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FEATURED SLIDESHOW Osteoporosis: Are Your Bones at Risk? There may not be any apparent symptoms. You may not know until you fracture a bone. VIEW SLIDESHOW    details belows  Osteoporosis Super-Foods for Strong Bones With Pictures What Is Osteoporosis? Osteoporosis is a disorder of the bones in which the bones become brittle, weak, and easily damaged or broken. A decrease in the mineralization and strength of the bones over time causes osteoporosis. Does Osteoporosis Only Affect the Elderly? While the effects of osteoporosis are often seen in the elderly, the disorder usually starts progressing from middle age on. Bones are their strongest in a person's mid-twenties, so it is important to have a good foundation early on to maintain healthy bones late in life. Why Is Osteoporosis an Important Public Health Issue? In the United States, 10 million people have osteoporosis (80% of those are women), and 34 million are at risk for developing the disease due to low bone density. Osteoporosis is a public health issue because the disease contributes to 1.5 million fractures (broken bones), including 350,000 hip fractures annually. The costs of medical care for these injures was an estimated $17 billion in 2005. These injuries can also result in permanent disability or an inability to return to work or perform daily activities. What Are the Symptoms of Osteoporosis? Osteoporosis may not cause any apparent symptoms. Patients may not know they have osteoporosis until they break (fracture) a bone. Osteoporosis Symptoms: Fractures of the Spine Vertebral (spinal) compression fractures are broken bones in the back that are due to weak bones caused by osteoporosis. The vertebrae (spinal bone) collapses as a result of even minor injuries related to falling, bending, twisting, or sneezing. As the bones of the spine lose their mineralization and strength, they can collapse, causing a hunched-over appearance, often referred to as a "dowager hump." Osteoporosis Symptoms: Stress Fracture Stress fractures occur in bones due to repetitive injuries, usually with minimal trauma. Patients with osteoporosis are more prone to stress fractures because of the weakness of their bones. Osteoporosis Symptoms: Hip Fracture Patients with osteoporosis are at greater risk for hip fractures. Even a simple fall can cause a hip fracture in a person with osteoporosis. Due to the weakness in the bones these injuries may take a long time or be difficult to fully heal. What Are the Consequences of Osteoporosis? Fractures related to osteoporosis can result in significant pain and disability. Hip fractures are common among patients with osteoporosis. Twenty percent of hip fracture patients die within one year following their injury, and one-third will remain in a nursing home for at least a year. Patients who have one vertebral (spinal) compression fracture are at high risk for developing other such fractures. What Factors Determine Bone Strength? Bone strength is related to bone mass (density), which refers to the amount of mineralization remaining in bones as people age. The denser the bones, the stronger they are. Factors that determine bone strength include: Genetics Environment Medications Ethnicity (African-Americans have higher bone density than Caucasians or Asians) Gender (men have higher bone density than women) Aging (bone density reaches its peak around age 25, and decreases after age 35) Menopause, Estrogen, and Osteoporosis Women tend to be diagnosed with osteoporosis more often than men because once they reach menopause estrogen levels decrease. Estrogen helps maintain bone density in women. Post-menopausal women can lose up to 4% of bone mass annually in the first 10 years following menopause. What Are the Risk Factors for Developing Osteoporosis? Risk factors for developing osteoporosis that cannot be controlled include: Female gender Ethnicity – Caucasian or Asian Family history Risk factors for developing osteoporosis that can be controlled include: Smoking Lack of exercise Diets lacking calcium Poor nutrition Alcohol abuse What Are the Risk Factors for Developing Osteoporosis? (continued) Additional risk factors for developing osteoporosis include medical conditions such as: Chronically low estrogen levels Vitamin D deficiency Hyperthyroidism Inability to exercise Medications, such as chemotherapy, corticosteroids, or seizure medications Hyperparathyroidism Loss of menstrual periods (amenorrhea) Inability to absorb nutrients properly in the digestive tract How Is Osteoporosis Diagnosed? Osteoporosis is often diagnosed on an X-ray when the patient suffers a fracture. However, by the time osteoporosis is visible on X-ray there may be significant bone loss. A dual energy X-ray absorptiometry (DEXA or DXA) scan can be used as a screening test for osteopenia (bone loss that precedes osteoporosis). This test measures bone density in the hip and spine and is more precise than an X-ray. Who Should Have Bone Density Testing? The National Osteoporosis Foundation recommends the following groups of people should have dual energy X-ray absorptiometry (DEXA or DXA) scans to screen for osteoporosis: All women age 65 and older All postmenopausal women under age 65 who have risk factors for osteoporosis Postmenopausal women with fractures Women with a medical condition