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Osteoporosis is a metabolic imbalance that makes bones brittle and prone to fractures. There usually aren’t any symptoms so you may not know you have the disease until you break a bone. Here are 11 things to keep in mind to prevent brittle bones.

Osteoporosis causes brittle bones that break easily. Broken bones cause chronic pain, and the resulting loss of mobility can mean an end to your active, independent life. Fortunately, fractures aren’t inevitable if you get timely treatment and take reasonable precautions to avoid breaking bones. Let’s take a look at 11 things you need to know about osteoporosis.

1. It’s never safe to assume you can’t get osteoporosis

There are several key nutrients that are essential for healthy bones (not just calcium and vitamin D), but osteoporosis is almost never just a nutritional deficiency disease. There are people who are at higher risk for osteoporosis, but almost anyone can develop the disease. Hormone imbalances are a a key factor in most cases of chronically brittle bones, but sometimes osteoporosis occurs when there are no hormonal imbalances. And the most difficult fact about this brittle bone disorder is that the most effective treatment has to be started before there are symptoms.

2. Osteoporosis can occur in any of your bones, but it is most common in the hip, wrist, and spine

A fracture in your hip can leave you bed bound. A fracture in your wrist can interfere with your working life. But it is fractures in the vertebrae of the spine that cause the collection of symptoms most often associated with osteoporosis:

  • Hunched back.
  • Sloping shoulders.
  • Chronic back pain.
  • Protruding abdomen, sometimes in a “beer belly” shape, even without gaining weight.
  • Getting shorter as you get older.

3. Osteoporosis is caused by an imbalance of the process of breaking down old bone and building up new bone

Human bones are constantly remodeling themselves. As a child develops into an adolescent and a teen matures into an adult, the bones have to lengthen, strengthen, and grow broader to support increased body mass. That’s also true of adults. When you pack on a few (or not just a few) extra pounds, your bones have to reshape and strengthen themselves to carry additional weight. Or if you break a bone, it has to remove damaged mineral deposits and replace them.

Bones regenerate with the help of two kinds of specialized cells. Osteoclasts break down bone. Osteoblasts build new bone. When osteoclasts are overactive, or osteoblasts are underactive bones become brittle and easy to break.

4. Osteoporosis occurs in many people who don’t have the usual risk factors for the disease

Osteoporosis is most common in women who have passed menopause, but it also can occur in men. It is most common in white people, but it occurs in people of every race. Osteoporosis is more frequently diagnosed after the age of 50, but it is not unknown in children, teens, and young adults.  

A majority of diagnoses of osteoporosis are made in people who are:

  • White or Asian,
  • Elderly, and
  • Female.

A stereotype of an osteoporosis patient is a 50-year-old woman who has had a hysterectomy but isn’t on hormone replacement, with a BMI under 21 (thin rather than fat), whose mother had osteoporosis, and who drinks alcoholic beverages every day. But there is reason for extra caution in people who have dementia, who have broken a bone as an adult for any reason, who consume more than three alcoholic beverages a day, or who smoke. People with bad eyesight or who have dementia are at greater risk for broken bones even if they have milder cases of osteoporosis. Overweight people are less likely to have bone fractures (because their extra weight forces their bones to remodel constantly), while people who are underweight are more likely to suffer broken bones. And just to make an important point:

5. Men can get osteoporosis, too

Osteoporosis is much less common in men, but if it progresses to the point a man suffers a hip fracture, he is considerably more likely to be disabled and die. This is particularly true of men who have not yet reached the age of 75. Men who break a hip before age 75 are 50 percent more likely to die in the next year than women who break a hip.

Men who have low testosterone levels are more likely to develop osteoporosis. It is also more likely in men who have used hormones for muscle gain or who have had to take steroids for arthritis or other inflammatory diseases. Physically inactive men are more prone to brittle bones, as are men who have a history of eating disorders.

6. Certain medications increase the risk of fractures

The most common problem medications in osteoporosis usually aren’t on your doctor’s radar. Any high blood pressure medication that causes orthostatic hypotension, dizziness immediately after moving from a seated position to a standing position. Any “pee pill” (diuretic) can have this effect, too. The medication increases the risk of a fall, and any preexisting, usually undiagnosed osteoporosis increases the risk of a fracture.

Steroid drugs increase the activity of the osteoclasts that break down bone. Some blood thinners (although not all blood thinners) such as Coumadin (warfarin) and heparin reduce the activity of the osteoblasts that build up bone. Anything that lowers estrogen levels increases the risk of osteoporosis, as do certain antidepressants, especially Prozac (fluoxetine).

7. When you have osteoporosis, fractures often occur without any identifiable trauma

Typically, someone who has brittle bones won’t be able to point to a single event that caused a fracture. Instead a relatively small fracture is noticed through relatively subtle symptoms. Sometimes it only takes a cough to cause a fracture in the vertebrae. Difficulty breathing or swallowing can be caused by a bone fracture. Bending, lifting, or tripping over something may result in a broken bone that causes considerable pain. Hip, pelvic, or lower back fractures may only be noticed when carrying something heavy.

8. Fractures of the spine have predictable symptoms

No two people have exactly the same symptoms, but when osteoporosis has caused a fracture of a vertebra of the spine, there most often will be:

  • The pain is specific and identifiable to a certain level of the spine. It may radiate to the abdomen, but it always radiates from a specific location.
  • The pain is dull and persistent rather than sharp and sudden.
  • There may be frequent muscle spasms.
  • Movement makes the pain worse. It’s not unusual for people who suffer vertebral fractures to want to spend time in bed.
  • Even without treatment, the pain resolves itself in four to six weeks — unless there have been multiple fractures over a long period of time. When there are multiple fractures and there is no medical intervention to treat the underlying disease, the pain may become permanent.

9. Hip fractures also have a predictable presentation

A broken hip tends to flop outward. The pain may show up in any of a number of locations other than the hip itself, including:

  • Buttock
  • Groin
  • Front of the thigh
  • Side of the thigh
  • Side of the knee

10. The only way to know whether you are at risk of osteoporosis while you can still prevent fractures is to have a bone density test

The dual-energy x-ray absorptiometry or DEXA scan measures the mineral content of your bones. It is painless, uses low levels of radiation, and just takes a few minutes. It’s the only way you can know whether you need medical intervention to prevent broken bones. Both women and men should have a DEXA scan after the age of 60.

11. There’s no single magic bullet for osteoporosis

Healthy bones require calcium, magnesium, boron, vitamin D, and vitamin K2 as well as other nutrients, but just taking nutritional supplements isn’t enough to avoid osteoporosis. (In fact, overdosing supplements can also cause problems.) Strength training exercises such as lifting weights help build strong bones, but you don’t want to start strength training before you have been cleared by your doctor as not already having weak bones. Medications help preserve bones, but they have side effects. The answer isn’t to stop the medications. You need to find a way to deal with their side effects to maintain bone density and bone strength.

Osteoporosis is an unusually complicated condition. Prevention isn’t easy, and neither is treatment. But you can prevent or manage the disease if you take timely steps armed with the right information.

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