Osteoporosis Treatment: Signs, Risk Factors, & 6 Prevention Techniques

• Osteoporosis is a bone disease that causes a decrease in bone density and mass, leading to an increased risk of fractures. 

• Osteoporosis often doesn’t present symptoms, but can be diagnosed by a healthcare provider through a Bone Density Test.

• Osteoporosis can occur in anyone, but there are treatments to help slow the process, as well as prevention techniques.

Osteoporosis is a bone disease that occurs when bone density and bone mass begin to decrease, which can lead to an increased risk of fractures. When one has this disease, new bone formation often slows down and cannot regenerate as quickly as it deteriorates, resulting in low bone density.

Osteoporosis is often a ​“silent” disease, meaning it usually doesn’t present symptoms. The condition is typically discovered after a person suffers a bone fracture.

However, in some cases, certain warning signs may appear, such as:

• The appearance of a ​“widow’s hump.” 

• A fracture to the wrist or hip. 

• A change in height.

• A large shift into poor posture. 

• Severe back pain.

Osteoporosis is a disease that can affect anyone. However, some may be more at risk than others, including:

• Women over the age of 50

• Those with a family history of osteoporosis

• Those with low calcium intake

• Those with low body weight.

• Those with a history of heavy alcohol/​tobacco use

• Those with kidney stones

It’s also worth noting that those with other diseases such as hyperthyroidism, kidney disease, liver failure, or diabetes can also experience a potentially higher risk. A history of certain types of cancer, including bone cancer, invasive breast cancer, or prostate cancer, also increases the risk.
 

A doctor or healthcare provider may give a Bone Density Test to diagnose osteoporosis; the most common being a dual-energy X‑ray absorptiometry (DXA). The goal is to diagnose osteoporosis before a fracture happens, but it can also help determine how much risk a person has of breaking a bone. This test can also predict the effectiveness of osteoporosis treatments if already diagnosed.

When it comes to determining a diagnosis, there are three ways:

• Bone Mineral Density: This is a number referred to as a T‑score, calculated by a DXA test to determine bone health and density. The average number is zero. However, a score of negative three or lower means the person has osteoporosis.

• Bone Fracture: This is often the most common way osteoporosis is diagnosed. Adults over 50 who experience a fracture in their hip or spine are diagnosed with osteoporosis even if their T‑score is above a negative three.

• FRAX: FRAX is a fracture risk assessment tool that uses a few questions (including age, height, bone density, etc.) to help determine the likelihood of a person experiencing bone fractures over the course of a decade. If the risk factor is above 20%, the person has osteoporosis.

Most notably, osteoporosis makes it much easier to experience a fracture due to a fall. Types of fractures someone may experience include:

• Vertebral fractures (in the backbone)
• Atypical femoral fracture (in the thighbone)
• Multiple vertebral fractures (when there are multiple fractures in the backbone)
• Lumbar spine fracture

If a person has low bone mass, the fractures can be severe, putting a person at a higher risk of disability or death. Osteoporosis can also result in bone pain that can make day-to-day living difficult. Additionally, osteoporosis may increase the risk of developing kidney stones (the two have a bidirectional relationship), of being diagnosed with myocardial infarction, and of experiencing severe renal impairment. 
 

There are a few different ways to treat osteoporosis, including medications, hormone therapy, and lifestyle changes.

Osteoporosis Medicines

In terms of osteoporosis medications, the most commonly used are bisphosphonates and antibody treatments.

Bisphosphonates

Bisphosphonates are medications that work to reduce bone thinning. They help bones retain calcium and slow down the natural process that often results in bone deterioration, which can help reduce the chance of fractures. In some cases, they may also increase bone density.

Types of bisphosphonates include:

• Alendronate
• Risedronate
• Ibandronate
• Zoledronic acid

Antibody Treatments

Antibody treatments can also work to slow bone density loss. Currently, two approved antibody treatments are prescribed:

• Denosumab: Denosumab is one of the most successful antibody treatments for osteoporosis. Studies on the drug showed an increase in bone mineral density without a high risk of side effects. Denosumab is a monoclonal antibody injection that is given twice a year and helps to prevent bone-dissolving osteoclast cells from forming.
• Romosozumab: Romosozumab also experiences success in studies to treat osteoporosis; however, it has also been shown to cause an increase in cardiovascular risks. Romosozumab is also a monoclonal antibody injection that is a treatment for women with severe osteoporosis. This treatment usually follows a fragility fracture and helps to block sclerostin (a protein that inhibits bone formation). This treatment is known for its efficacy in risk reduction of spine fractures, hip fractures, and other fragility fractures.

