Health Topics Publication Date: April 2007
Handout on Health: Osteoporosis
Information Boxes
This booklet is for people who have osteoporosis, their families, and others interested in learning more about the disease. The booklet describes osteoporosis and its impact, and contains information about the causes, diagnosis, and treatment of this disease as well as current research efforts supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other components of the Department of Health and Human Services’National Institutes of Health (NIH). It also discusses risk factors for osteoporotic fractures, ways to prevent the disease and its progression, and how people with the disease can reduce their risk of future fractures. If you have further questions after reading this booklet, you may wish to discuss them with your doctor, or seek additional information from the sources listed at the end of this booklet. Osteoporosis is a disease marked by reduced bone strength leading to an increased risk of fractures, or broken bones. Bone strength has two main features: bone mass (amount of bone) and bone quality. Osteoporosis is the major underlying cause of fractures in postmenopausal women and the elderly. Fractures occur most often in bones of the hip, spine, and wrist, but any bone can be affected. Some fractures can be permanently disabling, especially when they occur in the hip. Osteoporosis is often called a “silent disease”because it usually progresses without any symptoms until a fracture occurs or one or more vertebrae (bones in the spine) collapse. Collapsed vertebrae may first be felt or seen when a person develops severe back pain, loss of height, or spine malformations such as a stooped or hunched posture. Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of minor bumps, falls, or normal stresses and strains such as bending, lifting, or even coughing. Many people think that osteoporosis is a natural and unavoidable part of aging. However, medical experts now believe that osteoporosis is largely preventable. Furthermore, people who already have osteoporosis can take steps to prevent or slow further progress of the disease and reduce their risk of future fractures. Although osteoporosis was once viewed primarily as a disease of old age, it is now recognized as a disease that can stem from less-than-optimal bone growth during childhood and adolescence, as well as from bone loss later in life. The Occurrence and Impact of Osteoporosis In the United States today, an estimated 10 million people over age 50 have osteoporosis and almost 34 million have low bone mass that puts them at increased risk for developing the disease. Four out of five people who have osteoporosis are women, but about 2 million men in the U.S. also have the disease and 14 million more have low bone mass that puts them at risk for it. One in two women and as many as one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. Osteoporosis can strike at any age, although the risk of developing the disease increases as you get older. In the future, more people will be at risk of developing osteoporosis because people are living longer and the number of elderly people in the population is increasing. Osteoporosis affects women and men of all races and ethnic groups. It is most common in non-Hispanic white women and Asian women. African American women have a lower risk of developing osteoporosis, but they are still at significant risk. For Hispanic and Native American women the data aren’t clear. Among men, osteoporosis is more common in non-Hispanic whites and Asians than in men of other ethnic or racial groups. The cost of osteoporosis to society is high. In 2002 dollars, between $12.2 billion and $17.9 billion was spent in the U.S. on hospitals and nursing homes for people with osteoporosis-related and associated fractures, and the costs are rising. The indirect costs of the disease, such as those resulting from reduced productivity and lost wages, are unknown. In addition to the financial costs, osteoporosis takes a toll in terms of reduced quality of life for many people who suffer fractures. It can also affect the lives of family members and friends who serve as caregivers. Of all fractures, hip fractures have the most serious impact. Most hip fractures require hospitalization and surgery; some hip fracture patients require nursing home placement. Fifty percent of people who fracture a hip will be unable to walk without assistance. About one in five hip fracture patients over age 50 die in the year following their fracture as a result of associated medical complications. Vertebral fractures also can have serious consequences, including chronic back pain and disability. They have also been linked to increased mortality in older people. Bone is a living tissue that supports our muscles, protects vital internal organs, and stores most of the body’s calcium. It consists mainly of a framework of tough, elastic fibers of a protein called collagen and crystals of calcium phosphate mineral that harden and strengthen the framework. The combination of collagen and calcium phosphate makes bones strong yet flexible to hold up under stress. Bone also contains living cells, including some that nourish the