Osteoporosis

In this factsheet:
• The Facts on Osteoporosis
• Causes of Osteoporosis
• Symptoms and Complications of Osteoporosis
• Diagnosing Osteoporosis
• Treating and Preventing Osteoporosis

Diagnosing Osteoporosis

The key steps to diagnosing osteoporosis involve assessing your risk for fracture and evaluating your bone density.

If your doctor determines that you do have risk factors for fracture or osteoporosis (such as being 65 years or older or having had a fracture in the past), there are several effective and relatively quick tests that measure bone mineral density (BMD). If the results show that your bone density is too low, your doctor will likely diagnose you with osteoporosis.

Bone density measurement by a method called DEXA (dual energy X-ray absorptiometry) is the most effective way to assess osteoporosis risk. Scanning parts of the body such as the hips or spine using a special type of X-ray machine can confirm you have an increased risk of fractures. Computerized tomography (CT) scans can also be used to check the condition of the bones.

A heel ultrasound test may also be used to test bone density and estimate the risk of fracture for women over 65 years of age. However, heel ultrasound does not provide enough detail to monitor treatment for osteoporosis. If you have a heel ultrasound that detects low bone density, talk to your doctor about having your bone density tested by DEXA.

Following the diagnosis of osteoporosis, further studies are needed to look for possible causes. An examination to determine such causes might involve blood and urine tests to measure the levels of certain hormones produced in the body.

There are also two tools (CAROC and FRAX) available in Canada for your doctor to use to assess your 10-year absolute fracture risk. To determine your personal risk of fracture over the next 10 years, your doctor will take into consideration your age, gender, fracture history, family history, and use of corticosteroids.

If your doctor decides that you require medication to treat osteoporosis, BMD testing may be conducted every 1 to 3 years to see if the therapy is working. Once the medication is shown to be effective, you may not need to be tested as often. BMD testing may also be repeated to monitor for rapid bone loss in people who are not started on medications for osteoporosis but are at risk for developing the disease.

Treating and Preventing Osteoporosis

Treatment of osteoporosis is aimed at preventing or reducing bone fractures and maintaining or increasing bone density. There are several treatments for osteoporosis, but prevention is still very important. Many of the treatment and prevention strategies for osteoporosis are similar.

Maintenance of good bone strength requires that you have a regular intake of calcium. Osteoporosis Canada recommends 1,000 mg of elemental calcium daily for men and women between the ages of 19 and 50 years, and 1,200 mg for men and women over the age of 50 years. They recommend vitamin D in daily doses of 400 IU to 1,000 IU for adults without osteoporosis under 50 years of age, and 800 IU to 2,000 IU for both adults over the age of 50 and people with osteoporosis to help increase calcium absorption in the bones. Higher doses over 2,000 IU require medical supervision.

Osteoporosis Canada also recommends regular weight-bearing exercises and a healthy lifestyle with no smoking or excessive intake of alcohol.

Weight-bearing exercises (such as walking, weight training, or climbing stairs) play a role in strengthening bones and preventing fractures. Posture and balance can be improved through exercise and can significantly reduce the risk of bone fractures.

There are several medications that can be used to treat osteoporosis. Many of these treatments may also be used to prevent osteoporosis for people who are at high risk of developing it. The following are some of the osteoporosis medications available in Canada:

• bisphosphonates (e.g., alendronate, etidronate, risedronate, zoledronic acid): These are one of the main groups of medications that may be used to prevent and treat osteoporosis. These medications slow down bone loss and help repair bone, reducing the chance of fracture.
• selective estrogen receptor modulators (SERMs; e.g., raloxifene): These may also be used to prevent and treat osteoporosis in women.
• calcitonin: This is a hormone normally produced by the thyroid gland, and it has been shown to strengthen bone. It can be injected or taken through a nasal spray.
• denosumab: Given as an injection, denosumab is part of a class of medications called RANK ligand inhibitors. It stops the breakdown of bone, helping to strengthen your bones and lowering the chances of fracture.
• testosterone: This is not recommended for the treatment of osteoporosis in most men. However, in some cases where osteoporosis in men is the result of hypogonadism, which is a condition of low levels of the male hormone testosterone, testosterone replacement therapy (androgen) may be used alone or with a bisphosphonate.
• hormone-replacement therapies (HRTs): A variety of HRTs are available for women who have reached menopause. Estrogen replacement helps to preserve bone, but the therapy has a number of health risks. If you are taking or are considering taking HRT, talk to your doctor about the risks and benefits.
• parathyroid hormone analogues (e.g., teriparatide): This class of medication builds new bone faster than it breaks it down, and can be used to treat severe osteoporosis.

Two or more medications may also be used in combination to treat some cases of osteoporosis. In addition, doctors usually recommend that you continue to get enough calcium and vitamin D.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

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This condition and disease information is written and reviewed by the MedBroadcast Clinical Team.