It can happen without warning. You may sneeze, bend over to pick up the morning paper or lift the vacuum cleaner, when you experience sudden pain. Later you may learn you’ve experienced a bone fracture.

Osteoporosis, which means “porous bones,” causes bones to become weak and brittle—so brittle that simple movements can end with fractures. In the United States, osteoporosis causes more than 1.5 million fractures every year, mostly in the spine, hip and wrist.

Approximately 40% of Caucasian women will experience a broken bone from osteoporosis in their lifetime, while 13% of men over 50 will have fractures – a higher risk of fracture than of prostate cancer. The direct cost is now $17 billion per year, and fractures are expected to triple in 50 years along with dramatic cost increases. After a hip fracture, there is a 26% mortality rate within the first year, which is higher for men and African American women. Only 40% of hip fracture patients regain a pre-fracture level of functioning and only about 50% of hip fracture survivors are unable to walk without assistance. Some 33% become totally dependent.

Early stages of osteoporosis usually exhibit no pain or symptoms. However, once bones have been significantly weakened, there may be signs and symptoms that include back pain, loss of height over time, or fractures of the vertebrae (backbones), wrists, hip or other bones.

The consequences of vertebral fractures are:

• Spinal deformity and pain which impair function and decrease mobility


• A compressed abdomen which decreases appetite and leads to gastrointestinalsymptoms


• Reduced lung capacity which impairs pulmonary function


• Reduced self-esteem

Factors which determine peak bone mass:

• Genetic: Osteoporosis runs in the family. Having a parent or sibling with osteoporosis puts you at higher risk


• Exercise: Bone health begins in childhood. Children who are the most physically active have the greatest bone density. Exercise throughout life is important.


• Smoking: Researchers have found that tobacco use contributes to weakened bones.


• Sex hormones: Fractures from osteoporosis are about twice as common in women as they are in men. From age 75 on, osteoporosis is as common in men as it is in women.


• Chronic alcoholism: For men, alcoholism is one of the highest risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body’s ability to absorb calcium.

Bone loss begins in the 30s (women) and late 40s (men). The only way to diagnose the problem early is to measure bone density. Currently dual energy x-ray absorptiometry (DXA) of central bones (spine and hip) remains the most accurate method for detecting low bone mineral density. The procedure is quick, simple, and gives accurate results. It allows the doctor to measure the density of bones in the spine, hip and wrist and to accurately follow changes in these bones over time. Bone density correlates with fracture risk better than cholesterol with heart attack, similar to blood pressure for predicting stroke. DXA bone density can also be used to monitor response to therapy.

Who should have a bone density test (screening guidelines):

If you’re a woman, the National Osteoporosis Foundation and the American Association of Clinical Endocrinologists Recommends screening for:

• Women over 65 years of age


• Postmenstrual women with fragility fracture


• Women and men on or starting steroids


• Postmenstrual women under 65 years with weight less than 127 lbs, history of smoking, medical causes, early menopause, or a family history of fracture

When to measure bone density in men (prudent recommendations, no established guidelines):

• 70 years of age and older


• Prior fragility fracture as an adult


• Vertebral abnormality


• Osteopenia on x-ray


• Diseases and medications that cause bone loss

And finally, if you have osteoporosis, these suggestions may help relieve symptoms and maintain independence:

Maintain good posture. Good posture helps avoid stress on the spine. Keep the head held high, chin in, shoulders back, upper back flat and lower spine arched. When sitting or driving, place a rolled towel in the small of the back. Don’t lean while reading or doing work. When lifting, always bend at the knees and lift with the legs. Keep the upper back straight.

Prevent falls. Wear low-heeled shoes with non-slip soles and check the house for anything that might cause you to trip and fall.