tissue and others that control the process known as bone remodeling. Throughout life, our bones are constantly being renewed by means of this remodeling process, in which old bone is removed (bone resorption) and replaced by new bone (bone formation). Bone remodeling is carried out through the coordinated actions of bone-removing cells called osteoclasts and bone-forming cells called osteoblasts. During childhood and the teenage years, new bone is added to the skeleton faster than old bone is removed, or resorbed. As a result, bones grow in both size and strength. After you stop growing taller, bone formation continues at a faster pace than resorption until around the early 20s, when women and men reach their peak bone mass, or maximum amount of bone. Peak bone mass is influenced by various genetic and external, or environmental, factors, including whether you are male or female (your sex), hormones, nutrition, and physical activity. Genetic factors may determine as much as 50 to 90 percent of bone mass, while environmental factors account for the remaining 10 to 50 percent. This means you have some control over your peak bone mass. After your early 20s, your bone mass may remain stable or decrease very gradually for a period of years, depending on a variety of lifestyle factors such as diet and physical activity. Starting in midlife, both men and women experience an age-related decline in bone mass. Women lose bone rapidly in the first 4 to 8 years after menopause (the completion of a full year without a menstrual period), which usually occurs between ages 45 and 55. By age 65, men and women tend to be losing bone tissue at the same rate, and this more gradual bone loss continues throughout life. Amajor cause of osteoporosis is less-than-optimal bone growth during childhood and adolescence, resulting in failure to reach optimal peak bone mass. Thus, peak bone mass attained early in life is one of the most important factors affecting your risk of osteoporosis in later years. People who start out with greater reserves of bone (higher peak bone mass) are less likely to develop osteoporosis when bone loss occurs as a result of aging, menopause, or other factors. Other causes of osteoporosis are bone loss due to a greater-than-expected rate of bone resorption, a decreased rate of bone formation, or both. Deterioration of bone quality, which reflects the internal structure, or “architecture,”of bone as well as other factors, is also thought to contribute to decreased bone strength and increased fracture risk. Scientists do not yet clearly understand all the factors that affect bone quality and the relationship between these factors and the risk of osteoporosis and fractures. However, this is an active area of research. A major contributor to bone loss in women during later life is the reduction in estrogen production that occurs with menopause. Estrogen is a sex hormone that plays a critical role in building and maintaining bone. Decreased estrogen, whether due to natural menopause, surgical removal of the ovaries, or chemotherapy or radiation treatments for cancer, can lead to bone loss and eventually osteoporosis. After menopause, the rate of bone loss speeds up as the amount of estrogen produced by a woman’s ovaries drops dramatically. Bone loss is most rapid in the first few years after menopause but continues into the postmenopausal years. In men, sex hormone levels also decline after middle age, but the decline is more gradual. These declines probably also contribute to bone loss in men after around age 50. Osteoporosis can also result from bone loss that may accompany a wide range of disease conditions, eating disorders, and certain medications and medical treatments. For instance, osteoporosis may be caused by long-term use of some antiseizure medications (anticonvulsants) and glucocorticoid medications such as prednisone and cortisone. Glucocorticoids are anti-inflammatory drugs used to treat many diseases, including rheumatoid arthritis, lupus, asthma, and Crohn’s disease. Other causes of osteoporosis include alcoholism, anorexia nervosa, abnormally low levels of sex hormones, hyperthyroidism, kidney disease, and certain gastrointestinal disorders. Sometimes osteoporosis results from a combination of causes. Medications Associated With Osteoporosis
Factors that are linked to the development of osteoporosis or contribute to an individual’s likelihood of developing the disease are called risk factors. Many people with osteoporosis have several risk factors for the disease, but others who develop osteoporosis have no identified risk factors. There are some risk factors that you cannot change, and others that you can or may be able to change. Risk factors you cannot change:
Risk factors you can or may be able to change:
