Osteoporosis, which literally means "porous bone," is a disease of the
skeleton in which the bones gradually lose density and begin to deteriorate.
People with osteoporosis have brittle bones and an increased susceptibility to
fractures of the hip, spine, and wrist. According to the National Institutes of
Health (NIH), an estimated 10 million Americans have osteoporosis and 18 million
more have low bone mass, placing them at an increased risk for the disease.
Osteoporosis is common among the elderly, but the disease can strike at any age.
Although eighty percent of those affected by osteoporosis are women,
particularly menopausal and post-menopausal women, men are affected as well.
Osteoporosis is a potentially crippling disease. The latest estimates from
the NIH indicate that osteoporosis is responsible for more than 1.5 million
fractures annually, including 300,000 hip fractures, roughly 700,000 spinal
fractures, 250,000 wrist fractures, and more than 300,000 fractures at other
sites on the body. Fortunately, there are many medications and alternative
therapies to help treat the condition. Medical experts agree, however, that most
Americans can avoid osteoporosis altogether by eating well-balanced diet,
exercising regularly, and living a healthy lifestyle.
Signs and Symptoms
Osteoporosis is sometimes considered a "silent disease" because bone loss can
occur without symptoms. In fact, people may not know they have brittle bones
unless a sudden strain, bump, or fall causes one of their bones to fracture or a
vertebra (one of the 33 bony segments that form the spine) to collapse. Signs of
a collapsed vertebra include:
Loss of height
Kyphosis—a spine deformity characterized by a
Although many people think of the skeleton as an unchanging structure, bones
are living growing tissues. Bone consists of a strong, flexible mesh of collagen
fibers (proteins that form a soft framework) and calcium phosphate (a mineral
that hardens the framework). Throughout a person's lifetime, new bone is added
to the skeleton and old bone is removed (resorption). During the early years of
life, new bone is added faster than old bone is removed. As a result, bones
become larger, stronger, and more dense until they reach peak bone mass (maximum
bone density and strength). Peak bone mass tends to occur between the ages of 30
and 35. After this age, however, the bones lose increasing amounts of protein
and minerals—more than they can build
up—and the bones become thin and porous. The same is
true for menopausal women. During menopause, estrogen levels drop. Studies have
shown that the female hormone helps protect against bone loss. Without the
protective effects of estrogen, menopausal women are at an increased risk for
Other than age and menopause, causes of osteoporosis can
Long term use of certain medications, particularly steroids and
thyroid medications (see
Warnings and Precautions section)
Cushing's syndrome (a condition caused by an excess of a steroid
hormone called cortisol)
Diseases of the thyroid or adrenal glands
Deficiencies in calcium, vitamin D, vitamin A, vitamin K, and/or
magnesium (it is important to note that very high intake of vitamin A may
actually increase the risk of osteoporosis)
Hypogonadism (abnormally diminished function of the sexual organs,
such as the testes in men)
Elevated levels of prolactin (a hormone responsible for lactation)
Rare genetic disorders such as osteogenesis imperfecta, Ehlers-Danlos
syndrome, and Marfan's syndrome
Advanced age (50 years or older)
Being of European or Asian ancestry
Living a sedentary lifestyle
Family history of osteoporosis
Never having menstruated or given birth to a child
Late onset of menstruation or early menopause
Heavy caffeine use, smoking cigarettes and/or drinking alcohol
Low exposure to sunlight
Diets low in calcium or high in sodium
High exposure to heavy metals (such as cadmium, copper, and
Long-term use of certain medications including corticosteroids,
antibiotics, drugs that suppress the immune system, and thyroid
Osteoporosis is a highly preventable disease. As mentioned in the
Causes section, osteoporosis develops when
the amount of bone loss exceeds the amount of bone formation in the body.
Although osteoporosis tends to occur in menopausal women and the elderly, the
condition is most likely to develop in people who did not reach their optimal
bone mass during their critical bone-building years (childhood and adolescence).
