She sat in her wheelchair, frail, hunched over, and moaning in pain. She is 82 years old and has recently suffered a bout of pneumonia. The lingering cough had been almost as bad as the pneumonia itself. One massive spasm of coughing had produced a sudden severe pain in her lumbar spine. X-rays revealed a compression fracture.
Thinning of the bones, known as osteoporosis (the word actually means “porous bones”), has its greatest occurrence in the female population. Eight out of ten people with osteoporosis are female. Lack of calcium and phosphorus in bones causes them to become brittle, leading to ease of fracture, especially to the hips, spine, and wrists. The act of bending or coughing can lead to hospitalization and pain.
The thinning of bones is a gradual process, with no symptoms early on, but with the onset of osteoporosis, symptoms may include back pain, loss of height with a bent posture, or fractures.
With osteoporosis comes decreased strength. The bones have less density which depends to a large extent on the amount of calcium, phosphorus, and other minerals available.
Our bones have a remodeling process (old bone breaking down and new bone taking its place) that occurs, taking about three months for a complete cycle. This bone turn-over occurs throughout life. In our youth, bone mass builds up because the body makes new bone to a greater degree than it breaks it down. This changes after the mid-thirties when the body begins to lose bone more than build it up. For women, the decrease in estrogen levels during menopause puts them at increased risk of osteoporosis because of increased loss of bone mass.
Illnesses such as Chrohn’s disease can interfere with calcium absorption as can increased consumption of caffeinated sodas.
Increased thyroid hormones—Can occur either from the medical illness of hyperthyroidism or taking hormones to treat hypothyroidism.
The diagnosis of osteoporosis begins with a visit to your physician. He or she can order tests to measure bone density such as DEXA (dual energy x-ray absorption) which measures bone density in the most common areas to be affected by osteoporosis—hips, wrist, and spine. Other tests include ultrasound and CT scans. Consider testing if you have risk factors, are postmenopausal, or are older than 65.
Treatment of osteoporosis can include hormone therapy, but there are issues concerning the safety of these treatments. Speak with your physician to help determine if this treatment is best for you. Other options include medications such as Evista, Calcitonin, Tamoxifen, and Bisphosphonates. Bisphosphonates are especially helpful in people who require chronic steroid use, but can have daunting side effects such as esophageal ulcers and nausea. Forteo is a drug that works by actually stimulating bone growth.
Some preventative measures can be taken to reduce your risk of osteoporosis, the first of which is to start when you are young by building a reserve of bone mass. Exercise (walk, jog, skip rope) and eat enough calcium-containing foods. Vitamin D is important as well since it helps in the absorption of calcium and building muscle strength. It is not too late if you have been diagnosed with osteoporosis. Getting enough calcium and vitamin D remains important and can slow up the process or can help prevent further weakness.
Other measures to decrease the risk of bone thinning is to limit alcohol use, and quit smoking or don’t start smoking. Soy products contain plant estrogens that can help reduce bone loss. Discuss hormone therapy with your doctor.
The important thing to keep in mind regarding osteoporosis is to start early practicing prevention and never give up the fight—even when you are 82 years old and even if you are recovering from an osteoporotic fracture.

Risk factors for osteoporosis
Race Caucasians and Asians are at greater risk of osteoporosis than Blacks. Being Black is not a protection however.
Body frame Small frames place men or women at increased risk because of less bone mass to begin with.
Family history Having a family member with osteoporosis increases your risk.
Smoking Helps to weaken bones.
Steroid use Prednisone and other corticosteroids used for chronic illnesses such as asthma damage bones.
Breast cancer Some medications to treat breast cancer also suppress estrogen which places a woman at increased risk of osteoporosis. Tamoxifen is an exception. It may reduce fractures.
Low calcium diet Leads to bone loss.
Sedentary lifestyle Exercises, especially weight-bearing exercises, help to increase bone density.
Alcoholism Interferes with the absorption of calcium.
Medications such as anti-seizure medicines, long-term diuretics or heparin use, and antidepressants in the SSRI class can lead to bone loss.