Symptoms of low bone density

Osteoporosis

There’s a great deal you can do at different stages in your life to help protect yourself against osteoporosis.

Exercise

There’s a great deal you can do at different stages in your life to help protect yourself against osteoporosis.

Any exercise where the bones are made to carry the weight of the body, such as walking, can speed up the process of new bone growing.

The more weight-bearing exercise you do from a young age, the more this will reduce the risk of getting osteoporosis.

If you do have osteoporosis, doing weight-bearing exercise will minimise bone loss and strengthen muscles.

However, all forms of exercise will help to improve co-ordination and keep up muscle strength. This is important because muscles can also become weaker as we get older, and this is a risk factor for falling and therefore for fractures.

T’ai Chi can be very effective in reducing the risk of falls. Doing T’ai Chi regularly will strengthen muscles in the upper body, lower body and the core. It also improves balance.

Walking is a good exercise to improve bone strength and it is also good for keeping thigh and hip muscles strong, which is important to help people have good balance and prevent falls.

High-impact exercise such as skipping, aerobics, weight-training, running, jogging and tennis are thought to be useful for the prevention of osteoporosis. These exercises might not all be suitable if you have osteoporosis.

For more support, motivation and advice talk to your doctor, a physiotherapist or a personal trainer at a gym about your condition and the best exercise for you.

Diet and nutrition

Calcium

The best sources of calcium are:

  • dairy products such as milk, cheese and yogurt (low-fat ones are best)
  • calcium-enriched types of milk made from soya, rice or oats
  • fish that are eaten with the bones, such as tinned sardines.

Other sources of calcium include:

  • leafy green vegetables such as cabbage, kale, broccoli, watercress
  • beans and chick peas
  • some nuts, seeds and dried fruits.

If you don’t eat many dairy products or calcium-enriched substitutes, then you may need a calcium supplement. We recommend you discuss this with your doctor or a dietitian.

The table below lists the approximate calcium content of some common foods.

Food Calcium content (mg)
115 g (4 oz) whitebait (fried in flour) 980
60 g (2 oz) sardines (including bones) 260
0.2 litre (⅓ pint) semi-skimmed milk 230
0.2 litre (⅓ pint) whole milk 220
3 large slices brown or white bread 215
125 g (4½ oz) low-fat yogurt 205
30 g (1 oz) hard cheese 190
0.2 litre (⅓ pint) calcium-enriched soya milk 180
125 g (4½ oz) calcium-enriched soya yogurt 150
115 g (4 oz) cottage cheese 145
3 large slices wholemeal bread 125
115 g (4 oz) baked beans 60
115 g (4 oz) boiled cabbage 40

Note: measures shown in ounces or pints are approximate conversions only.

Vitamin D

Vitamin D is needed for the body to absorb and process calcium and there’s some evidence that arthritis progresses more quickly in people who don’t have enough vitamin D.

Vitamin D is sometimes called the ‘sunshine vitamin’ because it’s produced by the body when the skin is exposed to sunlight. A slight lack (deficiency) of vitamin D is quite common in the UK in winter.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance on safe sunlight exposure which aims to balance the benefits of vitamin D against the risks of skin cancer from too much exposure to sunlight.

Vitamin D can also be obtained from some foods, especially from oily fish, or from supplements such as fish liver oil. However, it’s important not to take too much fish liver oil.

Because we don’t get enough sunshine all year round in the UK, and because it’s difficult to guarantee getting enough vitamin D from what we eat, Public Health England recommends that everyone should take a 10 microgram supplement of vitamin D every day during the autumn and winter.

People in certain groups at risk of not having enough exposure to sunlight, or whose skin is not able to absorb enough vitamin D from the level of sunshine in the UK, are encouraged to take a daily supplement of 10 micrograms all year round.

For many people, calcium and vitamin D supplements are prescribed together with other osteoporosis treatments.

What else might help?

It’s important to try to prevent falls. Simple things you can do at home include:

  • mopping up spills straight away
  • making sure walkways are free from clutter or trailing wires.

Some hospitals also offer falls prevention clinics or support groups – ask your doctor if there’s one in your area.

Smoking can affect your hormones and so may increase your risk of osteoporosis. We strongly recommend you stop smoking. Support is available if you wish to stop.

Drinking a lot of alcohol can affect the production of new bone, so we recommend keeping within the maximum amounts (14 units per week) suggested by the government.

