Osteoporosis is a decrease in bone mass and strength causing increased susceptibility to fractures. It is the major cause of bone fractures in older people, especially postmenopausal women. Osteoporosis has no clear beginning, and until recently its first visible sign was a fracture of the hip, wrist or vertebrae.
During the mid-30s, everyone begins to lose very small amounts of bone. Bone loss accelerates at menopause, with some women losing up to 30% of bone mass in the first five years. A variety of medical and lifestyle factors may increase bone loss, causing osteoporosis to occur at a younger age.
Menopause is the most predictable medical cause of osteoporosis in women due to a decrease in estrogen levels. Estrogen loss, whether by menopause or surgical removal of the ovaries, has been shown to result in rapid bone loss. Women, especially Caucasian and Asian women, are more susceptible. Bone loss results in reduced bone strength that can easily lead to fractures in the wrist, spine and hip. Risk factors for developing osteoporosis are:
Low adult bone density can be detected by plain radiographs, ultrasound, and x-ray densitometry.
The best treatment for osteoporosis is prevention. Adequate calcium consumption and weight-bearing exercise by adolescent and young adult women can increase peak bone mass which can lower the risk of fractures in later years. Adequate consumption of calcium and vitamin D is essential throughout adulthood for healthy bones.
Estrogen replacement is an effective treatment to prevent postmenopausal bone loss and is effective in the prevention of fractures in women with or osteoporosis.
If a postmenopausal woman with established low bone mass or osteoporosis has a condition that prevents hormone replacement therapy, there are other effective treatments to prevent bone loss. Exercise such as walking and back extension exercises can stabilize or slightly increase bone mass and improve balance, and can strengthen muscles to prevent falls and fractures. Medications to treat osteoporosis include bisphosphonates (such as etidronate, alendronate, and risendronate), calcitonin, and raloxiphene.
Trained to evaluate musculoskeletal diseases, rheumatologists can differentiate osteoporosis from other types of bone loss and can provide and monitor a therapy program. Rheumatologists are active in educating the public and other physicians about this serious health problem.
