Frequently Asked Questions

Is osteoporosis a normal part of aging?

No! Osteoporosis is not a normal part of aging and it does not have to be a consequence of growing older. Osteoporosis may be prevented and can be treated.

Why do people with osteoporosis lose height?

Some people lose height as a result of osteoporosis. The loss of height happens as a result of compression fractures or collapse of the bones of the spine.

Why do some people with osteoporosis have a change in the shape of their back?

The change in the shape of the back is not a symtom of osteoporosis; it is a consequence of the disease.  It happens when there are many fractures (or breaks) in the bones of the spine. Kyphosis is the medical term for the change in the shape of the back caused by osteoporosis. Many people also refer to the curving of the back as a "dowager’s hump".

I have pain in my back and hip. Does that mean I have osteoporosis?

No! Osteoporosis does not usually cause pain unless a bone breaks. If you are experiencing pain it is important to speak to your medical professional so he or she can evaluate why you are having pain.

I heard that progesterone cream is a natural way for postmenopausal women to build bone. What is it and is it safe?

Progesterone cream is an irregularly absorbed form of progestin. The amount of progestin absorbed varies greatly between individuals. Very few studies indicate that progestin has a potent effect on bone at all. There is absolutely no fracture data available. In addition, there are no good clinical trials that can tell us whether progesterone cream is safe for bone or safe for the uterus if used along with estrogen therapy. In summary, progesterone cream is not recommended for the prevention or treatment of osteoporosis. And furthermore, progesterone cream is not recommended as a means to protect the uterus.

Is chronic pain a symptom of both osteoporosis and osteoarthritis?

Osteoporosis is a silent disease that generally does not cause pain unless a fracture has occurred. In the spine, multiple fractures can occur without symptoms until a deformity of the chest cavity results from substantial changes in the shape of one or more vertebrae. Chronic back pain can then occur. Hip pain from osteoporosis only occurs following hip fracture. On the other hand, the clinical hallmark of osteoarthritis is pain and deformity of the affected joints.

Is it correct that steroid medications such as prednisone or cortisone only cause bone loss if the preparations are taken by mouth?

For the general population, the short-term use of steroids does not pose a risk to bone health. It becomes a concern when an individual requires the long-term use of steroids (large doses for greater than three months). The higher the dose, the greater the risk for bone loss. Although there may be a somewhat lower risk of bone loss with non-oral steroids, similar effects can be seen with steroid nasal sprays, inhalants, topical preparations and injections if the doses taken are high enough. Speak to your medical professional so that he/she can determine the best treatment for your condition while minimizing the risk to your bones. If you take steroid medications, it is important to speak to your doctor about your bone health.

Are combined calcium-magnesium supplements better for bone than calcium alone?

No, in healthy individuals consuming typical U.S. diets, magnesium supplements are not recommended. Magnesium is widely available in a diet plentiful in nuts, seeds, legumes, certain green vegetables, and whole grains among other sources. In healthy individuals there is no risk associated with high intakes of magnesium from foods, however, chronic intake of excess magnesium from supplements (containing more than 350mg/day) may be associated with complications such as diarrhea.

There is no good clinical evidence that magnesium supplements reduce fracture risk in the healthy population. Magnesium supplements are not recommended for the prevention or treatment of osteoporosis in the general population. On the other hand, magnesium supplements may be prescribed for individuals with certain conditions or diseases that increase magnesium losses or reduce magnesium absorption. Some examples of these conditions include malabsorption syndromes (as a result of vomiting and/or diarrhea), alcoholism, the use of certain diuretics (water pills) or chemotherapy that increases magnesium losses.

Is the phosphorus in sodas harmful to bones?

The intake of too much phosphorus is not what is harmful to bones. What is important is that in most populations, as the consumption of sodas increases; the consumption of calcium-rich beverages like milk and calcium-fortified juices decreases. Inadequate calcium intake is harmful to bones. In healthy adults (with normal kidney function) who consume adequate calcium, even high phosphorus intakes are safe.

Can too much calcium cause kidney stones?

Health providers and scientists used to believe that eating less calcium would help reduce the risk of common calcium-oxalate kidney stones (that make up nearly 75% of all kidney stones). Current information indicates just the opposite. A diet adequate in calcium may actually reduce the risk of stone formation. The substance oxalate, which is found in tea, nuts and several fruits and vegetables, is believed to be more influential in kidney stone formation than calcium.