Signs and Symptoms of Osteoporosis

Generally, bones are constantly regenerating, but this process slows down considerably in the latter years of life – in fact, 1.5 million Canadians over the age of 40 report having been diagnosed with osteoporosis. . One of the tell-tale signs of osteoporosis is that bones fracture easily, due to their reduced density. Bones can become weak and brittle. The condition affects mainly the spine, hips and wrists. Chronic back pain is also a sign of the disease. Gender, medical history and age are a determining factor as to whether an individual can suffer with osteoporosis. Of Canadians diagnosed, 29% are women over the age of 50, and 33% are men over the age of 50.

Prevention and treatment of osteoporosis usually incorporate both an active lifestyle as well as calcium enhancing supplements. Lifestyle changes have had favorable results for osteoporosis sufferers. These changes include increased exercise, a balanced diet, a drastic decrease in alcohol and caffeine levels, decrease in smoking, more exposure to sunlight and reducing the possibility of fractures.
Hairline breaks are one of the types of fractures caused by osteoporosis, which will only show on x-rays and often go overlooked. Another common type of fracture, crushed spinal fractures, cause crumbling of the spinal column and are the forerunner to a bad posture. Osteoporosis can cause an obvious height loss of the individual as a result of the compression and deterioration of the vertebrae.

Some of risk factors that contribute to osteoporosis are:

  • Aging,
  • Hormonal changes or menopause due to a drop in estrogen in women, and testosterone in men,
  • Smoking (about 19% of Canadians with osteoporosis report smoking daily),
  • Low calcium intake,
  • Excessive caffeine or alcohol use (about 12% of Canadians with osteoporosis report drinking alcohol daily),
  • Low level of Vitamin D,
  • Low body mass,
  • Hereditary conditions

Some of the signs and symptoms associated with osteoporosis (or bone density loss) are:
Back pain caused by fractures and/or crumbled vertebra,

  • A stooped posture,
  • Gradual loss of height,
  • Bone fractures for no specific reason,
  • Receding gums,
  • Decreased grip strength,
  • Brittle bones,
  • Decline in general fitness

If you are concerned that your aging loved one is showing signs or symptoms of osteoporosis, contact a doctor immediately. With proper treatment, medication and lifestyle changes, the bones can be strengthened and the risk of fractures decreased. For more information about the home health care services Bayshore can offer to complement your osteoporosis treatment, contact us today 1-877-289-3997.

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Q: How can I know if I’m getting enough calcium? Are there any symptoms of calcium deficiency?

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A: Both calcium and vitamin D are essential for bone health. The body needs calcium for other functions as well, including those involving muscles, nerves, blood vessels, and the release of hormones and enzymes. You need to get enough calcium, which comes from food and is stored in the bones and teeth.

While it’s possible to get a blood test to determine your vitamin D level to see if you might be deficient, there’s no such test for calcium. That’s because when lacking enough calcium for basic function, the body takes it from bone, which keeps calcium levels normal.

There generally are no obvious symptoms (at least in the short term) from not consuming enough calcium. Over time, low calcium intake can have detrimental effects on different body systems, including contributing to low bone mass and risk for osteoporosis. A severe calcium deficiency can produce symptoms, such as numbness and tingling in the fingers, convulsions and abnormal heart rhythm.

To ensure you’re getting enough calcium, consume the recommended amount. Dairy products (milk, yogurt, cheese) are plentiful sources. Other sources include canned salmon and sardines with bones, kale, collards, broccoli, bok choy, almonds and sesame seeds. Some foods are fortified with calcium.

All adults age 19 to 50 and men up to age 70 should get 1,000 mg of calcium a day. Women age 51 and older and men age 71 and older need 1,200 mg a day. If you’re not getting this much from food, you can take a supplement. There is no need to exceed the recommended daily allowance for calcium since your body will simply eliminate the excess calcium.

— Rheumatologist Chad Deal, MD

How do we know whether our bones are healthy or not? We can’t see them like we can our skin, or listen to them like the heart or lungs. Bone density scans are one way to look inside bone, but we rarely get a bone density test until after menopause and even so, bone mineral density technology has a long way to go in my opinion. As a medical anthropologist, I’m always wondering what Nature can tell us about our health. And it turns out, there are many outward signs and symptoms of osteoporosis that may shed light on the health of your bones.

I refer to these signs and symptoms as “tips” from Nature. They certainly aren’t definitive or anything to scare you into thoughts of osteoporosis, but if you’re the type of person who’s planning to be active and strong well into old age like I am, it doesn’t hurt to assess your bones from the outside.

Let’s take a look at some signs and symptoms that may be indicators of early bone loss. Investigating these tips early on may save you from unwanted treatment or therapy down the line and offer you the freedom of strength and movement for the rest of your life.

