Dr. Noushin Milanchian
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Osteoporosis, Calcium and the Parathyroid

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Osteoporosis progresses silently, and sometimes the first sign is a fracture from a minor knock. This page explains who is at risk, what a bone density scan shows, what the parathyroid glands and blood calcium do, and what treatment generally looks like.

What is osteoporosis?

The NHS writes that osteoporosis is a long-term condition that weakens bone and raises the risk of fracture. BHOF says that in it the body loses too much bone, makes too little, or both. The bone becomes brittle and breaks with a fall or sometimes a minor knock. The most common fracture sites are the hip, spine and wrist.

There is usually no pain or other sign beforehand. A fracture, loss of height, or a stoop in the upper back may be the first sign.

Who is at risk?

The NHS and BHOF list these:

  • Older age and menopause
  • A parent with osteoporosis
  • Low calcium or vitamin D intake, low body weight, smoking, heavy alcohol use, little physical activity
  • Conditions such as diabetes, rheumatoid arthritis, an overactive thyroid or parathyroid, early menopause, and digestive conditions such as celiac disease and inflammatory bowel disease
  • Medicines such as long-term cortisone pills, some anti-seizure medicines and breast cancer medicines, and a large amount of thyroid hormone

The Endocrine Society writes that in the United States women make up 80 percent of cases, and that other hormonal causes, such as high cortisol or prolactin, are also possible.

Who should be seen?

Make an appointment if:

  • A bone has broken after age 50 from a minor knock.
  • You have taken cortisone for a long time.
  • You have lost height, your back has become curved, or you have back pain that does not improve after a few weeks.
  • You have a condition or medicine from the list above and are worried about your bones.

The NHS writes that if you have pain after a fall that does not ease, you should make an urgent appointment. If the pain after a fall is severe, go to the emergency room and do not drive yourself.

How is it assessed?

The NHS writes that the doctor assesses your risk and may refer you for a DEXA scan (bone density). The Endocrine Society explains that this scan measures bone using a very low dose of X-ray radiation, predicts fracture risk and helps with the decision about medicine. It may also show bone loss before it becomes serious.

If the doctor is checking for an overactive parathyroid or vitamin D deficiency, blood tests for calcium, parathyroid hormone (PTH) and vitamin D are needed (NIDDK).

This is general information. This page does not say where the density scan or the tests are done.

What does treatment generally look like?

The NHS writes that medicines either slow bone loss (bisphosphonates) or build new bone. The best option depends on the scan result, age and sex. The Endocrine Society says some people need medicine even with enough calcium and vitamin D.

What you can do:

  • Food that contains calcium and, if the doctor says so, a supplement (NHS)
  • Sunlight and vitamin D (NHS)
  • Regular weight-bearing, strength and balance exercise; walking and climbing stairs are examples (Endocrine Society)
  • Reducing the risk of falls, such as non-slip shoes and a non-slip bath mat (NHS)
  • Quitting smoking and cutting back on alcohol

Calcium and the parathyroid

Four small parathyroid glands sit behind the thyroid and regulate blood calcium.

Overactive parathyroid: NIDDK writes that one or more glands make too much parathyroid hormone (PTH). Blood calcium rises, bone weakens and kidney stones occur. Most people have no symptoms and it is found on a routine test. NIDDK says it is usually seen between ages 50 and 60 and is three to four times more common in women than in men. Mild symptoms: muscle weakness, tiredness, depression, and bone or joint pain. More severe symptoms: loss of appetite, nausea, vomiting, constipation, confusion, and thirst and frequent urination.

NIDDK says surgery to remove the overactive gland is the only sure treatment and is usually successful, but not everyone needs it. Some people with no symptoms and slightly high calcium are only monitored: a yearly calcium and kidney test and a density scan every one to two years, drinking enough water, and staying active. NIDDK and the NHS both write that you should not change your diet to lower calcium without a specialist’s opinion.

Underactive parathyroid: The NHS writes that low calcium causes tingling and burning in the fingers and face, muscle cramps and spasms, and abdominal pain. The most common cause is damage to the glands during head and neck surgery, such as thyroid surgery. Treatment is usually calcium and vitamin D for life. If you have recently had neck surgery and feel these symptoms, tell the surgical team.

When to get urgent help

  • Very low calcium: The NHS says to call emergency services if a seizure is the first one, lasts longer than usual, or lasts more than 5 minutes. Confusion or an irregular heartbeat is also a serious sign, and very low calcium is treated in hospital.
  • Very high calcium: MedlinePlus writes that severe cases with symptoms are usually admitted to the hospital. Take confusion, or vomiting with severe thirst, seriously.
  • Severe pain after a fall (NHS).

In Iran, call 115 (Iran’s emergency number; not valid abroad). See the full list in the guide “When should I call right away?”

Frequently asked questions

Does osteoporosis have symptoms?

The NHS writes that it often has no symptoms, and the first sign is sometimes a fracture after a fall or a minor knock. Back pain, a stooped or curved spine, and loss of height can also happen because of tiny fractures in the vertebrae. BHOF calls it a "silent disease."

Who should have a bone density scan?

BHOF writes that people aged 50 and older who have broken a bone, and people who have taken oral cortisone for a long time, should ask their doctor about a bone density test. The NHS says the doctor assesses the risk and may refer for a DEXA scan. The Endocrine Society writes that DXA measures bone strength using a very low dose of radiation and clarifies fracture risk and the treatment decision. This is general information only, and this page does not say where the scan is done.

Should I take calcium and vitamin D supplements?

BHOF writes that food is preferred and a supplement only fills the gap between food and need. The NHS considers vitamin D supplements for people who go outside little, cover most of their skin, have dark skin, or are housebound. Do not set the amount yourself; leave it to your doctor or pharmacist. See the article "Vitamin D and Calcium: Who Needs Them?"

What does it mean if my blood calcium is high?

MedlinePlus writes that the most common cause is an overactive parathyroid. Many people have no symptoms and it is found on a routine test. If there are symptoms, they are nausea, loss of appetite, constipation, thirst and frequent urination, muscle weakness, tiredness or confusion, and bone pain. The doctor finds the cause.

Does cortisone medicine weaken bones?

The NHS and BHOF both name long-term or high-dose oral cortisone as a risk for osteoporosis. BHOF writes that you should not stop your medicine on your own and should ask the doctor for the lowest effective dose. The NHS says the doctor may also prescribe a bone-protecting medicine.

Does taking thyroid pills cause osteoporosis?

The Endocrine Society writes that usual doses of thyroid pills for an underactive thyroid do not harm bone, and only high doses, such as in thyroid cancer, are a concern. NIDDK also writes that too much hormone can cause osteoporosis, so periodic blood test monitoring is needed. Do not reduce the pill on your own.

Sources

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