Risk Factors for Osteoporosis-Related Fractures While low bone mass (or low bone density) plays an important role in determining a person’s risk of osteoporosis, it is only one of many risk factors for fractures. Fracture risk results from a combination of bone-dependent and bone-independent factors. Various aspects of “bone geometry,”such as tallness, hip structure, and thighbone (femur) length, can also affect your chances of breaking a bone if you fall. Increasing age, excessive weight loss, a history of fractures since age 45, having an existing spine fracture, and having a mother who fractured her hip all increase the risk of hip fracture independent of a person’s bone density, and individuals with more risk factors have a higher chance of suffering a hip fracture. Factors that increase the likelihood of falling and the severity of falls also contribute to fracture risk. These include decreased muscle strength, poor balance, impaired eyesight, and impaired mental abilities. The angle at which you fall also affects your risk of fracture. Use of certain medications, such as tranquilizers and muscle relaxants, and hazardous elements in your living environment, such as slippery throw rugs and icy sidewalks, can also increase your risk of falls. Information on falls and fall prevention is provided in the “Treating Osteoporosis”section of this booklet. Risk Factors for Fractures
Diagnosing osteoporosis involves several steps, starting with a physical exam and a careful medical history, blood and urine tests, and possibly a bone mineral density assessment. When recording information about your medical history, your doctor will ask questions to find out whether you have risk factors for osteoporosis and fractures. The doctor may ask about any fractures you have had, your lifestyle (including diet, exercise habits, and whether you smoke), current or past health problems and medications that could contribute to low bone mass and increased fracture risk, your family history of osteoporosis and other diseases, and, for women, your menstrual history. The doctor will also do a physical exam that should include checking for loss of height and changes in posture and may also include checking your balance and gait (the way you walk). If you have back pain or have experienced a loss in height or a change in posture, the doctor may request an x ray of your spine to look for spinal fractures or malformations due to osteoporosis. However, x rays cannot necessarily detect osteoporosis. The results of laboratory tests of blood and urine samples can help your doctor identify conditions that may be contributing to bone loss, such as hormonal problems or vitamin D deficiency. If the results of your physical exam, medical history, x rays, or laboratory tests indicate that you may have osteoporosis or that you have significant risk factors for the disease, your doctor may recommend a bone density test. Mineral is what gives hardness to bones, and the density of mineral in the bones is an important determinant of bone strength. Bone mineral density (BMD) testing can be used to definitively diagnose osteoporosis, detect low bone mass before osteoporosis develops, and help predict your risk of future fractures. In general, the lower your bone density, the higher your risk for fracture. The results of a bone density test will help guide decisions about starting therapy to prevent or treat osteoporosis. BMD testing may also be used to monitor the effectiveness of ongoing therapy. The most widely recognized test for measuring bone mineral density is a quick, painless, noninvasive technology known as dual-energy x-ray absorptiometry (DXA). This technique, which uses low levels of x rays, involves passing a scanner over your body while you are lying on a cushioned table. DXA can be used to determine BMD of the entire skeleton and at various sites that are prone to fracture, such as the hip, spine, or wrist. Bone density measurement by DXA at the hip and spine is generally considered the most reliable way to diagnose osteoporosis and predict fracture risk. The doctor will compare your BMD test results to the average bone density of young, healthy people and to the average bone density of other people of your age, sex, and race. For both women and men, the diagnosis of osteoporosis using DXA measurements of BMD is currently based on a number called a T-score. Your T-score represents the extent to which your bone density differs from the average bone density of young, healthy people. If you are diagnosed with osteoporosis or very low bone density, or if your bone density is below a certain level and you have other risk factors for fractures, the doctor will talk with you about options for treatment or prevention of osteoporosis. The U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention, recommends that all women aged 65 and older be screened for osteoporosis. The task force also recommends that routine screening begin at age 60 for women at increased risk for fractures due to osteoporosis (for instance, those who have additional risk factors). If you have not been checked for osteoporosis and you are a woman over age 65, or you suspect that you have significant risk factors for the disease, you may want to talk to your doctor about being evaluated. For example, if you are over 50 and have broken a bone, you may have osteoporosis or be at increased risk for the disease. You should also ask your doctor about osteoporosis if you notice that you have lost height or your posture has become stooped or hunched, or if you experience sudden back pain. You may also want to be evaluated for osteoporosis and fracture risk if you have a chronic disease or eating disorder known to increase the risk of osteoporosis, are taking one or more medications known to cause bone loss, or have multiple risk factors for osteoporosis and osteoporosis-related fractures. When to Talk to Your Doctor About Osteoporosis Consider talking to your doctor about being evaluated for osteoporosis if:
The primary goal in treating people with osteoporosis is preventing fractures. A comprehensive treatment program includes a focus on proper nutrition, exercise, and prevention of falls that may result in fractures. Your doctor may also prescribe one of several medications that have been shown to slow or stop bone loss or build new bone, increase bone density, and reduce fracture risk. If you take medication to prevent or treat osteoporosis, it is still essential that you obtain the recommended amounts of calcium and vitamin D. Exercising and maintaining other aspects of a healthy lifestyle are also important. For people with osteoporosis resulting from another condition, the best approach is to identify and treat the underlying cause. If you are taking a medication that causes bone loss, your doctor may be able to reduce the dose of that medication or switch you to another medication that is effective but not harmful to your bones. If you have a disease that requires long-term glucocorticoid therapy, such as rheumatoid arthritis or lupus, you can also take certain medications approved for the prevention or treatment of osteoporosis associated with aging or menopause. Staying as active as possible, eating a healthy diet that includes adequate calcium and vitamins, and avoiding smoking and excess alcohol use are also important for people with osteoporosis resulting from other conditions. Children and adolescents with such conditions as juvenile rheumatic diseases and asthma can also be diagnosed with this kind of osteoporosis. Idiopathic Juvenile Osteoporosis Some children and adolescents develop osteoporosis that has no known cause, known as idiopathic juvenile osteoporosis (IJO). Young people who have this rare form of osteoporosis usually recover completely within 2 to 4 years. The basic treatment strategy is to protect the spine and other bones from fracture until recovery occurs. Doctors may also recommend treatment of IJO with calcium and vitamin D supplements or with certain medications used to treat adults with osteoporosis, especially in severe cases. Medical specialists who treat osteoporosis include family physicians, internists, endocrinologists, geriatricians, gynecologists, orthopaedic surgeons, rheumatologists, and physiatrists (doctors specializing in physical medicine and rehabilitation). Physical and occupational therapists and nurses may also participate in the care of people with osteoporosis. Nutrition Many people in the U.S. consume much less than the recommended amount of calcium in their diets. Good sources of calcium include low-fat dairy products; dark green leafy vegetables, including broccoli, bok choy, collards, and turnip greens; sardines and salmon with bones; soy beans, tofu, and other soy products; and calcium-fortified foods such as orange juice, cereals, and breads. If you have trouble getting enough calcium in your diet, you may need to take a calcium supplement such as calcium carbonate, calcium phosphate, or calcium citrate. Your daily calcium intake should not exceed 2,500 milligrams, because too much calcium can cause problems such as kidney stones. Calcium coming from food sources provides better protection from kidney stones. Anyone who has had a kidney stone should increase their dietary calcium and decrease the amount from supplements as well as increase fluid intake. Vitamin D is required for proper absorption of calcium from the intestine. It is made in the skin after exposure to sunlight. Fifteen minutes in the sun every day without sunscreen and with some of your skin exposed is enough to meet the body’s needs for vitamin D. Only a few foods naturally contain significant amounts of vitamin D, including fatty fish and fish oils. Foods fortified with vitamin D, such as milk and cereals, are a major dietary source of vitamin D. Although many people obtain enough vitamin D naturally, studies show that vitamin D production decreases in older adults, in people who are housebound, and during the winter –especially in northern latitudes. If you are at risk for vitamin D deficiency, you can take multivitamins or calcium supplements that contain vitamin D to meet the recommended daily intake of 400 International Units (IU) for men and women aged 51 to 70 and 600 IU for people over 70. Doses of more than 2,000 IU per day are not advised unless under the supervision of a physician. Larger doses can be given initially to people who are deficient as a way to replenish stores of vitamin D. Lifestyle Exercise Although exercise is beneficial for people with osteoporosis, it should not put any sudden or excessive strain on your bones. If you have osteoporosis, you should avoid high-impact exercise. To help ensure against fractures, a physical therapist or rehabilitation medicine specialist can recommend specific exercises to strengthen and support your back, teach you safe ways of moving and