Therefore, measures to prevent osteoporosis should begin during childhood and
should last throughout adulthood into old age. Ensuring adequate intake of
calcium, magnesium and
vitamin D is vital. Weight-bearing
exercise, such as walking and lifting weights, as well as other exercises,
including tai chi, can also help stave off the disease. Research has shown that
exercise early in life boosts bone mass, while exercise later in life helps to
maintain bone mass. Exercise also increases strength, coordination and
balance—important tools to help prevent falls that
cause fractures, especially in the elderly. Other ways to help prevent falls
include eliminating obstacles in the home such as throw rugs, loose cords, and
low pieces of furniture, keeping rooms well-lit, using hip pads, and getting
regular eye exams.
If a healthcare practitioner believes that a person is at risk for
osteoporosis, he or she often recommends a bone mineral density test (BMD) to
determine whether an individual's bone mass is below, at, or above normal
levels. BMDs are painless, noninvasive, and safe. They typically measure bone
density in the spine, wrist, and/or hip (the most common sites of fractures due
to osteoporosis), while others measure bone in the heel or hand. Having that
information will help the healthcare practitioner determine a treatment
approach. Prior to BMD tests, osteoporosis was only diagnosed after an
individual suffered a bone fracture. Today, however, BMD tests allow physicians
to identify people at risk for osteoporosis before a fracture occurs.
For those who are at risk for osteoporosis or already have the disease,
current treatments are designed to boost bone mass and prevent (further) bone
loss. For example,
medications such as estrogen are
commonly used to slow bone loss. Making
lifestyle choices, such as consuming a
diet rich in fruits and vegetables and participating in a weight-bearing
exercise program can also enhance bone strength.
Supplements such as calcium, vitamin
D, isoflavones (ingredients found in soy products) and vitamin K, can help
prevent osteoporosis and even slow the progression of the disease.
Studies suggest that diets rich in the following foods and nutrients may help
prevent bone loss in both men and women:
A large-scale study of older White women (a population at particular risk for
osteoporosis) found that those who consumed diets higher in animal protein than
vegetable protein experienced more bone loss and hip fractures than those who
consumed greater amounts of vegetable protein. These results suggest that adding
more vegetable protein and reducing the amount of animal protein may diminish
bone loss and reduce the risk of hip fractures, but further studies are needed
to confirm this hypothesis.
The main goal of exercise is to delay the onset of osteoporosis. This is best
accomplished by regular exercise throughout life. Research has shown that
exercise boosts bone mass early in life and prevents bone loss later in life.
This continues to be true even during and following menopause. Exercise also
improves balance, flexibility, strength, and
coordination—thereby, reducing falls and fractures
associated with osteoporosis. A combination of weight-bearing endurance activity
(such as walking), strength-training (such as weight-lifting or yoga),
flexibility and coordination exercises (such as tai chi) has been shown to
prevent bone loss and boost muscle mass and bone density in people with
Currently, estrogens, alendronate, risedronate, and raloxifene are approved
by the U.S. Food and Drug Administration (FDA) for the prevention and treatment
of postmenopausal osteoporosis. Calcitonin is approved for treatment only.These
medications, also known as anti-resorptive medications slow or stop bone loss.
Estrogen—boosts bone density and reduces the
risk of fracture by decreasing the amount of bone lost, enhancing the body's
ability to absorb calcium, and diminishing the amount of calcium excreted in the
urine. When taken alone, estrogen can increase a woman's risk for developing
cancer in her uterine lining (endometrial cancer); so many healthcare
practitioners prescribe the hormone progestin in combination with estrogen to
reduce this risk. Some studies have suggested that estrogen therapy also
increases a woman's risk for breast cancer, abnormal blood clotting, and
gallbladder disease. For this reason, many practitioners advise using very low
doses of estrogen.