Hormone Replacement Therapy

Hormone therapy treatments are often used to increase estrogen, which can help promote bone growth and prevent postmenopausal osteoporosis. It may also treat other menopausal symptoms, like hot flashes. Hormone therapy treatment options include:

• Selective Estrogen Receptor Modulators (SERMS): These modulators are used primarily in postmenopausal women to help increase estrogen. They are also used in treatments for breast cancer. Types of SERMS include:
  • Tamoxifen
  • Raloxifene
• Calcitonin: Calcitonin is a synthetic hormone used to treat postmenopausal women. The naturally occurring hormone helps in regulating calcium and strengthening bone metabolism.
• Parathyroid hormones (PTH): Parathyroid hormones are treatments used to help increase bone formation, which overall helps with bone density and strength. Common parathyroid hormone treatments include Teriparatide (Forteo) and abaloparatide (Tymlos) that consist of a daily injection. Typically this option is reserved for women who have very low bone density and more severe cases of osteoporosis.

Note: For postmenopausal women with osteoporosis, bisphosphonates might not be the right medication to start out with. Or for some women with severe osteoporosis, they may have been on bisphosphonates for five years and need to switch to estrogen therapy or another medication for low bone mineral density.

While anyone can potentially experience osteoporosis, there are ways to help reduce the likelihood or severity of the disease.

1 | Engage in Physical Activity

Exercising regularly can help build bone mass and increase bone elasticity to help prevent fractures and injuries. Some examples of exercises that can be particularly beneficial include:

• Walking

• Jogging

• Dancing

• An exercise routine that includes low impact weights

2 | Eat More Sources of Calcium and Vitamin D

While eating a healthy diet is always encouraged to maintain proper health, certain foods can help prevent osteoporosis. In particular, consuming foods with Calcium and Vitamin D can make a difference.

Calcium

Calcium is the mineral most associated with preventing bone breakdown and is essential to maintaining healthy bones. It also plays a vital role in preventing blood clots and regulating normal heart rhythms and functions. Examples of foods high in calcium include:

• Yogurt

• Tofu

• Broccoli

• Leafy greens (kale, bok choy, spinach)

• Beans and legumes

• Canned sardines or salmon (with bones)

Vitamin D

In addition to calcium, it’s crucial to have the appropriate amount of Vitamin D. Vitamin D helps the body better absorb calcium and phosphate, which is vital to aid in preventing bone loss. Vitamin D has also been known to help prevent cancer cell growth and reduce inflammation. Some foods that are high in Vitamin D include:

• Tuna fish

• Egg yolk

• Canned sardines

• Salmon

• Fortified cereals

• Dairy and plant milks fortified with Vitamin D

3 | Consider Taking Supplements

If you can’t get enough calcium or live somewhere where it’s hard to increaseVitamin D intake, a primary care provider may recommend taking supplements to help promote bone health and maintain bone density.

4 | Avoid Harmful Substances

Harmful substances, such as tobacco products and alcohol, can potentially increase the risk for osteoporosis. Choosing to quit/​not start smoking and keep alcohol use to a minimum not only contributes to overall health but can also reduce the chances of being diagnosed with osteoporosis.

5 | Reduce the Risk of Falls

To prevent fractures, some measures can be taken to help avoid falls in and out of the home.

• Preventing Indoor Falls

  • Keep rooms well-lit

  • Wear nonslip shoes

  • Installing grab bars in the bathroom/​shower

  • Removing clutter from floor/​pathways

• Preventing Outdoor Falls

  • Salt surfaces when the weather is icy

  • Provide clear pathways to walk on

  • Use supporting devices like a cane or walker

6 | Reduce Fracture Risk

If someone has a high risk of fracture or multiple risk factors for osteoporosis, there are fracture prevention measures they can take:

• Take any osteoporosis medicines as prescribed
• Avoid any weight bearing exercises
• Remove clutter from the home, such as excessive rugs or storage containers
• Stick to well-lit paths when out
• Work with a healthcare provider to treat bone loss or any underlying health conditions that may cause fatigue or impair movement, such as chronic kidney disease, vertigo, or cancer

While there aren’t always surefire symptoms for osteoporosis, a primary care provider should be called if a person is experiencing severe pain, especially in their hips or back. Severe pain that worsens when sitting/​standing, or that feels as if it’s occurring in the bone could indicate a fracture that needs attention.

Maintaining yearly physicals and checkups can also help catch osteoporosis early and start treatment immediately.