Osteoporosis FAQ
April 3, 2008
by Alan Jacobs M.D.

My hip hurts. Isn't that osteoporosis?
No. Osteoporosis causes broken bones so there is no pain until a bone fractures.

What's the difference between osteoporosis and osteoarthritis?
Osteoarthritis is the joint disease when the joint surface disappears and leads to a grinding, painful joint. Osteoporosis is a bone disease with "porous" or thin bones that are low in calcium and snap like brown twigs.

So what is the big deal about osteoporosis?
Osteoporosis is very common in women after age 60 and 50% get a spine fracture and 30% have a hip fracture. The spine can develop a big hump from the fractures. The hip fracture leads to surgery and often prolonged nursing home care. Complications from surgery are common and death may occur. Younger people may have osteoporosis but the real risk for fractures is after age 60.

How do you get osteoporosis?
Your bones are a reflection of your genes, age, gender, and entire life so it can be very complicated. For most, age and a family tendency are the most common factors. Women never quite have the same level of calcium as men and may lose a lot for the 5 years after menopause. Bone loss occurs in men and women after age 40 but more so in women. With age, the bones snap and break instead of bending.

I heard there are other ways to get a weak skeleton. Is that right?
Yes. There is a long list of things like not eating calcium while growing up, being low in Vitamin D, taking oral cortisone-like medications, seizure medications, DepoProvera, early menopause, endocrine problems like too much parathyroid hormone, kidneys which leak too much calcium, GI absorption problems, prolonged bedrest, and so forth. It would be a good idea to be checked for these if you are in the lowest 10% of bone density for your age.

How do you know if you have osteoporosis?
It's easy. Get a "bone density test" or BMD. The best one is when the spine and hip are measured.

Is the BMD test painful or dangerous?
No, unless just lying on a table bothers you. The radiation is negligible.

Does it matter where you get the BMD test?
Yes, if there needs to be followup tests in the future or "serial studies". To do these accurately, the location has to be sure to use the same machine and verify the accuracy of their technique which is not being done in most places. It is at the Arthritis and Osteoporosis Center which has been performing this test since 1986. Repeating the BMD every 2 years can help make the correct treatment decisions and give reassurance.

Won't just taking calcium protect me from osteoporosis?
Sorry, this applies mostly to kids. Most adults get reasonable amounts in the diet and taking calcium does not build bone up, only make a bad situation from getting worse. Exceptions make be those who have totally avoided dairy products.

I heard something about the sun and Vitamin D.
Vitamin D is needed to absorb calcium and maintain bone. Many adults are very low in Vitamin D since they avoid the sun's radiation in the summer which causes the skin to make Vitamin D. Some also may not absorb it from diet or supplements. A lot may needs to be learned about Vitamin D and osteoporosis. Being low also may lead to muscle pain and weakness.

Ok, if I have to use a prescription medication, what are the options?
The real problem with prescription medications is the cost. Fosamax and Actonel are excellent remedies and Boniva will join them soon. Evista is a female hormone that may help. Miacalcin is a nasal spray this is weaker and used when the others are not tolerated well. Forteo is a very expensive daily injection used for 2 years for special cases.

Being on the right treatment is critical if you remember that 50% of all fractures from osteoporosis are preventable including a 90% reduction in the spine. Get the proper help and make sure you are protecting your skeleton if you at risk.