Adequate calcium (1000 to 1200 mg per day for adults depending on age) may reduce the risk of stone formation because calcium in the diet combines with oxalates in the intestine, prevents oxalate absorption, and thereby reduces oxalates available to form kidney stones. Experts recommend people who have a history of kidney stones check with their doctor or health provider before modifying their calcium intake or making any dietary changes.

Is spinach a good source of calcium?

Although spinach contains a significant amount of calcium, it is unavailable to the body because it is combined with a simple organic compound (called oxalic acid) found in plant foods. When combined with calcium, oxalic acid forms a salt known as an oxalate. Oxalate blocks the absorption of calcium. In addition to the calcium in spinach, that in swiss chard, beet greens, and rhubarb is also unavailable to the body. However, eating high oxalate foods like spinach along with milk or any other calcium source will not interfere with the availability of calcium in the other food. Oxalates will not have a negative effect on healthy bones as long as your calcium intake is adequate. Green leafy vegetables are good sources of other bone healthy nutrients such as beta-carotene and vitamin K. They are good choices as part of a well-balanced diet.

Can my first bone density test tell me if I am losing bone mass?

No, a single bone density test cannot tell you that you have lost bone or that you are losing bone mass. It is, however, the best way to diagnose your bone density at the current time. A low result may simply mean that you had a low peak mass (the maximum bone density you can reach, usually between the ages 16 to 25). A repeat bone density test ideally on the same machine at the same location is the only way to show a change in bone density (bone loss or gain) over time. A repeat bone density test is generally recommended after two years, but it may be recommended after one year if you are taking an osteoporosis medication.

Is it true that a baseline bone density test is recommended for women at the age of 40?

Bone density testing is rarely indicated for premenopausal women since medication options for treatment are not FDA-approved for premenopausal use, except in the rare case of premenopausal osteoporosis caused by long-term steroid use. The ultimate goal of osteoporosis medication is to reduce fractures. However, fractures from osteoporosis are rare in premenopausal women, even in those who have very low bone mass.

What are the usual indications for bone mineral density testing?

BMD testing is recommended for the following populations:

• Postmenopausal women and men who have sustained a fracture without any major trauma at age 40 or older
• Women aged 65 or older regardless of additional risk factors
• Postmenopausal women under age 65 who have one or more additional risk factors for osteoporosis (besides menopause)
• Men aged 70 or older
• Men with major risk factors for osteoporosis (alcoholism, steroid use, low testosterone levels and other secondary causes)
• Premenopausal women, only in rare cases such as the use of longterm steroids (for more than 3 months).

What are biochemical markers and can they be used to diagnose osteoporosis?

Biochemical markers are tests of both blood and urine that measure the rate of bone remodeling which includes both bone resorption (breakdown) and bone formation. These tests reflect only the rates of bone remodeling at the time of the test. They do not measure long-term bone health. The major use of biochemical markers is to confirm a response to therapy. With some treatments (estrogens and bisphosphonates) changes in biochemical markers can be seen quickly, within 3-6 months. It takes a longer time to measure the changes in bone mineral density, usually at least one year. 

I heard that proton pump inhibitors (PPIs) can increase the risk for hip fractures. Should I be concerned about taking these medications?

The association between PPIs and hip fracture seems to be an issue only for those people who are on relatively high doses (equivalent to 40 mg/day or more of Prilosec, Nexium or Prevacid).

People taking occasional over the counter or even prescription doses of PPIs should not be concerned. However, it should be recognized that longterm use of high doses of PPIs may be a risk factor for osteoporosis and fractures.  Bone density testing should be considered in all postmenopausal women with this risk factor. It is important to take your medication as prescribed and to discuss use of PPIs with your prescibing doctor to make sure that your are taking the lowest effective dose of the medication for the shortest time necessary to control your symptoms.  

Interestingly, there does not seem to be the same association between H2 blockers (such as cimetidine and ranitidine) and fracture risk.

It is important for individuals taking PPIs to make sure to get the recommended calcium intakes (1200 milligrams/day for adults over 50 years of age) or perhaps aim for a bit more but no greater than 1500mg/day. If calcium supplements are necessary to meet your calcium requirements, it is important to take any type of calcium (other than calcium citrate) with food. Calcium citrate supplements do not require acid for absorption, so they do not need to be taken with food. As we advise everybody, it is also important to get the recommended vitamin D intake, regular exercise, and follow bone-healthy strategies for osteoporosis risk reduction.