Do you have signs of early osteoporosis?

    1. Receding gums. Receding gums are quite common and can be attributed to a variety of factors, one of which is bone loss. Our teeth are connected to the jaw bone and if the jaw is losing bone, gums can recede. In studies of women, jaw bone loss has also been associated with lower bone mineral density in areas such as the vertebral bodies of the lumbar spine. The standard panoramic x-rays during your visits to the dentist can provide a well-informed dentist with an opportunity to screen you for bone loss. So ask your dentist to share any information and insight he or she may glean from your exam and x-rays regarding your bone health.
    2. Decreased grip strength. As we grow older, one of the surest ways to keep the risk of fracture to a minimum is through fall prevention — and for that, good balance, overall muscle strength, and grip strength are fundamental. In a recent study of postmenopausal women, handgrip strength was the most important physical test factor related to overall bone mineral density. And fortunately, improving handgrip strength and overall muscle strength is within your reach, no matter what your age.
    3. Weak and brittle fingernails. At the Center for Better Bones, I often observe that after women start a program for better bone health, their fingernails grow stronger and healthier right along with their bones. We always consider it a good sign when nail strength improves, and recent science suggests this nail-bone health observation is indeed valid. However, spending time in water, exposure to harsh cleaning chemicals, digging in the garden and/or other manual work, can be tough on your nails, so take these into consideration as you assess your own nails.
    4. Cramps, muscle aches, and bone pain. As we get older, many of us accept aches and pains as a part of life, but these symptoms may indicate that your bones are in need of some support. Muscle and bone pain is an often overlooked, but well-documented symptom of severely inadequate vitamin D — an important bone builder. According to experts, vitamin D deficiency has reached alarming proportions, and researchers worldwide have been evaluating its association with muscle pain. Cramps are another symptom to pay attention to. There can be a number of mechanisms causing leg and foot cramps, but leg cramps that occur at night are often a signal that your calcium, magnesium, and/or potassium blood levels have dropped too low during the night, when you are not consuming food. If this situation were to persist over time, excessive bone loss could occur. At the Center for Better Bones, I recommend that women experiencing nocturnal calf and foot cramps take their calcium–magnesium supplements closer to bedtime.
    5. Height loss. Losing height is very common as we age and there are many precursors to it, including poor posture and vertebral fractures. Poor posture may not mean you have bone loss, but it can indicate weakening of the muscles around your spine, and since bone and muscle work in one unit and typically gain and lose strength in synchrony, it’s likely that a loss in muscle is connected to an eventual loss in bone.
    6. Lower overall fitness. Osteoporosis has been linked to overall decline in physical fitness, as measured by aerobic capacity, muscle strength, and even balance. If your general fitness declines, it is likely that bone mass will also decline. Instead of feeling scared or worried by these changes, take the opportunity to put more attention on your personal health and longevity by taking care your bones. Even women who have been sedentary their whole lives can make significant gains, including better physical coordination, when they undertake a moderate, self-paced exercise program designed for their needs. And even people in their 80s and 90s have the ability to adapt and respond to both endurance and strength training. For ideas, read my article on exercise and bone health.

Strong bones are your fountain of youth

Call me biased, but I think strong bones are the fountain of youth. If your bones are healthy and strong, it’s likely your muscles are too, and it’s also likely you have a great reserve of minerals tucked away for the future. Strong bones mean you have the ability to be active and even flexible into your older years. You don’t have anything to lose by taking good care of your bones — and you have everything down to the bone to gain.

I’m Dr. Susan Brown. I am a nutritionist, medical anthropologist, writer, and speaker. Get my free weekly newsletter here.

Medical Conditions that can Cause Bone Loss, Falls and/or Fractures

A variety of diseases or conditions can increase bone loss and/or fall risk. Some of the more common examples are discussed below.

Rheumatoid Arthritis and Other Rheumatological Conditions

An inflammatory disease of the joints, rheumatoid arthritis is often treated with glucocorticoids, usually prednisone. Pain and loss of joint function can lead to inactivity, which can further contribute to bone loss. Research suggests that osteoclast (a bone removing cell) activity and bone resorption is increased at the affected sites. In addition to rheumatoid arthritis, ankylosing spondylitis has been associated with bone loss. Several other rheumatological conditions may affect the joints, resulting in poor balance and increased risk of falls, including lupus, psoriatic arthritis and severe osteoarthritis of the hip or knee.

Malabsorption Syndromes

Malabsorption can result from bowel diseases such as Crohn’s disease, ulcerative colitis and celiac disease, and other conditions that affect the bowel such as weight loss surgery. These conditions reduce the absorption of nutrients from the intestine including dietary calcium and vitamin D. The result is lower levels of calcium and vitamin D, which can increase bone loss and falls risk, leading to fractures.