Alendronate and risedronate—both of these
medications belong to a class of drugs known as bisphosphonates. These drugs
have been shown to boost bone density, slow or stop bone loss, and reduce the
risk of fractures. Side effects are uncommon but may include abdominal pain,
heartburn, nausea, and irritation of the esophagus. These effects may be
minimized by taking the medications first thing in the morning before eating
anything else, with 8 oz. of water, and standing upright for at least 30 minutes
Raloxifene—from a class of drugs called
Selective Estrogen Receptor Modifiers (SERMS), this medication has estrogen-like
effects on bone (prevents bone loss) but does not increase the risk for breast
cancer. Side effects can include hot flashes and blood clotting.
Calcitonin—although it does not improve bone
density as effectively as estrogen or the bisphosphonates, calcitonin slows bone
loss, reduces spinal fractures, and eases pain associated with bone fractures.
Calcitonin is considered an alternative for women who cannot take estrogen or
Parathyroid hormone—used in low doses, this
drug can jump start bone production and increase bone mass. It is often
prescribed for women who have low levels of estrogen, people who take
corticosteroids, or women who are undergoing fertility treatment with
gonadotropin-releasing hormone analogue.
Testosterone—used to treat hypogonadism in
men and in combination with estrogen to treat hot flashes in menopausal women.
The effectiveness and long-term safety for women, however, is not known. Discuss
potential use with your physician.
Surgery and Other Procedures
Although any bone can be affected by osteoporosis, fractures of the hip and
spine are most serious. Hip fractures may cause permanent disability or even
death. They almost always require hospitalization and major reconstructive
surgery. People with osteoporosis caused by hyperparathyroidism (a condition in
which the parathyroid glands secrete excess hormones) may experience improved
bone density from a surgical procedure that removes the parathyroid glands
(parathyroidectomy). Other surgical procedures that help boost bone mass are
currently under investigation.
Nutrition and Dietary Supplements
Eating fruits and vegetables and consuming adequate amounts of calcium and
vitamin D are crucial in the prevention of osteoporosis. Keeping bones healthy
throughout life depends on getting sufficient amounts of specific vitamins and
minerals, including phosphorous, magnesium, boron, manganese, copper, zinc,
folate, and vitamins B12, B6, C, and K. Avoiding sodium, alcohol, and caffeine
will also enhance bone health.
An inadequate supply of calcium over the lifetime is thought to play a
significant role in contributing to the development of osteoporosis. In fact,
many studies have shown that low intakes of calcium are associated with low bone
mass, rapid bone loss, and high fracture rates. According to the National
Institutes of Health, many Americans consume less than half the amount of
calcium recommended to build and maintain healthy bones. Recommended intakes of
calcium for the prevention and/or treatment of osteoporosis are as
Children: 800 to 1200 mg/day
Adolescent girls: 1200 to 1500 mg/day
Premenopausal women (19 to 50 years old): 1000 mg/day
Older adults (51 to 70 years old): 1200 to 1500
(Recommended intake for older women is 1500 mg/day, except for those on
estrogen, who need only 1000 mg/day.)
Good dietary sources of calcium include low fat dairy products (such as milk,
yogurt, and cheese), dark green, leafy vegetables (such as broccoli, collard
greens, and spinach), sardines and salmon, tofu, and almonds. Since most people
have difficulty obtaining the recommended amounts of calcium from their diets
alone, supplements are an effective addition. Because there are several
different types of calcium and a variety of supplements available, your
healthcare provider can help you choose the most appropriate supplement for you.
Calcium citrate tends to be the most easily absorbed and digested form.
Vitamin D plays a major role in calcium absorption (calcium must be absorbed
into the bloodstream in order to have an effect on the body) and bone health.
Vitamin D supplements and/or exposure to the sun (about 20 minutes a day), in
combination with calcium, can help heal bone fractures and decrease the risk of
future bone breaks. Recommended intakes of vitamin D for the prevention and/or
treatment of osteoporosis are as follows:
Older adults (51 to 70 years old): 400 IU/day; (71 years and older):
During the winter, or in the case of a bone fracture, 800 IU/day may be
Isoflavones are substances that have estrogen-like effects on the body. Found
primarily in soy products, isoflavones have been shown to increase bone density
and slow bone loss in menopausal women. Results from several studies suggest
that, in the years leading up to menopause, women may decrease their risk of
osteoporosis by consuming soy products rich in isoflavones. Further studies are
needed to confirm these findings, however.
