Osteoporosis

Osteoporosis is a systemic skeletal disorder characterized by low bone mass (osteopenia), micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in fracture risk. Bones undergo continuous remodeling: osteoclasts resorb old bone, and osteoblasts synthesize new bone. With advancing age, the rate of resorption exceeds that of bone formation, causing bones to lose density and become more susceptible to fractures.

It is the most common reason for a broken bone among the elderly. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, the wrist, and the hip.

Until a broken bone occurs, there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. After the broken bone heals, some people may have chronic pain and a decreased ability to carry out normal activities.

Osteoporosis may be due to lower-than-normal maximum bone mass and greater-than-normal bone loss. Bone loss increases after menopause in women due to lower levels of estrogen, and after andropause in older men due to lower levels of testosterone. Osteoporosis may also occur due to several diseases or treatments, including alcoholism, anorexia or underweight, hyperparathyroidism, hyperthyroidism, kidney disease, and after oophorectomy (surgical removal of the ovaries). Certain medications increase the rate of bone loss, including some antiseizure medications, chemotherapy, proton pump inhibitors, selective serotonin reuptake inhibitors, glucocorticosteroids, and overzealous levothyroxine suppression therapy. Smoking and sedentary lifestyle are also recognized as major risk factors. Osteoporosis is defined as a bone density of 2.5 standard deviations below that of a young adult. This is typically measured by dual-energy X-ray absorptiometry (DXA or DEXA).

Prevention of osteoporosis includes a proper diet during childhood, hormone replacement therapy for menopausal women, and efforts to avoid medications that increase the rate of bone loss. Efforts to prevent broken bones in those with osteoporosis include a good diet, exercise, and fall prevention. Lifestyle changes such as stopping smoking and not drinking alcohol may help. Bisphosphonate medications are useful to decrease future broken bones in those with previous broken bones due to osteoporosis. In those with osteoporosis but no previous broken bones, they have been shown to be less effective. They do not appear to affect the risk of death.

Osteoporosis becomes more common with age. About 15% of Caucasians in their 50s and 70% of those over 80 are affected. It is more common in women than men. In the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected. Rates of disease in the developing world are unclear. About 22 million women and 5.5 million men in the European Union had osteoporosis in 2010. In the United States in 2010, about 8 million women and between 1 and 2 million men had osteoporosis. White and Asian people are at greater risk for low bone mineral density due to their lower serum vitamin D levels and less vitamin D synthesis at certain latitudes. The word "osteoporosis" is from the Greek terms for "porous bones".