An Overview of Osteoporosis in Women

Osteoporosis is a condition that weakens bones. It can affect anyone, but older women usually have the highest risk of developing the condition. In fact, osteoporosis is four times more common in women than it is in men.

The risk of developing osteoporosis also increases as women age. In this article, we'll discuss osteoporosis in women and its causes, signs, symptoms, prevention, and treatment methods.

What Is Osteoporosis?

Osteoporosis means “porous bone." It is the most common form of bone disease and can occur as part of the natural aging process.

The inside of a healthy bone has a structure that is similar to a honeycomb. If you look at it under a microscope, you'll see small holes throughout the bone. When a person has osteoporosis, these holes become much larger and, as a result, the bones become smaller. This makes the bones less dense and weaker.

Osteoporosis can be primary or secondary. Primary osteoporosis is the most common form and is related to aging, whereas secondary osteoporosis develops because of another condition.  

Causes of Osteoporosis

The risk of osteoporosis is higher in women because women have smaller and thinner bones than men. There are also other factors that can increase a woman's risk of developing osteoporosis.

Premature Ovarian Failure

Premature ovarian failure, or primary ovarian insufficiency, occurs when your ovaries stop functioning properly before you reach the age of 40. The hormone estrogen is not sufficiently produced and eggs are not released regularly from your ovaries (which often leads to infertility).

Estrogen protects bone health, which is why not having enough of it can contribute to osteoporosis.

Low Weight

Being underweight can lead to the development of osteoporosis. This is because of the impact that a reduced-calorie diet can have on certain hormones in the body that play a role in bone health.

Nutritional Deficiencies

Vitamin D and calcium play a role in the health of bones. If a person does not get enough of either throughout their life, they are more at risk for osteoporosis. Women are more likely than men to have lower levels of vitamin D and calcium, which adds to their osteoporosis risk.

You should talk to your doctor about vitamin D supplements because some people need to take more than the recommended 800 international units (IU) per day to keep their bones healthy.

Autoimmune Diseases

Autoimmune diseases can increase the risk of developing osteoporosis and occur more often in women than in men.

Autoimmune diseases that affect women more often than men and can lead to osteoporosis include rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis. 

Female Athlete Triad

The female athlete triad is characterized by the loss of menstrual periods, low energy that could be accompanied by an eating disorder, and a decrease in bone mineral density. This could eventually lead to osteoporosis.

Smoking and Alcohol Use

Excessive alcohol or tobacco use can also increase the risk of osteoporosis. Smoking can hinder hormone production, leading to changes in bone health. Excessive alcohol intake has been shown to decrease bone density.  

Menopause

During menopause, levels of the hormone estrogen decrease in the body. Estrogen plays a role in the healthy functioning of the reproductive system. A decrease in estrogen also leads to an increase in osteoclasts, which are cells that break down bones. This leads to increased risk of osteoporosis in postmenopausal women.

Long-Term Medication Use

Over time, some medications can lead to an increased risk of osteoporosis. These include corticosteroids, blood thinners, anti-seizure medications, chemotherapy drugs, and estrogen-blocking drugs.

Surgeries

Having a hysterectomy or oophorectomy, which are surgeries to remove the uterus and the ovaries, respectively, can increase the risk of osteoporosis.

Osteoporosis in Women

Roughly 10 million Americans have osteoporosis, with 80% of them being women. Half of women over the age of 50 are likely to break a bone due to osteoporosis, because as they reach menopause, the loss of estrogen causes an increased loss of bone density.

Signs and Symptoms of Osteoporosis

Osteoporosis is often referred to as a silent disease because the majority of people with the condition will not experience any symptoms until they have fractured a bone. If symptoms do appear, they often include:

• Losing height by an inch or more
• Posture changes that cause you to bend or stoop forward
• Pain in the low back
• Shortness of breath if there are compressed discs in the spine

Diagnosis of Osteoporosis in Women

Diagnosing osteoporosis in women can be complicated, especially if they haven't reached menopause. The types of tests used to diagnose osteoporosis aren’t typically recommended for young women. This is because it isn’t likely that young women with low bone density are going to break a bone in the near future.

