Researched by Marianne I
Submitted June 2001

It is a systemic skeletal disease. Osteo means bone and porosis is porous (full of pores or holes). The bones become thin and brittle. They become so fragile that they can break from the stress of ordinary activities or falls. Deterioration of the bone happens slowly over a long period of time without making itself noticeable. Microfractures of the spinal vertebrae can be caused by everyday activities. These can lead to a stooped posture, which results in a reduction of height. This can eventually develop into a deformity known as dowager’s hump. Osteoporosis can also lead to loss of teeth. This happens when the jawbone loses density and the teeth can no longer be held securely. The teeth loosen and eventually fall out. The most serious of all fractures are those to the hip. Starting with the age of 50 and as people progressively get older, their mobility reduces and this leads to more complications. The result being as many as one-quarter of those who sustain a hip fracture die within a year.

When you touch your bones through your skin, they feel solid and hard because they are made from calcium and other minerals. These materials make the outer bone shell so hard. It does not seem to change. However, with time, a slow remodeling process takes place as the bones repair and renew themselves. Underneath the outer bone layer, the tissue is porous and alive with blood vessels running through it. In the center is the bone marrow where the blood cells are formed.

• Estrogen and some other hormones help prevent deterioration of bone tissue.


• Calcium along with vitamin D helps to build bone tissue.


• Physical impact exercises such as walking help to stimulate bone formation.

In the average healthy person from birth to about age twenty-five, more bone mass is built than is lost. From ages twenty-five to thirty-five bone density is maintained. After age thirty-five until menopause the tendency is to lose up to one percent of bone density each year. This can lead to a transformation period between healthy bones and osteoporosis called osteopenia, meaning bone loss.

Very unfortunately, beginning around age forty, the majority of women start to lose half a pound of muscle each year. This is typically replaced with fat. This process is known as sarcopenia, meaning muscle loss. If nothing is done about this process, a person will lose about one third of the muscle mass they had at the age of forty, by the time they reach eighty. In normal everyday activities strong muscles, tendons, and ligaments produce positive stresses on the bones encouraging the bones to produce more mass. At the same time they also act as a protective covering that takes the negative stresses such as falls away from the bones.

Until recently it was common understanding that there was only one critical time for bone loss in women: the first five years after menopause. If preventive measures (which we will discuss later) are not taken, a women will lose a minimum of 1 to 2 percent or even more bone mass every year during this period. This critical phase can be slowed down or postponed with the use of estrogens. From approximately fifty-five to about sixty-five a women will lose 1 percent of the bone mass.

The second wave of bone loss occurs after age 65. Until recently it was thought bone loss stopped or slowed at older ages. According to epidemiologist Dennis Black, Ph.D. from University of California, San Francisco, "But now we know that there's a second wave of bone loss, and if we prevent that, we may be able to prevent many fractures".

Let me give you an example of what can happen. Several years ago my friend, who I will call Pandora, was at church one Sunday, and for no apparent reason her leg gave way and she fell down concrete stairs resulting in a multiple fracture of her leg. With a fall like that, where the leg just gives way, the x-rays show a bone loss of less than 50% bone density. Pandora had broken her knee cap two years earlier, but the attending doctor did not look for osteoporosis, and my friend certainly never even considered osteoporosis for the cause of the break. Now when she looks back on those knee cap x-rays, the osteoporosis was obvious at that time.

The lesson from this is, if you break a bone and you are over 50, bug your doctor about bone density. Do not be put off with: "You are O.K. for your age". That may be another way of saying, your bones are thinner than they should be. Ask for numbers, (we will go into that later).

When Pandora's two daughters, 19 and 21, were tested, osteopenia was found. Beware, young ladies.

Pandora's husband also has osteoporosis. In his case it could be caused by a parathyroid problem (Nebenschilddrüse) problem or heredity. Let me go back to the parathyroid for a minute; it is a gland close to the thyroid gland. That produces a hormone which regulates the calcium level in the blood. The condition is treated with medication. An uncle of Pandora's husband had osteoporosis.

Let us go back and ask who is at risk and why? I have already mentioned several risk factors: women, age, and heredity. Women have the greatest danger. Caucasian and Asian women are more vulnerable than African-American and Hispanic women to develop serious problems. As people get older, the risk increases. Heredity and family history (Pandora's family) are a big factor, as mentioned in our example. Have your older relatives, who were once your size, shrunk by a head or more? Have they broken their bones, particularly due to osteoporosis? Other factors are a small frame and being thin and, for women, early menopause before the age of forty-five.

Additional risk factors have more to do with lifestyle:

• A sedentary or inactive lifestyle, either by choice or due to other health problems. I have had and still have problems with that one.


• Menstrual interruptions not due to pregnancy or menopause. The most common other causes are anorexia, bulimia, or excessive exercise. These often result in an inadequate diet.


• Poor diet is another factor. Young American women are notorious for poor eating habits.


• It is necessary to get enough calcium in your diet your whole life long.


• Cigarette smoking causes women after the age of forty to lose bone density more rapidly.


• Alcohol consumption of more than seven drinks a week or 4 ounce a day interferes with the calcium metabolism and is detrimental to the bones. Drinking less alcohol than that seems to have no effect on bone density.


• Certain long term medical treatments also increase the risk of osteoporosis. Glucocorticoids, steroids such as prednisone for asthma and arthritis, and some immune disorders, thyroid hormones (Pandora's husband has to take those), barbiturates and anticonvulsants, and methotrexate (a chemotherapy drug used for arthritis, cancer, psoriasis, and immune disorders). I had to take cortisone for one long period of time and very occasionally for short treatments.