carrying out daily activities, and recommend an exercise program that is tailored to your circumstances. Other trained exercise specialists, such as exercise physiologists, may also be able to help you develop a safe and effective exercise program. Fall Prevention Falls can be caused by impaired vision or balance, loss of muscle mass, and chronic or short-term illnesses that impair your mental or physical functioning. They can also be caused by the effects of certain medications, including sedatives or tranquilizers, sleeping pills, antidepressants, anticonvulsants, muscle relaxants, some heart medicines, blood pressure pills, and diuretics. Use of four or more prescription medications has also been shown to increase the risk for falling. Drinking alcoholic beverages is another risk factor. If you have osteoporosis, it is important to be aware of any physical changes you may be experiencing that affect your balance or gait and to discuss these changes with your doctor or other health care provider. It is also important to have regular checkups and tell your doctor if you have had problems with falling. The force or impact of a fall (how hard you land) plays a major role in determining whether you will break a bone. Catching yourself so that you land on your hands or grabbing onto an object as you fall can prevent a hip fracture. You may break your wrist or arm instead, but the consequences are not as serious as if you break your hip. Studies have shown that wearing a specially designed garment that contains hip padding may reduce hip fractures resulting from falls in frail, elderly people living in nursing homes or residential care facilities, but use of the garments by residents is often low. Falls can also be caused by factors in your environment that create unsafe conditions. Some tips to help eliminate the environmental factors that lead to falls include: Outdoors and away from home:
Indoors:
Preventing Falls Among Seniors1 Falls are not just the result of getting older. Many falls can be prevented. Falls are usually caused by a number of things. By changing some of these things, you can lower your chances of falling. You can reduce your chance of falling by doing these things: Begin a regular exercise program: Exercise is one of the most important ways to reduce your chances of falling. It makes you stronger and helps you feel better. Exercises that improve balance and coordination (like Tai Chi) are the most helpful. Lack of exercise leads to weakness and increases your chances of falling. Ask your doctor or health care worker about the best type of exercise program for you. Make your home safer: About half of all falls happen at home. To make your home safer:
Have your health care provider review your medicines: Have your doctor or pharmacist look at all the medicines you take (including the ones that don’t need prescriptions, such as cold medicines). As you get older, the way some medicines work in your body can change. Some medicines, or combinations of medicines, can make you drowsy or lightheaded, which can lead to a fall. Have your vision checked: Have your eyes checked by an eye doctor. You may be wearing the wrong glasses or have a condition such as glaucoma or cataracts that limits your vision. Poor vision can increase your chances of falling. 1 U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2004. Medications Alendronate, risedronate, and ibandronate belong to a group of drugs known as bisphosphonates, which reduce the activity of cells that cause bone loss. In postmenopausal women with osteoporosis, the bisphosphonate drugs reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of fracture. Side effects may include digestive system problems. Raloxifene is also approved for the treatment and prevention of osteoporosis. It is one of a relatively new group of drugs known as selective estrogen receptor modulators, or SERMs. These drugs are not estrogens, but they have estrogen-like effects on some tissues and estrogen-blocking effects on other tissues. Raloxifene mimics the effects of estrogen on bones, but does not have estrogen’s potentially harmful effects on breast tissue or the uterus. Raloxifene has been shown to prevent bone loss, have beneficial effects on bone mass, and reduce the risk of spine fractures. It is taken as a tablet once a day. Side effects may include hot flashes, sweating, clot formation in some blood vessels, muscle soreness, weight gain, or a rash. Teriparatide is an injectable form of human parathyroid hormone (PTH) that is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. It is the first approved agent for the treatment of osteoporosis that stimulates new bone formation. Teriparatide is taken by once-daily injection into the thigh or abdomen. This treatment stimulates new bone formation in both the spine and hip and reduces the risk of fractures in postmenopausal women and men. Side effects include nausea, dizziness, and leg cramps. Use of teriparatide for more than 2 years is not recommended because the effects of long-term treatment are not yet known. Following PTH treatment with a bisphosphonate drug will preserve the bone mass gains. Calcitonin is approved for the treatment of osteoporosis in women who are