Frequently asked questions about osteoporosis:

1. What is osteoporosis?
2. What are the symptoms of osteoporosis?
3. What are the causes of osteoporosis?
4. What are the risk factors for osteoporosis?
5. What are the ICD-10 codes for osteoporosis?
6. What medications are available to treat osteoporosis?
7. Can osteoporosis be reversed?
8. How can I prevent osteoporosis?
9. What's the difference between osteoporosis, osteopenia and osteoarthritis?
10. Is osteoporosis hereditary?
11. What is the best diet or foods to help with osteoporosis?
12. Are there any natural treatments for osteoporosis?
13. What exercises are good for osteoporosis?
14. How does resistance training prevent osteoporosis?
15. What is the connection between the endocrine system and osteoporosis?

1. What is osteoporosis?

Osteoporosis is a common bone disease that leads to an increased risk of fracture.

Although our bones look solid, only the outside is hard. Inside our bones are two other layers: a soft layer of spongy bone that looks like honeycomb, and an inner core of bone marrow. Throughout our lives, our bones are constantly being broken down and built up again. 

Osteoporosis occurs when too much bone is lost and/or too little is made. This causes bones to become brittle and weak and fracture easily. In more severe osteoporosis, a minor bump or sneeze may be all it takes to break a bone.

2. What are the symptoms of osteoporosis?

Most people with osteoporosis do not know they have the disease until they break a bone which is why osteoporosis is often called a “silent” disease. Fractures usually occur in the spine, wrist, or hip.

Once a bone fractures, it can be very painful and may take a very long time to heal. Many people with osteoporosis never fully recover from a significant fracture, such as one involving the hip, with 50% unable to fully return to independent living.

Symptoms become more noticeable with worsening disease and may include:

• A gradual loss in height because of compressed vertebrae, resulting in a stooped posture or “Dowager’s hump”
• Persistent back pain from collapsed or fractured vertebrae or other bone pain
• More frequent fractures.

3. What are the causes of osteoporosis?

Osteoporosis occurs because of a combination of factors that lower bone density; there is not usually just a single cause.

Bone density is a term that is used to describe how much bone tissue there is in a certain part of your skeleton. An x-ray in people with good bone density shows a dense matrix of bone cells. Compare this to an x-ray of someone with severe osteoporosis that shows mostly air with a few thin strands of bone tissue.

Your bone density usually peaks between the ages of 18 and 25 years. People who have very good bone densities at this age are less likely than people who don’t to get osteoporosis later in life. After this age, bone density starts to decline.

4. What are the risk factors for osteoporosis?

Your risk of osteoporosis depends on:

• Your age – bone density declines at a faster rate over the age of 50
• Your diet – a regular intake of calcium and other minerals is necessary
• How much you exercise and what type of exercise you do - weight-bearing exercises increase bone density
• Sex hormone levels – women after menopause and men with low testosterone are at higher risk
• Sun exposure – sun is needed in small amounts for our skin to make vitamin D
• What other medical conditions you have – people with celiac disease, Crohn’s disease, or rheumatoid arthritis have a higher risk of osteoporosis
• What medicines you take – corticosteroids, antiandrogens, and aromatase inhibitors increase risk
• If you are deficient in any vitamins and minerals such as vitamin D or calcium
• How much you smoke or drink – smoking or a high alcohol intake increases risk
• How much you weigh – people who are underweight generally have lower bone densities
• If you have had any previous fractures.

5. What are the ICD-10 codes for osteoporosis?

The ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification) is a system that doctors and other health care providers use to uniformly classify all diagnoses, symptoms, and procedures. It is published by the World Health Organization (WHO).

ICD-10-CM diagnosis codes consist of three to seven digits. The codes for osteoporosis can generally be found under Disorders of Bone Density and Structure (M80-M82), with a few exceptions.

• M80 codes relate to osteoporosis with a pathological fracture: 8 subsets
• M81 codes relate to osteoporosis without a pathological fracture: 9 subsets
• M82 codes relate to osteoporosis in diseases classified elsewhere: 3 subsets.

6. What medications are available to treat osteoporosis?

There are a number of different medicines used to treat osteoporosis. Some work by decreasing how fast bone is broken down, others increase the rate at which bone is built back up. Some can only be used in postmenopausal women.

Common medicines prescribed for osteoporosis include:

• Bisphosphonates such as Actonel, Atelvia, Boniva, Binosto, Fosamax, Reclast, and Zometa
• Hormone therapies, that replace missing hormones or mimic the actions of hormones, such as Calcitonin, Duavee, Evista, Femhrt, Forteo, Premarin, or Tymlos
• Prolia – directly targets cells that break down bone.

7. Can osteoporosis be reversed?

Yes! Several treatments have been shown to improve bone density which slows or reverses the progression of osteoporosis, reducing the risk of fracture. It is never too late to treat your osteoporosis; however, osteoporosis cannot be cured indefinitely.