Tests are also skipped in some cases because genetics can cause low bone density, and there’s no remedy for that. Some osteoporosis medications aren’t approved for use in women who have not yet reached menopause.

During the diagnostic process, a doctor will take a physical exam and medical history, which will help them determine if your risk of developing osteoporosis is high. If your symptoms and physical exams warrant further testing, it will be done. Other tests that measure levels of nutrients or hormones in the blood or check for abnormalities that could indicate a chronic disease will also be performed.

When further tests are needed, your doctor will order a DEXA scan, which stands for dual X-ray absorptiometry. It is a type of X-ray that uses two beams of different energy levels. When the images are captured, it can show how dense the bone is.

The scores for diagnosis are outlined by the World Health Organization and are used to determine a proper diagnosis. They are called T scores. If a person has a -2.5 density or below, they have osteoporosis.

Treatment of Osteoporosis

Treatment for osteoporosis in women will depend on their age and risk of fractures. For example, having a family history of fractures, low bone mass, frequent falls, early menopause, and a higher alcohol intake can all increase your risk.

Low Risk

For women of all ages with a low risk of fractures, lifestyle modifications are typically prescribed. These lifestyle changes can include supplementation with a daily intake of 1,200 milligrams (mg) of calcium and 800 IU of vitamin D.

Quitting both smoking and excessive alcohol use is also recommended. Exercise has also been shown to help improve bone health, so a regular exercise routine will also be recommended.

Moderate Risk 

For those at moderate risk of fractures, lifestyle modifications and medications will be used. However, medication isn’t typically necessary for women at moderate risk of fractures. Treatment will also depend on several factors, such as whether they are losing height, if they are receiving treatment for other diseases, and if they have a history of falls.

The lifestyle modifications for those at low risk will also be prescribed to women in the moderate-risk category. Medications used for women in the high-risk category may also be used for those at moderate risk, but medication isn't always needed if doctors believe a woman isn't at a high risk of breaking a bone in the near future.

High Risk

Women at high risk of fractures will have to take medication and implement lifestyle changes. For women who have not yet reached menopause, osteoporosis medications are not approved for use.

If a woman has taken steroid medications for a long time, there are a few medications that they can use for osteoporosis:

• Estrogen therapy, which restores levels of estrogen to help limit bone density loss
• Bisphosphonates, which are specifically formulated to limit bone loss
• Parathyroid hormone analogs, which help build bone mass in women with low bone density

Those same medications are also used in women who have reached menopause, but other treatments are available as well for older women, including:

• Denosumab, which helps block a receptor in the body to reduce the breakdown of bones
• Calcitonin, a type of peptide hormone that can reduce the risk of fractures by reducing the breakdown of bone
• SERMS, which are medications that target estrogen receptors to help inhibit the action of osteoclasts

Ways for Women to Prevent Osteoporosis

The prevention of osteoporosis in women should start as early as possible. Young women and teens can implement certain lifestyle changes that can help them reduce their risk of developing osteoporosis and protect their bone health.

The first and most important thing you can do at any age is to make sure you are getting enough calcium and vitamin D. This can be done by eating foods that are high in both nutrients and getting enough sunlight throughout your lifetime. Weight-bearing exercises such as lifting weights, walking, hiking, jogging, tennis, and dancing should also be done on a regular basis to help prevent osteoporosis later on in life.

Other nutrients such as protein and vitamins C and K can also lend a hand in the prevention of osteoporosis. Protein helps build muscle mass and increase the body's ability to absorb calcium. It can also suppress certain hormones that can lead to an increase in low bone mass.

Vitamins C and K are also vital to bone health because of the way they affect certain processes in the body such as the production of collagen and proper bone resorption, respectively. Bone resorption occurs after osteoclasts have broken down the bones, releasing minerals such as calcium into the bloodstream. This is important because it can help repair normal micro-damage that can happen to bones as a person moves and ages.

Summary

Osteoporosis is very common in women due to a variety of factors, including nutritional deficiencies, estrogen levels, lifestyle factors, and overall health. Young women should begin prevention strategies for osteoporosis as early as possible to help reduce their risk of developing osteoporosis as they reach menopause and age into older adults.