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ABCMD definition of Osteoporosis: A loss of the substance making up your bones.

What is Osteoporosis?:
This is a somewhat complex disease to explain, but the easiest way to think about Osteoporosis is with the following two examples. 1) This first example is not the best, but it will start you off in the right direction. Think about normal bone as a solid block of cheese. In Osteoporosis your bones are more like Swiss cheese. 2) Now, in reality if you were to look at a patient’s bones with Osteoporosis they wouldn’t really have big holes in them like Swiss cheese, but what they actually have is bone loss at a very small level making the solid bone more spongy.

What actually defines Osteoporosis to doctors is a little more complex. Diagnosing Osteoporosis has to be done with what doctors call a bone scan. In this test pictures much like X-rays are taken of your bones and a Radiologist (a doctor who specializes in medical imaging) measures the amount of substance in your bones and assigns it a number based on how solid the bone is. The Radiologist then compares this number to what is expected in normal bone for someone your age and also to what is expected in a young adult. The doctors are then able to determine both how much bone you have lost compared to a young adult and also how similar you are to people of your same age. If your bone loss is severe enough, you will be diagnosed with Osteoporosis. However, if you have some bone loss, but not enough to diagnose you with Osteoporosis, your doctors will call it Osteopenia instead. This is just a step along the way to full blown Osteoporosis.

What happens as a result of Osteoporosis?
Because of this loss of substance in the bones, patients with Osteoporosis have an increased risk of fractures (breaks), especially in the bones that make up the back (vertebrae) and the biggest bone in your leg, called the femur (thigh bone). This increased risk of fractures is due to the changes that occur in the bone, leading to the bones not being as strong as usual.

What causes Osteoporosis?
Many factors play into this loss of bone substance.
1) Gender: women are more likely to have Osteoporosis then men.
2) Activity: Inactive people are more likely to develop Osteoporosis then those who try and exercise regularly. “Weight bearing exercise” is a phrase doctors like to use. This means activity that requires you to support your body weight (not in the pool) such as walking, running, lifting weights, etc. The “weight bearing” is very important as when you are forced to support your body weight, your bones have the job of handling your weight. This signals the bones to stay strong and keep on developing new/strong bone.
3) Age: Older women are more likely to have Osteoporosis then younger women. This is mostly due to increased time after menopause (the time at which a woman stops having periods). Normally when a woman is having menstrual cycles (periods) they have a production of estrogen from the ovaries (organs that make the eggs). Estrogen is a hormone that not only plays a role in the menstrual cycle, but also one that has a role in bone formation. You see, there are basically 2 types of cells in bones: those that make new bone, called osteoblasts, and those that break down old bone, called osteoclasts. Estrogen normally slows down the cells that break down the bone and as a result, leads to more bone being formed then bone being broken down. With menopause this protective effect of the Estrogen on the bone is lost and the bone begins to break down more then before.
4) Race: Caucasians (white) are more likely to develop Osteoporosis compared with Hispanics and African Americans.
5) Not enough Calcium: Calcium is a major building block in normal bone and without it bone is not made (you can’t build a brick wall without the bricks).
6) Not enough Vitamin D: Vitamin D is actually a hormone that signals the cells in the bones to make more bone. Without the signal to keep on building bone more bone is broken down then is built, leading to a loss of bone.

This lack of new bone formation due to a loss of the normal signal (Vitamin D) has a special name, Osteomalacia.

Vitamin D is made by your skin with sunlight exposure (some is good) and also by your liver and kidneys. As a result, patients with liver and kidney disease can be at increased risk of Osteoporosis.

7) Other risk factors of Osteoporosis are smoking, steroid use, malabsorption syndromes (you don’t absorb the required pieces to make good strong bone from your diet) and alcohol use.

What are some signs/symptoms of Osteoprosis?
1) Bone pain and tenderness, especially in the spine (back and neck), ribs and legs.
2) Muscle weakness, especially in the shoulders and hips.
3) Bowed lower extremities (bow-legged).

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