at least 5 years beyond menopause. Calcitonin is a hormone involved in calcium regulation and bone metabolism. It is taken as a single daily nasal spray or as an injection under the skin. In women who are at least 5 years beyond menopause, calcitonin slows bone loss and increases spinal bone density. Some patients report that calcitonin also relieves pain from bone fractures. The effects of calcitonin on fracture risk are still unclear. Injected calcitonin does not affect other organs or systems in the body besides bone, but it may cause an allergic reaction. Side effects may include flushing of the face and hands, increased frequency of urination, nausea, and skin rash. The only side effects reported with nasal calcitonin are a runny nose and other signs of nasal irritation. Estrogen and combined estrogen and progestin (hormone therapy) are approved for the prevention of postmenopausal osteoporosis as well as the treatment of moderate to severe hot flashes and vaginal dryness that may accompany menopause. Estrogen without an added progestin is recommended only for women who have had a hysterectomy (surgery to remove the uterus), because estrogen increases the risk of developing cancer of the uterine lining and progestin reduces that risk. Studies have shown that hormone therapy can increase bone density and prevent bone loss, and that estrogen plus progestin prevents osteoporosis-related fractures in the hip and other sites in postmenopausal women. Results of the NIH-sponsored Women’s Health Initiative (WHI), a large, long-term study of disease prevention strategies in postmenopausal women, show that both estrogen alone as well as estrogen plus progestin prevent osteoporosis and fractures when used at the commonly administered doses. The drugs used in these trials were Conjugated Equine Estrogens (CEE 0.625 mg /day) and Medroxyprogesterone Acetate (MPA, 2.5 mg/day). At these doses, there was no protection from cardiovascular disease and an increase in strokes and blood clots. In the trial of combination therapy, there was also an increase in breast cancer. On the basis of these findings, medical experts concluded that, in most women, the harmful effects of long-term use of hormone therapy are likely to outweigh the disease prevention benefits. The Food and Drug Administration has recommended that women use hormone therapy at the lowest dose and for the shortest time. The risks and benefits of low-dose hormone therapy and estrogen patches are still unclear. Women who use, or are considering, hormone therapy (either estrogen plus progestin or estrogen alone) solely for the prevention of osteoporosis should carefully consider and discuss with their doctor other approved treatments. They should also talk to the doctor about whether the benefits of hormone therapy outweigh the potential harms in view of their personal preferences and individual risk factors for various diseases and consider whether lower doses of hormone therapy may be appropriate. 2 Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory. Alternative Therapies Preventing osteoporosis is a lifelong endeavor. To reach optimal peak bone mass and minimize loss of bone as you get older, there are several factors you should consider. Addressing all of these factors is the best way to optimize bone health throughout life. Calcium Calcium needs change during your lifetime (see the “Recommended Calcium Intakes”list for details). The body’s demand for calcium is greater during childhood and adolescence, when the skeleton is growing rapidly, and in women during pregnancy and breastfeeding. Postmenopausal women and older men also need to consume more calcium. Increased calcium requirements in older people may be related to vitamin D deficiencies that reduce intestinal absorption of calcium. Also, as you age, your body becomes less efficient at absorbing calcium and other nutrients. Older adults are also more likely to have chronic medical problems and to use medications that may impair calcium absorption. Calcium and vitamin D supplements may help slow bone loss and prevent hip fracture. Results from the Women’s Health Initiative Calcium with Vitamin D trial showed that for postmenopausal women, particularly those over 60, a daily dose of 1,000 milligrams of calcium carbonate combined with 400 IUs of vitamin D3 led to improvements in hip bone density and a reduction in hip fracture. Information on how to ensure adequate calcium intake is provided in the “Treating Osteoporosis”section of this booklet. Further details are also available from several of the organizations listed at the end of this booklet. Adolescence is the most critical period for building bone mass that helps protect against osteoporosis later in life. Yet studies show that in the U.S., among children aged 9 to19, few meet the recommended levels. Therefore, it is especially important for parents, other caregivers, and pediatricians to talk to children and young teens about developing bone-healthy habits, including eating calcium-rich foods and getting enough exercise. More information on this subject is available in the NIH publication “Kids and Their Bones”(see the section on “For More Information”at the end of this booklet for details).
