Osteoporosis.

Last updated Monday, December 27, 2004

Figure 1 - Osteoporosis makes bones less dense

Incidence and risk factors

Incidence

Both the amount of bone mass you have as a young adult and how fast you lose it as you age determine your risk for osteoporosis. Throughout life, your body removes and replaces small amounts of old bone. The amount of bone you have is called bone mass. As you age, your bones lose mass and may become porous, or less dense. This happens because you lose more old bone than your body can replace.

Bones that have less mass are more likely to break or fracture, even in a minor fall. The first warning that you have osteoporosis may be a broken bone. Broken bones limit activities for many older adults.

Women

Women are at greater risk of losing bone mass than men because they start with 30 percent less than men and lose it faster after menopause. Caucasian and Asian women have less bone mass than African American women, which puts them at greater risk.

A third or more of the women in the United States over age 45 may be affected at any point in time. Half may experience a broken bone from osteoporosis during their lifetime.

Bone mass in women is affected by levels of the hormone estrogen. Bone mass builds in younger years, levels off at ages 30 to 35, and remains stable until menopause. After menopause, women lose bone mass rapidly, about two to three percent each year. This loss continues for five to ten years. Women are more likely to break bones in the wrist or spine in the years after menopause, usually from ages 45 to 60, because of the drop in estrogen levels. Fractures of the spine, can cause loss of height and rounded shoulders, sometimes called dowager's hump.

Hip fractures

Both men and women tend to break hips in their 70s and 80s. Since men are affected, factors other than lack of estrogen must be important in causing hip fractures.

Reducing your risk

You can take steps now to reduce your risk of developing osteoporosis. If you already have osteoporosis, many of the same steps for reducing your risk can be used as treatment.

Before age 35, your body is building bone mass. During these years, you can take steps to build as much bone mass as possible. These same steps may help slow the rate of bone loss later. The steps include: increasing calcium in your diet, avoiding smoking, avoiding heavy alcohol use, and doing weightbearing exercise regularly.

If you are a woman, your doctor may recommend taking estrogen after menopause to slow bone loss. For women, taking estrogen is one of the most effective ways to prevent fractures from osteoporosis.

As you get older, you are more likely to fall and break a bone. You can reduce your risk of falling with exercise, regular eye exams, good lighting, and home safety.

Checking your risk

Researchers cannot yet predict exactly who will develop osteoporosis. The check list below shows risk factors that are common in people with osteoporosis. If you have one or more of these risk factors, you are at greater risk of breaking a bone.

Risk factors you can change:

• Eating a low-calcium diet
• Smoking cigarettes
• Drinking more than two alcoholic drinks a day
• Not exercising regularly

Risk factors your doctor can help you change:

• Having low bone mass
• Going through menopause before age 45 (especially after surgery to remove the ovaries)
• Taking drugs that reduce bone strength (cortisone, anticonvulsants, or heparin)
• Having diseases that affect calcium levels (disorders of intestines, liver, kidneys, or glands that produce hormones)
• Having poor eyesight or balance

Risk factors you cannot change:

• Being female
• Being Caucasian or Asian
• Being thin and small-boned
• Having a history or wrist, spine, pelvic, or hip fractures

Prevention

Avoiding falls and injuries

Preventing falls, especially in the home, reduces your risk of fractures from osteoporosis. You may reduce your chances of falling with exercise, regular eye exams, and home safety.

As you get older, you may experience certain changes that increase your chances for falling and breaking a bone. These changes include loss of the ability to move easily, poor eyesight, and dizziness caused by illness or medications. Even a minor fall can break a bone already weakened by osteoporosis.

There are things you can do to reduce your risk of falling. Exercising regularly and wearing low-heeled shoes with firm, non-slip soles may help improve your balance. Having regular vision checks and wearing glasses, if you need them, can improve eyesight. Ask your doctor if you are taking any medications which might cause dizziness.

Many older people break a wrist or hip by falling at home. You can avoid falls by making your home a safer place. You can make your home safer in several simple ways:

Lights:

• Night lights in hallways, bathrooms, and bedrooms
• Flashlight beside the bed
• Hallways, stairs, and rooms well lit

Floors:

• No throw rugs, or use rugs with non-slip backing
• Carpet edges tacked down
• Non-skid wax on floors
• No electrical cords in walkways

Stairs:

• Light switches at top and bottom of stairs
• Stairs covered with non-slip surface
• Sturdy handrails

Bathroom:

• Handrails beside bathtub, toilet, and in shower
• Bathtub with rubber mats for traction

Kitchen:

• Items within easy reach
• Stable step stool for reaching items on top shelves

Surgery for Osteoporosis at the University of Washington

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