Frequently Asked Questions about Osteoporosis

What is osteoporosis? Osteoporosis is a bone disease that weakens our bones, making them thinner and easier to break. These fractures can lead to pain, stooped and poor posture, or significant trouble moving around.

What is osteopenia? Osteopenia is often referred to as the beginning stage of osteoporosis. It is weakening of the bones and reduced bone mass, but not quite to the severity of osteoporosis. If your bones continue to lose mass over time, osteopenia can turn into osteoporosis, but the good news is that it doesn’t have to! There are many healthy habits and lifestyle choices that can strengthen your bones, slow osteopenia and prevent osteoporosis.

How many people have osteoporosis? According to the National Osteoporosis Foundation, about 54 million Americans have osteoporosis or osteopenia. Studies suggest that approximately one and in two women and one and four men age 50 and older will break a bone due to osteoporosis.

What are osteoporosis risk factors that cannot be changed?

These factors include:

– Gender – approximately 80% of cases affect women
– Age – As we age, our bones naturally lose some density and become weaker
– Family history of osteoporosis – Studies show that if either of your parents had it, you are more likely to get it.
– History of broken bones – even one broken bone increases your risk of developing osteoporosis, simply because it shows your bones may already be slightly compromised.
– Size of body frame – people with smaller frames are more prone to osteoporosis. Their bones are lighter and thinner. Conversely, a large frame is NOT a defense against the disease.
– Ethnicity – Osteoporosis affects all races and ethnicities, but those of Asian, Latino and Caucasian descent have a higher risk.
– Post-menopausal – There is a steep drop in estrogen after menopause. Estrogen protects the bones. When estrogen decreases, bones may lose density and be prone to fractures.

There are many health conditions and problems that increase the likelihood of osteoporosis. If you live with any of the following, talk with your primary care provider about what you can do to keep your bones healthy. This does not include

all conditions that may cause bone loss.

• Rheumatoid Arthritis
• Lupus
• Multiple Sclerosis
• Celiac disease
• Inflammatory bowel disease
• Weight loss surgery
• Breast cancer
• Prostate cancer
• Leukemia
• Lymphoma
• Sickle Cell disease
• Stroke
• Parkinson’s disease
• Spinal cord injuries
• Diabetes
• Hyperthyroidism
• Hyperparathyroidism
• Cushing’s syndrome
• COPD
• Chronic kidney disease
• Liver disease
• Organ transplants

What can I do to try to avoid osteoporosis? There are many risk factors that you are able to control by making good lifestyle choices. These are:

– Get enough vitamin D and calcium
– Exercise regularly
– Quit smoking
– Do not abuse alcohol
– Work with your physician to bring hormonal imbalances under control
– Educate yourself on the long-term use and side effects of medications you are taking

Why are women at greater risk for osteoporosis than men? The first reason is that women tend to have smaller, thinner bones than men. The second is related to hormones: When women reach menopause, there is a major drop in estrogen levels. This loss slows the bone remodeling process and may help the body lose bone mass at a faster rate. This continues for several years after menopause. The rate of bone loss eventually returns to where it was before menopause, but in the meantime, it gives postmenopausal women a greater chance of having a fracture. The good news is that osteoporosis is NOT an inevitable part of aging. There are many lifestyle habits that help you protect your bones and decrease your chances of getting osteoporosis. If your healthcare provider has not yet talked to you about your bone health, you should bring it up!

Can taking certain medications increase my chances of developing osteoporosis? Some medications may be harmful to your bones, even if you need to take them for other conditions. Always talk to your healthcare provider about risks and side effects of medicines you take and how they may affect your bones.

How can I prevent falls and fractures? People of any age can injure themselves with a fall. It is important that people with osteoporosis avoid trips and falls because of the greater risk of experiencing a fracture. Some tips to prevent falls:

– Use a cane or walker if you need it
– Wear rubber soled shoes so you don’t slip
– Walk on the grass when sidewalks are slick
– Put salt on icy sidewalks
– Keep rooms free of clutter
– Wear low-heeled shoes
– Avoid walking in socks or stockings
– Be sure rugs have skid proof backs
– Be sure stairs and all walkways are well lit
– Install hand rails on both sides of the steps
– Put grab bars in the bathroom near tub, shower, and toilet
– Use a non-skid bath mat
– Keep a flashlight next to your bed
– Add more lights around your home so areas are well-lit
– For reaching high cabinets, use a very sturdy step stool with a handrail and wide steps.

You may also wish to do exercises to improve balance. Consider having a consultation with a physical therapist to help you create an at-home program.