3 Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 1997 Vitamin D Overall Nutrition Exercise Strength training to build and maintain muscle mass and exercises that help with coordination and balance are also important. Later in life, the benefits of exercise for building and maintaining bone mass are not nearly as great, but staying active and doing weight-bearing exercise is still important. A properly designed exercise program that builds muscles and improves balance and coordination provides other benefits for older people, including helping to prevent falls and maintaining overall health and independence. Experts recommend 30 minutes or more of moderate physical activity on most (preferably all) days of the week, including a mix of weight-bearing exercises, strength training (two or three times a week), and balance training. Smoking Alcohol Medications That Cause Bone Loss Prevention Medications Osteoporosis and Quality of Life Aside from its effects on your bones, osteoporosis can change your life in many other ways. Osteoporosis affects each person differently and to different degrees. For example, people with a single fracture and people who have had multiple fractures do not face the same challenges. The particular site of a fracture (hip, spine, etc.) may also influence a person’s life in different ways. The effects of osteoporosis on quality of life can include:
Because osteoporosis has such wide-ranging effects, experts say, doctors and other health care providers should treat the whole person, not only the disease. Various measures are available to address the impact of osteoporosis on an individual’s quality of life, including the emotional, physical, and functional effects of the disease as well as its social aspects. Some of these issues and how to address them are outlined below. Emotional Impacts of Osteoporosis
Functional and Physical Aspects of Osteoporosis
Social Aspects of Osteoporosis
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) leads the Federal research effort on osteoporosis. Scientists at universities, medical centers, and other research institutions across the U.S. who are funded by NIAMS and other NIH components are pursuing a wide range of basic and clinical studies on the disease. Significant advances in preventing and treating osteoporosis continue to be made. Such advances are the direct result of research focused on:
Some key areas of osteoporosis research supported by NIAMS and its partners at NIH are described below. Genetic Studies Scientists also continue to identify many genes that may affect bone mass. Experiments with genetically modified mice have been particularly useful in pinpointing areas of interest for human studies. Such efforts seem likely to identify targets for the development of new osteoporosis therapies. Results may also lead to the development of simple genetic tests that can detect early in life those individuals who are at greatest risk of developing the disease, which could in turn lead to effective targeting of prevention-based treatment strategies. Bone Cell Biology Study of Osteoporotic Fractures (SOF) Osteoporosis in Men Evaluating and Assessing Bone Quality Treatments for Osteoporosis Nutritional Studies With ongoing research, experts hope that osteoporosis will come to be considered a curable disease. Research has enhanced our knowledge about how to maintain a healthy skeleton throughout life and has led to progress in understanding the causes, prevention, diagnosis, and treatment of osteoporosis. Every research advance brings us closer to eliminating the pain and suffering caused by this disease. NIH Osteoporosis and Related Bone Diseases~National
Resource Center The NIH Osteoporosis and Related Bone Diseases~National Resource Center (ORBD~NRC) provides patients, health professionals, and the public with an important link to resources and information on osteoporosis and other metabolic bone diseases. The mission of NIH ORBD~NRC is to expand awareness and enhance knowledge and understanding of the prevention, early detection, and treatment of these diseases as well as strategies for coping with them. The center has a wide range of publications on osteoporosis, including “Bone Health and Osteoporosis: A Report of the Surgeon General”and an accompanying booklet written for the general public. Fact sheets on osteoporosis include more detailed information on topics such as prevention of falls and fractures, calcium supplements, exercise, quality-of-life issues, and osteoporosis in men and various ethnic groups. Fact sheets on bone health and osteoporosis are also available in Spanish and Chinese. These and other fact sheets are available by mail and on the center’s Web site, which also provides links to other sources of information on