associated with osteoporosis How Are Bone Density Results Measured? The DXA scan lists results as a "T score." This measurement is a statistical comparison (SD, or standard deviation) of the patient's bone density compared to the average peak bone density of a young adult of the same gender and ethnicity. A T score of -1 to -2.5 SD is characteristic of osteopenia, which is a precursor to osteoporosis A T score of -2.5 SD or below indicates osteoporosis How Is Osteoporosis Treated and Prevented? There is no current cure for osteoporosis. Osteoporosis treatment involves stopping further bone loss, and strengthening bones that show signs of weakness. Prevention of osteoporosis is key. Prevention and Treatment: Exercise Exercise is important in helping improve muscle strength and balance, which can decrease falls and other accidents. Weight-bearing exercise also has the benefit of helping to strengthen bones. Consult your doctor for the type and duration of exercise that is right for you. A Word of Caution About Exercise In patients with osteoporosis, exercise may injure weakened bones. It is important to discuss with a health care practitioner the exercises that are appropriate for patients with osteoporosis. It is also important to consider other medical problems that may also be present (heart disease, diabetes, high blood pressure) before starting any exercise program. Some types of extreme exercise such as marathon running may not be recommended for patients with osteoporosis. Prevention and Treatment: Quit Smoking and Curtail Alcohol Smoking can result in bone loss. In patients with osteoporosis this can accelerate the progression of the disease. It also decreases estrogen levels in women, which can lead to earlier menopause, and further bone loss. The effect of alcohol and caffeine on osteoporosis is not clear. To maintain optimal heath, consume alcohol and caffeine in moderation. Prevention and Treatment: Calcium Supplements Calcium intake is important for strong and healthy bones. Adequate calcium intake must occur earlier in life to help prevent osteopenia and osteoporosis. Recommended calcium intake for all adults and female teens is 1,000-1,300 mg daily. Good sources of dietary calcium include dairy products, vegetables (kale, cabbage, broccoli, spinach), and fortified foods (fruit juices, non-dairy milks, cereals). Postmenopausal women may need more calcium. Prevention and Treatment: Calcium-Fortified Foods Most Americans do not get enough of the U.S. Recommended Daily Allowance (USRDA) of calcium. Some examples of dietary sources of calcium include milk, yogurt, cheese, and fortified orange juice. Prevention and Treatment: Vitamin D In order to properly absorb calcium in the diet and maintain good bone health, the body also needs vitamin D for the following: Absorption of calcium from the intestines Prevent osteomalacia, which can further weaken bones Increase bone density and decrease fractures in postmenopausal women The USRDA for vitamin D is 600 IU (international units) per day for children age 1 year up to adults of 70 years. Infants under 1 year need 400 IU, while adults 71 and older require 800 IU. Good sources of vitamin D include sunlight, fatty fish such as salmon or mackerel, beef liver, egg yolk, milk or orange juice fortified with vitamin D, fortified cereals, and infant formulas. Prevention and Treatment: Menopausal Hormone Therapy Because estrogen can play a role in maintaining bone density and strength in women, many menopausal women with osteoporosis are prescribed hormone therapy (menopausal hormone therapy, formerly referred to as hormone replacement therapy, or HRT) to prevent bone loss and fractures. Estrogen may be prescribed alone orally (Premarin, Estrace, Estratest) or as a skin patch (Estraderm, Vivelle), or along with progesterone. The combination of the two hormones can help prevent uterine cancer that can result from using estrogen alone. Menopausal hormone therapy can have side effects including increased risk of heart attack, stroke, blood clots, and breast cancer so it is not typically recommended for long-term use. Consult a doctor for more information on menopausal hormone replacement. Prevention and Treatment: Medications There are several types of medications used to treat osteoporosis. 1. Anti-resorptive drugs: These medications prevent bone resorption (breakdown) and can help increase bone mass. Examples include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast). 2. Menopausal estrogen hormone therapy: this can act much as the anti-resorptive drugs do, preventing bone loss and helping increase bone mass. 3. Selective estrogen receptor modulators (SERMs): These medications work like estrogen, and include tamoxifen and Raloxifene (Evista). 