How can I be sure I get enough calcium and vitamin D in my diet? It is recommended that most people take a vitamin D3 supplement. If you are on medications to treat irregular heartbeat, blood pressure, talk with your doctor. If you have lymphoma, kidney disease, liver disease, or hormonal disease, talk to your doctor. Most foods are not high enough in Vitamin D to provide all that we need for optimal wellness. The following foods and drinks are listed because they are either high in calcium and other minerals and are alkaline, therefore allies in the fight against osteoporosis, OR they are low in the necessary minerals and/or acidic and increase your chance of osteoporosis.

Eat often:

• Fresh fruits (oranges, dates, olives)
• Vegetables (turnip greens, kale, collards, spinach, broccoli)
• Beans and Legumes
• Nuts (Brazil nuts, almonds)
• Fish (herring, salmon, sardines)
• Eggs
• Fortified dairy products
• Fortified juices, cereals, and oatmeal
• Non-GMO, minimally processed soy is an excellent source of plant based protein

Eat Rarely or Not at All:

• Sodas
• Refined, processed packaged foods
• Excessive amounts of animal proteins
• Excessive sodium and table salt
• Coffee (limit to one or two per day, as caffeine leaches calcium from the bones)
• GMO, processed soy products, as the oxalates (chemical components in soy products) can bind up calcium and make it unavailable to the body.

Can I get all the vitamin D I need from sunshine? Large amounts of Vitamin D3 are made in your skin when you expose your entire body to summer sun, so it is technically possible that sun exposure will produce all you need. However, the average person does not spend enough time outdoors every single day so a quality D3 supplement is important. As far as sun exposure goes, there is no magical formula to tell you how long one should be outside each day because there are many factors that play into just how much exposure is necessary. It could be just 15 minutes of exposure for a fair skinned person, but a couple of hours for a more dark skinned person. The amount of vitamin D you get from exposing your bare skin to the sun depends on:

– The time of day – Your skin produces more vitamin D if you expose it during the middle of the day
– Your geographic location – the closer you are to the equator, the more intense the exposure is to the sun, so it would be quicker to produce vitamin D.
– The color of your skin – pale skin makes vitamin D quicker than dark skin
– The amount of skin you expose – the more skin that is exposed, the more vitamin D your body will produce.
– Age – as we age, our skin has a harder time producing vitamin D

Why is exercise good for bone health? Weight bearing physical activity is one of the best defenses against osteoporosis. Bone is living tissue and responds to loads placed on it. Regular exercise is beneficial for minimizing progressive bone loss during aging. During exercise, as you put more tension on your muscles, it puts more pressure on your bone, which causes new tissue to form and enables the body to continuously create fresh, new bone. Exercise can increase your muscle strength, improve your balance, decrease the risk of bone fracture, maintain or improve your posture, and relieve or decrease pain. It is important to exercise safely and with caution.

Which exercises are best for bone health? What are some safe tips for exercising? Because of the varying degrees of osteoporosis and the risk of fracture, certain exercises may be discouraged. Ask your doctor or physical therapist whether you’re at risk of osteoporosis-related problems, and find out what exercises are appropriate for you. These types of activities are often recommended for people with osteoporosis:

• Strength training exercises, especially those for the upper back -includes the use of free weights, weight machines, resistance bands or water exercises to strengthen the muscles and bones in your arms and upper spine. Strength training can also work directly on your bones to slow mineral loss. Exercises that gently stretch and extend your upper back, strengthen the muscles between your shoulder blades, and improve your posture can all help to reduce harmful stress on your bones and maintain bone density.

• Weight-bearing aerobic activities involve doing aerobic exercise on your feet, with your bones supporting your weight. Examples include walking, dancing, low-impact aerobics, elliptical training machines, stair climbing and gardening. These types of exercise work directly on the bones in your legs, hips and lower spine to slow mineral loss. They can also provide cardiovascular benefits, which boost heart and circulatory system health.

• Flexibility exercises – Being able to move your joints through their full range of motion helps you maintain good balance and prevent muscle injury. Stretches are best performed after your muscles are warmed up — at the end of your exercise session, for example. They should be done gently and slowly, without bouncing. Avoid stretches that flex your spine or cause you to bend at the waist.

• Stability and balance exercises – Fall prevention is important for people who have osteoporosis. Stability and balance exercises help your muscles work together in a way that helps keep you more stable and less likely to fall. Simple exercises, such as standing on one leg or movement-based exercises, such as tai chi can improve your stability and balance.

• Swimming and water aerobics have many benefits, but they don’t have the impact your bones need to slow mineral loss. However, these activities can be useful in cases of extreme osteoporosis, during rehabilitation following a fracture or for increasing aerobic capacity.

Movements to Avoid

If you have osteoporosis, don’t do the following types of exercises:

• High-impact exercises – Activities, such as jumping, running or jogging can lead to fractures in weakened bones. Avoid jerky, rapid movements in general. Choose exercises with slow, controlled movements.

