The term osteoporosis comes from two words. "Osteo-" refers to bones and "-porosis" refers to many holes. Osteoporosis means that the normal bones are replaced with weakened bones containing many holes. If you look at osteoporotic bones under the microscope, they look like hard sponges with lots of large holes.

Bones are made of protein (primarily collagen) and mineral (hydroxyapatite). The mineral hydroxyapatite is calcium and phosphorus. The outer layer of bone is called "cortical" or "compact" bone. The inner parts of bone are called "cancellous" or "trabecular" bone. The inner parts of the bone provide most of the strength, just as arches support buildings. Under each arch is a "hole". The more arches there are, the smaller and fewer the "holes" and the stronger the bone. Bone is constantly being "remodeled". It is constantly being broken down and reformed. About 3% of cancellous bone is renewed each year, and about 25% of the trabecular bone is renewed each year. Some of the calcium is recycled, but some must be replaced.

The medical term osteoporosis is applied to bones that are measured to have a T-score 2.5 times below the normal healthy young adult woman. Osteoporosis is not medically defined for men or children. Osteopenia refers to bones that are measured to have a T-score between
-1.0 and -2.5.

Why is diagnosing osteoporosis important?

Osteoporosis significantly increases your risk of fracturing a bone. If you are diagnosed with osteoporosis, your risk of fracturing any bone increases to about 5 times the normal. One in two women and one in eight men over the age of 50 will have an osteoporotic fracture during their lifetime. The most common site of osteoporotic fractures is the spine, with the hip fracture second in incidence. Falls become more common with age, and falls are the most common reason for compression fractures of the spine, for hip fractures and for forearm and wrist fractures. Spine fractures can result in back pain and loss of height - as well as other consequences. Approximately one in three women who get a hip fracture die of complications from the hip fracture. Fifty percent of hip fracture survivors are permanently incapacitated and 20% require long term nursing home care. Treatment of a hip fractures cost between $26,000 and $37,000.

How common is osteoporosis?

About 28 million people in the United States have osteopenia or osteoporosis. This is more people than have diabetes, about the same number that have hypertension and about half as many as have elevated cholesterol. Osteoporosis is twice as common in women as in men. Ethnicity also influences your risk of developing osteoporosis. A family history of osteoporosis (in a mother, daughter or sister), abnormally low weight, tobacco use or a previous fracture increases your risk of osteoporosis. There are some diseases and certain medications (especially long term steroid use) that increase your risk.

What causes osteoporosis?

Everyone - men and women - lose bone as they age. The peak bone density is usually achieved by about 27 years of age for women. After this age, the bones very slowly lose density until the menopause. At menopause, the bone density loss is much more rapid. Developing osteoporotic bones depends on two things - the first is how dense the bones were at their peak density (at about 27 years of age) and the second is how rapidly the bones are losing density.

How do I know if I have osteoporosis?

Osteoporosis does not cause any symptoms; until the bones are so weak that they break. A bone that breaks with only a minor trauma and the break is not caused by a bone disease also defines osteoporosis. There is no warning pain associated with developing osteoporosis. Having a bone density test or waiting for a bone to break are the only ways to know if you have osteoporosis. A bone density test is called a DEXA scan (which stands for Dual Energy X-ray Absorptiometry).

How is a DEXA scan done?

A DEXA scan is a type of x-ray study. You will be asked to wear comfortable, loose fitting clothing without any buttons, zippers or other metal fasteners. You will lie comfortably on an examination table and the small x-ray arm will pass over your hip and lower spine. The entire test takes about five minutes. There are other machines that can do similar studies of your forearm, heel or finger. These are generally screening tests for osteoporosis. Only a true central DEXA (looking at your hip and spine) can diagnose osteoporosis. The amount of x-rays you will get during a DEXA scan is minimal. It is about 1/12 the radiation you receive from the natural background during a round trip flight between Los Angeles and New York.

How is the DEXA scan reported?

Your healthcare provider receives a rather complicated report. It tells the bone mineral density in the lumbar spine and one hip. Several different measures are taken in each of these areas. These numbers are compared with an average population of normal healthy 27-year-old women. The number produced by the comparison is called the "T-score". A T-score of -1.0 means your bones are weaker than about 67% of the normal healthy 27-year-old population. Your risk of fracturing a bone increases about 2-fold if your T-score is -1.0 and about 4-fold if your T-score is -2.0.

What can I do to help protect myself from
developing Osteoporosis?

The most important thing you can do is to assure you have an adequate calcium intake every day. Most of us no longer get 4 glasses of milk every day, and therefore require a supplement. Over age 50 the calcium requirement is 1,200 milligrams per day. This must be divided as two doses because your body cannot absorb more than 600 milligrams at one time. Children 9 to 18 years old require 1,300 milligrams per day, and adults age 19 to 50 require slightly less at 1,000 milligrams per day. These numbers are based on elemental calcium. Calcium carbonate is the most readily absorbed form of calcium. For people taking acid blocker medications, calcium citrate is a better choice.

In addition, vitamin D is necessary to absorb the calcium. The minimum daily requirement of vitamin D is 400 to 800 IU. Sunlight is necessary to activate the vitamin D, but most of us get sufficient sunlight from our normal daily activities. Sunbathing or tanning beds are not necessary.

Also, regular weight bearing and muscle strengthening exercise (such as walking, bicycling or swimming) help strengthen bones. At a minimum, you should exercise for 30 minutes four times per week.

What can I do if I have osteopenia or osteoporosis?

Probably the most important thing is fall prevention. Discuss with your healthcare provider what you can do to make your surroundings safer.

There are medications available to help strengthen osteoporotic bones. Talk with your healthcare provider whether these are appropriate
for you.

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