TWO. Risk Factors and Testing
Who gets osteoporosis?
Both men and women can develop osteoporosis. Although more people with osteoporosis are women, particularly those who are postmenopausal, about 2 million men in the United States currently have osteoporosis, and one out of four will experience a fracture related to osteoporosis in his lifetime.
Primary osteoporosis, which occurs in both men and women, is a result of aging. It occurs most frequently in postmenopausal women due to the rapid loss in bone associated with the normal drop in estrogen around menopause. The average age of menopause in the United States is 51. The World Health Organization (WHO) reports that 35% of postmenopausal White women have osteoporosis. Primary osteoporosis or age-related osteoporosis tends to develop toward the end of life in men. The American Academy of Orthopedic Surgeons reports that almost 14% of men over the age of 85 have osteoporosis, while only 2% of men between the ages of 65 and 74 have osteoporosis.
Secondary osteoporosis, which occurs as a result of medications or diseases that cause bone loss, can also occur in both men and women, at any age. Since more women than men have the medical conditions treated with the class of drugs known as glucocorticoids and other medications that cause bone loss, this type of osteoporosis occurs more frequently in women.
White and Asian women develop osteoporosis more frequently than their Hispanic and Black counterparts. White men are also at higher risk for developing osteoporosis than Hispanic and Black men. There are few data available on Asian men and osteoporosis, but like Asian women, Asian men are likely at greater risk than Hispanic and Black men.
Postmenopausal women and men in later life are not the only ones who experience osteoporosis and osteopenia. Children, adolescents, and young adults can get osteoporosis too, particularly those with genetic or nutritional disorders and those with eating disorders such as anorexia nervosa and bulimia, because they do not make hormones or absorb calcium, vitamin D, and other nutrients and protein required for normal bone development. Those who are treated with medications that interfere with bone development may also get osteoporosis. People who are treated with long-term methotrexate (> 1 month), usually for cancer or arthritis, are more at risk. Long-term use of the gonadotropin-releasing hormone analogs, such as Lupron® for the treatment of endometriosis in young women, can contribute to the development of osteoporosis as well. The most common class of medication to cause osteoporosis or osteopenia at any age is corticosteroids, used for such problems as lupus, arthritis, or asthma. Osteoporosis occurring after taking a glucocorticoid is so common that it has its own name: glucocorticoid-induced osteoporosis (GIO).
The more risk factors you have, the more likely it is that you will develop osteoporosis. Question 12 has a list of risk factors.
When I went for my annual gynecology check-up at around the age of 52, my gynecologist asked me, as usual, if my family history of medical conditions had changed. His ears perked up when I told him that my mother had been diagnosed with spinal stenosis. When I looked back, I remembered that my dad had an unusual fracture of his collarbone when he was about 72, and for the last 10 years of his life he had a very stooped appearance.
My doctor said that I should have a bone density test to determine if I had osteoporosis in my hip or spine. My test did show some bone loss in my hip. I was angry because I had no symptoms whatsoever and believed that I was taking good care of my health.
When I was first diagnosed with bone loss, I told my two younger brothers about it. My brothers were tested for osteoporosis but did not have it. Their doctors, however, were careful to note that they have a family history of bone loss.
Unless you break a bone, osteoporosis is painless.