Sex Hormone Deficiency (Hypogonadism)

In women this generally results in the early stoppage of menstrual periods (amenorrhea). Common causes include premature menopause (before the age of 45), eating disorders such as anorexia nervosa, exercise-induced amenorrhea (typically seen in high performance athletes and dancers), pituitary disease, chemotherapy and chronic illness. Some of these conditions can be treated with hormone therapy.

In men low levels of testosterone can be caused by a number of conditions including liver disease, pituitary disease, chemotherapy, chronic illness and ageing. Some of these conditions can be treated with testosterone.

Primary Hyperparathyroidism

The parathyroid glands produce parathyroid hormone, which controls blood calcium levels. In primary hyperparathyroidism a tumour (generally benign) in one or more of these glands causes the production of more parathyroid hormone than is needed. This causes an increase in bone turnover, which results in excess calcium release from bone and a rise in the level of calcium in the blood. As a result, the risk of osteoporosis and fractures also increases.

Chronic Kidney Disease

Many patients with chronic kidney disease are treated with glucocorticoids such as prednisone, which puts them at risk for developing osteoporosis. In addition, chronic kidney disease may cause several different metabolic bone diseases (called renal osteodystrophy) that are associated with reduced bone formation, hyperparathyroidism, and vitamin D deficiency. In renal osteodystrophy bone quality is poor, and this increases the risk of fracture.

Chronic Liver Disease

Chronic liver disease is associated with reduced bone formation, vitamin D deficiency and low sex hormones, all of which may result in bone loss. In addition, some forms of liver disease may be treated with glucocorticoids such as prednisone, which may cause even greater bone loss. Up to 50% of patients with chronic liver disease develop osteoporosis.

Diabetes

There is evidence to suggest that both men and women with type 1 diabetes are at higher risk for low bone density and for osteoporotic fractures. Poorly controlled type I and type II diabetes are often associated with hypoglycemic episodes (low blood sugar) and/or neuropathy (poor sensation) in the feet. Both of these complications of diabetes can increase the risk of falls and fractures.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a type of chronic lung disease that usually results after prolonged smoking but can also occur due to other causes. COPD can consist of chronic bronchitis or emphysema or both, and is often associated with a chronic cough, phlegm production, shortness of breath on exertion or at rest (depending on the severity) and frequent chest infections. There is a strong association between COPD and low bone mass or osteoporosis, usually from a combination of factors such as smoking history, low body weight, poor nutrition and treatment with oral glucocorticoids.

Untreated Hyperthyroidism

Normal thyroid hormone levels maintain good bone health. Too much thyroid hormone interferes with the body’s ability to absorb calcium into the bones and increases bone turnover, which can cause bone loss over time.

Neurological Disorders

Many neurological disorders are associated with an increased risk of fractures (broken bones) because they increase fall risk, bone loss or both. For example:

1. Conditions or injuries resulting in immobility are associated with bone loss. This includes stroke, multiple sclerosis and spinal cord injury.

2. Conditions or injuries that result in poor balance, or problems with gait or movement, are associated with an increased risk of falls and fractures. These include cerebral palsy, multiple sclerosis, Parkinson’s disease, spinal cord injury, stroke, confusion (due to dementia or delirium), dizziness and vertigo, and lower limb muscle weakness.

3. Neuropathy (numbness or reduced sensation) of the feet or legs can also lead to poor balance. This includes diabetic neuropathy, sciatica and other types of neuropathy.

The Table below summarizes other common conditions or diseases that may increase the risk of fracture by increasing either bone loss or fall risk or both.

Other Medical Conditions that May Increase Risk of Osteoporotic Fracture

Drug Treatment May Cause Bone Loss May Increase Bone Loss May Increase Fall Risk
Cushing’s syndrome *
Pituitary disease *
Multiple myeloma * *
Leukemia and Lymphoma *
Thalassemia major *
AIDS/HIV * *
Low blood sugar *
Dehydration

Recognizing the Early Signs of Osteoporosis

If you have risk factors for osteoporosis— for example, if you’re a postmenopausal woman, have taken glucocorticoids for more than three months, or are calcium or vitamin D-deficient — don’t wait until you experience symptoms to get screened.

“Osteoporosis is an asymptomatic condition until you experience a fracture,” explains endocrinologist Geetha Gopalakrishnan, MD, an assistant professor of medicine in the division of endocrinology, diabetes, and metabolism at Brown University School of Medicine in Providence, Rhode Island. Whether the fracture is in your wrist, hip, or spine, if you have osteoporosis, it could have happened because you fell or simply bumped into something in a way that, when you were younger, would probably not have harmed your bones.

