Osteoporosis

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Causes and Risk Factors

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The more risk factors for osteoporosis that a person has, the greater the chance of fracture. Women with small body frames, a family history of osteoporosis, and early onset of menopause are at the highest risk.

Age
After age 65, osteoporosis damages both trabecular and cortical bone, making sites besides the hip, wrist, and vertebrae vulnerable to fracture. In the most severe cases, the disease also affects teeth and jawbones, resulting in periodontal disease and tooth loss.

Genetics
According to the National Institutes of Health, genetics may determine up to 80% of the risk for osteoporosis. Genetic risk factors include the following:

• Gender—Female
• Ethnicity—Caucasian and Asian
• Body Size—Small frame, low body weight (less than 125 pounds), optimal bone density not reached
• Family history—Maternal history of osteoporosis, hip fracture, smoking, tallness, thinness

Hormones
Hormones regulate bone remodeling, which affects bone mass. After age 50, the rapid and severe decrease in estrogen production that occurs during and after menopause increases the risk for osteoporosis.

Modifiable Risk Factors
Although optimal bone mass is determined mostly by genetics, other factors are involved. The amount of calcium, phosphorus, and vitamin D in the diet affects bone formation. Additionally, regular exercise, which increases bone mass, helps determine whether a person obtains optimal bone mass.

Several risk factors can be modified or eliminated by changing diet and habits:

• Cigarette smoking decreases estrogen production.
• Excessive alcohol use inhibits osteoblast activity and increases risk for falling.
• High caffeine intake increases loss of calcium in urine.
• Inactive, sedentary lifestyle eliminates physical activity that stimulates bone remodeling.
• Calcium and phosphorus deficiencies decrease formation of hydroxyapatite, the major mineral in bone.
• Lack of vitamin D reduces intestinal absorption of calcium and phosphorus.

Medication

Prolonged use of certain medications can induce or speed up the rate of osteoporosis, including:

• Antiseizure medications
• Glucocorticoids
• Gonadotropin releasing hormone (GnRH) analogs
• Heparin
• Thyroid hormone

Excessive amounts of antacids containing aluminum (e.g., Maalox®, Mylanta®) may increase the risk for osteoporosis in certain people.

Diseases
Diseases caused by hormone imbalances (e.g., hyperthyroidism, hyperparathyroidism, Cushing's syndrome) may increase the risk for osteoporosis because they interfere with the regulation of the hormones that regulate remodeling. Gastrointestinal disorders (e.g., celiac disease, Crohn's disease) that affect absorption of calcium and vitamin D also increase the risk.

Early onset menopause brought on by the removal of the uterus (hysterectomy) and the complete removal of the ovaries (oophorectomy) is associated with osteoporisis.

Signs and Symptoms

Osteoporosis initially progresses with little evidence. Pain (especially in the back) is experienced when there is a fracture.

Complications from osteoporotic fractures include:

• Chronic pain (neck, lower back)
• Compressed or collapsed vertebra
• Disability, limited activity
• Dowager's hump, stooped posture
• Loss of height

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