Good Words Never Die

Setting the record straight about osteoporosis.

By Robert H. Shmerling, M.D., Harvard Health Publications

Chances are you’ve heard a lot about osteoporosis. This remarkably common condition affects 8 million women in the United States. And recent advances in its diagnosis and treatment make it a condition that’s often in the news.

Why should we care about osteoporosis? Just having the disease is not the problem. The problem is the broken bones (fractures) that can occur in people with osteoporosis. They cause enormous suffering, often require surgery, and may lead to loss of independence or even death. Current estimates suggest that half of all women over age 50 will suffer a fracture related to osteoporosis.

Unfortunately, there’s a lot about osteoporosis that is misunderstood. So, let’s talk about a few of the myths and set the record straight.

What’s in a Name?

“Osteo” means bone and “-porosis” refers to the porous quality of the bone. Porous bones have fewer connections within the bones than needed for optimal bone strength. Just as a bridge with too few supportive struts may be prone to collapse, people with osteoporosis are prone to bone fracture, especially of the hip, pelvis, spine and wrist.

Myths and Truths

Myth #1: Osteoporosis is painful.

This is probably the most common myth. In fact, osteoporosis causes no symptoms unless a bone breaks. In fact, most people with osteoporosis don’t know they have it unless they break a bone or learn of the diagnosis from a bone mineral density test.

Myth #2: You have to fall to break a bone due to osteoporosis.

Actually, certain fractures, especially those of the spine (called compression fractures) may happen without a fall or any recognized injury.

Myth #3: All osteoporotic fractures are painful.

It’s generally true that when you break a bone, it hurts. And hip, pelvis or wrist fractures due to osteoporosis are almost always painful. But, compression fractures, as mentioned above, may develop gradually and painlessly, making the normally rectangular spine bone crunched into more of a triangle. It’s one of the reasons people with osteoporosis often lose height and can develop a hunched-over posture.

Myth #4: Osteoporosis is unlikely if your posture is normal.

The other part of this myth is that a bent-over posture is a cause of osteoporosis. While compression fractures can cause the spine to bend forward (a condition called kyphosis), plenty of people with osteoporosis have perfectly normal posture. “Poor posture” (however that’s defined!) does not cause osteoporosis and does not make existing osteoporosis worse. The opposite is also untrue: Good posture does not prevent osteoporosis.

Myth #5: Only postmenopausal women get osteoporosis.

While osteoporosis is 4 to 5 times more common among women than men (and it affects mostly postmenopausal women), an estimated 25% of men will break a bone due to osteoporosis at some point in their lives. In younger people, there is often at least one risk factor for the disease, especially family history or use of medicines called corticosteroids. Among men, advanced age and low testosterone are important risk factors.

Myth #6: Calcium and vitamin D are adequate treatments for most cases of osteoporosis.

While these nutrients are necessary to build back lost bone mass, they are rarely enough on their own to reverse osteoporosis. To build bone, doctors prescribe medicines called bisphosphonates, such as alendronate (Fosamax) or risedronate (Actonel).

Myth #7: Aggressive treatment of osteopenia (sometimes called “pre-osteoporosis”) is always necessary.

The term “osteopenia” means “too little bone.” It is not a disease. It refers to low bone mass that is not severe enough to indicate osteoporosis. Osteopenia only slightly increases fracture risk. That’s why calcium, vitamin D and exercise (the standard recommendations for postmenopausal women even with normal bone mass) may be all that’s necessary to maintain bone health. If you have osteopenia, talk to your doctor about whether you need to do anything other than the routine measures for bone health.

Myth #8: Osteoporosis is inevitable.

While getting older is the strongest risk factor for osteoporosis, many elderly individuals never develop the disorder. Dietary or supplemental calcium, vitamin D, exercise and good genes probably play a role. Avoiding risk factors is also important. Besides age, risk factors include:

  • Being a postmenopausal woman or a man over age 70
  • Being bedridden
  • Having low body weight
  • Smoking
  • Having low testosterone (in men)
  • Taking certain medications (such as corticosteroids, anti-estrogen drugs, or some anti-seizure medicines)
  • Having certain medical conditions, including rheumatoid arthritis, chronic kidney disease, or an eating disorder
  • Being Caucasian (as compared with African American)
  • Missing menstrual periods
  • Having alcoholism
  • Having a family history of osteoporosis
  • Having a low intake of calcium

Myth #9: Osteoporosis is not a big deal.

For people who feel well and learn they have osteoporosis from a bone density test, it may not seem like an important problem. Weight-bearing exercise, treatment with calcium, vitamin D and a bone-building medication may be recommended. But, for the person who falls and breaks a hip, it’s a very big deal.

Besides the pain, there is a risk of complications of hip surgery to worry about. About 20% of people who suffer an osteoporotic hip fracture lose their independence. And, up to 25% of people over age 50 with an osteoporotic hip fracture die within a year. Health care costs associated with osteoporosis-related fractures are more than $20 billion, and this figure is rising dramatically as our population ages. It is a big deal.

Myth #10: It’s impossible to build bone beyond a certain age.

It’s true that we reach our highest bone density in early adulthood — around age 20 or 25. After that, bone mass tends to fall. However, studies show that resistance exercise can build bone even among older adults. And approved drugs for osteoporosis can build bone mass among the elderly as well as younger adults. It was once thought that the best we can do is slow bone loss; we now know we can do better than that.

The Challenges Ahead

We know much more now about osteoporosis than ever before. But there are many challenges to address in the future. For example:

  • How often should a bone mineral density test be repeated?
  • Are we overdiagnosing and overtreating bone disease? This is a particularly important question for the many people with osteopenia who are taking medicines to prevent a fracture they are unlikely to ever have.
  • Are we underdiagnosing and undertreating bone disease? Studies suggest that a minority of older adults get bone mineral density tests as recommended.
  • What are the long-term risks of taking a bone-building medicine such as alendronate (Fosamax)? These drugs have been around for many years. While their safety profile is good, there are concerns that benefits to bone may diminish (and risks may rise) over time.

The Botton Line

Osteoporosis is common and serious. But there’s a lot you can do. Learn the facts. Don’t fall for the myths. And, keep an eye out for new developments. It seems likely that as we learn more about osteoporosis, there will be new ways to prevent, detect and treat this important disease.

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