Fractures due to osteoporosis are costly in terms of time and money as well being a serious health threat. They tend to require a longer hospital stay than for most other conditions that require hospitalization among seniors, and have the highest medical costs, according to a health data analysis by a team of researchers at East Virginia Medical School published in 2016 in Osteoporosis International.

If you can identify bone loss early, you can take steps to reduce your risk of osteoporosis.

Who Should Get Screened?

Men and women older than 50 should start talking to their doctor about their risk factors for osteoporosis to find out whether they need to be screened.

In general, according to guidelines outlined in the 2014 issue of Osteoporosis International, those who should be screened for osteoporosis include:

  • Women older than 65
  • Men older than 70
  • Any adult who has had a fracture after age 50
  • Women who have more than one risk factor other than being Caucasian or postmenopausal (for example, a family history of osteoporosis and low body weight)
  • Adults who have a health condition that increases the risk of osteoporosis
  • Adults who are taking or have taken medications that can increase osteoporosis risk, such as steroids, contraceptives given by injection, or some cancer treatments

Because bone loss begins without noticeable symptoms, screening should ideally occur before you have reason to worry.

Fracture: The Most Common Early Symptom

You may have a fragility-related fracture before you are diagnosed with bone loss or osteoporosis. This means that your wrist, back, hip, or another bone is fractured as a result of a mild to moderate trauma, such as falling from below your standing height. Mild impact caused by tripping, falling, or hitting an object that might not have fractured or broken a bone in previous years can cause future fractures when you develop bone loss or osteoporosis. If you experience this kind of fracture and are older than 50, the National Institutes of Health (NIH) recommends talking to your doctor about bone-loss screening or other tests for bone loss. Depending on the results, you may need to discuss treatment options that can help reduce bone loss.

When researchers looked at the records of 47,171 women, most in their early 60s, who had a fragility fracture, they found that only about one in five knew they had osteoporosis beforehand. For the majority, the fracture prompted them to talk to a doctor about bone health. Yet, according to the report, which was published in 2014 in Osteoporosis International, very few of the women started follow-up treatment designed to prevent another fracture.

How do you know if you’ve experienced a fragility-related fracture? Sometimes they’re obvious — you’ll experience pain and swelling immediately after a fall or impact, even one that you wouldn’t think could hurt you. The American Academy of Orthopedic Surgery points out that you also might notice that the affected area looks out of alignment, caused by the fracture. In other instances, you may feel pain, such as in your back, but not be able to trace it to a single event. Back pain can also be a result of a vertebral fracture, in which the pain may last as long as six weeks while your bones heal. If you suspect that a fracture is possible, see your doctor.

Other Early Signs of Osteoporosis

Certain physical changes can signal osteoporosis. A loss of height or change in posture, such as stooping over, can be signs that you might have osteoporosis, according to the NIH. Guidelines encourage doctors to measure the height of their patients regularly to monitor changes that occur with age. Ask for your measurement at every wellness checkup.

“If you have a height loss of more than two inches or you have curvature of the spine, these are symptoms to pay attention to,” Dr. Gopalakrishnan says. These changes suggest that osteoporosis is affecting your vertebrae.

Other signs or conditions also can mean you’re at a higher risk for a bone fracture, including:

  • High levels of serum calcium or alkaline phosphatase on a blood test
  • Bone mineral density results showing a T-score of -2.5 or less (the T-score indicates whether your bone density is above or below average, and a score -2.5 or less indicates osteoporosis)
  • Vitamin D deficiency
  • Difficulty getting up from a chair without using your arms to push
  • Joint or muscle aches

These symptoms can indicate other health problems as well, so it’s important to talk to your doctor so you can get an accurate diagnosis and proper treatment. Remember that aches and pains are not unusual as you get older, Gopalakrishnan says, and most of them do not mean you have osteoporosis. But, to be sure, don’t hesitate to bring up any noticeable pain you’re feeling.