8. How can I prevent osteoporosis?

There are a number of things you can do to reduce your risk of developing osteoporosis or slow down its progression.

• Do at least 30 minutes of weight-bearing physical activity, every day
• Eat at least five servings of fruit and vegetables a day (preferably more) in addition to high-calcium, low-fat foods such as milk, yogurt, almonds, broccoli, figs, tinned whole fish (salmon with bones, sardines), and tofu
• Include more potassium-rich foods in your diet such as apricots, bananas, oranges, prunes, and sweet potatoes
• Limit your intake of sodium chloride (salt)
• Avoid carbonated beverages; water is the best fluid to drink
• Expose your arms and face to the sun for at least half an hour each day, but avoid sunburn, so during the morning or late afternoon is best
• Don’t smoke and limit the amount of alcohol you drink.

If you already have osteoporosis, take care to reduce your chances of having a fall around your home.

• Keep a torch on your bedside table or a night-light on if you must get up at night
• Remove or firmly anchor any rugs and tidy away any clutter or cords
• Be careful going down stairs particularly if you have pets about
• Wear low-heeled shoes that offer good support
• Install safety rails near your shower or bath and by the toilet to prevent slipping.

9. What's the difference between osteoporosis, osteopenia and osteoarthritis?

Osteoporosis is a condition that affects bone density. Bone density is reduced, which makes bones porous and brittle and they break easily.

Osteopenia is when your bone density is less than normal but is not decreased to the extent that your bones will break easily, which is the main characteristic of osteoporosis. Osteopenia is a precursor to osteoporosis. Taking steps to improve your bone mineral density, including dietary measures and increasing weight-bearing exercise, can prevent osteopenia progressing to osteoporosis.

Osteoarthritis is a condition where the cartilage that covers the end of each bone in a joint begins to break down, leaving the ends of the bones unprotected. Cartilage helps bones to glide over each other and cushions them from impact. Initial symptoms of osteoarthritis are usually mild and may include a temporary morning stiffness in a joint lasting less than 30 minutes. Symptoms become more prominent when there is significant cartilage breakdown and include:

• More pronounced pain that comes on during movement and decreases with rest
• Persistent stiffness in a joint or joints
• Noticeable swelling around the affected joint(s)
• Bony growths, commonly seen around the fingers. These are called Heberden’s nodes and are more common in older women
• A creaking sound during movement due to bone rubbing against bone or roughened cartilage
• With very advanced disease, the joint may feel “hot” due to inflammation within the joint.

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10. Is osteoporosis hereditary?

Experts estimate that about 75% of the peak bone mass that you will obtain between the ages of 18 and 25 years is influenced by your genes, so, yes, osteoporosis is hereditary.

This means that if somebody in your family has osteoporosis, then you are more likely to develop it too. If this is your situation, then eating a good diet and keeping up with weight-bearing exercises is even more important for you.

11. What is the best diet or foods to help with osteoporosis?

Foods rich in calcium, magnesium, potassium, vitamin C, D, and K are not only important for your overall health but for your bone health as well. Vitamin D is also made in our skin when it is exposed to sunlight. Half an hour early morning or late afternoon is considered adequate without putting you at high risk of sunburn.

If you eat a mainly plant-based, healthy diet that contains more than five servings of fruit and vegetables per day (some experts consider nine servings of fruit or vegetables a day the optimum), then your bones will stay happy! Also:

• Limit your intake of sodium chloride (salt) because it can cause your body to lose calcium
• Avoid carbonated beverages; water is the best fluid to drink
• Drink caffeinated beverages in moderation because caffeine can interfere with the absorption of calcium
• Even though beans contain high levels of calcium, fiber, magnesium, and other nutrients, they also contain phytates which can interfere with your body’s ability to absorb the calcium contained in beans. Soaking beans for several hours can help reduce phytate levels
• Eat protein, but don’t eat too much protein (excessive amounts of protein can cause the body to lose calcium)
• Wheat bran can also reduce the absorption of foods containing calcium when eaten at the same time (generally only applies to 100% wheat bran)
• Don’t smoke and limit the amount of alcohol you drink.

Foods That Contain Bone Healthy Vitamins or Minerals

Bone Healthy Vitamin or Mineral	Food Examples
Calcium	Low-fat dairy foods (eg, milk, yogurt, cheese), almonds, broccoli, collard greens, figs, kale, okra, tinned whole fish (salmon with bones, sardines), tofu
Magnesium	Almonds, artichokes, avocados, beet greens, Brazil nuts, collard greens, mushrooms, okra, plantains, spinach, tomatoes
Potassium	Apricots, bananas, dried fruits, mushrooms, oranges, papaya, plantains, prunes, sweet potatoes, tomatoes
Vitamin C	Broccoli, Brussel sprouts, capsicums, grapefruit, kiwifruit, oranges, papaya, pineapples, strawberries
Vitamin D	Cheese, egg yolks, fortified low-fat dairy foods, and other products, fatty fish (eg, mackerel, salmon, sardines, tuna), mushrooms
Vitamin K	Brussel sprouts, chard, dark leafy vegetables (eg, collard greens, kale, spinach), parsley

12. Are there any natural treatments for osteoporosis?

In addition to eating a bone-healthy diet and partaking in at least 30 minutes of weight-bearing physical activity every day, the following natural treatments for osteoporosis may help; however, you should be aware that there is often little scientific evidence to prove that they do in fact truly work.