• Bending and twisting – Exercises in which you bend forward and twist your waist, such as touching your toes or doing sit-ups, can increase the risk of compression fractures in your spine. Other activities that may require you to bend or twist forcefully at the waist are golf, tennis, bowling and some yoga poses.

Can I still enjoy sports with osteoporosis? Yes! Most sports can be played even if living with osteoporosis.

Research shows that there are sports that are more effective for preventing bone loss than others: Jogging, running, soccer, weight lifting.

Some sports offer lots of great benefits, but have little to no bearing on your bone density due to the absence of “loading” the bones via contact with the earth: Cycling, swimming, yoga

Does osteoporosis have any warning signs? Osteoporosis often starts silently, and may not be found until someone suffers a fracture. Other early signs may include:

– Progressive loss of height or stooped posture
– Sudden back pain without any obvious cause – it could be a vertebral compression fracture
– A fracture after a seemingly minor incident

When should I consider seeing a doctor about being evaluated for osteoporosis? It is recommended to do a baseline bone density scan at age 50, unless you have risk factors that are more common with people with osteoporosis. If the test comes back abnormal, your doctor may suggest you have the test each year.

Risk factors include:

– Family history of osteoporosis – Studies show that if either of your parents had it, you are more likely to get it.
– History of broken bones – even one broken bone increases your risk of developing osteoporosis, simply because it shows your bones may already be slightly compromised.
– Size of body frame – people with smaller frames are more prone to osteoporosis. Their bones are lighter and thinner. Conversely, a large frame is NOT a defense against the disease.
– Ethnicity – Osteoporosis affects all races and ethnicities, but those of Asian, Latino and Caucasian descent have a higher risk.
– Post-menopausal – There is a steep drop in estrogen after menopause. Estrogen protects the bones. When estrogen decreases, bones may lose density and be prone to fractures.

Also remember that approximately 80% of cases affect women and as we age, our bones naturally lose some density and become weaker.

How is osteoporosis diagnosed? The gold standard for osteoporosis diagnosis is a combination of assessing risk factors and performing a full body Bone Mineral Density (BMD) assessment of the spine, lower back, and hips, which is done as a Dual-Energy X-ray absorptiometry, or DEXA scan. The DEXA is brief and painless. It requires the patient to lay flat for a few minutes on the DEXA scanner. You will be exposed to a very small amount of radiation. The results are given as a number called a T-Score. This score will tell you whether your BMD is above or below that of a young, healthy adult.

Is there a cure for osteoporosis? How is it treated? There is not a cure for osteoporosis, but there are steps you can take to prevent, slow, or stop its progress. In some cases, you may even be able to improve bone density and reverse the disorder to some degree. The keys are getting enough Vitamin D, Calcium, eating the proper nutrition, and weight-bearing exercise.

Your physician may also recommend a medication that may reduce the risk of broken bones. These either slow or stop bone loss, or rebuild bone. There are many things to think about when choosing the right medicine:

– Certain medications are designed for women because they are estrogen and hormone therapies, while some are designed for both men and women
– Some medicines are more appropriate for younger postmenopausal women, while others are for older women
– In general, these medications are not recommended for pre-menopausal women
– Certain medications are approved for pre-menopausal women who are preventing/treating osteoporosis due to the long term use of corticosteroids
– Severity of your osteoporosis and other medical conditions you live with also play a role in deciding which medication might be best for you
– These medications come in the form of pills, liquid, IV, nasal spray, or injection and can vary in dosage frequency from every day, once a week, once a month, several times a year, to once a year.

I feel hopeless about living with osteoporosis? What do I do? A diagnosis of osteoporosis can lead to anxiety, depression, and negative self-esteem. This diagnosis may trigger feelings that you are getting old and becoming fragile. It might start a negative cycle of fear of falling, which might preclude you from taking part in physical activities that you enjoy. Here are a few things you can do to better manage your emotional health:

– Make it a priority to manage your osteoporosis. There is no cure, but there are choices you can make that may slow or prevent its progress. Make sure to get the right amount of calcium and vitamin D. If necessary, you may wish to meet with a nutritionist who can help you plan your diet.
– Keep moving. Bone grows by experiencing stress! Just be sure to talk to your doctor before you begin a new exercise program. Exercise can also help release endorphins, which are the “feel-good” hormones.
– Join a support group – This can help you see that you are not alone! People living with the condition often have great coping tips and share them in support groups.
– Get help for the depression – if these feelings go on for more than 2 weeks, talk to your doctor about getting help. There are various therapies or medications that can help!
– Consider physical therapy – they can help build your comfort level and confidence to do your day-to-day activities AND things you enjoy doing.
– Find your joy – Each of us values things that bring us joy. Make a list of what makes you happy, and bring those things into your life.