Ipriflavone, a synthetic isoflavone derived from natural isoflavones found in
soy, red clover, and other food sources, may also be effective in preventing and
treating osteoporosis. Although several studies have found that ipriflavone
prevents bone loss and increases bone density in menopausal women, other
large-scale studies have failed to support these findings. Results from one
study suggest that ipriflavone may even cause lymphocytopenia, a condition
characterized by abnormally low white blood cell count. Further studies are
needed to determine whether ipriflavone is safe and effective for the treatment
and/or prevention of osteoporosis.
Essential Fatty Acids
A deficiency in essential fatty acids (such as gamma-linolenic acid [GLA],
found in evening primrose oil, and eicosapentaenoic acid [EPA], found in fish
oil) can lead to severe bone loss and osteoporosis. Studies have shown that
supplements containing essential fatty acids help maintain or increase bone
mass. Essential fatty acids have also been shown to enhance calcium absorption,
increase calcium deposits in bones, diminish calcium loss in urine, improve bone
strength, and enhance bone growth. Foods rich in essential fatty acids
(including coldwater fish such as salmon and mackerel) may confer the same
Studies show that women who consume vitamin K supplements may improve bone
density and decrease their risk of bone fractures. The current recommended daily
intake of vitamin K for adults is 75 to 120 mcg, but some researchers suggest
that higher dosages may be necessary for optimal bone health. Be sure to consult
with your healthcare provider to determine the most appropriate dosage for you.
People taking blood-thinning medications such as warfarin should avoid vitamin
Preliminary studies also suggest that the following nutrients show promise in
the prevention and/or treatment of osteoporosis:
Zinc—stimulates bone formation and inhibits
bone loss in animals
Vitamin C—may limit bone loss in early years
of menopause but results are inconclusive
Fluoride—increases bone mineral density but
may increase risk of fractures
Dehydroepiandrosterone (DHEA)—available in
supplement and cream form; studies have shown that cream applied to the inner
thigh may boost bone density in older women
Melatonin—loss of melatonin with age may
contribute to development of osteoporosis, but further studies are needed to
determine whether it helps to prevent or treat osteoporosis
Warnings and Precautions section for a
list of supplements that should be avoided by people with
Although most herbs have not been studied extensively for the treatment of
osteoporosis, many professional herbalists would recommend the following
botanical remedies for the prevention and/or treatment of osteoporosis
(particularly in postmenopausal women) because they have a proven track record
for balancing hormones and benefiting bone health:
Black cohosh (Cimicifuga
racemosa)—contains phytoestrogens (estrogen-like
substances that help protect against bone loss); has been shown to relieve
menopausal symptoms; used traditionally by Native Americans for musculoskeletal
Chaste tree (Vitex agnus castus)—used
traditionally for menstrual and menopausal symptoms; may prove to have benefits
for preventing or treating osteoporosis as well
Red clover (Trifolium
pratense)—isoflavones extracted from this herb may
slow bone loss in women, but it is not clear whether the whole herb has similar
Wild yam (Dioscorea villosa)—may be
beneficial for menopausal symptoms and osteoporosis but further studies are
Horsetail (Equisetum arvense)—contains
substances believed to strengthen bone
Kelp (Fucus vesiculosus L.)—used for
disorders of the male and female reproductive systems as well as for
musculoskeletal disorders; rich in minerals so may be an effective complementary
treatment for osteoporosis
Oat straw (Avena sativa)—boosts
hormone levels that stimulate cell growth
Chiropractic manipulation should not be applied to areas of the body directly
affected by osteoporosis. However, spinal manipulation and/or gentle
chiropractic techniques may be safely provided to areas of the body that are not
affected by osteoporosis. Because many people with osteoporosis are elderly,
chiropractors are trained to modify their techniques to the bone density level
of each individual.
