Osteoporosis

Osteoporosis is a disease that thins and weakens the bones. Bones become fragile and fracture (break) easily, especially the bones in the hip, spine, and wrist. In the United States, millions of people either already have osteoporosis or are at high risk due to low bone mass. Osteoporosis is a silent disease, meaning some people don’t know they have it until a bone is broken.^[1]

Osteoporosis is diagnosed by bone mineral density (BMD) of the spine or hip, which is measured with dual energy x-ray absorptiometry (DEXA) scans. A normal BMD is no more than 1 standard deviation (SD) below the average or reference value. Osteopenia (low bone mass) is 1-2.5 SDs below the reference and osteoporosis is 2.5 SD or more below the reference BMD value.^[2]

The main goal of treating osteoporosis is to prevent fractures. This is done by strengthening the bones and by preventing falls. Medication treatments to strengthen the bones include bisphosphonates (alendronate, risedronate, etc.), raloxifene (Evista), calcitonin, and for more severe osteoporosis teriparatide (Forteo) and denosumab (Prolia).^[2]

Many supplements have been studied for osteoporosis. Adequate calcium and vitamin D is important for preventing and treating osteoporosis, so if there’s not enough in the diet, a dietary supplement is recommended.^[2] Other supplements such as multivitamins, vitamin K, and probiotics might also have some benefit, but higher quality research is needed.^[3][4][5]

To keep bones strong and to prevent osteoporosis, a healthy diet sufficient in calcium and vitamin D is recommended.^[2] A meta-analysis of observational research has found that Western diets involving fast food, refined foods, meats and sugar are associated with lower BMD in contrast to a Mediterranean diet pattern or dietary pattern higher in dairy.^[6][7]

One of the key goals of treating osteoporosis is to prevent fractures by preventing falls. Exercise that involves strength and balance training helps to prevent falls. Other recommendations which may reduce the risk of fractures include limiting alcohol and caffeine intake, stopping smoking, and increasing exposure to sunlight.^[2]

Anyone can develop osteoporosis, but it is more common in females of older age. Risk factors for getting osteoporosis include old age, low body weight, family history, smoking, certain medications (corticosteroids, anticonvulsants, etc.), and low bone mass (osteopenia).^[1] Certain medical conditions can also increase the risk of developing osteoporosis, either due to effects of the disease itself, the medications used to treat the condition, or both. This includes epilepsy, multiple sclerosis, Parkinson’s disease, stroke, COPD, adrenal insufficiency, Cushing’s syndrome, inflammatory bowel disease, multiple myeloma, sickle cell disease, HIV, and many others.^[2]