What is Osteoporosis?
Osteoporosis is a disease of the skeletal system characterized by low bone mass and deterioration of bone tissue causing bones to become weak, porous and more prone to fractures. Bone is living growing tissue that changes throughout life. Bone remodeling is the process that removes older bones (resorption) and replaces it with newer bones (formation) to maintain a healthy skeleton. In the early years of life, new bone forms faster than resorption occurs until peak bone mass is reached. Usually, after the age of 30, bone resorption starts to exceed bone formation. As bone is lost, the skeletal structure weakens, leading to an increased risk of fractures. Thus, osteoporosis develops when bone resorption happens too quickly or bone replacement happens too slowly.
The possible consequences of osteoporosis include fractures, loss of height, stooped posture, back and hip pain, and breathing problems.
In the United States, osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 % of the people 50 years of age and older. Osteoporosis is a disease that affects considerably more women than men. Of the 10 million Americans estimated to have osteoporosis, 8 million are women and 2 million are men. Additionally, 34 million Americans have low bone mass, which puts them at increased risk of developing osteoporosis and related fractures. One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime. While osteoporosis is often thought of as an older person’s disease, it can strike at any age.
What Are Risk Factors for Osteoporosis?
Risk factors for osteoporosis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for osteoporosis makes the chances of getting the condition higher but does not always lead to it. In addition, the absence of any risk factors or having a protective factor does not necessarily guard you against getting it. Certain people are more likely to develop osteoporosis than others; for example, women at a much higher risk for osteoporosis than are men.
Major Risk Factors
- Being female
- Advanced age/ Postmenopausal
- Being thin and/or having a small frame
- Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well.
- Family history of osteoporosis
- Presence of certain chronic medical conditions
Risk Factors that are Modifiable
- Current low bone mass
- Abnormal absence of menstrual periods
- Anorexia nervosa or bulimia
- Deficiency or diet low in calcium and vitamin D
- Use of certain medications, such as corticosteroids and anticonvulsants
- A sedentary lifestyle
- Current cigarette smoking
- Excessive use of alcohol or caffeine
Screening and Diagnosis
To establish or confirm a diagnosis of osteoporosis, a bone mass measurement needs to be taken. Bone mineral density (BMD) tests are painless, non-invasive and safe. Bone density may be measured in the spine, hip, writs, finger, kneecap, shine bone, or heel depending on the machine. BMD can also be used to predict future fracture risk, monitor changes in bone mass and assess response to therapy.
Treatment and Prevention
Since there is no cure for osteoporosis, preventing it is the best strategy available. Osteoporosis requires building as much bone as possible during your younger years and maintaining them as you age.
Diet, exercise, calcium, vitamin D and vitamin K play a key role in this process. Also, weight-bearing and muscle-strengthening activities should be performed regularly throughout life. Weight bearing exercises such as walking, hiking, jogging, stair-climbing, dancing, etc make bones and muscles work against gravity. Strength training improves bone density, muscle mass, strength and balance, protecting against both bone loss and falls.
A variety of medications are now effective in treating and preventing osteoporosis.
Osteoporosis and Celiac Disease
The link between celiac disease and excess bone loss remains controversial. However, there are several potential mechanisms for the relationship between celiac disease and bone density:
- Body composition
- Vitamin D deficiency
- Calcium malabsorption
- Magnesium malabsorption
Since celiac disease is a problem of malabsorption and the small intestine is responsible for absorbing important nutrients, people with celiac disease can be deficient of nutrients such as calcium. Since calcium is needed to keep bones healthy, low bone density is common in both children and adults with untreated and newly diagnosed celiac disease. Some studies have shown normal or low BMD in children at the time of diagnosis. For example, Kalayci et al. found an approximate 10% improvement in BMD after children where put on a gluten-free diet. Additionally, osteopenia has been found in approximately 40-45% of patients at the time of diagnosis with celiac disease. However, it is important to keep in mind that there are conflicting data showing no higher incidence of CD in osteoporotic patients, such as in Mather et al.’s study in 2001.
It is important to screen celiac patients for calcium and vitamin D deficiencies, since most children and adults have significant improvements in bone density after adhering to a gluten-free diet. People with celiac disease who are on a gluten-free diet also need to follow the strategies mentioned above for bone health.
For more information, please visit the National Osteoporosis Foundation
Sports + Spinal Physical Therapy
2021 K Street, NW Suite 500
Washington, DC 20006
Bone Health and Osteoporosis: A Report of the Surgeon General. www.surgeongeneral.gov/library/bonehealth/chapter_5.html
Dalkin, Alan. Celiac Disease: Implications for Osteoporosis lecture. “Maximizing Your Nutrition and Health on the Gluten Free Diet” Seminar. Inova Alexandria Hospital. January 20, 2007.
International Osteoporosis Foundation
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
National Osteoporosis Foundation.
Do you or a family member suffer from this disease? You may have celiac disease, find ouy now, take our celiac disease symptoms checklist.