Osteoporosis
Signs and Symptoms

Risk Factors for Men

  • Heredity
  • Race — White men appear to be at the greatest risk for developing osteoporosis, although the condition can affect people of all ethnic groups
  • Undiagnosed low levels of testosterone
  • Falling
  • Inadequate physical activity
  • Age — Bone loss increases with age
  • Chronic disease that alters hormone levels and affects the kidneys, lungs, stomach and intestines
  • Smoking tobacco
  • Alcoholism
  • Lifelong low calcium intake
  • Low body weight

In addition, having a history of one of the following diseases can increase both a woman and man’s risk of developing osteoporosis:

  • Hyperparathyroidism, having an overactive parathyroid gland
  • Hyperthyroidism, having an overactive thyroid gland
  • Severe liver disease
  • Kidney failure
  • Pituitary tumor
  • Adrenal disease
  • Malabsorption
  • Multiple sclerosis
  • Rheumatoid arthritis
  • Multiple myeloma
  • Lymphoma
  • Leukemia
  • Diabetes

Taking one of the following medications can increase one’s risk as well:

  • Seizure medication
  • Immunosuppressive drugs
  • Steroids (prednisone, hydrocortisone, dexamethasone)
  • Heparin
  • Lithium
  • Excess Thyroxine, thyroid replacement

What to know about osteoporosis

Doctors have identified several risk factors for osteoporosis. Some are modifiable, but it is not possible to avoid others.

The body continually absorbs old bone tissue and generates new bone to maintain bone density, strength, and structural integrity.

Bone density peaks when a person is in their late 20s, and it starts to weaken at around 35 years of age, As a person grows older, bone breaks down faster than it rebuilds. Osteoporosis may develop if this breakdown occurs excessively.

It can affect both males and females, but it is most likely to occur in women after menopause because of the sudden decrease in estrogen. Estrogen normally protects women against osteoporosis.

The IOF advises that once people reach 50 years of age, 1 in 3 women and 1 in 5 men will experience fractures due to osteoporosis.

Unavoidable factors

According to the American College of rheumatology, nonmodifiable risk factors include:

  • Age: Risk increases after the mid-30s and especially after menopause.
  • Reduced sex hormones: Lower estrogen levels appear to make it harder for bone to regenerate.
  • Ethnicity: White people and Asian people have a higher risk than other ethnic groups.
  • Height and weight: Being over 5 feet 7 inches tall or weighing under 125 pounds increases the risk.
  • Genetic factors: Having a close family member with a diagnosis of hip fracture or osteoporosis makes osteoporosis more likely.
  • Fracture history: A person over 50 years of age with previous fractures after a low-level injury is more likely to receive a diagnosis of osteoporosis.

Diet and lifestyle choices

Modifiable risk factors include:

  • inactivity
  • immobility

Weight bearing exercise helps prevent osteoporosis. It places controlled stress on the bones, which encourages bone growth.

Drugs and health conditions

Share on PinterestTaking certain medications may increase the risk of osteoporosis.

Some diseases or medications cause changes in hormone levels, and some drugs reduce bone mass.

Diseases that affect hormone levels include hyperthyroidism, hyperparathyroidism, and Cushing’s syndrome.

Research published in 2015 suggests that transgender women who receive hormone treatment (HT) may have an increased risk of osteoporosis. However, using anti-androgens for a year before starting HT may reduce this risk.

Transgender men do not appear to have a high risk of osteoporosis. However, scientists need to carry out more research to confirm these findings.

Medical conditions that increase the risk include:

  • some autoimmune diseases, such as rheumatoid arthritis and ankylosing spondylitis
  • Cushing’s syndrome, an adrenal gland disorder
  • pituitary gland disorders
  • hyperthyroidism and hyperparathyroidism
  • a shortage of estrogen or testosterone
  • problems with mineral absorption, such as celiac disease

Medications that raise the risk include:

  • glucocorticoids and corticosteroids, including prednisone and prednisolone
  • thyroid hormone
  • anticoagulants and blood-thinners, including heparin and warfarin
  • protein-pump inhibitors (PPIs) and other antacids that adversely affect mineral status
  • some antidepressant medications
  • some vitamin A (retinoid) medications
  • thiazide diuretics (https://www.uptodate.com/contents/drugs-that-affect-bone-metabolism)
  • thiazolidinediones, used to treat type 2 diabetes, as these decrease bone formation
  • some immunosuppressant agents, such as cyclosporine, which increase both bone resorption and formation
  • aromatase inhibitors and other treatments that deplete sex hormones, such as anastrozole, or Arimidex
  • some chemotherapeutic agents, including letrozole (Femara), used to treat breast cancer and leuprorelin (Lupron) for prostate cancer and other conditions

Glucocorticoid-induced osteoporosis is the most common type osteoporosis that develops due to medication use.

Warning Signs of Osteoporosis

One of the most troubling parts about osteoporosis is that it is often considered a “silent disease” in its early stages—you may not realize that you have the condition until you suffer from a bone fracture or break. You may be experiencing bone loss slowly over time without any indication that it is happening.

