporosis curable?
A better way of asking the question is: do we have therapy that can prevent fractures? Yes, we have very effective treatment that can dramatically reduce the risk of fractures. We can never eliminate fractures, but we can dramatically reduce the risk of having more fractures.
The first thing to do is to educate yourself and become knowledgeable about the disease. The Osteoporosis Canada website is an excellent website that provides very reliable information. The BC Coalition of Osteoporosis Physicians (BCCOP) has a website that links to multiple sites and is another excellent local source in British Columbia for osteoporosis.
How do I help someone I care about, live with osteoporosis?
Often people need practical and sometimes emotional support when they have experienced pain or complications due to osteoporosis. For more information, please visit Osteoporosis Canada: Get Support.
Frequently asked questions
What’s the difference between osteoporosis and osteopenia?
Osteoporosis is a medical disease that increases your likelihood or predisposition to fracture. Osteopenia is a medical term created by radiologists to describe a T-score on the bone density test. It’s not a disease; it’s a range of bone density that is defined as osteopenia.
How serious is osteoporosis?
Osteoporosis is very serious. The risk of a hip fracture is profoundly significant; it can shorten your life and dramatically changes the quality of your life. Therefore, it’s a significant health problem.
Is obesity a risk factor for osteoporosis?
Indirectly it can be, but low body mass and being underweight create a higher risk for osteoporosis.