American Medical Association Family Medical Guide - American Medical Association [692]
• Eating few calcium-rich foods and not taking calcium supplements.
• Having long-term therapy with medications (such as corticosteroids) that affect the bones (see page 992).
• Being a male with a low testosterone level.
• Getting little exercise.
• Smoking or a history of smoking.
• Drinking alcohol excessively.
• Being white or Asian.
• Having a gastrointestinal disorder such as a peptic ulcer (see page 755) or lactose intolerance (see page 770), which can interfere with the body’s ability to absorb calcium.
• Having a history of fractures.
Osteoporosis
Healthy bone has dense, strong tissue. Bone weakened by osteoporosis gradually becomes thinner and weaker and susceptible to fractures. Bone thins from the loss of its structural protein, collagen, and its strengthening mineral, calcium.
Symptoms
If you have osteoporosis, you may notice that you are shorter than you used to be, your posture is somewhat stooped, or your shoulders are rounded because the bones in your spine (vertebrae) have weakened. Other than these, osteoporosis seldom causes noticeable symptoms until a bone breaks. Osteoporosis can affect any bone, but the bones most likely to fracture are those in the hip, spine, and wrist. The hip and wrist usually break as the result of a fall, but the vertebrae can weaken gradually and fracture from a routine movement such as bending over. If one or more vertebrae break, you will have sudden, severe back pain.
Diagnosis
To diagnose osteoporosis, doctors perform a physical examination to check for a change in posture or loss of height. No test is available to accurately measure overall bone strength, but your doctor will recommend an imaging test that measures bone density (see next page) in different parts of the body. (Regular X-rays do not show bone loss unless the loss is severe.)
Compression fracture from osteoporosis
A bone in the spine (vertebra) weakened by osteoporosis may, over time, develop tiny cracks. Eventually, the weakened bone can collapse, causing a compression fracture. Compression fractures can make the upper part of the spine curve, affecting posture and reducing height.
Q & A
Osteoporosis
Q. My 18-year-old daughter is an athlete and works out rigorously every day. She hasn’t had a period in 6 months. Could this be a problem for her health?
A. Your daughter should see a doctor right away. She is at risk of developing osteoporosis at a young age. Many young women who exercise strenuously and fail to consume enough calories stop menstruating, which means that their body is not producing the female hormone estrogen in normal amounts. Estrogen is essential for building bones, and bones reach their peak strength and density in adolescence. Your daughter may need to take birth-control pills to restart her estrogen production and periods. The doctor may also recommend that she decrease her workout regimen, consume more calories, and take in 1,300 to 1,500 milligrams of calcium every day.
Q. My mother and my sister both have osteoporosis. I’m 40 years old and I’m starting to worry that I might develop it too. Is there anything I can do now?
A. Because of your family history of osteoporosis, you are at increased risk of developing it. The first thing you should do is have a bone density test to evaluate the strength of your bones, which can help determine your risk of developing osteoporosis or breaking a bone. If your bone density is lower than normal for your age and build, your doctor will probably recommend a number of strategies to prevent you from losing more bone and, possibly, help you build more bone. For example, getting a sufficient amount of calcium (about 1,500 milligrams each day) and doing as much weight-bearing exercise (such as walking) as you can each day will help keep your bones strong. Also, your doctor may prescribe a medication that