4. Anabolic drugs: these are the only drugs that actually build bone mass. Teriparatide, a form of parathyroid hormone, is one example of this type of drug Prevention of Hip Fractures Hip protectors can reduce the risk of hip fractures in people who have osteoporosis and are at risk for falls. Hip protectors are undergarments with thin layers of foam or plastic on the hips. Hipsaver and Safehip are two of the brands available. Osteoporosis At A Glance Osteoporosis is a disorder of the bones in which the bones become brittle, weak, and easily damaged or broken. Bone mass (bone density) reaches its peak around age 25, and decreases after age 35 years and decreases more rapidly in women after menopause. Risk factors for osteoporosis include genetics, lack of exercise, lack of calcium and vitamin D, cigarette smoking, excessive alcohol consumption, and family history of osteoporosis. Patients with osteoporosis may have no symptoms until bone fractures occur. Osteoporosis may be diagnosed using X-rays but it is more likely to be detected with DEXA scans which measure bone density. Treatments for osteoporosis include prescription osteoporosis medications, quitting smoking, and getting appropriate exercise, calcium, and vitamin D. Reviewed by Aimee V. HachigianGould, MD on 7/27/2016 Sources:  This tool does not provide medical advice. See additional information:  © 1996-2018 WebMD, LLC. All rights reserved. Source slideshow at OnHealth CONTINUE SCROLLING FOR RELATED SLIDESHOW Osteoporosis Super-Foods for Strong Bones With Pictures 1. Go darker with your greens. Nothing beats calcium for your bones. Sure, you can get it from dairy, but it’s also found in lots of vegetables. Why not do both? One great choice: dark leafy greens such as bok choy, Chinese cabbage, kale, collard greens, and turnip greens. One cup of cooked turnip greens has about 200 milligrams of calcium (20% of your daily goal). On top of that, dark greens also have vitamin K, which can reduce your risk for osteoporosis. 2. This spud’s for you. Two lesser known nutrients that help keep bones healthy are magnesium and potassium. If you’re low on magnesium, you can have problems with your vitamin D balance, which may affect your bone health. Potassium neutralizes acid in your body that can leach calcium out of your bones. One delicious way to get some of both of those nutrients is by eating a baked medium-size sweet potato with no salt, which has 31 milligrams of magnesium and 542 milligrams of potassium. 3. Start your day off tart. Add a grapefruit to your breakfast and you’ll be doing more than waking up your taste buds. Citrus fruits have vitamin C, which has been shown to help prevent bone loss. One whole pink or red grapefruit has about 91 milligrams of vitamin C, giving you the amount you need for the entire day. Can’t handle the sourness of a grapefruit? A navel orange comes in close with 83 milligrams. 4. Get figgy with it. If you’re looking for bone-strengthening fruits, figs should be near the top of your shopping list. Five medium fresh figs have around 90 milligrams of calcium and other skeleton-saving nutrients like potassium and magnesium. Fresh figs are grown in California through the summer and fall, but you can find them dried all year. And dried ones are just as good: Half a cup of dried figs have 120 milligrams of calcium. 5. Think beyond canned tuna. Salmon and other types of fatty fish offer an array of bone-boosting nutrients. They contain vitamin D, which helps your body use calcium, and omega-3 fatty acids, which may also aid bones. One of the best ways to buy salmon is actually canned. Three ounces has 183 milligrams of calcium. Why such a high amount? Small, soft bones get included with the meat in the canning process (don’t worry, you won’t even notice them). 6. A superior sandwich spread. Made simply from ground up almonds (and maybe a little salt), almond butter is an easy way to boost your calcium intake. Two tablespoons has 112 milligrams of calcium. Plus, almonds contain potassium (240 milligrams in 2 tablespoons) as well as protein and other nutrients that play a supportive role in building strong bones. 7. “Milks” from plants. You’d think that by swapping out dairy milk for the kind made from soybeans, almonds, or coconuts, you’d lose all that calcium and vitamin D. But most of the varieties you’ll find in the store have been given an extra boost of those nutrients. Check the label to be sure. 8. Swap in some vegetarian proteins. Tofu is a mainstay in Asian cooking, both for its versatility and the fact that it’s a nutritional powerhouse. Half a cup of calcium-enriched tofu contains more than 400 milligrams of calcium. Tofu has other bone-building benefits, too. Research suggests that isoflavones, which are plentiful in tofu, may make soy useful in warding off bone disease in women after menopause. 9. Juice up a classic. It may go perfectly with pancakes, but orange juice doesn’t naturally contain much calcium. That said, it can still be a great way to increase your intake. How? Manufacturers often sell versions that have been fortified with calcium (look for it on the packaging). In fact, fortified orange juice has about the same amount of bone-building calcium as dairy milk. 10. A dried fruit often ignored. Hear the word “prune” and you probably think of something older people eat to stay regular. But everyone should actually be snacking on dried plums (what is what prunes actually are!). Research has found that eating them every day, along with calcium and vitamin D, can help improve your bone density by slowing the breakdown of bone in your body. 11. Select a smarter sweetener. Unlike refined white sugar, molasses is a source of calcium. In just 1 tablespoon of the sweet syrup you’ll get 41 milligrams of calcium. You can do more than bake with it. Try it instead of honey to top your yogurt or oatmeal or mix into a smoothie. Reviewed by Maryann Tomovich Jacobsen, MS, RD on 2/16/2016