Question: What is osteoporosis?
Answer: Osteoporosis is a weakening of your bones, which increases the risk of a fracture. People with osteoporosis have bones that break too easily (for example, after a fall on the sidewalk).
Question: What conditions can cause osteoporosis?
Answer: Osteoporosis is most common in post-menopausal women. Additional causes of osteoporosis should be considered especially in younger (pre-menopausal) women and men. These include:
Question: Does osteoporosis cause bone pain or achy joints?
Answer: It is a common misconception that osteoporosis usually causes bone pain. In fact, most people have no symptoms unless there is a fracture. So a person can be completely free of pain and still have osteoporosis. Vertebral fractures (in the spine) can also be painless but cause progressive loss of height over time.
Question: I eat a diet that is high in calcium. Why did I still get osteoporosis?
Answer: Calcium is only one component of keeping your bones healthy. There are other risk factors for osteoporosis including genetics (having a family member with osteoporosis), the conditions listed above, and aging (especially for women).
Question: How does hyperparathyroidism cause osteoporosis?
Answer: Hyperparathyroidism causes one or more of the parathyroid glands to produce too much parathyroid hormone (PTH). PTH increases bone turnover, and too much PTH causes cortical bone thinning especially in the femoral neck (thigh) and distal radius (forearm).
Question: How is osteoporosis detected?
Answer: The main way to diagnose osteoporosis is with a bone density scan called dual-energy x-ray absorptiometry (DXA). X-ray beams are aimed at the patient’s bones, allowing the bone density to be measured at multiple areas including the spine, hip, and forearm. Patients with osteoporosis have a T-score of less than 2.5, which is a comparison between the patient’s bone density and the average bone density of a young adult.
Question: Are there any blood tests that can detect osteoporosis?
Answer: Bone turnover markers have been developed that can be checked with a blood test. These include osteocalcin, bone alkaline phosphatase, and Type 1 collage peptides (NTX and CTX). Their role in the clinical care of patients is still being investigated. Bone turnover markers often improve following parathyroidectomy. Currently there are no specific recommendations for routinely checking bone turnover markers before or after parathyroidectomy.
Question: Should all patients with hyperparathyroidism have a bone density scan?
Answer: According to the 2016 American Association of Endocrine Surgeons (AAES) Guidelines, the answer is yes. Patients with hyperparathyroidism should have a DXA scan to check bone mineral density at the lumbar spine, hip, and distal radius. A repeat DXA scan may be recommended 1 year following parathyroidectomy to look for changes in the bone density.
Question: How can patients with hyperparathyroidism minimize bone loss while waiting for parathyroidectomy?
Answer: The best way to keep your bones healthy is with weight-bearing exercise, if possible 30 minutes daily at least 4 times per week. This does not mean you have to lift weights. These are exercises that you do while on your feet so that your bones have to work against gravity to support you. Of course, be careful not to fall especially if you have problems with balance.
Some examples include:
Vitamin D supplementation can help in patients with Vitamin D deficiency.
You should also avoid smoking and excessive alcohol use.