What Is Osteoporosis?

Osteoporosis is a diffuse disease process that affects the osseus (bone) structures within the body by decreasing the mineralization within the bone.

Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million U.S. women and men aged 50 and older.  Unfortunately, only a fraction of the affected people are receiving treatment.

Osteoporosis essentially means a diminished bone quantity in NORMAL bone as opposed to osteomalacia, which is normal bone quantity in demineralized bone. Osteoporosis can be further classified into primary and secondary.  Primary osteoporosis is most commonly seen in postmenopausal females and elderly patients.  Secondary osteoporosis implies an underlying disease process.

The bones in osteoporosis weaken and the risk of fracture is increased. While any fracture is a serious occurrence, hip fractures are of greatest public health concern because the consequences are often devastating. For example, those who experience hip fractures have an increased risk of death during the first 12 months after the fracture. Among those who survive, many experience loss of mobility and may have to enter long-term care facilities.

Osteoporosis Treatment

Osteoporosis diagramBisphosphonates are the most commonly used medication for the treatment of osteoporosis.  They work by inhibiting bone breakdown, preserving bone mass, and increasing bone density.

A different class of medication is Raloxifene, which is a selective estrogen receptor modulator.  This medication mimics estrogen’s beneficial effects on bone density in postmenopausal women without some of the risks associated with estrogen.

Calcitonin and teriparatide are hormones produced by your thyroid and parathyroid glands, respectively.  Calcitonin reduces bone resorption and may slow bone loss, however, it has not been shown to be as effective as the aforementioned treatments.  Teriparatide is an analog of parathyroid hormone, reserved for patients who are at high risk for fractures. It works by stimulating new bone growth, while other medications prevent further bone loss.

Estrogen is typically started in women following menopause.  Estrogen can help maintain bone density, however, there are many risk factors, including blood clots, endometrial/ breast cancer, and cardiovascular concerns. Because of concerns about its safety and because other treatments are available, hormone therapy is generally not a first-choice treatment.

In addition to pharmacologic management, physical therapy and exercise can assist in building bone strength and muscle strengthening.