Always talk to your doctor before taking any of these products, because some may not be suitable if you have certain other medical conditions.

• Acupuncture – Used widely in China as a treatment for osteoporosis, a review concluded that acupuncture could be an effective therapy for osteoporosis
• Black Cohosh and Red clover – both these herbs contain estrogen-like compounds which may help protect against bone loss
• Horsetail is rich in silica, an important mineral that is needed for bone formation and may help improve bone density
• Melatonin – typically used to help restore sleep cycles, melatonin has also been shown to promote healthy bone cell growth
• Soy contains isoflavones which are estrogen-like compounds that may protect against bone loss
• Supplements of calcium, magnesium, potassium, vitamin C, D, and K may help with osteoporosis; however, it is much better to just eat foods that contain these bone-healthy nutrients in your diet, because they are much better absorbed and utilized by your body
• Tai Chi – Studies have shown that Tai Chi does reduce the risk of falls in seniors, as well as improving muscle strength and coordination and reduce joint pain and stiffness. In addition, don’t smoke, don’t drink alcohol, limit your intake of caffeine and expose your arms and face to the sun for at least half an hour each day.

13. What exercises are good for osteoporosis?

The best exercises for osteoporosis are those that you do on your feet so that your bones and muscles are working against gravity to keep you upright. These are called weight-bearing exercises.

Exercises such as swimming and cycling aren’t weight bearing exercises because, when swimming, your body is supported by water; and when cycling, your body is supported by a bike. Even though they may not help strengthen bones, they are good for other reasons, such as improving flexibility and fitness, which is still important for your overall bone health.

Weight-bearing exercises can be grouped into those that are high impact and those that are low impact. High impact exercise usually involves a lot of jumping around and may not be suitable for people who are at high risk of breaking a bone.

The best time to start exercising to protect your bones is now! Encourage your children and grandchildren to be active, because how your bones are later in life depends upon how strong they were when you were young. Always talk with your doctor before starting any new exercise. Some of the exercises listed below are not suitable for all age groups.

High impact exercises to prevent against osteoporosis

• Aerobics
• Ball games such as basketball, football, hockey
• Dancing
• Gymnastics
• Hiking
• Jogging or running
• Jumping rope or skipping
• Racket sports such as badminton, tennis, and squash
• Trampolining.

Low impact exercise to protect against osteoporosis

• Balance exercises
• Cross-training machines
• Elliptical training machines
• Exercising with resistance bands
• Gardening
• Low-impact aerobics
• Martial arts (such as karate and taekwondo)
• Press-ups, Squats, and Lunges
• Resistance bands
• Rock climbing
• Strength-training using your body weight
• Tai Chi
• Walking
• Weightlifting.

For people with significant osteoporosis, a gentler approach may be needed. Some examples of exercises that you can do while seated in a chair are:

• Chest stretch: Sit upright and stretch your arms out. Gently push your chest out until you feel a stretch. Hold for 10 seconds, relax and repeat 10 times.
• Upper body twist: Sit upright, cross your arms and put your hands on your shoulders. Keep your hips still and twist your upper body to look over your left shoulder and hold for 5 to 10 seconds. Repeat for the right shoulder. Do 10 times each side.
• Hip marching: Sit upright and hold the base of the chair. Lift your left leg with the knee bent as high as possible, then place on the floor. Repeat with the right leg. Do each leg 10 times.

14. How does resistance training prevent osteoporosis?

Resistance training, also called strength training, uses free weights, stretchy bands, or your own body weight to build muscle and help strengthen bones.

This type of exercise helps “load” your bones, putting stress on them. Research has shown that this is what is needed to stimulate bone-forming cells (called osteoblasts) into action. Osteoblasts help lay down more bone tissue, which improves your bone density, making your bones stronger.

Resistance training exercise also tends to target the areas of your skeleton that are most likely to fracture, such as your hips, spine, and wrists. It also improves the muscles attached to the bones, as well as your overall coordination and balance.

15. What is the connection between the endocrine system and osteoporosis?

Your endocrine system is a collection of glands that all produce hormones. It is responsible for ensuring good growth and development, regulating your metabolism, maintaining tissue and sexual function, supporting reproduction, and assisting sleep and mood, among other things

Endocrine disorders are the most frequent cause of osteoporosis that is caused by a disease. Common endocrine disorders include diabetes and high thyroid levels (hyperthyroidism). These disorders cause osteoporosis because hormones that are needed to ensure healthy bone growth and development are compromised. A lack of certain hormones accelerates bone loss and increases fracture risk. Once these disorders have been identified and treated, bone density often increases.

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