A diet rich in vitamin D and key minerals and daily walking or other physical activity will help keep your bones strong and reduce your risk of fractures. Photo: edwardolive @ istock

Because of this, it is important to practice healthy bone behaviors, including those outlined in this Patients’ Guide, even if you do not have any symptoms of osteoporosis. You can reduce your risk factors for the condition and better prepare yourself if you do eventually develop osteoporosis by taking proactive steps to:

  • improve your diet by incorporating more calcium, vitamin D, and other bone-friendly nutrients,
  • create an osteoporosis prevention exercise regimen that incorporates strength-training and weight-bearing exercise,
  • and open up a dialogue with your doctor about osteoporosis.

There are, however, a few warning signs that may indicate low bone mineral density and a heightened risk for developing osteoporosis. If you have any of the symptoms or conditions below, talk to your doctor about steps you can take to strengthen and protect your bones.

  1. Low bone density: Low bow density (which is sometimes called “osteopenia”) refers to a condition in which your bone density is lower than average, but not low enough to be considered osteoporosis. Low bone density does not guarantee that you will have osteoporosis in the future; in fact, for some people, the condition is completely normal. However, it does mean that if you do begin to lose bone, you may be more likely to suffer from fractures or breaks since you have less bone to lose than other people.
  2. Bones that easily fracture: Bone fractures and breaks are often the earliest signs that people experience of osteoporosis. Since your bones have less strength, you are more likely to experience serious bone injuries if you suffer from a fall, or experience other bone trauma. If you find that your bones fracture easily, talk to you doctor about a bone density test which can determine whether or not your frequent bone trauma is a result of osteoporosis.
  3. Poor posture or a “widow’s hump”: Compression fractures in the vertebrae, the bones in your spine, are more common in people with osteoporosis (the weakened bones can fracture under normal pressure, such as the effort it takes to open a window, or lift something). This can lead to problems with your posture, or the appearance of a “widow’s hump”—a curvature in the spine near the shoulders.
  4. Having an immediate relative with osteoporosis: Your risk of having osteoporosis goes up if you have a close family member with the condition.

In its earliest stages, osteoporosis often shows no symptoms. However, low bone density in osteopenia, frequent fractures, and problems with your posture can all be signs of osteoporosis. If you think you might have osteoporosis, talk to your doctor about how to obtain an accurate diagnosis, and about treatment options that can improve both your bone health and your quality of life.

Updated on: 10/07/19 View Sources

Sources

  • Low Bone Density or “Osteopenia” – What Does it Mean? National Osteoporosis Foundation Web site. http://www.nof.org/aboutosteoporosis/detectingosteoporosis/osteopoenia. Accessed October 7, 2012.
  • Osteoporosis Signs and Symptoms. University of California San Francisco Medical Center. http://www.ucsfhealth.org/conditions/osteoporosis/signs_and_symptoms.html. Accessed October 7, 2012.

Bone is living, growing tissue that changes throughout the lifespan.

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.

Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure. As bones become less dense, they weaken and are more likely to break. If you’re 50 or older and have broken a bone, ask your doctor or healthcare provider about a bone density test.

Osteoporosis is Common

About 54 million Americans have osteoporosis and low bone mass, placing them at increased risk for osteoporosis. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.

Osteoporosis is Serious

Breaking a bone is a serious complication of osteoporosis, especially with older patients. Osteoporotic bone breaks are most likely to occur in the hip, spine or wrist, but other bones can break too. In addition to causing permanent pain, osteoporosis causes some patients to lose height. When osteoporosis affects vertebrae, or the bones of the spine, it often leads to a stooped or hunched posture.

Osteoporosis may limit mobility, which often leads to feelings of isolation or depression. Additionally, twenty percent of seniors who break a hip die within one year from either complications related to the broken bone itself or the surgery to repair it. Many patients require long-term nursing home care.

Osteoporosis is Costly

Osteoporosis is responsible for two million broken bones and $19 billion in related costs every year. By 2025, experts predict that osteoporosis will be responsible for approximately three million fractures and $25.3 billion in costs annually.

Osteoporosis Can Sneak up on You

Osteoporosis is often called a silent disease because one can’t feel bones weakening. Breaking a bone is often the first sign of osteoporosis or a patient may notice that he or she is getting shorter or their upper back is curving forward. If you are experiencing height loss or your spine is curving, be sure to consult your doctor or healthcare professional immediately.

Diseases, Conditions and Medical Procedures That May Cause Bone Loss

There are many health problems and a few medical procedures that increase the likelihood of osteoporosis. If you have any of the following diseases or conditions, talk to your doctor or health care provider about what you can do to keep your bones healthy.