Traditional Chinese Medicine
A TCM practitioner would generally treat osteoporosis with a combination of
acupuncture and herbs. According to traditional Chinese beliefs, the kidney
governs bone and stores the qi (energy) for bone and marrow. Osteoporosis
occurs when the bone marrow is not longer nourished, and, according to TCM, this
results from exhaustion of kidney Yin energy. The acupuncturist would energize
the qi at points that stimulate kidney energy.
In addition to acupuncture, a Chinese practitioner would treat osteoporosis
with a combination of herbs that boost estrogen levels and provide much-needed
minerals for the skeleton. Several of these herbs overlap with remedies that
might be chosen by a Western herbal specialist.
Black cohosh(Cimicifuga racemosa)
Cypress (Cupressus sempervirens)
Pomegranate husk(Punica granatum)
Sage (Salvia officinalis)
Horsetail (Equisetum arvense)
Stinging nettle (Urtica dioica)
Knotweed (Polygunum aviculare)
Hemp nettle (Galeopsis dubia or Gaelopsis
Maërl (Lithothamnium calcareum)
In addition to these herbs, the Chinese practices of qi gong and tai chi, as
well as other types of exercise may enhance muscle tone and improve balance and
coordination, thereby reducing the risk of falls (and subsequent bone fractures)
associated with osteoporosis.
Warnings and Precautions
Some studies suggest that excessive intake of vitamin A may increase the risk
for osteoporisis. People with osteoporosis, or those at risk for it, should not
exceed the daily recommended intake of vitamin A (900 mcg/day for men and 700
mcg/day for women) because high levels of this vitamin have been linked to
decreased bone mineral density and an increased risk for hip fracture. The same
is not true of carotenoids (a preformed version of vitamin A, such as
beta-carotene). An appropriate balance of vitamin A—not
to much and not too little—is necessary for normal bone
There are also certain medications that may contribute to the development of
osteoporosis. For example, the long-term use of glucocorticoids (steroid
hormones), thyroid medications, blood-thinners, diuretics (medications that
promote excretion of urine), antibiotics, immune system suppressants,
aluminum-containing antacids, and gonadotropin releasing hormone analogs (used
to treat endometriosis) may cause bone loss. Use of these medications should be
directed by your physician.
Prognosis and Complications
Bone fractures are the most common complications of osteoporosis and are a
significant cause of crippling disability and death. After age 60, 25% of women
have a spinal fracture—and that percentage doubles
after age 75. By age 90, 33% of women and 17% of men have had a hip fracture,
usually resulting from a minor fall or accident. Many elderly people who suffer
a hip fracture lose the ability to walk, become housebound, require
institutionalization, and, most significantly, up to 36% die within one
Although an estimated 1.5 million bone fractures in the U.S. each year result
from osteoporosis, most of these fractures are preventable. Several medications
are currently being researched that may expand the treatment options available
to people with osteoporosis. With continued research, the future for
osteoporosis prevention and treatment is promising. In the meantime, a
combination of medications (particularly estrogen treatment), diet, exercise,
and certain herbs and supplements can ease the pain associated with bone
fractures and help slow the progression of the
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Review Date: June 2001
Reviewed By: Participants in the review process include: Ruth Debusk, RD, PhD, Editor,
Nutrition in Complementary Care, Tallahassee, FL; Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; R. Lynn Shumake, PD, Director, Alternative
Medicine Apothecary, Blue Mountain Apothecary & Healing Arts, University of
Maryland Medical Center, Glenwood, MD; Joseph Trainor, DC, (Chiropractic section
October 2001) Integrative Therapeutics, Inc., Natick, MA; Allan Warshowsky, MD,
Continuum Center for Health and Healing, Beth Isreal Medical Center, Scarsdale,
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