osteoporosis. National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) The NIAMS leads the Federal research effort on osteoporosis and related bone diseases. NIAMS distributes patient and professional educational materials about osteoporosis and can refer people to other sources of information. Through its Web site, NIAMS also provides information about current research related to osteoporosis, as well as health information about the disease. “Kids and Their Bones,”a publication produced jointly by NIAMS and the NIH Osteoporosis and Related Bone Diseases~National Resource Center, is available on the NIAMS Web site and by mail. National Institute on Aging (NIA) Information Center The National Institute on Aging (NIA), a part of the National Institutes of Health, has a book and video about exercise for older people. For more information and a free publications list, write or call the NIA Information Center. In consultation with NIAMS, NIA has also provided information about the prevention and treatment of osteoporosis on the NIHSeniorHealth Web site (www.nihseniorhealth.gov), a joint effort of NIA and the National Library of Medicine (NLM). American Academy of Orthopaedic Surgeons The academy provides education and practice management services for orthopaedic surgeons and allied health professionals. It also serves as an advocate for improved patient care and informs the public about the science of orthopaedics. The orthopaedist’s scope of practice includes disorders of the body’s bones, joints, ligaments, muscles, and tendons. For a single copy of an AAOS brochure, send a self-addressed stamped envelope to the address above or visit the AAOS Web site. American Geriatrics Society The American Geriatrics Society (AGS), a national nonprofit organization, is the premier professional organization of health care providers dedicated to improving the health and well-being of all older adults. Through its Web site, it provides information to geriatrics health care professionals, the public, and other concerned individuals dedicated to improving the health, independence, and quality of life of all older people. The AGS provides educational materials on fall prevention, osteoporosis, and bone health for patients and health professionals on its Web site. American Society for Bone and Mineral Research The American Society for Bone and Mineral Research (ASBMR) is a professional scientific and medical society established to bring together clinical and experimental scientists involved in the study of bone and mineral metabolism. ASBMR encourages and promotes the study of this expanding field through annual scientific meetings; an official journal, the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism; and advocacy and interaction with government agencies and related societies. National Osteoporosis Foundation The National Osteoporosis Foundation (NOF) is the leading nonprofit, voluntary health organization dedicated to promoting lifelong bone health in order to reduce the widespread prevalence of osteoporosis and associated fractures, while working to find a cure for the disease through programs of research, education, and advocacy. NOF provides information and resources on osteoporosis for patients and the public. It also provides resources and professional relations and education programs on the disease for health professionals. Acknowledgments The NIAMS gratefully acknowledges the assistance of Joan McGowan, Ph.D., and William Sharrock, Ph.D., NIAMS, NIH; Sundeep Khosla, M.D., Mayo Clinic College of Medicine, Rochester, MN; Barbara Lukert, M.D., University of Kansas, Kansas City; and Eric Orwoll, M.D., Oregon Health and Science University, Portland in the preparation and review of this publication. Elia Ben-Ari, Ph.D., was the primary author of this booklet. The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services’National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at www.niams.nih.gov. Information on bone and its disorders can be obtained from the NIH Osteoporosis and Related Bone Diseases~National Resource Center; phone (toll-free) 800-624-BONE (2663) or visit www.niams.nih.gov/bone. For Your Information This publication contains information about medications used to treat the health condition discussed here. When this booklet was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released. For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at 1-888-INFO-FDA (1-888-463-6332, a toll-free call) or visit their Web site at www.fda.gov. This booklet is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed. Additional copies of this booklet are available from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIAMS/National Institutes of Health, 1 AMS Circle, Bethesda, MD 20892-3675, and on the NIAMS Web site at www.niams.nih.gov. NIH Pub. No. 07-5158 |