Autoimmune Disorders

  • Rheumatoid arthritis (RA)
  • Lupus
  • Multiple sclerosis
  • Ankylosing spondylitis

Digestive and Gastrointestinal Disorders

  • Celiac disease
  • Inflammatory bowel disease (IBD)
  • Weight loss surgery

Medical Procedures

  • Gastrectomy
  • Gastrointestinal bypass procedures

Cancer

  • Breast cancer
  • Prostate cancer

Hematologic/Blood Disorders

  • Leukemia and lymphoma
  • Multiple myeloma
  • Sickle cell disease

Neurological/Nervous System Disorders

  • Stroke
  • Parkinson’s disease
  • multiple sclerosis (MS)
  • Spinal cord injuries

Blood and bone marrow disorders

  • Thalassemia

Mental Illness

  • Depression
  • Eating disorders

Endocrine/Hormonal Disorders

  • Diabetes
  • Hyperparathyroidism
  • Hyperthyroidism
  • Cushing’s syndrome
  • Thyrotoxicosis
  • Irregular periods
  • Premature menopause
  • Low levels of testosterone and estrogen in men

Other Diseases and Conditions

  • AIDS/HIV
  • Chronic obstructive pulmonary disease (COPD), including emphysema
  • Female athlete triad (includes loss of menstrual periods, an eating disorder and excessive exercise)
  • Chronic kidney disease
  • Liver disease, including biliary cirrhosis
  • Organ transplants
  • Polio and post-polio syndrome
  • Poor diet, including malnutrition
  • Scoliosis
  • Weight loss

Note: This list may not include all of the diseases and conditions that may cause bone loss. Talk to your doctor and ask if any of the conditions you have may be causing bone loss.

Medicines that May Cause Bone Loss

Some medicines can be harmful to your bones, even if you need to take them for another condition. Bone loss is usually greater if you take the medication in high doses or for a long time.

It’s important to talk with your healthcare provider about the risks and benefits of any medicines you take and about how they may affect your bones, but do not stop any treatment or change the dose of your medicines unless your healthcare provider says it’s safe to do so. If you need to take a medicine that causes bone loss, work with your healthcare provider to determine the lowest possible dose you can take to control your symptoms.

The following medicines may cause bone loss:

  • Aluminum-containing antacids
  • Antiseizure medicines (only some) such as Dilantin® or Phenobarbital
  • Aromatase inhibitors such as Arimidex®, Aromasin® and Femara®
  • Cancer chemotherapeutic drugs
  • Cyclosporine A and FK506 (Tacrolimus)
  • Gonadotropin releasing hormone (GnRH) such as Lupron® and Zoladex®
  • Heparin
  • Lithium
  • Medroxyprogesterone acetate for contraception (Depo-Provera®)
  • Methotrexate
  • Proton pump inhibitors (PPIs) such as Nexium®, Prevacid® and Prilosec®
  • Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro®, Prozac® and Zoloft®
  • Steroids (glucocorticoids) such as cortisone and prednisone
  • Tamoxifen® (premenopausal use)
  • Thiazolidinediones such as Actos® and Avandia®
  • Thyroid hormones in excess

Note: This list may not include all medicines that may cause bone loss.

Osteoporosis and Steroid Medicines

While steroid medicines can be lifesaving treatments for some conditions, they can also cause bone loss and osteoporosis. These medicines are often referred to as steroids, glucocorticoids or corticosteroids. They should not be confused with anabolic steroids, which are male hormones that some athletes use to build muscle.

Steroids are much like certain hormones made by your own body. Healthcare providers prescribe them for many conditions, including rheumatoid arthritis (but not osteoarthritis), asthma, Crohn’s disease, lupus and allergies. They are often prescribed to relieve inflammation. They are also used along with other medicines to treat cancer and autoimmune conditions and to support organ transplants. Common steroid medicines are cortisone, dexamethasone (Decadron®), methylprednisolone (Medrol®) and prednisone. Intravenous forms include methylprednisolone sodium succinate (Solu-Medrol®).

Taking steroid medicines as pills in a dose of 5 mg or more for three or more months can increase the chance of bone loss and developing osteoporosis. Talk with your healthcare provider about taking the lowest dose for the shortest period of time for your condition. If you need to take steroid medicines for longer than this, you should take steps to prevent bone loss. While taking steroids, it is especially important to get enough calcium and vitamin D. It’s also important to exercise and not smoke. You may also want to ask your healthcare provider if you need a bone density test.

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