Understanding Osteoporosis

December 1, 2004

What is Osteoporosis?

Osteoporosis is a condition that causes formerly strong bones to gradually thin and weaken, leaving them susceptible to fractures. Although the disease can affect all bones, those of the spine, hip, and wrist are the ones most likely to break. In elderly people, hip fractures can be particularly dangerous because the prolonged immobility required during the healing process often leads to blood clots or pneumonia, both of which can be fatal.

What causes osteoporosis?

Although the exact cause of osteoporosis is unknown, bone loss begins in the mid-30s. Bones begin to lose calcium, the mineral that makes them hard, faster than they can replace it. For women, the loss of bone density speeds up during the first five to seven years after menopause caused by a sharp decline in the body’s production of estrogen, which appears to help keep calcium in the bones.

Certain women are at higher risk than others for developing the very porous bones and the fractures associated with osteoporosis. Women who are thin or have a small frame, for example, are at higher risk, as are those who smoke, drink more than moderately, or live a sedentary lifestyle. Women with a family history of osteoporosis and those who have had their ovaries removed, especially before age 40 are also more prone to the condition. White and Asian women are more frequently affected than African-American and Hispanic women.

Certain conditions that increase bone breakdown, such as kidney disease, Cushing’s syndrome, an overactive thyroid, or too much thyroid replacement hormone, can also lead to osteoporosis. Glucocorticoids and antiseizure medications also increase bone loss.

What are the symptoms of Osteoporosis?

Unfortunately, a person is usually not aware they have osteoporosis until a fracture occurs.

How do I know if I have Osteoporosis?

The vertebrae are often the first bones affected, so, if you have lost a half an inch or more in height, you may have osteoporosis.

Your doctor may recommend that your bone density be measured using a bone densitometry machine, such as the Dexascan at Cascade Valley Hospital. Ordinary X-ray does not reveal bone loss until at least 30% to 50% of the bone mass has disappeared, limiting its usefulness for early screening of the condition.

How is Osteoporosis treated?

Because osteoporosis is difficult to reverse, prevention is the key to treatment.

Calcium and Vitamin D are the cornerstones of treatment and prevention. A regular exercise program -- including weight-bearing exercises, such as walking and aerobics -- can help keep your bones strong and free of fractures.

Menopausal hormone replacement therapy has been used for prevention and treatment of osteoporosis. However, in July 2002, a landmark study revealed hormone therapy may increase the risk of breast cancer, heart disease, and stroke in some women. This is a subject you should discuss carefully with your health care provider to determine if the benefits justify the risks. In women who have been on menopausal hormone therapy in the past and then stop it, the bone begins to thin again -- at the same rate as during menopause.

Other medications you and your provider may want to discuss include:
· Evista is a drug that has some actions similar to estrogen, such as the ability to maintain bone mass.
· Actonel and Fosamax treat osteoporosis by inhibiting cells that break down bone.
· Calcitonin is a naturally occurring hormone that inhibits bone loss.
· Forteo is a new medication used for the treatment of osteoporosis in postmenopausal women and men who are at high risk for a fracture. Forteo is the first drug shown to stimulate new bone formation and increase bone mineral density. It is self-administered as a daily injection for up to 24 months.

What can I do to help prevent Osteoporosis?

· Eat foods rich in calcium, such as nonfat milk, low-fat yogurt, broccoli, cauliflower, salmon, tofu, sesame seeds, almonds, and leafy green vegetables.
· Avoid foods that can interfere with your body’s absorption of calcium, such as red meats, soft drinks, and excessive amounts of alcohol and caffeine.
· Do weight-bearing exercises for 30 to 45 minutes at least three times a week.
· Do not smoke. Some studies have shown that women who smoke increase their risk of developing osteoporosis by 50%.
· Avoid antacids containing aluminum, as they can prevent calcium absorption by binding with phosphorus in the intestines. Many over-the-counter antacids do not contain aluminum and are a good source of calcium.
· Make sure you get enough calcium. The recommended amount of calcium you should eat ranges from 1,000-1,500 mg, with 1,500 mg suggested for older men and postmenopausal women. Preferably, this should be obtained through diet, but calcium supplements should be used when needed. Be sure to also take 400 to 800 IU of Vitamin D daily. Calcium supplements can inhibit the absorption of certain drugs. Check with your doctor before beginning calcium supplements.
· Consider hormone replacement therapy but discuss the risks and benefits with your health care provider carefully in light of research suggesting it may increase your risk of cancer.
· Consider taking Calcitonin, Fosamax, Actonel, Evista, or Forteo.