Osteoporosis is a disease noted by loss of bone mass or density and a drastic disruption of bone replenishment and healing, resulting in brittle and porous bones prone to fracture.  Osteopenia while not a disease, refers to the decreased calcification of bone, usually seen on X-ray, which may or may not be associated with osteoporosis.  Osteoporosis essentially increases the risk of painful fractures, can be disfiguring, and can reduce your ability to lead an active life.  Bone-mass loss however can be controlled by practicing early prevention methods and making beneficial lifestyle choices.

Anatomy 101

Bone remodeling is the process that removes older bones (resorption) replacing it with new bone (formation) in order to maintain a healthy skeleton.  Bone mass tends to be at its greatest in our mid-twenties, with new bone tissue forming faster than resorption occurs.  Entering our 30s, bone mass gradually reduces as resorption begins to exceed bone replenishment.  

Protein collagen and calcium, both of which are necessary for bone formation, are deteriorated by osteoporosis, resulting in weakening bones.  Postmenopausal women experience a significant drop in the production of estrogen, a hormone that aids in maintaining calcium levels as well as other minerals necessary for normal bone regeneration, resulting in an accelerated loss of bone mass of up to 3% per year over a period of five to seven years. 

The Symptoms

Unfortunately, detecting osteoporosis is not a straightforward matter.  Deemed the "silent disease," visible symptoms simply may not be present until the condition has deteriorated and a bone breaks.  Otherwise, loss in stature, defined as more than 1 inch in height, and curvature of the spine due to vertebral collapse,  are indicative signs of the disease, present only in advanced cases. For this reason, early detection and prevention techniques are vital.

Risk Factors

Age brings wisdom but also decreased bone density.  The older you are, the greater your risk of developing osteoporosis.  Women, especially following menopause, are at greater risk of developing osteoporosis.  They have less bone tissue and due to menopausal changes, lose bone more rapidly than men, who don't typically see significant bone loss until their late sixties.  Normal or early menopause as well as premenopausal cessation of menstruation (i.e. caused by eating disorders or excessive physical exercise) can also contribute to bone tissue loss.  The first few years after menopause are the most significant for bone loss. Race, primarily Caucasian or Asian heritage, can also mean increased risk.  This disorder also has a genetic component, including family and personal history of fractures as well as body stature (specifically thin-boned with a small frame). 

Modifiable risks, factors that are within your control for the most part, include lifestyle choices such as tobacco use, excessive consumption of alcohol or caffeine, lack of weight-bearing exercise, and other issues relating to diet such as inadequate Calcium and Vitamin D intake and eating disorders. Additionally, certain medications used to treat chronic medical conditions have adverse effects on bone health and can lead to osteoporosis. These medications include, but are not limited to corticosteroids (e.g. Prednisone), anticonvulsants, and thyroid hormones, as well as drugs intended to treat rheumatoid arthritis and gastrointestinal disorders. As in any instance where pharmaceuticals are involved, it is best to consult with your doctor.

An Ounce of Prevention

Becoming informed about bone health and the effects of osteoporosis and understanding the risk factors is a good place to start. If you feel you are at risk for developing osteoporosis, speak to your doctor about diagnosis, prevention, and treatment strategies. A baseline bone density test is recommended before menopause. This is usually done with the DEXA (Dual Photon X-ray Absorptiometry) scan. If you have osteopenia or osteoporosis, it is recommended that you work with your health care provider to implement a bone-building program.  For more information on bone density testing and pharmacological drugs used for osteoporosis, see the featured article: A Medical Approach to Detecting and Treating Osteoporosis.

In addition to medical attention, several proactive behavior modification measures can easily be implemented as part of your lifestyle to ensure bone health as you age. Avoiding a sedentary lifestyle by incorporating regular weight- bearing exercise is highly recommended for improving both your physical and mental health. These include any activity you do on your feet that works your body against gravity, such as walking, hiking, running, dancing, and a number of sports and everyday activities. What you put in your body can be as important as what you do with your body. Consider cutting out tobacco products and consuming alcohol and caffeine only in moderation. Also, make alterations in your diet to increase intake of vitamin D and calcium.